The question about whether the LePage administration will cut funding for Healthy Maine Partnerships is yet another example of why the Maine Department of Health and Human Services needs to be more than just a political pirate ship ride swinging from one extreme to another with each administration change.
A few months ago, I used that analogy to analyze Commissioner Mary Mayhew’s performance in the context of her predecessors. This analysis was intended to suggest that the management structure and the structure of the overall organization itself was far more problematic and in need of attention than was Mayhew’s individual performance. I was trying to expand the focus beyond four-year snippets and the soundbites of each administration or its opponents.
Some readers thought for sure I was somehow defending Mayhew rather than suggesting it was time for a paradigm shift in our delivery of health and social services. Lest that happen again, I will clarify right off the bat that I am a fan of public health systems in theory. Public health systems can play such a critical role in the health and well-being of communities in a state as rural as ours.
The analysis that is to follow is not to suggest that the LePage administration’s past or pending changes to the system are right. It is to suggest, however, that a closer look at these programs may very well be warranted, and we might have already known that given a different structure at DHHS. Like the example of the consent decree in my previous post, Healthy Maine Partnerships has been around a while (though not quite as long), swinging on that same pirate ship ride.
What reports I found give the mixed bag kind of results one might expect from a program swinging on a pirate ship ride.
The first is a peer review, dated 2009, and available at the National Institute of Health website. The report details the history of the Maine Centers for Disease Control and Prevention program, which began in January 2001 using tobacco settlement funds. It highlights the development of the partnerships and their program priorities, and summarizes “the progress made by HMPs during their first few years (July 2002 – June 2005).”
The report applauds the initiatives undertaken and speaks to “the notable changes made by local HMPs and suggests momentum for improving Maine’s public health infrastructure.”
However, the report documents “several limitations” to the process by which HMP’s outcomes are evaluated including measurement errors and significant time lapses between activities and reporting on said activities. The most telling limitation for me, though, is the fact that the reports “only counted successes,” and those success counts were susceptible to inconsistencies created by the aforementioned measurement errors.
The reporting process had “no means for detecting barriers existed,” which means there was no “documentation of contextual factors and barriers encountered.” The report cited that a “new online system and the addition of a case study” would allow for this documentation to “help identify issues to be addressed in the second round of funding.”
When I read that passage I couldn’t help but wonder if the then-brewing opiate epidemic was one of those factors or barriers that could have used a little documentation.
Unfortunately the problem of evaluating program outcomes appears to remain consistent for a couple swings of the pirate ship. The problems identified in the 2009 report foreshadow the findings of a December 2013 OPEGA report, “Healthy Maine Partnerships’ FY13 Contracts and Funding.”
This report looked at the process used to make changes to the structure of HMPs and how funds were awarded. It is pretty scathing in its findings about the process hastily implemented under the LePage administration during that round of funding and somewhat justifies the fears of advocates concerning this next round of changes.
But the report itself begins where the 2009 peer review left off: evaluating outcomes.
This report calls it “performance data,” saying “existing HMP performance data was not useful.” Tomato, Tom-ahto. Either way, several years of programming lacking in evaluation.
Ideally the LePage administration would have wanted to thoroughly evaluate efficacy before instituting changes, but I’ve come to accept that I can’t expect common sense actions from our former business consultant chief executive.
Back to my pirate ship ride analogy: The problem with making changes to things we don’t understand the efficacy of is that some next round of leadership will come in and undo those changes to programs we still don’t understand the efficacy of. Change for the sake of change is usually shortsighted and inhibits real progress.
The only way to make effective changes to Healthy Maine Partnerships or any of the other programs and agencies under the DHHS umbrella is to change the structure of DHHS itself. As I said in my previous post, it may be time to rethink the entire department and its management structure. A look at the value of independent evaluations of its various programs wouldn’t hurt either.
It’s time for substantive change for the sake of real progress, change that stabilizes department and improves its outcomes, change that makes its programs less susceptible to the motion of the swings from one administration to the next.