Policy & Practice | Summer 2024

Program Delivery and Stakeholder Needs

Program priorities, rules, and opera tions will evolve over the course of time; and it helps to work in an envi ronment that embraces change, along with IT systems that can adapt quickly. Key Lessons Learned Several factors help determine program outcomes in the early years, and rulemaking, systems design, and operational constraints all drive these factors: 1. Design for equity and access. Ensuring equitable access to PFML benefits remains a signifi cant challenge. Workers with low wages, part-time employees, and gig workers often face barriers to accessing programs, highlighting the need for policies that address these disparities. Human-centered design offers the processes and tools to understand varied stakeholders’ needs and to fashion programs with those needs in mind. 2.Defining goals and measuring success. Clear and unambiguous program goals support efficient rulemaking, operational design, and IT delivery. This includes metrics across all aspects of the program, including equitable access, customer experience measurement, automa tion targets, claim processing/first payment targets, and operational costs and expense ratio. 3.Implementation approaches. Flexibility and adaptability are key to successful delivery, given the complexity of launching a new program. Managers should deploy supporting systems in an iterative and agile manner, pre senting opportunities to offer—and receive—feedback. Early launches, pilots, and beta releases offer the means to iterate and improve while managing go-live risks. 4.Design for program integrity. Benefit program abuse spiked during the COVID-19 pandemic, and bad actors continue to target these programs. 5 Program direc tors should keep integrity central during rulemaking, systems design, and operations. Certain core com ponents—employer verification, employee ID verification, health care provider verification—are

To implement PFML programs, many states utilize a social insurance policy model that funds benefits through pooled payroll taxes—premiums—on employees and/or employers. Only one state has gone its own way in utilizing a mandatory private insur ance system that requires employers to provide coverage through a state approved plan. 4 Many states with PFML programs exempt employers that already offer paid leave through private plans, as long as the coverage meets or exceeds that of the state. No matter the system parameters, or the state, the program’s stakeholder group is large and varied. Specifically, PFML programs offer wage replacement and job protection to support employees who need to take leave, aiming to maintain their finan cial security and employment status. And naturally, these programs have an impact on other stakeholders— employers, of course, but also health care providers and state programs such as unemployment insurance and workers’ compensation. Many state PFML programs offer special dispen sation to smaller employers in order to limit their financial burden, while larger employers tend to look for scale and efficiencies with similar payroll taxes enforced by unemployment insurance programs. Similarly, health care providers, with patient interests taking precedence, seek a seamless and automated process to certify medical claims for leave applicants. Human-centered design (HCD) offers the processes and tools to understand these varied stakeholders and to design programs with their needs in mind (see Figure 1). Recent successful launches of PFML programs have all included enactment of PFML to program launch is about two years—not long to design and build a management organization, develop rules and policy, procure and implement IT systems, and stand-up customer support structures. State program directors have had success by embracing a startup mentality and utilizing agile processes across these varying and concurrent threads. HCD in their implementation. For many states, the time from

Arjun Gupte is a managing director with

Deloitte Consulting LLP’s Government & Public Services practice.

Tiffany Dovey Fishman is a senior manager with Deloitte’s Center for Government Insights.

Scott Malm is a principal in Deloitte’s

Government and Public Services practice.

Sagar Pandit is a managing director with Deloitte Consulting LLP and leads Deloitte’s Paid Family and Medical Leave services.

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Policy & Practice Summer 2024