Monday, December 20, 2010

Tracking local government in metro Milwaukee

For years, the Public Policy Forum has urged local governments to use performance measurement as a means of tracking progress toward strategic objectives and educating constituents about the outcomes associated with various government services and expenditures. Today, as government budgets grow tighter and taxpayer tolerance for spending money on all but the most essential services diminishes, it would appear that use of this tool is a necessity.

In keeping with that sentiment, the Forum has released its inaugural Tracking Local Government report. The report – made possible by a grant from the Northwestern Mutual Foundation – should be viewed as a resource both for the ordinary citizen to use in understanding the breadth and effectiveness of local government services, and as a potential model for local governments to consider in determining the types of information they should be collecting and sharing with constituents.

The 47-page report identifies 25 local government or government-funded services in nine functional categories that are considered critical to the metro area’s economy and quality of life. For each set of services, the report tracks fiscal and performance data over a five-year period to provide readers with a sense of revenue and expenditure levels, as well as a sense of what taxpayers are getting for their money. The report also provides brief analysis and observations regarding why the services are important, data trends, and future implications associated with those trends.

Performance measurement has been used increasingly by all levels of government since the early 1990s to better manage programs and services and communicate results to stakeholders and constituents. Unfortunately, not all government entities and departments in our metro area do an adequate job collecting performance data, and even those that adequately collect it often do not share it with policymakers and citizens.

The Tracking Local Government report is an effort to compile such data – to the extent it is readily available – in an easily understandable format in one place. In addition to informing citizens, the Forum’s objective is to “encourage those agencies that are not engaged in an appropriate level of performance measurement to improve their efforts."

The inaugural Tracking Local Government report is considered a work in progress. Time and data limitations required us to focus exclusively on Milwaukee County, City of Milwaukee and other Milwaukee-based governmental entities, as opposed to looking at government services within other Milwaukee County municipalities or other southeast Wisconsin counties. We hope to expand the project in the future to include a broader perspective.

The full report can be accessed here.

Thursday, December 16, 2010

Some good news from Milwaukee County's mental health complex

While the problems experienced by Milwaukee County's Behavioral Health Division (BHD) justifiably receive considerable attention in the local news media, there also are some shining success stories that seldom are reported.

One obvious example is the division's Wraparound Milwaukee program for children with complex mental health and emotional needs, which received an "innovations" award from Harvard's Kennedy School of Government in September 2009. Another - discussed recently in a report submitted to the county's Health and Human Needs Committee - is its WIser Choice program for individuals suffering from substance abuse.

WIser Choice was created by BHD and the state after they were awarded a three-year, $22 million federal Access to Recovery (ATR) grant in 2004. The grant funds gave BHD the resources to transform its substance abuse program into one that provides a comprehensive blend of recovery-oriented services. Those services extend beyond traditional drug and alcohol treatment to also include pre-employment education/training, transportation, housing, life skills training and other supports. The county and state successfully collaborated on a second three-year ATR award in 2007 and recently received federal approval for a third three-year installment.

The program's success in competing for scarce federal funds is a direct reflection of its impressive client outcomes. In fact, according to BHD, those outcomes - based on national measures established as part of ATR - generally have been the best of any ATR grantee. Also, in the 2002-2004 pre-WIser Choice period, Milwaukee had the highest rate (13.47%) of any urban area in the nation of persons with a past-year substance use disorder. From 2006-2008, however, Milwaukee’s rate dropped to 9.96%, which ranks it only 22nd among urban areas.

Recently released federal data also show the following impressive results:

  • Milwaukee dropped from 1st among urban areas to 7th in binge drinking.

  • Milwaukee dropped from 2nd to 20th among urban areas in past-year treatment gap for alcohol use disorders.

  • Milwaukee’s rate of substance use disorders dropped 20.1% from 2004 to 2008, while the nation’s rate as a whole decreased only 1.8%.

The success of Wraparound and WIser Choice has relevance to efforts to address the serious problems plaguing BHD's adult mental health operations. A report released in October by the Forum and Human Services Research Institute argues for a redesign of those operations, highlighted by a much greater emphasis on community-based services and a gradual downsizing of the county's role in inpatient and long-term care. A few of the encouraging lessons from Wraparound and WIser Choice that might inspire the adult mental health redesign effort:

  1. BHD has shown that with sufficient resources and appropriate support from elected officials, it is fully capable of designing and implementing successful models of behavioral health care and treatment.

  2. BHD and the Wisconsin Department of Health Services have shown they can put the politics of their elected leaders aside to collaborate effectively and bring additional federal resources to Milwaukee County.

  3. BHD has deftly created and managed relationships with community-based providers in both programs to achieve results that benefit both clients and taxpayers.

Good news from Milwaukee County’s mental health complex may be rare, but in this case it should provide hope for the future.

Monday, December 13, 2010

PPF's top research findings of 2010

The Forum recently received a communication from a national research group detailing its top five findings this year. That got us to thinking about our top five research findings of 2010. The competition was stiff, but here they are, in chronological order (drum roll please):

  1. Southeast Wisconsin's skilled workforce may be its greatest economic strength. Our March Innovation Index report benchmarked our region with three Midwestern peers and three innovation leaders using several indicators linked to success in building a knowledge-based economy. While the overall assessment was mixed, we found southeast Wisconsin was number one among the group in its percentage of residents working in middle-skill jobs, i.e. those that require specialized training or education beyond a high school diploma, but less than a four-year degree. The finding suggests that while our region may be lacking in college graduates, we still possess the type of workforce that should be very attractive to certain industries.

  2. Milwaukee County's structural deficit is really, really daunting. In our July preview of the county's 2011 budget, we used the county's fiscal forecasting tool to determine how its five-year fiscal outlook would change under two relatively dramatic scenarios: 1) the property tax increased at double the projected growth rate, or 6.6% per year, for each of the next five years; or 2) projected growth in salaries and fringe benefits was reduced by 50% and 25% respectively in each of the next five years. We found that in both cases, the projected structural deficit in 2016 still would be in the range of $65 to $70 million. Quite a challenge, indeed, for the next county executive.

  3. MATC clearly spends more than its peers. Our September fiscal assessment of the Milwaukee Area Technical College found an institution struggling to accommodate shrinking revenue streams at the very time that demand for its services had reached historic highs. While plummeting property tax capacity and shrinking state revenues certainly hurt, however, it appears there is capacity to make adjustments to the expenditure side of MATC's ledger. Our research compared MATC with 84 other large two-year technical and community colleges nationally with regard to total operating expenses, salary expenditures and fringe benefit expenditures. We found that MATC ranks number one in expenditures per full-time-equivalent student on each of those measures.

  4. Milwaukee County's mental health system is out of balance. Our October report on mental health care for adults in Milwaukee County - released jointly with the Human Services Research Institute - found a system that is out of sync with national trends and best practices in light of its emphasis on inpatient care and its lack of comprehensive community-based services. Particularly telling was a finding that the county's 472 public and private acute inpatient beds are nearly triple the number that would be expected in a mature mental health system that contains the appropriate balance of inpatient, crisis and community-based services.

  5. The state's expensive child care subsidy program has grown as household incomes have shrunk. When the state created the Wisconsin Shares child care subsidy program in 1996, all low-income families became eligible, not just former welfare recipients. Participation has grown nearly 350% since then, in part because of a decline in household incomes. Whereas the program's eligibility limit of 185% of federal poverty line represented 57% of the state median income in 1999, today it equals 68%. As we point out in a December report, this trend does not bode well for the state’s new child care quality ratings system initiative, as a continued decline in household incomes may mean continued growth in program enrollment. That, in turn, could translate into less money available to offer incentives to providers for quality improvements.

Narrowing the list to five wasn't easy. We were forced to leave out additional key findings from reports on the Milwaukee Parental Choice Program, the region's public schools, regional property values and taxes, the City of Milwaukee's Main Street Milwaukee program, and three People Speak surveys, among others. Each of the 20 reports the Forum has published so far this year can be accessed here.

Friday, December 10, 2010

The People Speak: Citizens' Views on Energy Policy

Most area residents are at least somewhat concerned about increases in energy costs and, accordingly, most say they have taken steps to conserve energy. That’s according to the latest People Speak poll of 395 residents of Southeast Wisconsin, which also shows that most citizens in the region are willing to pay more for fuel efficient cars, appliances, and homes, and that most support certain tax incentives to conserve energy or lessen reliance on non-renewable energy sources.

The latest People Speak is the fourth edition of this regional tracking poll, which is a partnership between the Public Policy Forum, UWM's Center for Urban Initiatives and Research, and The Business Journal Serving Greater Milwaukee. Over the past six months there has been a sharp increase in the percentage of respondents who feel jobs and economic development are the most important issues facing the region. The environment ranks low as a concern for most citizens, as it has in each of the previous People Speak polls.

Despite the low priority placed on environmental issues, citizens are concerned about energy costs and climate change. These concerns are echoed in the actions most citizens report taking to conserve energy, including purchasing energy-efficient light bulbs, turning down the air or heat at home, and buying energy-efficient appliances. Fewer respondents report reducing their driving by walking or bicycling more often, and a very small percentage of respondents say they carpool or take public transit.

Overall, citizens' concerns about cost and climate change are also reflected in their support for energy conservation policies such as tax incentives or benefits to individuals and businesses for conservation, requirements that cars be more fuel efficient, and requiring utility companies and business to use more alternative, renewable energy sources. There is less support building a new nuclear energy plant in Wisconsin. Reducing the speed limit and establishing a utility surcharge for exceeding monthly household energy-use limits are not supported.

For the complete People Speak poll results, as well as analysis of the results, visit the poll's homepage.

Wednesday, December 8, 2010

Moving the goal posts on early childhood care and education

The Forum's latest report on early childhood education finds the original goals of welfare reform produced state child care policies that had detrimental impacts on child care quality and that may be difficult to reverse under YoungStar, the state’s new quality ratings system initiative.

The report finds that as the existing Wisconsin Shares child care subsidy system became operational, certain policy decisions produced results – many of which were unintended – that ended up boosting child care costs for the state while reducing child care quality. Those include:

  1. Creating a new, less regulated category of care provider, which was intended to allow parents broader choices in providers, quickly create jobs, and keep child care costs low for parents and the state.

  2. Sharing costs with parents by basing co-payments on the cost of care, as opposed to the parents’ income, which would have allowed parents to opt for more costly care only if they wished to pay more out of pocket but which, ultimately, could not be implemented.

  3. Creating a more restrictive definition of “low-income,” in order to serve the working poor in general, and not just those obtaining or seeking jobs as part of the W-2 program.

  4. Tying subsidy rates to prices in the private market, which was intended to provide low-income parents with access to the entire market while also relying on competition to keep the state’s costs in check.

Each of these four policies helped the state achieve its primary goal of providing a sufficient child care supply that would allow low-income parents to move from welfare to work, but at a high cost to the state and at the expense of quality within the child care market.

As policymakers look to reform the system under the new YoungStar initiative, can they successfully change the emphasis to quality within a system originally built to emphasize low cost and quantity? The policy challenges with which YoungStar’s designers and implementers must grapple include:
  • Stepping up collections of co-payments from parents. Under YoungStar, child care providers will be contractually obligated to collect parent co-payments, which they have not been required to do previously. An enforced co-payment requirement might cause providers who serve mostly low-income families to leave the program if they are not able to collect the co-payments, even if they are providing quality care.

  • Keeping income eligibility limits for working families at current levels. The pool of families eligible for Wisconsin Shares subsidies is growing because Wisconsin family incomes are not, which swells overall program costs. As more money is tied up in providing access to care, less will be available to improve the quality of care. Options for cutting costs would be to reset eligibility limits to exclude more families, or to appropriate a sum-certain amount and create a wait list for the subsidy. Both of those options, however, would retreat from the goal of serving all the state’s low-income families.

  • Tying subsidy rates to quality so as to incentivize quality improvements. Higher subsidy rates for higher quality might price some private pay families out of the market. If that were to happen, such families may have to seek lower quality options than they are using today. In addition, because YoungStar has been designed to be revenue neutral (at least initially), most providers will continue to earn the same subsidy rate after the initial round of quality rankings as they do today. If providers are not certain their investments in quality will result in higher subsidies, they may not see YoungStar as an incentive to improve.

Several policy options are highlighted for consideration as YoungStar’s implementation moves forward, including having the state collect parent co-payments directly, reducing the subsidy for lower-quality providers, and eliminating one category of provider—the minimally regulated provisionally certified provider.

In the end, the success of YoungStar may well rest on the ability and willingness of administrators and legislators to monitor real-world impacts on families and the child care market in Milwaukee County and to be flexible enough to tweak policies throughout implementation, in order to avoid a new set of unintended consequences.