Equity Considerations in Linking Payments to Outcomes
Most programmatic delivery has a degree of fixed costs that the organization will incur, such as rent and utilities, materials, and staff, regardless of the outcome of the individual. When establishing the amount of funding that will be tied to performance outcomes, setting the threshold too high can disincentivize small organizations that do not have the capital to operate their programs while waiting for payments tied to future outcomes. Take care to establish a percentage allocation that is meaningful but that does not require the provider to operate at too high of a risk. Talking directly with providers is a good way to find out what is feasible for them.
Incorporate equity considerations into feasibility study, programmatic design, and evaluation plan. This includes incorporating participant voices, whenever possible, to ensure that the selected outcomes do not discourage the service provider from serving participants equitably nor unintentionally block focus populations from participating in an intervention that is otherwise intended to meet their needs.