Treating Medicaid Users Like Birds, a Case for Humor in Government, and a Pension Guide for Politicians

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by | September 19, 2013

Gotta wonder how something like this happens. One of the issues in managed care in Kentucky (and many other states) is that there can be difficulties building a big enough network to provide health-care access to Medicaid users without undue hardship.

Kentucky monitors the proximity of Medicaid clients to providers, particularly in rural communities. But according to a recent auditor’s report, the data collected is the straight-line mile distance to available providers -- not the driving distance. In other words, the distances are being measured in a way only applicable to birds who don't need roads to get from place to place.

We’ve heard it a hundred times from public officials: “Why don’t we get credit for our accomplishments?” Well, there’s a way for one of you to be honored big time. It's called the Harry Hatry Distinguished Performance Measurement Practice Award, presented by the Center for Accountability and Performance. Nominations are due Nov. 22, and the nomination forms are remarkably short and simple.

We know from years of research that there are many, many great candidates out there, so let’s make sure at least one of them gets appropriate credit.

Return on investment for public policies is powerfully persuasive. Consider this from a U.S. Department of Justice press release: Apparently prison inmates who took part in correctional education programs were far less likely to find themselves back behind bars than others. Based on research, “a one dollar investment in prison education translates into reducing incarceration costs by four to five dollars during the first three years after release, when those leaving prison are most likely to return.”

This feels like the the kind of information that could persuade even the biggest skeptics of the importance of correctional educational programs.

The state auditor of Missouri, Tom Schweich, wanted to audit Kansas City’s water department after hearing worrisome news from local residents. But he doesn’t have authority to do so without the city council's approval -- which they wouldn't give. Instead, the city put through a no-bid $12 million contract for a consultant to deal with the water department’s issues.

According to the state auditor, "Our office is in receipt of heartbreaking stories of the elderly and working families being forced to pay bills they claim they do not owe while corporations and municipalities go months without paying their water bill. This evidence is only anecdotal and only a thorough and complete audit will reveal the extent of any problems and the best solutions."

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We have no special insights into this issue, but we’ll keep our eyes on it and keep you posted. Frankly, the journalists inside us are always intrigued when any government entity refuses an audit.

The State Integrity Investigation has once again analyzed and ranked each states’ efforts to “deter corruption and promote accountability.” Based on 330 different criteria, the states received letter grades in 14 categories, including openness in budgeting and lobbying disclosure.

The five states with the highest grades were New Jersey, Connecticut, Washington, California and Nebraska. Congratulations!

But there’s a problem with the rankings in that they measure the laws in place but not whether or not the laws are actually being enforced. So while this analysis is a valuable first step in encouraging states to focus on corruption and accountability, as far as we’re concerned, a poorly enforced statute doesn’t have a whole lot of value.

We’ve flown on Delta Air Lines a few times in the last couple of months and, to our own surprise, were thoroughly engaged by the safety warnings at the beginning of each flight, which are being delivered with a subtle sense of humor and visual jokes interspersed throughout. It's the first time in years that we’ve really focused on these safety videos.

So our question is: Can cities, counties and states learn a lesson from Delta? Take recycling: The signs we so often see in parks directing people to put bottles in one spot and so on are clear, but maybe a little humor would get more public attention.

The latest Governmental Accounting Standards Board rules on pension reporting make it clear that funding decisions are in the hands of local decision-makers. Fortunately, a “Guide for Elected Officials” has just been issued by a host of well-respected organizations, including the National Governors Association, the National Conference of State Legislatures, the National Association of Counties and the National League of Cities. You can find it here.

“The time is always right to do what is right.” -- Martin Luther King Jr.

We recently asked Paul Epstein, the highly regarded principal consultant of the Results That Matter Team, what the flaws are (if any) with using A-F scales to measure performance. Here are some excerpts from his comments, in which he discusses the County Health Rankings of the University of Wisconsin and the Robert Wood Johnson Foundation.

“For each state, publicly available data are used to rank each county on a range of health outcomes, with a big once-a-year release of data and a lot of online advice and examples of how to use the rankings to mobilize your community to improve outcomes. From my anecdotal experience, local [government] health departments have not blown off the County Health Rankings, even though data issues abound. I've seen and read about examples of these rankings being taken quite seriously and used to spur improvement. Some top-ranked counties want to stay on top, and they zoom in on the few indicators where they are weak. And some counties closer to the bottom use their documented poor health outcomes to pull many public, private and nonprofit organizations together to determine what they can do, working together, to improve health in the community.

“Maybe this example is particular to public health. But I don't think it has to be. There are a lot of important public outcomes that require efforts by more than one organization to address effectively. In communities that "get" that, a poor showing from benchmarking outcomes is less likely to be used to punish the cognizant public agency, and more likely to be used to rally many in the community to work together to do what they can to improve outcomes. Maybe, paradoxically, it will be the realm of difficult-to-measure-and-compare public outcomes that opens a door to more fruitful government benchmarking.”

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