County Audit of Human Services Recommendations

Posted May 15th, 2014 @ 6:21 PM by

So, there was quite a bit of talking about how they did the study and some of the strengths, but here is what I took away as a bottom line from the presentation. Full audio will be included when uploaded. Live blogged, not proofread.

INTRODUCTION
– We need to return to a more collaborative model that we were once on the forefront of.
– They suggest realigning funding with priorities.
– They recommend no additional funds for implementing the report.

RECOMMENDATIONS
They have 23 recommendations grouped in areas of people, process and technology. They are ranked short, medium and long term goals.

– page 28 – They recommend competencies not only in the direct service or service area, but the management or business end of things. They think there can be some efficiencies. Performance management, reviewing audits and some other areas were specifically recommended. There used to be training, but that has ended and they think it should be formalized and reinstitututed.
– Collaboration, page 36. There seems to be inconsistent collaboration, they would like regular meetings between project managers and agencies. At least an annual meeting with the providers and face to face contact. They say that there should be annual reports that are tied to performance standards and the funding.
– Administrative overhead, page 40. There is a cap of 15%, when the administrative cap goes down, that is reset, but there is no mechanism for it to go back up. It’s not transparent what the process is to request an increase. Other counties have formal written procedures. There is a national concern that administrative overhead cannot be too low.
– Medical assistance billing – page 42 – There is no incentive to increase billings if they don’t share in the fruits of the increased billing. Other counties encourage increased billings and the service provider got 100% of the increased billings (Milwaukee) or split the difference (LaCrosse). They recommend looking at if the programs are underfunded or adequately funded and there is a sliding scale for he share of the parties.
– Process of contracting – page 47 – There is a written process but it is not consistently applied across program managers. The evaluation process is applied differently.
– Performance Indicators – page 51 – there is an instinct to pay per person seen, but you need to get beyond that is what are we trying to achieve and the outcomes are hard to determine.
– RFP process, page 60. There are several areas where there is only one respondent. There might not be organizations prepared to provide the services or the county might be better to do that. They suggest that the county do a risk assessment there. How can they build competencies to get people to respond to the RFP. They also think that they need more innovative programs, they want to encourage competition to challenge each other to provide stronger services. Some feel that the award is a foregone conclusion and they won’t respond, so that doesn’t encourage innovation.
– Funding, page 63. This was the number one message from service providers, that they have not gotten a cost of living increase in a long time and that they are being asked to do more. They recommend that they look at the priorities and to fully fund those priorities. It might mean a decrease in some areas and there is a recommendation that we can’t do everything. National average is 43% that funding is a great concern, Wisconsin is 55%, 2nd in the study. They recommend having more advisory boards to take on what the community needs or to do a prioritization process to include community members, service providers and the county. They found that most counties have an annual cost of living increase.
– People are still using carbon paper! They are using paper. This create redundancies on both sides. Technology and email can be used. Info can be FTP’d. There is a lot of re-typing and redundant data entry.
– Financial management of the grants is entered in two systems. They identified some efficiencies.
– They also did have a high, medium or low risk catagories.

SUMMARY
Prioritization of issues is key. We need to focus on core services if we are going to have quality services.

QUESTIONS FROM THE BOARD
Stubbs wanted to make sure all the agencies got the report. Also, she asks about the advisory boards. THe advisory committee could be a point of input to talk about the priorities and immediate needs. Where should the limited resources be put in the short term. There are several best practices listed. The boards have consumers, parents of onsumers and supervisors, and they had public input. It was a transparent process. This is not during the budget process, but throughout the year.

Baryd asks if they only focused on the implementable issues, did you leave out the ideal? They were asked to give recommendations within fiscal constraints. They do think there is some challenging recommendation, especially performance based funding. They tried to give a framework to achieve success. (see appendices) They say implementable and easy are not the same thing.

Bayrd asks about creativity and the RFP process. Do you feel like there are agencies providing services that they are not interacting with. They give example of having a mobile crisis unit for 5 counties for mentally ill persons, its not about more providers, but bringing people together in a different way.

DEPARTMENT RESPONSE
The written response is here.

(Sigh, I hope I can make it through this without puking.)

Lynn Green thanks everyone. They agree with the vast majority of what is in the report and support many of the recommendations. They won’t let it sit on a shelf and will take it seriously and item by item have started a review and have talked about approaching one of the advisory committees to do in depth analysis. Health and Human Needs committee chair have talked with Green about how to make this tackle-able and they have this on their agenda for next week. What is of main interest is the performance based contracting, they are challenged staff and IT wise. They are doing an analysis about what it would take to pursue it. The other main interest is revenue sharing. That is challenging and they have had false starts in the past. They have undertaken some of the low hanging fruit. They are working on getting communications position back in the department, which they combined with the homeless services position. They think trying to do it all might not be feasible since they don’t have resources and the core services have more demand and need. Prevention and early intervention might not be sustained, to maintain mandated core services. 1% COLA increase is $1M and that would take a lot of work to implement them. They are also looking internally at their structure to eliminate duplication. Department feels strongly about the program managers being contract managers, she says the POS agencies fulfill mandates. They know they need to do some internal training for program managers, since they hire who know best practices and knows how to provide services.

OTHER QUESTIONS
Chenowith asks about the priority list, do you agree with this as the implementation plan. She says she hasn’t studied their recommendations, but they developed a way to look at it. They will look at what they can do. They will do it independently and compare with Baker Tilly. Chenowith asks when that will be done, he says they need it before budget.


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