Stefaan Verhulst

Using data to treat the sickest and most expensive patients

Curated on April 29, 2014July 18, 2019 by Stefaan Verhulst

Dan Gorenstein for Marketplace (radio): “Driving to a big data conference a few weeks back, Dr. Jeffrey Brenner brought his compact SUV to a full stop – in the middle of a short highway entrance ramp in downtown Philadelphia…

Here’s what you need to know about Dr. Jeffrey Brenner: He really likes to figure out how things work. And he’s willing to go to extremes to do it – so far that he’s risking his health policy celebrity status.
Perhaps it’s not the smartest move from a guy who just last fall was named a MacArthur Genius, but this month, Brenner began to test his theory for treating some of the sickest and most expensive patients.
“We can actually take the sickest and most complicated patients, go to their bedside, go to their home, go with them to their appointments and help them for about 90 days and dramatically improve outcomes and reduce cost,” he says.
That’s the theory anyway. Like many ideas when it comes to treating the sickest patients, there’s little data to back up that it works.
Brenner’s willing to risk his reputation precisely because he’s not positive his approach for treating folks who cycle in and out of the healthcare system — “super-utilizers” — actually works.
“It’s really easy for me at this point having gotten a MacArthur award to simply declare what we do works and to drive this work forward without rigorously testing it,” Brenner said. “We are not going to do that,” he said. “We don’t think that’s the right thing to do. So we are going to do a randomized controlled trial on our work and prove whether it works and how well it works.”
Helping lower costs and improve care for the super-utilizers is one of the most pressing policy questions in healthcare today. And given its importance, there is a striking lack of data in the field.
People like to call randomized controlled trials (RCTs) the gold standard of scientific testing because two groups are randomly assigned – one gets the treatment, while the other doesn’t – and researchers closely monitor differences.
But a 2012 British Medical Journal article found over the last 25 years, a total of six RCTs have focused on care delivery for super-utilizers.

…Every major health insurance company – Medicare and Medicaid, too – has spent billions on programs for super-utilizers. The absence of rigorous evidence raises the question: Is all this effort built on health policy quicksand?
Not being 100 percent sure can be dangerous, says Duke behavioral scientist Peter Ubel, particularly in healthcare.
Ubel said back in the 1980s and 90s doctors prescribed certain drugs for irregular heartbeats. The medication, he said, made those weird rhythms go away, leaving beautiful-looking EKGs.
“But no one had tested whether people receiving these drugs actually lived longer, and many people thought, ‘Why would you do that? We can look at their cardiogram and see that they’re getting better,’” Ubel said. “Finally when somebody put that evidence to the test of a randomized trial, it turned out that these drugs killed people.”
WellPoint’s Nussbaum said he hoped Brenner’s project would inspire others to follow his lead and insert data into the discussion.
“I believe more people should be bold in challenging the status quo of our delivery system,” Nussbaum said. “The Jeff Brenners of the world should be embraced. We should be advocating for them to take on these studies.”
So why aren’t more healthcare luminaries putting their brilliance to the test? There are a couple of reasons.
Harvard economist Kate Baicker said until now there have been few personal incentives pushing people.
“If you’re focused on branding and spreading your brand, you have no incentive to say, ‘How good is my brand after all?’” she said.
And Venrock healthcare venture capitalist Bob Kocher said no one would fault Brenner if he put his brand before science, an age-old practice in this business.
“Healthcare has benefitted from the fact that you don’t understand it. It’s a bit of an art, and it hasn’t been a science,” he said. “You made money in healthcare by putting a banner outside your building saying you are a top something without having to justify whether you really are top at whatever you do.”
Duke’s Ubel said it’s too easy – and frankly, wrong – to say the main reason doctors avoid these rigorous studies is because they’re afraid to lose money and status. He said doctors aren’t immune from the very human trap of being sure their own ideas are right.
He says psychologists call it confirmation bias.
“Everything you see is filtered through your hopes, your expectations and your pre-existing beliefs,” Ubel said. “And that’s why I might look at a grilled cheese sandwich and see a grilled cheese sandwich and you might see an image of Jesus,” he says.
Even with all these hurdles, MIT economist Amy Finkelstein – who is running the RCT with Brenner – sees change coming.
“Providers have a lot more incentive now than they use to,” she said. “They have much more skin in the game.”
Finkelstein said hospital readmission penalties and new ways to pay doctors are bringing market incentives that have long been missing.
Brenner said he accepts that the truth of what he’s doing in Camden may be messier than the myth.“

Cyberlibertarians’ Digital Deletion of the Left

Curated on April 29, 2014August 3, 2018 by Stefaan Verhulst

David Golumbia in Jacobin: “The digital revolution, we are told everywhere today, produces democracy. It gives “power to the people” and dethrones authoritarians; it levels the playing field for distribution of information critical to political engagement; it destabilizes hierarchies, decentralizes what had been centralized, democratizes what was the domain of elites.
Most on the Left would endorse these ends. The widespread availability of tools whose uses are harmonious with leftist goals would, one might think, accompany broad advancement of those goals in some form. Yet the Left today is scattered, nearly toothless in most advanced democracies. If digital communication technology promotes leftist values, why has its spread coincided with such a stark decline in the Left’s political fortunes?
Part of this disconnect between advancing technology and a retreating left can be explained by the advent of cyberlibertarianism, a view that widespread computerization naturally produces democracy and freedom.
In the 1990s, UK media theorists Richard Barbrook and Andy Cameron, US journalist Paulina Borsook, and US philosopher of technology Langdon Winner introduced the term to describe a prominent worldview in Silicon Valley and digital culture generally; a related analysis can be found more recently in Stanford communication scholar Fred Turner’s work. While cyberlibertarianism can be defined as a general digital utopianism, summed up by a simple slogan like “computerization will set us free” or “computers provide the solution to any and all problems,” these writers note a specific political formation — one Winner describes as “ecstatic enthusiasm for electronically mediated forms of living with radical, right-wing libertarian ideas about the proper definition of freedom, social life, economics, and politics.”
There are overt libertarians who are also digital utopians — figures like Jimmy Wales, Eric Raymond, John Perry Barlow, Kevin Kelly, Peter Thiel, Elon Musk, Julian Assange, Dread Pirate Roberts, and Sergey Brin, and the members of the Technology Liberation Front who explicitly describe themselves as cyberlibertarians. But the term also describes a wider ideological formation in which people embrace digital utopianism as compatible or even identical with leftist politics opposed to neoliberalism.
In perhaps the most pointed form of cyberlibertarianism, computer expertise is seen as directly applicable to social questions. In The Cultural Logic of Computation, I argue that computational practices are intrinsically hierarchical and shaped by identification with power. To the extent that algorithmic forms of reason and social organization can be said to have an inherent politics, these have long been understood as compatible with political formations on the Right rather than the Left.
Yet today, “hacktivists” and other promoters of the liberatory nature of mass computerization are prominent political voices, despite their overall political commitments remaining quite unclear. They are championed by partisans of both the Right and the Left as if they obviously serve the political ends of each. One need only reflect on the leftist support for a project like Open Source software to notice the strange and under-examined convergence of the Right and Left around specifically digital practices whose underlying motivations are often explicitly libertarian. Open Source is a deliberate commercialization of Richard Stallman’s largely noncommercial notion ofFree Software (see Stallman himself on the distinction). Open Source is widely celebrated by libertarians and corporations, and was started by libertarian Eric Raymond and programmer Bruce Perens, with support from businessman and corporate sympathizer Tim O’Reilly. Today the term Open Source has wide currency as a political imperative outside the software development community, despite its place on the Right-Left spectrum being at best ambiguous, and at worst explicitly libertarian and pro-corporate.
When computers are involved, otherwise brilliant leftists who carefully examine the political commitments of most everyone they side with suddenly throw their lot in with libertarians — even when those libertarians explicitly disavow Left principles in their work…”

Handbook Of The International Political Economy Of Governance

Curated on April 29, 2014October 10, 2018 by Stefaan Verhulst

New book edited by Anthony Payne, and Nicola Phillips: “Since the 1990s many of the assumptions that anchored the study of governance in international political economy (IPE) have been shaken loose. Reflecting on the intriguing and important processes of change that have occurred, and are occurring, Professors Anthony Payne and Nicola Phillips bring together the best research currently being undertaken in the field. They explore the complex ways that the global political economy is presently being governed, and indeed misgoverned. Covering all themes central to the field of politics, this extensive and detailed Handbook will be of great value to students of governance, political economy, international relations and development studies.”

Twitter Can Now Predict Crime, and This Raises Serious Questions

Curated on April 28, 2014May 29, 2019 by Stefaan Verhulst

Motherboard: “Police departments in New York City may soon be using geo-tagged tweets to predict crime. It sounds like a far-fetched sci-fi scenario a la Minority Report, but when I contacted Dr. Matthew Greber, the University of Virginia researcher behind the technology, he explained that the system is far more mathematical than metaphysical.
The system Greber has devised is an amalgam of both old and new techniques. Currently, many police departments target hot spots for criminal activity based on actual occurrences of crime. This approach, called kernel density estimation (KDE), involves pairing a historical crime record with a geographic location and using a probability function to calculate the possibility of future crimes occurring in that area. While KDE is a serviceable approach to anticipating crime, it pales in comparison to the dynamism of Twitter’s real-time data stream, according to Dr. Gerber’s research paper “Predicting Crime Using Twitter and Kernel Density Estimation”.
Dr. Greber’s approach is similar to KDE, but deals in the ethereal realm of data and language, not paperwork. The system involves mapping the Twitter environment; much like how police currently map the physical environment with KDE. The big difference is that Greber is looking at what people are talking about in real time, as well as what they do after the fact, and seeing how well they match up. The algorithms look for certain language that is likely to indicate the imminent occurrence of a crime in the area, Greber says. “We might observe people talking about going out, getting drunk, going to bars, sporting events, and so on—we know that these sort of events correlate with crime, and that’s what the models are picking up on.”
Once this data is collected, the GPS tags in tweets allows Greber and his team to pin them to a virtual map and outline hot spots for potential crime. However, everyone who tweets about hitting the club later isn’t necessarily going to commit a crime. Greber tests the accuracy of his approach by comparing Twitter-based KDE predictions with traditional KDE predictions based on police data alone. The big question is, does it work? For Greber, the answer is a firm “sometimes.” “It helps for some, and it hurts for others,” he says.
According to the study’s results, Twitter-based KDE analysis yielded improvements in predictive accuracy over traditional KDE for stalking, criminal damage, and gambling. Arson, kidnapping, and intimidation, on the other hand, showed a decrease in accuracy from traditional KDE analysis. It’s not clear why these crimes are harder to predict using Twitter, but the study notes that the issue may lie with the kind of language used on Twitter, which is characterized by shorthand and informal language that can be difficult for algorithms to parse.
This kind of approach to high-tech crime prevention brings up the familiar debate over privacy and the use of users’ date for purposes they didn’t explicitly agree to. The case becomes especially sensitive when data will be used by police to track down criminals. On this point, though he acknowledges post-Snowden societal skepticism regarding data harvesting for state purposes, Greber is indifferent. “People sign up to have their tweets GPS tagged. It’s an opt-in thing, and if you don’t do it, your tweets won’t be collected in this way,” he says. “Twitter is a public service, and I think people are pretty aware of that.”…

Is Participatory Budgeting Real Democracy?

Curated on April 28, 2014August 3, 2018 by Stefaan Verhulst

Anna Clark in NextCity: “Drawing from a practice pioneered 25 years ago in Porto Alegre, Brazil and imported to North America via progressive leaders in Toronto and Quebec, participatory budgeting cracks open the closed-door process of fiscal decision-making in cities, letting citizens vote on exactly how government money is spent in their community. It’s an auspicious departure from traditional ways of allocating tax dollars, let alone in Chicago, which has long been known for deeply entrenched machine politics. As Alderman Joe Moore puts it, in Chicago, “so many decisions are made from the top down.”
Participatory budgeting works pretty simply in the 49th Ward. Instead of Moore deciding how to spend $1.3 million in “menu money” that is allotted annually to each of Chicago’s 50 council members for capital improvements, the councilman opens up a public process to determine how to spend $1 million of the allotment. The remaining $300,000 is socked away in the bank for emergencies and cost overruns.
And the unusual vote on $1 million in menu money is open to a wider swath of the community than your standard Election Day: you don’t have to be a citizen to cast a ballot, and the voting age is sixteen.
Thanks to the process, Rogers Park can now boast of a new community garden, dozens of underpass murals, heating shelters at three transit stations, hundreds of tree plantings, an outdoor shower at Loyola Park, a $110,000 dog park, and eye-catching “You Are Here” neighborhood information boards at transit station entrances.
…
Another prominent supporter of participatory budgeting? The White House. In December—about eight months after Joe Moore met with President Barack Obama about bringing participatory budgeting to the federal level—PB became an option for determining how to spend community development block-grant money from the Department of Housing and Urban Development. The Obama administration also declared that, in a yet-to-be-detailed partnership, it will help create tools that can be used for participatory budgeting on a local level.
All this activity has so far added up to $45 million in tax dollars allocated to 203 voter-approved projects across the country. Some 46,000 people and 500 organizations nationwide have been part of the decision-making, according to the nonprofit Participatory Budgeting Project.
….
But to fulfill this vision, the process needs resources behind it—enough funds for projects to demonstrate a visible community benefit, and ample capacity from the facilitators of the process (whether it’s district officials or city hall) to truly reach out to the community. Without intention and capacity, PB risks duplicating the process of elections for ordinary representative democracy, where white middle- and upper-class voters are far more likely to vote and therefore enjoy an outsized influence on their neighborhood.
…
Participatory budgeting works differently for every city. In Porto Alegre, Brazil, where the process was created a generation ago by The Worker’s Party to give disadvantaged people a stronger voice in government, as many as 50,000 people vote on how to spend public money each year. More than $700 million has been funneled through the process since its inception. Vallejo, Calif., embraced participatory budgeting in 2012 after emerging from bankruptcy as part of its citywide reinvention. In its first PB vote in May 2013, 3,917 residents voted over the course of a week at 13 polling locations. That translated into four percent of the city’s eligible voters—a tiny number, but a much higher percentage than previous PB processes in Chicago and New York.
But the 5th Ward in Hyde Park, a South Side neighborhood that’s home to the University of Chicago, dropped PB in December, citing low turnout in neighborhood assemblies and residents who felt the process was too much work to be worthwhile. “They said it was very time consuming, a lot of meetings, and that they thought the neighborhood groups that they had were active enough to do it without having all of the expenses that were associated with it,” Alderman Leslie Hairston told the Hyde Park Herald. In 2013, its first year with participatory budgeting, the 5th Ward held a PB vote that saw only 100 ballots cast.
Josh Lerner of the Participatory Budgeting Project says low turnout is a problem that can be solved through outreach and promotion. “It is challenging to do this without capacity,” he said. Internationally, according to Lerner, PB is part of a city administration, with a whole office coordinating the process. Without the backing from City Hall in Porto Alegre, participatory budgeting would have a hard time attracting the tens of thousands who now count themselves as part of the process. And even with the support from City Hall, the 50,000 participants represent less than one percent of the city’s population of 1.4 million.
…
So what’s next for participatory budgeting in Rogers Park and beyond?
Well, first off, Rahm Emanuel’s new Manager of Participatory Budgeting will be responsible for supporting council districts if and when they opt to go participatory. There won’t be a requirement to do so, but if a district wishes to follow the 49th, they will have high-level backup from City Hall.
But this new manager—as well as Chicago’s aldermen and engaged citizens—must understand that there is no one-size-fits-all formula for participatory budgeting. The process must be adapted to the unique needs and culture of each district if it is to resonate with locals. And timing is key for rolling out the process.
While still in the hazy early days, federal support through the new White House initiative may also prove crucial in streamlining the participatory budgeting process, easing the burden on local leaders and citizens, and ultimately generating better participation—and, therefore, better on-the-ground results in communities around the country.
One of the key lessons of participatory budgeting—as with democracy more broadly—is that efficiency is not the highest value in the public sphere. It would be much easier and more cost-effective for aldermen to return to the old days and simply check off the boxes for where he or she thinks menu money should be spent. “We could sign off on menu money in a couple hours, a couple days,” Vandercook said. By choosing the participatory path, aldermen effectively create more work for themselves. They risk low rates of participation and the possibility that winning projects may not be the most worthy. Scalability, too, is a problem — the larger the community served by the process, the more difficult it is to ensure that both the process and the resulting projects reflect the needs of the entire community.
Nonetheless, participatory budgeting serves a harder-to-measure purpose that may well be, in the final accounting, more important. It is a profound civic education for citizens, who dig into both the limits and possibilities of public money. They experience what their elected leaders must navigate every day. But it’s also a civic education for council members and city staff who may find that they are engaging with those they represent more than they ever had before, learning about what they value most. Owen Burgh, chief of staff for Alderman Joe Arena in Chicago’s 45th Ward, told the Participatory Budgeting Project, “I was really surprised by the amazing knowledge base we have among our volunteers. So many of our volunteers came to the process with a background where they understood some principles of traffic management, community development and urban planning. It was very refreshing. Usually, in an alderman’s office, people contact us to fix an isolated problem. Through this process, we discussed not just what needed to be fixed but what we wanted our community to be.”
The participatory budgeting process expands the scope and depth of civic spaces in the community, where elected leaders work with—not for—residents. Even for those who do not show up to vote, there is an empowerment that comes simply in knowing that they could; the sincere invitation to participate matters, whether or not it is accepted…”

The California Report Card

Curated on April 27, 2014August 3, 2018 by Stefaan Verhulst

“The California Report Card (CRC) is an online platform developed by the CITRIS Data and Democracy Initiative at UC Berkeley and Lt. Governor Gavin Newsom that explores how smartphones and networks can enhance communication between the public and government leaders. The California Report Card allows visitors to grade issues facing California and to suggest issues for future report cards.

The CRC is a mobile-optimized web application that allows participants to advise the state government on timely policy issues. We are exploring how technology can streamline and structure input from the public to elected officials, to provide them with timely feedback on the changing opinions and priorities of their constituents.

Version 1.0 of the CRC was launched in California on 28 January 2014. Since then, over 7000 people from almost every county have assigned over 20,000 grades to the State of California and suggested issues for the next report card.
Lt. Governor Gavin Newsom: “The California Report Card is a new way for me to keep an ear to the ground. This new app/website makes it easy for Californians to assign grades and suggest pressing issues that merit our attention. In the first few weeks, participants conveyed that they approve of our rollout of Obamacare but are very concerned about the future of California schools and universities. I’m also gaining insights on issues ranging from speed limits to fracking to disaster preparedness.”
“This platform allows us to have our voices heard. The ability to review and grade what others suggest is important. It enables us and elected officials to hear directly how Californians feel.” – Matt Harris, Truck Driver, Ione, CA
“This is the first system that lets us directly express our feelings to government leaders. I also really enjoy reading and grading the suggestions from other participants.” – Patricia Ellis Pasko, Senior Care Giver, Apple Valley, CA
“Everyone knows that report cards can motivate learning by providing quantitative feedback on strengths and weaknesses. Similarly, the California Report Card has potential to motivate Californians and their leaders to learn from each other about timely issues. As researchers, the patterns of participation and how they vary over time and across geography will help us learn how to design future platforms.” – Prof. Ken Goldberg, UC Berkeley.
It takes only two minutes and works on all screens (best on mobile phones held vertically), just click “Participate“.
Anyone can participate by taking a few minutes to assign grades to the State of California on issues such as: Healthcare, Education, Marriage Equality, Immigrant Rights, and Marijuana Decriminalization. Participants are also invited to enter an online “cafe” to propose issues that they’d like to see included in the next report card (version 2.0 will come out later this Spring).
Lt. Gov. Gavin Newsom and UC Berkeley Professor Ken Goldberg reviewed the data and lessons learned from version 1.0 in a public forum at UC Berkeley on 20 March 2014 that included participants who actively contributed to identifying the most important issues for version 2.0. The event can be viewed at http://bit.ly/1kv6523.
We offer community outreach programs/workshops to train local leaders on how to use the CRC and how to reach and engage under-represented groups (low-income, rural, persons with disabilities, etc.). If you are interested in participating in or hosting a workshop, please contact Brandie Nonnecke at [email protected]”

Minecraft: All of Denmark virtually recreated

Curated on April 26, 2014October 31, 2018 by Stefaan Verhulst

BBC: “The whole of Denmark has been recreated, to scale, within the virtual world of Minecraft. The whole country has been faithfully reproduced in the hugely popular title’s building-block style by the Danish government. Danish residents are urged to “freely move around in Denmark” and “find your own residential area, to build and tear down”.
Around 50 million copies of Minecraft have been sold worldwide.Known as a “sandbox” game, the title allows players to exist in a virtual world, using building blocks to create everything from basic structures to entire worlds. Minecraft was launched in 2011 by independent Swedish developer Markus “Notch” Persson.
The Danish government said the maps were created to be used as an educational tool – suggesting “virtual field trips” to hard-to-reach parts of the country.
Flat roofs
There are no specific goals to achieve other than continued survival. Recreating real-world locations is of particular interest for many players. Last year an intern working with the UK’s Ordnance Survey team built geographically accurate landscapes covering 86,000 sq miles (224,000 sq km) of Britain.The Danish project is more ambitious however, with buildings and towns reproduced in more detail. The only difference, the team behind it said, was that all roofs were flat.
It has also banned the use of one of the game’s typical tools – dynamite. The full map download of Denmark will be available until 23 October.”

LEG/EX – Legislative Explorer

Curated on April 26, 2014October 31, 2018 by Stefaan Verhulst

LEG/EX: Legislative Explorer:Data Driven Discovery: “A one of a kind interactive visualization that allows anyone to explore actual patterns of lawmaking in Congress.

Get the ‘big picture’

Compare the bills and resolutions introduced by Senators and Representatives and follow their progress from the beginning to the end of a two year Congress.

Dive deeper

Filter by topic, type of legislation, chamber, party, member, or even search for a specific bill.

Want to learn more about the legislative process?

The Legislative Process from the Library of Congress
Who’s your Representative or Senator?
LegSim — a student run simulation for government courses”

Feds see innovation decline within government

Curated on April 25, 2014May 29, 2019 by Stefaan Verhulst

Federal Times: “Support for innovation is declining across the government, according to a report by the Partnership for Public Service released April 23.
Federal employee answers to three innovation-related questions on the annual Federal Employee Viewpoint Survey dropped from 61.5 out of 100 in 2012 to 59.4 out of 100, according to the report, produced in partnership with Deloitte.

This chart, extracted from the Partnership for Public Service report, shows the slow but steady decline of innovation measures. (Partnership for Public Service)

While 90 percent of employees surveyed report they are always looking for better ways to do their jobs only 54.7 percent feel encouraged to do so and only 33.4 percent believe their agency rewards creativity and innovation.
“The bottom line is that federal workers are motivated to improve the way they do their work, but they do not feel supported by their organizations,” the report said.
Dave Dye, a director of human capital at Deloitte, LLP, said the report is a message to agency leaders to pay attention and have discussions on innovation and make concerted efforts to enhance innovation in their areas.
“It’s not that leaders have to be innovative in their own right it means they need to set up environments for people to feel that innovation Is encouraged, rewarded and respected,” Dye said.
Most agencies saw a decline in their “innovation score” according to the report, including:
■ The Army saw one of the largest drops in its innovation score – from 64.2 out of 100 I 2012 to 60.1 out of 100 in 2013.
■ NASA – which had the highest score at 76.0 out of 100 in 2013 – also dropped from 76.5 in 2012.
■ The Financial Crimes Enforcement Network at the Treasury Department saw one of the largest drops among component agencies, from 63.8 out of 100 in 2012 to 52.0 in 2013.
Some agencies that have shown improvement are the National Science Foundation and the Peace Corps. Some NASA facilities also saw improvement, including the John C. Stennis Space Center in Mississippi and the George C. Marshall Space Flight Center in Alabama.
The ongoing effects of sequestration, budget cuts and threat of furloughs may also have had a dampening effect on federal employees, Dye said.
“When people feel safer or more sure about whats going on they are going to better focus on the mission,” he said.
Agency managers should also work to improve their work environments to build trust and confidence in their workforce by showing concerns about people’s careers and supporting development opportunities while recognizing good work, according to Dye.
The report recommends that agencies recognize employees at team meetings or with more formal awards to highlight innovation and creativity and reward success. Managers should make sure to share specific goals, provide a forum for open discussion and work to build trust among the workforce that is needed to help spur innovation.”