WILMINGTON – New Castle County and a coalition of nonprofit and charitable partners have launched a new initiative to assist first-time mothers access quality prenatal and postnatal health care that will utilize innovative, outcomes-based funding and a public-private reimbursement plan.
The funding approach, sometimes known as Pay for Success, is unusual for most nonprofit work but is a model that is gaining ground nationally. The county program is the first time that a Pay for Success model has been used in Delaware.
As explained by the Urban Institute, Pay for Success shifts financial risk from a traditional funder — usually government — to a new investor, who provides up-front capital to scale an evidence-based social program to improve outcomes for a vulnerable population. If an independent evaluation shows that the program achieved agreed-upon outcomes, then the investment is repaid by the traditional funder. If not, the investor takes the loss.
In New Castle County’s program, the local nonprofit Children & Families First (CFF) will provide services using the evidence-based Nurse-Family Partnership model, which pairs mothers with specialized registered nurses who offer home-based care to support healthy pregnancies and improve childhood health. Services would begin this fall, with the goal of serving 120 Medicaid-eligible, first-time mothers living in New Castle County over four years.
The Longwood Foundation, a philanthropy based in Wilmington, has granted $1.8 million to CFF to expand those services, and it will grant an additional $1.2 million in early 2024 should CFF meet or surpass its goals.
Should CFF meet its outcomes before 2026, the county will reimburse Longwood up to $3 million from its federal American Rescue Plan Act funds. In that scenario, Longwood has agreed to reinvest a portion of those funds into the CFF to serve more families following the conclusion of the initial initiative.
New Castle County Executive Matt Meyer told Delaware Business Times that he’s been looking for an opportunity to use the Pay for Success model for about a decade, even preceding his time leading the county, after reading about the first initiatives. What started in Europe arrived in the U.S. in 2012, when Bloomberg Philanthropies and Goldman Sachs launched the first initiative to fight recidivism.
“It’s great value for taxpayer money. This enables me to look taxpayers in the eyes and say this money we’re spending will only be spent if the program works, which is kind of extraordinary,” he said. “It’s a big win for families with some of the greatest challenges in our community and it’s a big win for taxpayers.”
The county’s contract with Longwood was drafted by Social Finance, an impact finance nonprofit that has been working on Pay for Success programs. Meyer began seriously looking at setting up such an initiative after receiving the pandemic-era ARPA funds, which have provisions attached that prioritizes outcomes-based programs.
He credited both Longwood, led by Thère du Pont, and the county council for backing the idea, which is still novel in Delaware.
Charuni Patibanda, the economic development director for New Castle County, said they selected prenatal and postnatal health care for their initiative because homebound care was an area specifically discussed in ARPA regulations.
“Pregnant mothers were very vulnerable not only to getting COVID-19, but to losing access to care for their pregnancies, due to closures or fear of going to the hospitals, and the home-visiting professional can flag things like domestic violence and a whole host of other issues,” she explained.
An estimated 780 Medicaid-eligible, first-time mothers give birth in New Castle County each year, officials said. For these parents, it can be challenging to find employment with family-sustaining wages or health benefits.
“We know that nearly 20% of all pregnant women in New Castle County do not access pre-natal care, which can have serious consequences for both mother and baby. Further, there are significant barriers to care for low-income, Medicaid-eligible women, such as inadequate transportation, unstable housing, and other social determinants of health,” said Kirsten Olson, CEO of Children & Families First, in a statement. “That is why we believe so strongly in the Nurse-Family Partnership model, which is designed to reduce or eliminate some of these barriers by providing community-based care guided by the unique needs of each family. Families who participate in NFP have improved outcomes, such as healthy birthweight, increased use of breastfeeding, and higher child immunization rates.”
Enrollment for the program begins this fall and those interested in participating can learn more at cffde.org/nfp. The CFF will be hiring four nurses and an outreach coordinator to complete the work over the next few years.
