Redesigning the Adult Intellectual and Developmental Disabilities Service System in Milwaukee County

Examining the effects of new frameworks

Over the past two decades, Wisconsin’s system of long-term care services and supports has undergone significant change, affecting seniors and people with intellectual and developmental disabilities (IDD). A shift to a managed care framework was a central focus of these changes.

Change inevitably requires that policy choices be made that have impacts, positive or negative, on the system.  As a result, it is prudent to pause and take stock of what has been achieved, take measure of the challenges that remain, and make informed plans for pressing forward.  In this spirit, we assisted Milwaukee County policymakers to explore circumstances surrounding services for people with IDD in the county and develop a “blueprint” for improvement while meeting the challenges ahead.

Reviewing performance and drawing conclusions

As part of our review, we examined relevant literature and data available at the national, state, and county level, and conducted interviews with more than 30 informants.  We found that the system, while accomplishing important goals with respect to system access, faced significant challenges going forward:

While Wisconsin policymakers had invested heavily in expanding service capacity and successfully eliminated waitlists, there was now a perception among key informants that the service mix may have become more standardized and somewhat less ample.

These challenges were made more complicated by the existing managed care framework that includes multiple managed care entities, alternative service response emphasizing self-direction, and county involvement to determine initial service eligibility and guidance to service recipients.

Suggesting strategies to shore up and improve performance

With our project partner, the Public Policy Forum, we suggested several strategies to shore up services for people with IDD in Milwaukee County. The actions suggested targeted four areas:

• Invest in self-advocacy – We noted a lack of opportunity for people with IDD to inform and shape provider policies, and suggested that managed care organizations and provider agencies take a series of steps to ensure that the voices of self-advocates are heard.
• Assure system transparency - To address the lack of performance information available to individuals, we recommend that Milwaukee County form a Performance Outcomes Committee to establish standards for the collection and dissemination of performance data.
• Invest in peer support and contribution – We recognized a need to formalize networks of people with IDD and their families to offer mutual support to one another, and suggested an increased use of formal cooperatives where participants can work together to manage the services they receive.
• Provide direction and oversight – We identified a possible new role for the County's human services department and the Combined Community Services Board and suggested the two entities could work together to function as a repository of performance information on IDD services provided in the County and best practices nationally.