Policy Design

Pay for Prevention (P4P) – Advancing Pay for Success in Oregon 

Pay for Success is an innovative funding model that drives government resources toward social programs that prove effective at providing results to the people who need them most. 

The model gives highly effective service providers, including nonprofits and charities, access to flexible, reliable, and upfront resources to tackle critical social problems by tapping private funding to cover the up-front costs of the programs. By rigorously measuring the effectiveness of these programs over time, Pay for Success ensures increased accountability for government spending and taxpayer dollars are being spent on programs that are actually succeeding in improving people’s lives. Pay for Success initiatives presently underway range from recidivism reduction in the U.K and New York City to high quality preschool in Salt Lake City. More information about the Pay for Success field can be found here: http://payforsuccess.org/learn-out-loud/pfs-101

Since 2009 a broad-based steering committee of elected officials, health systems, charitable foundations, and child advocates has overseen the Center’s work in advancing Pay for Success approaches through the Center’s Pay for Prevention (P4P) initiative. In partnership with the State of Oregon, P4P is targeted toward preventing entry into Oregon’s child welfare and foster care systems, with a focus on services to children ages 0-6. The Center has methodically researched the factors leading to foster care, the outcomes of foster care in Oregon, and effective provider approaches from across the country. The Center is developing the research base, provider supports, implementation tools, performance measurement, policy guidance, and financing structures for P4P pilot phase implementation in 2015-2016. 

The Pay for Prevention website is now live at http://www.oregonp4p.org.

New York Medicaid Benefit Design

The Center is working with the New York State Department of Health (NYDOH) and State University of New York to support the State's Medicaid redesign efforts. The Center was commissioned to provide the State's Medicaid Redesign Team's Benefit Package Subcommittee with evidence regarding the effectiveness and harms of a list of existing benefits. This information was used by the subcommittee to identify potential benefit policy changes.In addition, the Center conducted research and is developing a report for NYDOH that describes a potential process for setting New York's Medicaid health services priorities, as well as processes for reviewing evidence for health services and new technologies to inform benefit coverage decisions.


Oregon Clinical Guidelines Project

In June 2009, the Oregon legislature passed health reform legislation, which created the Oregon Health Policy Board and charged it with creating a comprehensive health reform plan for the state. In December 2010, the board released Oregon's Action Plan for Health laying out eight foundational strategies that "reflect the urgency of the health care crisis and a timeline for actions that will lead Oregon to a more affordable, world-class health care system."

One of these foundational strategies is to "set standards for safe and effective care." By identifying and developing Oregon-based best practice guidelines and standards, policymakers aim to improve health care so it is "consistently high quality, evidence-based and safe." Once developed, these guidelines can be uniformly applied across public and private health care to drive down costs and reduce unnecessary care."

In 2011, subsequent legislation was passed to create the Health Evidence Review Commission (HERC), the purpose of which is to develop and maintain a list of health services ranked by priority, develop or identify and disseminate evidence-based health care guidelines, and conduct comparative effectiveness research of health technologies. The Center is providing evidence review and staffing to the HERC and several of its subcommittees.

Washington Health Benefit Exchange

In 2010, the Patient Protection and Affordable Care Act (PPACA) was passed and signed into federal law. One key element in this overall health reform legislation is the creation of health benefit exchanges (HBE) at the state and federal level to increase access and affordability of insurance, individuals, and small businesses. In preparation, the state of Washington received a Level 1 Planning Grant to develop a methodology for reviewing existing state-mandated benefits in relation to federally-established Essential Health Benefits (EHB). As part of this planning grant, the Center was commissioned to conduct a horizon scan of state planning efforts in preparation for EHBs, as well as provide a methodology for evaluation of the clinical efficacy of mandated benefits.

Washington Health Technology Assessment

The primary purpose of Washington Health Technology Assessment (WA HTA) Program is to ensure medical treatments and services paid for with state health care dollars are safe and proven to work. The WA HTA serves as a resource for state agencies purchasing health care by contracting with independent external researchers, including the Center, to produce scientific, evidence-based reports about the safety and efficacy of select medical devices, procedures, and tests. An independent clinical committee of health care practitioners uses the reports to "determine the conditions, if any, under which" programs should pay for the medical device, procedure, or test. Participating state agencies include the Health Care Authority Department of Social and Health Services (Medicaid); Labor and IndustriesDepartment of Corrections; and Department of Veterans Affairs.

Reports developed by the Center for the WA HTA include:

  • Stereotactic radiation surgery (SRS) and stereotactic body radiation therapy (SBRT)
  • Intensity Modulated Radiation Therapy
  • Robotic Assisted Surgery
  • Upper Endoscopy for GERD and GI symptoms
  • Sleep Apnea Diagnosis and Treatment in Adults
  • Positron Emission Tomography (PET) Scans for Lymphoma
  • Applied Behavioral Analysis (ABA) Therapy for Autism


Early Learning and Family Investment Policy 

Upon his election in 2010, Oregon Governor Kitzhaber appointed an Early Childhood and Family Investment team to recommend strategies for a sustained investment in early childhood as a foundational element in achieving the state's long term educational and economic objectives. Based on the Governor's charge, the goal of the Early Childhood and Family Investment team was to integrate state funded services, agencies and structures to ensure that every child enters school ready and able to learn, enters first grade ready to read, and leaves first grade reading. 

After surveying the research and reaching out to early childhood service providers across the state, the team produced a set of recommendations that change the way in which Oregon identifies, delivers, and funds services so that a more efficient, accountable approach is used which delivers measurable results. 

Staff from the Center for Evidence-based Policy co-chaired and staffed the production of the initial set of recommendations, leading to wholesale legislative changes in Oregon’s policy, governance, budget, and program approach for Early Learning in Oregon.

Early Childhood Transition Project Report