Administration for Children & Families: 'Module 4 – Administrative, Government Cost Data Sources'

WASHINGTON, Oct. 21 -- The U.S. Department of Health and Human Services Administration for Children and Families Office of Planning, Research and Evaluation issued the following report (No. 2020-90) entitled "Planning for a Pay for Outcomes Approach in Home Visiting, Module 4: Administrative and Government Cost Data Sources".

Introduction

Pay for outcomes (PFO) is a payment model that promotes innovative financing for social initiatives, connecting funding to outcomes and cost savings. The Bipartisan Budget Act of 2018 (Public Law 115-123, Section 50605) allows Maternal Infant and Early Childhood Home Visiting Program awardees to pursue PFO arrangements. PFO can help awardees expand services, improve outcomes, reach new or underserved populations, and/or engage new stakeholders. This resource provides information to inform PFO feasibility studies and PFO project development, including outcome selection, projected savings, and outcome payment pricing for financial agreements. Module 4 summarizes the administrative and government data sources used in return on investment (ROI) calculations cited in previous modules.

Purpose of this resource

One of the first steps in a PFO feasibility study (see Introduction) is to identify outcomes to be monetized. This resource provides information about existing studies and reports to inform decisions about outcomes, but it does not walk through how to conduct a PFO project.

* Introduction provides background information on PFO and feasibility studies.

* Module 1: Overview of Outcomes Demonstrated in Home Visiting Studies presents an indepth scan of home visiting outcomes achieved by model.

* Module 2: Economic Value of Home Visiting Outcomes details monetary values researchers have used to establish savings in home visiting return on investment analyses.

* Module 3: Economic Value of Outcomes in Non-Home Visiting Research summarizes monetary values researchers have used for similar outcomes beyond home visiting studies.

* Module 4: Administrative and Government Cost Data Sources collates the administrative data sources used in the return on investment calculations.

Module 4 Overview

A key step in determining the feasibility of a PFO approach and structuring a PFO initiative is estimating cost savings associated with achieving targeted outcomes through home visiting. Administrative data is one source to inform these estimates.

Module 4 provides an overview of the types of data sources awardees may use to monetize outcomes. It then summarizes administrative and government data sources that ROI studies from Modules 2 and 3 used to determine per unit costs of outcomes.

Information is organized by the outcome domains used in the Home Visiting Evidence of Effectiveness (HomVEE) review, which assesses the quality of the research evidence for early childhood home visiting models (Sama-Miller et al., 2019). ROI studies have used administrative or government data to monetize outcomes in six of the eight domains.

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HomVEE Outcome Domains

Child development and school readiness

Child health

Family self-sufficiency

Linkages and referrals

Maternal health

Positive parenting practices

Reduction in child maltreatment

Reduction in juvenile delinquency, family violence, and crime

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How to Use Module 4

Once an awardee identifies potential outcome measures for a PFO initiative, the next step is to estimate the monetary value of improved outcomes. These estimates inform both the PFO feasibility study and the structuring of the PFO initiative. Awardees may estimate potential value based on anticipated cost savings or cost avoidance and social benefit.

One approach is to apply the per unit costs to the outcomes they have achieved in the past to estimate future savings. Awardees should use local cost data when possible to ensure a value more reflective of their community.

Awardees can use Module 4 to identify sources for local cost data. Module 4 provides administrative and government data sources researchers have used to monetize home visiting outcomes. Awardees can use these sources to help find similar data sources for their own location via an Internet search.

Administrative and Government Cost Data Sources

Awardees can use data from a variety of sources to inform the monetary value of home visiting outcomes. Researchers have drawn per unit costs from published research, technical reports, national surveys, program participant interviews, and so on. Administrative and government data sources offer the advantage of already being collected, available, and specific to the awardee's location.

Administrative records include client and program-level data collected by local implementing agencies and partner organizations. Patient billing records, for instance, provide data to determine the actual average cost for emergency department usage in a particular health system. Awardees could also use Medicaid data to calculate the health care cost of preterm births to low-income mothers for a geographic area.

Government reports, surveys, or websites may also provide cost data for a region, state, or other locality. State departments of human or social services, for example, often publish their daily reimbursement rates for foster care out-of-home placement. States also post the monthly value of public assistance packages such as Temporary Assistance to Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP) or food stamps, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and childcare subsidies. Data from state or federally sponsored surveys are also available online.

Exhibits 1-6 summarize the administrative data sources researchers have used to calculate per unit costs for home visiting outcomes, as cited in Modules 2 and 3. Government sources that allow users to view results at the regional, state, or local level appear as well. Outcomes are listed as defined by each study.

Content omitted: Exhibit 1. Administrative and Government Cost Data Sources for Child Development and School Readiness Outcomes, Exhibit 2. Administrative and Government Cost Data Sources for Child Health Outcomes, Exhibit 3. Administrative and Government Cost Data Sources for Family Economic Self-Sufficiency Outcomes, Exhibit 4. Administrative and Government Cost Data Sources for Maternal Health Outcomes, Exhibit 5. Administrative and Government Cost Data Sources for Reductions in Child Maltreatment Outcomes, Exhibit 6. Administrative and Government Cost Data Sources for Reductions in Juvenile Delinquency, Crime, and Family Violence Outcomes Used in ROI studies

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References

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Dumont, K., Kirkland, K., Mitchell-Herzfeld, S., Ehrhard-Dietzel, S., Rodriguez, M. L., Lee, E., Layne, C., & Greene, R. (2010). A randomized trial of Healthy Families New York (HFNY): Does home visiting prevent child maltreatment? New York State Office of Children & Family Services and The University of Albany, State University of New York.

French, A. N., Yates, B. T., & Fowles, T. R. (2018). Cost-effectiveness of Parent-Child Interaction Therapy in clinics versus homes: Client, provider, administrator, and overall perspectives. Journal of Child and Family Studies, 27, 3329-3344. https://doi.org/10.1007/s10826-018-1159-4

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Karoly, L. A. (2017). The economic returns from investing in early childhood programs in the Granite State. RAND Corporation.

Lynch, F. L., Dickerson, J. F., Pears, K. C., & Fisher, P. A. (2017). Cost effectiveness of a school readiness intervention for foster children. Children and Youth Services Review, 81, 63-71.

Noor, I., & Caldwell, R. A. (2005). The cost of child abuse vs. child abuse prevention: A multi-year follow-up in Michigan. Michigan Children's Trust Fund and Michigan State University. https://www.michigan.gov/documents/ctf/cost2005_528033_7.pdf

Peters, C., McKane, P., & Meghea, C. (2015). Cost savings to Medicaid from the Maternal Infant Health Program due to reduction in preterm birth rate (ROI Fact Sheet Series Volume 1, Issue 1). Michigan Department of Community Health. https://www.michigan.gov/documents/mdch/ROI_fact_sheet_2015.3_final_486914_7.pdf

Pugh, L. C., Milligan, R. A., Frick, K. D., Spatz, D., & Bronner, Y. (2002). Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Birth, 29(2), 95- 100.

Sama-Miller, E., Akers, L., Mraz-Esposito, A., Zukiewicz, M., Avellar, S., Paulsell, D., & Del Grosso, P. (2017). Home Visiting Evidence of Effectiveness review: Executive summary. Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov/sites/default/files/opre/homvee_executive_summary_03162017_508.pdf

Stankaitis, J. A., Brill, H. R., & Walker, D. M. (2005). Reduction in neonatal intensive care unit admission rates in a Medicaid managed care program. American Journal of Managed Care, 11(3), 166-172.

Washington State Institute for Public Policy. (2019). Benefit-cost technical documentation. http://www.wsipp.wa.gov/TechnicalDocumentation/WsippBenefitCostTechnicalDocumentation.pd f

Wilkinson, A., Anderson, S., & Wheeler, S. B. (2017). Screening for and treating postpartum depression and psychosis: A cost-effectiveness analysis. Maternal and Child Health Journal, 21, 903-914.

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REPORT and TABLES: https://www.acf.hhs.gov/sites/default/files/opre/pfo_module_4_508.pdf