Pay for Success

The innovative Pay for Success partnership — a unique blend of $29 million in public and private investment — enabled the Nurse-Family Partnership to reach nearly 4,000 additional first-time mothers across South Carolina.

The Nurse-Family Partnership Pay for Success Project Overview

Pay for Success is a public-private partnership that changes the way that the government does business by holding programs accountable to achieving pre-specified outcomes. In this specific Pay for Success project, the upfront cost to scale the Nurse-Family Partnership’s services to nearly 4,000 pregnant women across South Carolina was covered by philanthropic investments and a Medicaid 1915(b) waiver that allows NFP to draw down federal and state Medicaid funding. If the contract-specified targets are met, South Carolina Department of Health and Human Services will make success payments — all of which would be reinvested in the Nurse-Family Partnership’s programming in South Carolina — based on the achievement of four outcomes selected with the Nurse Family Partnership.

How Pay for Success Works in the South Carolina Nurse-Family Partnership Study

This project brings together partners across public, private, philanthropic, and academic organizations in order to scale up nurse home visiting services and rigorously evaluate the program’s impact on the lives of mothers and children in South Carolina.

South Carolina Nurse-Family Partnership Pay for Success Project Flow Chart

Pay for Success Report: Interim Results

The J-PAL North America study team is evaluating the outcomes for the Pay for Success project through a broader randomized controlled trial that will assess the full impact of Nurse-Family Partnership. Our future analysis with estimates of the Nurse-Family Partnership’s impact will be available on this site’s Results page.

Per the terms of the Pay for Success Contract, South Carolina Department of Health and Human Services and Nurse-Family Partnership agreed to base success payments on four interim outcomes: coverage in low-income zip codes, child injury, healthy birth intervals, and preterm birth. These outcomes were chosen because they align with the State’s policy objectives, have high associated costs, translate to meaningful impact for families, and can be partially observed during the timeline of the contract. 

The Pay for Success project period has concluded. The Pay for Success Report with interim results for the four outcomes was made available on this site on April 1, 2021. Answers to frequently asked questions can be found here.

The interim results — based on partial samples — did not find statistically significant effects of participating in NFP for any of the four Pay for Success outcomes. Although the report found that one outcome (preterm birth) qualified for a potential success payment, no payments were made after netting out South Carolina Department of Health and Human Services’ 1915(b) Medicaid Waiver expenditures. A much fuller picture of NFP’s potential impact will emerge in the academic analysis with analyses of the full sample starting in Summer 2021 and continuing for many years to come.

PFS Outcome Definitions* Threshold where partial fixed payments begin Threshold where complete fixed payments reached
Preterm Birth Reduction in preterm births. 13.5% reduction in preterm births 15% reduction in preterm births
Short Birth Interval

 

Reduction in subsequent births within two years. 18% reduction in subsequent births within 24 months 20% reduction in subsequent births within 24 months
Number of Injuries Reduction in emergency department visits and hospitalizations for acute child injury in the first two years of life. 23.4% reduction in hospitalizations for acute injury within the first 24 months of life 26% reduction in hospitalizations for acute injury within the first 24 months of life
Low-Income ZIP Code Percentage of mothers whose primary residential address was within a Low-Income Zip Code at the time of enrollment. 65% of mothers from low-income zip codes at the time of enrollment

 * For a complete description of outcomes and definitions please refer to the Pay for Success Analysis Plan.

Sign up for updates about the project and study here.