When I first heard about the new law proposed in Washington (enrolled house bill 2106) it didn’t bother me that it mandated performance based contracts with providers. That was because I equated performance measures with increased accountability. The state settled a lawsuit (Braam) by agreeing to improve the system. In order to see if the system improved, we had to measure how the state did in meeting the goals for improvement. They tried to improve, but keep missing the agreed upon marks. The goal posts kept moving a little closer – and they kept trying…meanwhile, a consulting group was formed in Seattle to come up with a way to improve the system – and the idea of shifting to a contracts only system – with performance measures was the result.
It was the overall concept of privatizing the system that bothered me. Which I equated with decreased accountability. Hey, here’s an idea – If you can’t fix a problem – make it somebody else’s problem.
If they first shifted responsibility, and then enacted accountability – they would never get stuck with their own toe in the crack. Who cares, because at least we still get some genuine accountability from somebody, right? The system improves. Yeah! Goal Accomplished!
Sounds right. But I’ve come to realize that’s not true. Not because I’m smart. I can’t take credit for my new insight. I had time to read the information that is surfacing in states where they already adopted performance based contracting as their foster care system.
My first “heads-up” that this performance-based initiative meant reduced services was the way many of the articles in favor of performance based contracting called it “managed care.” Insurance companies (also known as banks) adopted managed care systems in order to increase profits from health insurance. So I began to ask whether the driving force for using performance measures in the provider contracts was to find ways to improve the system or to find ways to save money.
Now, to their credit – the legislature NEEDS to save money right now – ‘cause we don’t have any to spend. And, to her credit, the Governor vetoed the section that said performance based contracting was intended to improve child welfare.
If you want to read more about the intent of performance based contracting or whether it has been demonstrated to improve child welfare – go here.
On average, non-pilot agencies provided significantly more in-agency services than did
– Non-pilot agencies made an average of 85 inperson non-therapeutic service contacts for each
foster child and/or foster family, as opposed to 51such contacts per child by pilot agencies
– Non-pilot agencies had roughly six therapeutic service contacts with each foster child, as opposed
to one therapeutic service contact per child made by pilot agencies
– Non-pilot agencies made roughly 23 phone calls and other collateral contacts per child, compared to
17 such contacts made per child in pilot agencies.
Results suggest that performance-based, managed care contracting is related to suppressed service provision and may lead to service disparities between foster children and families served under different market environments.