WISCONSIN LEGISLATIVE AUDIT BUREAU
WISCONSIN FAMILY CARE IMPLEMENTATION PROCESS EVALUATION REPORT
Section 9131(3m) of 1999 Wisconsin Act 9 requires the Legislative Audit Bureau to
contract with an organization to evaluate the cost-effectiveness, access to services, and
quality of care provided by the Family Care pilot projects. In collaboration with staff
from the Department of Health and Family Services, the Legislative Audit Bureau released a
request for proposals and, from among the five competitive proposals submitted,
selected The Lewin Group to evaluate the Family Care program. As contract
administrator, the Legislative Audit Bureau approves each work product delivered by The
Lewin Group to ensure objectivity and independence. However, the findings, conclusions,
and recommendations in the report are those of The Lewin Group.
The evaluation process has three stages. The first stage was the
development of the enclosed Wisconsin Family Care Implementation Process Evaluation
Report. The second stage will be the development of an impact evaluation, which will
assess the extent to which the pilot projects are meeting the stated goals of Family Care.
That stage is currently scheduled to begin in June 2001. The final stage of the evaluation
will assess the benefits and costs of the program. Work on it is currently scheduled to
begin in January 2002.
The enclosed report is the first of five The Lewin Group will develop on
the status of Family Care implementation. The report contains background information on
the Family Care program as a whole, as well as evaluative information on the
development of each pilot project. The report also contains a glossary of terms and a
research methodology section that demonstrates the contacts made by The Lewin Group in the
five pilot countiesFond du Lac, La Crosse, Milwaukee, Portage and Richlandin
order to assess the current status of the Family Care program.
Through contact with these pilot projects and numerous interviews with
staff from the Department, The Lewin Group advances the following key findings about the
implementation of Family Care:
- In the five pilot counties, enrollment in the Care Management
Organizations (CMO) that arrange and manage services for individuals enrolled in Family
Care was essentially limited to the conversion of Community Options Program (COP) clients
and the removal of individuals from existing waiting lists. Through September 8, 2000,
1,513 individuals were enrolled in Family Care in the four pilot counties with fully
operational CMOs. (Richland County is not yet operating its CMO.) The pilot projects were
not able to enroll new consumers from all target populations as efficiently as they had
- The number of actual contacts made by Resource Centers, which provide
one-stop shopping for information and assistance in obtaining long-term care services,
exceeded projected goals. From March to June 2000, 15,734 contacts were made by the
Resource Centers in Fond du Lac, La Crosse, Milwaukee, and Portage counties. The
projected goal was 3,223. The extensive use of the Resource Centers indicates that
they are meeting a need for information about long-term care choices.
- While the Resource Centers have improved consumers ability to make
informed choices about long-term care, there is significant variation among pilot projects
in the manner in which information is organized and provided. There are also some needs
that the pilot projects report are unmet. These include transportation, short-term case
management, and supported employment for the developmentally disabled population.
- Consumer direction and advocacy are important components in the
structural design of Family Care. However, these components have yet to be fully
implemented. The pilot projects have been focused on administrative issues such as
staffing and case conversion and are just beginning to concentrate on incorporating
other requirements. Similarly, quality assurance and improvement efforts are just
beginning in the pilot projects.
- Pilot projects are making progress in integrating the management of
medical and social care. However, it is too early to discern when changes in care
management will actually occur. Pilot projects have reported that care management is much
more time-intensive than expected because of the need to develop a care plan with
significant consumer input and because there are more services to manage and monitor under
the Family Care model.
- A capitated rate-setting methodology has evolved over time, and the
Department appears to have made an effort to include the pilot counties in the process.
The report chronicles the creation and refinement of the methodology and defines its
components in detail.
- Unresolved governance issues have emerged as a central issue in the
implementation of Family Care. The Department continues to work to resolve issues
involving potential conflicts of interest when a county board oversees both the entity
that receives capitated funds to provide Family Care services and the entity that
determines the necessary level of care and provides enrollment counseling.
The report is available on the Legislative Audit Bureaus Web page
If you are interested in receiving a copy, please contact our office and request the
Family Care report. If you have further questions, please contact Kate Wade at (608)
LEGISLATIVE AUDIT BUREAU
full report, PDF file (475KB) This
file requires Adobe
Go to LAB Reports Page
Go back one page