Strong Beginnings to pilot pay-for-success model


Over the past 11 years, the Strong Beginnings program, which is administered by Spectrum Health in Kent County, has helped reduce infant mortality and adverse birth outcomes by 50 percent for African-Americans.

The Strong Beginnings program is a partnership of eight community agencies.

It focuses on improving health and early childhood development outcomes for high-risk African-American and Latina mothers and their babies through home visitation, community programs and better coordination of care throughout pregnancy until the child’s second birthday.

Due to its tremendous success, Strong Beginnings was chosen as a “pay-for-success” pilot program by the state of Michigan.

Gov. Rick Snyder announced the program’s selection earlier this month.

The pilot program is a result of Michigan being selected in 2014 by the Harvard Kennedy School to work with the institution’s Government Performance Lab on a project using the pay-for-success funding model, also known as social impact bonds.

The way the pay-for-success model works is private investors put up money for a program with a specific goal, and a contract is signed with a service provider. If the goal is achieved, the government pays back the investors, with a profit. If not, the government pays nothing.

The pay-for-success model is relatively new.

Kenneth Fawcett, M.D., vice president of Spectrum Health Healthier Communities, said he is aware of less than 10 pay-for-success programs in the country, most of which are related to education or juvenile justice programs.

He said the Strong Beginnings program is the only pay-for-success funded program currently underway in Michigan.

Christina Freese-Decker, president of Spectrum Health Hospital Group, said Spectrum and its partners worked very hard to bring the pay-for-success pilot to West Michigan.

“This is a great start for us to learn how to use these social impact bonds and to help us spread this work these teams are doing so we can help more people,” she said.

Freese-Decker and Fawcett said the pay-for-success model will help ensure financial stability for Strong Beginnings.

A federally funded Healthy Start program, Strong Beginnings also has received grants from the W.K. Kellogg Foundation, which have allowed it to expand over the years.

Recently, Fawcett said there has been some concern federal funding could be cut, however, putting the program in jeopardy.

“If it had gone away, it’s unclear how we would have secured the funding to continue the program,” he said.

Fawcett said Strong Beginnings operates on an annual budget of approximately $1.4 million. He said the pay-for-success contract will give the program $1 million per year.

Strong Beginnings works with 800 families annually that are considered to be the “most at-risk” in Kent County.

Fawcett said these families experience high rates of mental health issues, domestic abuse and homelessness.

Participants receive services that include: home visits by community health workers, nurses and social workers; assistance accessing resources, such as transportation, food, baby supplies and medical care; parenting classes and education about ways to improve the health of mothers and babies; and counseling and support groups for those struggling with mental health issues.

The Strong Beginnings program promotes breastfeeding, safe sleep practices and parenting skills.

Fawcett said Strong Beginnings is successful because of its three-pronged approach, which includes using community health workers, providing behavioral health support and offering a program specifically aimed at fathers.

“The community health workers are from the communities,” he said. “Many are individuals who have benefitted from the program and want to give back, and they have a cultural sensitivity and can establish trust relatively easily with their clients.

“We’ve also embedded behavioral health resources into the program. We can deliver the mental health services right in the construct of our program, and that is a differentiator and something that allows us to be so successful.”

Fawcett said the infant mortality rate is measured based on live births.

In Kent County, the infant mortality rate among African-Americans is just under 10 per 1,000 live births, which means 10 infants do not make it to their first birthday. For Caucasians, that number is about five.

“So, there is a 2-1 relative risk ratio,” Fawcett said. “Thirteen years ago, that relative risk was 4-1. So, we’ve made great progress, but we mustn’t stop. Our work isn’t done. It’s still not acceptable.”

Strong Beginnings’ success over its first decade was acknowledged this summer, when it received an American Hospital Association NOVA Award.

It was one of only five programs nationwide to receive the award.

Freese-Decker said being selected as a pay-for-success program will allow Strong Beginnings to continue to make an impact and potentially expand beyond Kent County.

“The social impact bonds provide financial sustainability for us to be able to work on improving or reducing infant mortality and potentially to spread this to other areas, so we can have a greater impact on our community and have higher quality of life for these vulnerable families,” she said.

Snyder said continuing to improve health outcomes for pregnant women and infants is “important work in Michigan.”

“It’s great to partner on this innovative program with Spectrum Health and the Harvard Kennedy School Government Performance Lab to achieve better coordination of care,” he said.

Additional Strong Beginnings partner organizations are: Arbor Circle, Cherry Health, Family Futures, Grand Rapids African American Health Institute, Healthy Kent 2020 Infant Health Team, Kent County Health Department and Metro Health.

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