The evidence is clear. Addressing the social determinants of health can dramatically improve health outcomes and reduce spending in healthcare, social services, education, criminal justice, and more. The problem is that not all interventions can be isolated and measured, and the value is not always realized by the entity that pays the bill. This creates a tremendous amount of friction that prevents us from moving forward on initiatives that we all agree should happen. That’s where Pay for Success comes in:

Pay for Success (PFS) financing models are cross-sector partnerships in which funders pay upfront for a social service and then a government, healthcare, or other back-end payer repays the investment if, and only if, predetermined outcomes are met.

On this episode, we talk with Ruth Ann Norton, President & CEO of the Green & Healthy Homes Initiative (GHHI), about how they’re using Pay For Success to enable social innovation across the country. We discuss:

  • GHHI’s history and mission to break the link between unhealthy housing and unhealthy families
  • How to gather evidence that social interventions work
  • How to quantify that value in terms of outcomes and cashable savings
  • How to communicate that value to stakeholders
  • How to document and acknowledge that the one who pays for the intervention is not always the direct beneficiary of the improved outcomes or savings.
  • Why we need to avoid “penalizing innovation” through unintended consequences of our funding mechanisms
  • How Pay for Success (PFS) funding models work
  • How Pay for Success (PFS) funding differs from pay for performance

This is an important topic and conversation for anyone trying to drive meaningful change through social innovation. Give it a listen and let us know what you think on Twitter by tagging @The_HCBiz.

Ruth Ann Norton

Ruth Ann Norton serves as President & CEO of the Green & Healthy Homes Initiative (GHHI), a nonprofit organization founded in 1986 that is dedicated to the elimination of childhood lead poisoning and the creation of healthy, safe and energy efficient housing for America’s children. A strong advocate for healthy housing and health equity, she broadened the mission of the organization by designing and implementing an innovative GHHI model in 2009 in partnership with HUD, CDC and the Council on Foundations that is built on a framework of cross-sector collaboration that cost effectively integrates resources to comprehensively deliver lead hazard reduction, healthy homes, weatherization and housing rehabilitation interventions in homes. The architect of Maryland’s 98% reduction in childhood lead poisoning, Ms. Norton served as lead author for GHHI’s national Strategic Plan to End Childhood Lead Poisoning – A Blueprint for Action, served on the expert panel for the Pew Charitable Trust’s 10 Policies to Prevent and Respond to Childhood Lead Exposure and has authored multiple state and local lead centric strategic plans including the State of New Jersey Lead Poisoning Prevention Action Plan. She is an advisor to the District of Columbia Housing Authority and local housing departments on how to improve healthy homes standards as well as compliance rates with the Lead Safe Housing Rule for public and federally assisted housing.

Ms. Norton has developed 38 pieces of successful healthy housing legislation and lead GHHI’s entry into the Pay for Success field to advance innovative healthcare financing for healthy homes and create models for Medicaid reimbursement. She heads GHHI’s groundbreaking work across the United States where jurisdictions are using housing as a platform for improved health, education and social outcomes. Through the implementation of the GHHI model and its best practices Toolbox, cities are improving the ability of children to arrive in the classroom healthy and ready to learn and to stay in school through reduced health related absences. She provides a leading voice to articulate the significant health and social benefits of weatherization investments through her advisory role with Energy Efficiency for All and has authored research publications on the non-energy benefits of energy efficiency. In 2016, she received the Tony Woods Award for Excellence from the Building Performance Industry for her efforts to integrate energy efficiency upgrades with healthy home interventions on a national scale. Ms. Norton is a Robert Wood Johnson Foundation Community Health Leader, a Weinberg Foundation Fellow, a WE ACT Environmental and Social Justice awardee, and was named one of Maryland’s most influential women by the Daily Record.

Twitter: @RuthAnnNorton


Green and Healthy Homes Initiative (GHHI)

GHHI has created innovative programs to improve the delivery of services and ensure the efficient use of resources to reduce lead poisoning (in Maryland by 98%), asthma and injury in low income housing while improving energy efficiency. GHHI continues its mission to end lead poisoning while continuing to look at housing as an integral factor in the health of families and communities.

GHHI provides technical assistance and project management services to government, healthcare, and community-based service provider partners interested in innovative models that improve outcomes in low-income communities through addressing the social determinants of health. While GHHI assists partners in exploring and building a variety of financing and contracting structures, the majority of our social innovation projects in development focus on Pay for Success. Pay for Success (PFS) financing models are cross-sector partnerships in which funders pay upfront for a social service and then a government, healthcare, or other back-end payer repays the investment if, and only if, predetermined outcomes are met.



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