The Opioid Crisis In CT: How Family Data Collection Grows Pay for Success Profit

The next logical step in the evolution of pay for success finance is broadening the scope of interventions from individuals to families. Rather than focusing on a child that needs educational support, an incarcerated person planning for re-entry, a veteran’s PTSD, or a substance user’s recovery, investors are developing new models that expand targeted populations and capture “impact” data across MULTIPLE lives. In this way investors will leverage targeted (limited cost) investments in privatized public services to capture more metrics of “success” and thereby increase profit-taking.

An example of this is the Connecticut Family Stability project. This pay for success effort was launched in 2016 and targeted households where a parent was identified as having a substance use problem, and the child had involvement with the state’s Department of Children and Families. The Family-Based Recovery program was used, an in-home treatment developed in 2006 by the Yale Child Study Center in partnership with Johns Hopkins University for the Connecticut Department of Children and Families.

Connecticut Family Stability SIB

Interactive map of the Connecticut Family Stability Pay for Success Project here.

The deal, lauded by the US Department of Health and Human Services, the Office of National Drug Control Policy, and the Office of Social Innovation and Civic Participation, attracted investment not only domestically (the Non-Profit Finance Fund, Arnold Ventures, and the Reinvestment Fund), but also from overseas, namely, France (BNP Paribas) and Australia (QBE Insurance). As far as I am aware, it is the first US venture taking advantage of the tragic opioid crisis to create a global impact investment vehicle using pay for success finance. The deal was particularly attractive for investors, because impacts were captured on BOTH the recovery of the parent AND improved outcomes for the child.

BNP Paribas Connecticut Family Stability

The above op-ed was written in the spring of 2018 by Tina Rosenberg, co-founder of Solutions Journalism Network (read more on impact media here). It speaks glowingly of the project and the $11.2 million investment BNP Paribas made in it. It’s a puff piece promoting innovative finance, that provides background on social impact bond mastermind Sir Ronald Cohen, and pitches the wonders of his “what works” approach and data-driven outcomes.

Rosenberg describes teams of social workers deployed to hundreds of people’s homes. Parents were required to urinate in a cup three times a week. The counseling provided to these families, most of whom earn less than $10,000 per year, could last “up to an hour.” The piece attempts to make it sound comforting and convenient, but having an official of the state in your home every other day for six months monitoring your parenting and deciding whether or not you can keep your family together must have been a harrowing experience.

The “success” metrics for the program were 1) clean screens 2) fewer reports of mistreatment and 3) reduced foster care placements.  It’s easy to see how those metrics could be gamed, and in the end, even if the parents were able to stay clean for the specified period of time, they were still left attempting to care for their children on an impossible income. Of course that essential fact is not addressed by the “family STABILITY project;” as if one could achieve STABILITY without a living wage and ongoing family support. But the government and the investors are the ones that get to set the terms of “success,” and in the business of speculative human capital finance, metrics are not established to serve the interests of “at risk” populations.

A 2016 Obama White House report describing “opportunities” for leveraging Pay for Success to address the opioid crisis is shown below the map. Page twenty-one outlines “next steps.” The depravity of the “pay for success” approach can be seen in the language used. The authors recommend identifying “which AGENCIES would benefit from a reduction of opioid misuse” and “potential sources of ECONOMIC BENEFIT.” There is nothing about the people being harmed. There is no moral argument made about providing treatment merely because everyone deserves to be treated humanely. No, the primary thing that matters is identifying a cost-offset that can be easily tracked and will generate a solid rate of return for investors. They don’t care if people are truly cured as long as the numbers on the dashboards allow them to claim “success” and take their profit.

Pay for Success Opioid White House

Read the full report here.

These folks never let a humanitarian crisis go to waste. Predators made fortunes improperly prescribing pills. More money was made on recovery programs, but even that wasn’t enough. To that they added “creative financing solutions” that permit MORE profit to be extracted based program outcomes. And thus the tentacles of pay for success continue to extend their reach, grasping at the misery of the masses and using their pain to further concentrate wealth and power in the greedy hands of an elite transnational class.

All the profit accrued from the supposed “success” of “evidence-based” interventions ultimately gets redirected to those at the top. Everyone at the bottom is compelled to attempt to survive on fewer and fewer resources. The Connecticut families struggling with addiction on less than $10,000 this year are likely to be in the same boat next year, but with a few thousand fewer dollars in their pocket. That money, of course, will be sitting as an outcomes-based “success” payment in the coffers of BNP Paribas or QBE Insurance or some other financier, ready for the next go around.

Pay for success does not advance redistribution of resources. It does not ensure people have access to what they need to survive. It is not designed to ameliorate the harm wrought by manufactured poverty. It is a false promise, that concept of “success,” if “succeeding” means the rich always get richer and the poor always get poorer.

Connecticut Family Stability Project Social Finace Tweet

Source of tweet here.






Anti-Abortion Legislation and the Perverse Logic of Human Capital Impact Investing

If an increasingly automated Fourth Industrial Revolution economic system demands an abundance of poverty data to keep global capital markets moving, it makes sense that those in power might seek to increase births resulting from unwanted pregnancies. I do not believe it is coincidental that provisions for home-visits, widespread ACEs screenings, and early childhood investments are hitting state legislatures at the same time as bills that restrict access to abortion. In a world where abortion is restricted, more pregnancies = more health outcomes data to track. More “at-risk” babies = more children to be channeled through “evidence-based” early childhood interventions.

The impact economy thrives on trauma (see this post on ACEs). The more trauma, the more opportunities to demonstrate “impact,” gamble on life outcomes, and generate profit from privatized social services. According to the twisted logic of late-stage capitalism, there is a real financial incentive to increase traumatic pregnancies. That trauma can be physical, emotional, economic or some combination. Legislation that denies a person bodily autonomy and limits their ability to choose whether or not to carry a pregnancy to term will create tremendous stress, and thus many humans (adults and children) who will likely be identified as needing some type of “evidence-based” intervention.

In the cold, calculating world of social impact investing, the poor, even those still in the womb, exist on a continuum of potential criminality and need. Their perceived value to the system lies less and less in their productive labor, but instead in their willingness to be pre-emptively “fixed” by bureaucratic systems that do not see their innate humanity, just data, data on a dashboard.

Providing unconditional support to those in need is seen less and less as an acceptable option. Instead, society is adopting a mindset where the worthy poor will be separated from the unworthy; where ubiquitous surveillance and Internet of Things tracking will monitor compliance, algorithmically assess a person’s risk profile, and award assistance, or not. In this future, social supports will be ephemeral and conditional. Rights, privileges, and value will exist as data, tied to a digital identity, on a phone (or eventually embedded in a chip), ready to be erased on command.

Data-mining is the next frontier of predatory resource extraction. Just as experts began to postulate capitalism cannot expand further, it jumps the shark into the digital realm, seeding itself in virtual worlds, claiming private property on Blockchain, colonizing the cloud. As rivers were for the fur trade and railroads were for lumber and minerals, so too will broadband, 5G, smart phones, wearables, and data dashboards be for the human capital / Internet of Things impact economy.

Maternal, fetal, and child wellbeing have become the focus of intense electronic data collection over the past decade. Mobile health or mHealth is a practice increasingly imposed on Black and Brown communities to monitor behaviors and deliver digital nudges via SMS text messages. Such interventions are grounded in behavioral economics and are intended to manage vulnerable populations. While they may ameliorate some degree of harm, the neoliberal policies enacted place the burden to change on those with the fewest resources to do so, and simultaneously maintain systems of resource inequality and oppression that must remain in place to keep the game going.

Pregnancy Advice SMS

Such protocols have been developed as a disruptive force by US business interests and delivered, often through global aid programs, to cement austerity in healthcare, pressure patients to conform to prescriptive regimes of self-care under challenging circumstances, and generate data profiles that can be then used to justify successful “results” payments.

It is telling that the rise of mHealth, starting around 2009, corresponds to the rise of global impact investing. The timing also aligns with adoption of the Patient Protection and Affordable Care Act. That legislation pushed adoption of e-health records, systems that are now paving the way for a shift to value-based payments from fee for service. It is these digital platforms, once they can be made interoperable with data across other social sectors, that will channel massive private investment into public health outcomes; that and IoT preventative health monitoring. Once that happens, people will become the batteries-just like the Matrix.

The plan of the one percent is to maximize human capital profit extraction capturing data starting in utero and using it to predict risk and track the relative worth of a given life within globalized financial marketplaces. You get a sense of what they have in mind reviewing screen shots taken from the Global Education Futures’ 2015-2035 foresight map.

Prenatal University

School In Womb

Genetic Passport

Human Futures

In the end, digital life is about lean production and data harvest in service of financiers desperately trying to find ways to make money off poor people, even as the poor have less and less money to spend. Unwanted pregnancies are a mechanism of social and economic control.

It is important to understand that the legislative changes limiting access to safe, legal abortion will undergird this perverse system of social impact capitalism, an enterprise predicated on perpetual poverty of the masses. As we move towards a world dominated by surveillance, digitized public services, and predictive profiling, we must recognize that powerful global interests are attempting to turn our lives into a petty game, a game for their entertainment, for their profit.

Kevin Werbach, a Wharton professor and expert in gamification and Blockchain, closed a 2012 talk on Lifelong learning with the following assessment.

In any game:

1) rules matter

2) rules can be surprising

3) players must respond to the rules the game designer has set up in advance

4) be the one who makes the rules.

We must wake up and realize we’re in their game. We’ll never win if we play by the rules. Time to flip the table.

Kevin Werbach The Rules Matter 1

Kevin Werback Rules 2

Kevin Werbach Rules 3

Kevin Werbach Rules 4.jpg