By Allison Hiltz
Literacy. Diabetes. Homelessness.
At first glance, these three words don’t appear to have much in common. Yet each represents a set of policies set forth by state legislatures around the country. While most agree literacy rates could improve, diabetes could be prevented or managed better and homelessness could decline, the way states achieve these ends varies.
Eagle-eye lawmakers ask how by homing in on program operations and effectiveness. With increasing legislative scrutiny on program effectiveness, state legislators use performance management systems, also known as outcome monitoring systems, for guidance. Nearly every state has an outcome monitoring system in place, yet just under half regularly review or audit performance indicators to evaluate success.
A recent report from The Pew Charitable Trusts examines these systems and how they operate. Laying out a near step-by-step guide for states interested in outcome monitoring, the report explores how states currently measure programs, as well as creative and innovative processes states are adopting to achieve success.
Through myriad examples, the report highlights the possibilities of outcome monitoring for states at any level of engagement, whether they are just starting out or are deep into the process.
When effective, outcome monitoring systems regularly track and report on the progress of key indicators (such as number of people served or cost of delivery) at the state and agency levels, depending on the administration of the program. This information is subsequently compiled and analyzed to report on areas for improvement or to allocate resources. The challenge is to ensure the reports are accessible and digestible for legislators. Armed with information, lawmakers can then make more informed decisions, identify which programs work, which don’t, and shore up accountability to the public and stakeholders.
Performance data informs the decision-making process in four primary ways. First, outcome monitoring systems can be a great surveillance tool, shining light on areas that need improvement. New Mexico’s Legislative Finance Committee uses outcome monitoring for exactly this purpose—to identify deficient areas, then identify what’s causing the deficiencies (such as increased workload or inadequate resources), and lastly, provide the tools necessary for addressing the problem.
Second, outcome monitoring helps spot strategies for improvement. Colorado, for example, holds monthly meetings among various agency executives and program office leaders to go through data from C-Stat, its performance management system. Relying on this data, Colorado implemented strategies that reduced the use of isolation for chronically mentally ill patients by 95 percent in one of its state-run psychiatric hospitals.
Third, performance data allows policymakers to target resources to their greatest area of need and track progress on strategic planning efforts. Idaho has used data to target resources to programs related to access to care, while Connecticut uses the data to maintain focus on key goals outlined in their state health improvement plan.
The report also highlights how states looking to get their proverbial feet wet in the world of outcome monitoring can do so. Beginning with the identifying objectives and measurements and ending with coordinated monitoring alongside other evidence-based policymaking efforts, each step breaks down into a series of action items. It also offers ways to create and sustain a data-driven culture, even after the initial novelty disappears.
One main driver behind nearly every step in the world of outcome monitoring is the need for collaboration.
Gathering stakeholders to work together both aids in the process and allows for more informed decision-making. Whether it’s the 100 coalition partners working together on health outcomes in Connecticut, or Idaho’s contract with local agencies to provide data-driven services, collaboration is key. Once again, states are forging ahead with new and innovative approaches to familiar problems.
Allison Hiltz is a policy associate in NCSL's Employment, Labor and Retirement Program.