Expanding Home ­Visiting Programs in Virginia Using "Pay for Success"

Premature and low­ birth-­weight infants face significant risks for medical and developmental disabilities, which saddles government and private entities with billions in additional health care, education, and welfare spending from birth and infancy and throughout a child’s life. In addition, the impaired ability of these children to become productive young adults increases tax burdens on citizens, and worsens emerging workforce deficits. Though the U.S. is one of the wealthiest nations in the world, and Virginia is one of its most prosperous states, both have among the highest rates of premature and low­ birth-weight births in the developed world.

One way to reverse these trends is through home­ visiting programs, in which nurses and peer counselors provide support and education to high­-risk pregnant women in their homes. However, only about 15 percent of high­-risk mothers in Virginia with children under age five receive home visiting services.

This brief proposes an innovative approach to expand nurse visiting programs to the more than 31,000 high­-risk pregnant women in Virginia who need these services but are not receiving them, using a Pay For Success (PFS) social impact finance model. PFS is a new financial and contracting arrangement that increases investment in evidence­-based programs resulting in measurable social outcomes. Savings from these outcomes can repay investors and fund continued services.