Kavita Patel, Elizabeth Cliff, and Mark Fendrick in Health Affairs: “In Capitol Hill, there’s a growing chorus of support from both sides of the aisle to move the focus of health care payment incentives from volume to value. Earlier this month, legislators introduced proposals that would have fixed the sustainable growth rate in Medicare, as well as made other changes, including allowing for clinical nuance in Medicare benefit designs. The Centers for Medicare and Medicaid Services, too, is embracing this trend, recently asking for partners in a demonstration project to used value-based arrangements in benefit design. These efforts of policymakers and agencies to innovate Medicare’s benefit design are crucial both for the health of seniors and to ensure value in the Medicare program.
The concept of clinical nuance, implemented using value-based insurance design (V-BID), is a key innovation already widely implemented in the private and public payers. It recognizes two important facts about the provision of medical care: 1) medical services differ in the amount of health produced, and 2) the clinical benefit derived from a medical service depends on who is using it, who is delivering the service, and where it is being delivered.
Today’s Medicare beneficiaries face little clinical nuance in their benefit structure. Medicare largely uses a “one-size-fits-all” structure that does not recognize that some treatments, drugs or tests are more important to health than others. Not only does it create inefficiencies in the health system, it can actually harm the health of beneficiaries.
Some discussion of economics explains why. The concept of moral hazard, which posits that individuals over-consume when they are not on the hook for the cost of their behavior, is well established in health care. It is used to explain why those who are insured use more care than they might need to remain optimally healthy. But, that’s only half the story. There are lots of beneficial medications or services that we wish people would use—and for some treatment adherence is low. So what gives?
Recently, three economists — Katherine Baicker, Sendhil Mullainathan and Joshua Schwartzstein — coined the term “behavioral hazard.” They use it to refer to suboptimal choices that people make based on their own behavioral biases. For example, a diabetic patient might feel fine and choose to forgo regular eye exams, only to have their disease progress. Here, higher levels of cost sharing worsen the problem. A beneficiary who faces both financial and behavioral obstacles to treatment adherence is less likely to behave in a way that ensures optimal health.
That brings us back to the concept of clinical nuance. Clinically nuanced insurance designs recognize both moral and behavioral hazard, and seek to shape incentives to minimize their impact. When patients’ incentives are aligned with evidence-based medicine, it improves outcomes, helps patients and, in some clinical situations, lowers costs.”
Crowdsourcing “Monopoly”
The Economist: “In 1904 a young American named Elizabeth Magie received a patent for a board game in which players used tokens to move around a four-sided board buying properties, avoiding taxes and jail, and collecting $100 every time they passed the board’s starting-point. Three decades later Charles Darrow, a struggling salesman in Pennsylvania, patented a tweaked version of the game as “Monopoly”. Now owned by Hasbro, a big toymaker, it has become one of the world’s most popular board games, available in dozens of languages and innumerable variations.
Magie was a devotee of Henry George, an economist who believed in common ownership of land; her game was designed to be a “practical demonstration of the present system of land-grabbing with all its usual outcomes and consequences.” And so it has become, though players snatch properties more in zeal than sadness. In “Monopoly” as in life, it is better to be rich than poor, children gleefully bankrupt their parents and nobody uses a flat iron any more.
Board-game makers have had to find their footing in a digital age. Hasbro’s game-and-puzzle sales fell by 4% in 2010—the year the iPad came to market—and 10% in 2011. Since then, however, its game-and-puzzle sales have rebounded, rising by 2% in 2012 and 10% in 2013. Stephanie Wissink, a youth-market analyst with Piper Jaffray, an investment bank, says that Hasbro has learned to become “co-creative…They’re infusing more social-generated content into their marketing and product development.”
Some of that content comes from Facebook. Last year, “Monopoly” fans voted on Hasbro’s Facebook page to jettison the poor old flat iron in favour of a new cat token. “Scrabble” players are voting on which word to add to the new dictionary (at press time, 16 remain, including “booyah”, “adorbs” and “cosplay”). “Monopoly” fans, meanwhile, are voting on which of ten house rules—among them collecting $400 rather than $200 for landing on “Go”, requiring players to make a full circuit of the board before buying property and “Mom always gets out of jail free. Always. No questions asked”—to make official…”
Facebook’s Connectivity Lab will develop advanced technology to provide internet across the world
Signe Brewster and Lauren Hockenson at GigaOm: “The Internet.org initiative will rely on a new team at Facebook called the Connectivity Lab, based at the company’s Menlo Park campus, to develop technology on the ground, in the air and in space, CEO Mark Zuckerberg announced Thursday. The team will develop technology like drones and satellites to expand access to the internet across the world.
“The team’s approach is based on the principle that different sized communities need different solutions and they are already working on new delivery platforms—including planes and satellites—to provide connectivity for communities with different population densities,” a post on Internet.org says.
Internet.org, which is backed by companies like Facebook, Samsung and Qualcomm, wants to provide internet to the two thirds of the world that remains disconnected due to cost, lack of infrastructure or remoteness. While many companies are developing business models and partnerships in areas that lack internet, the Connectivity Lab will focus on sustainable technology that will transmit the signals. Facebook envisions using drones that could fly for months to connect suburban areas, while more rural areas would rely on satellites. Both would use infrared lasers to blanket whole areas with connectivity.
Members of the Connectivity Lab have backgrounds at NASA’s Jet Propulsion Laboratory, NASA’s Ames Research Center and the National Optical Astronomy Observatory. Facebook also confirmed today that it acquired five employees from Ascenta, a U.K.-based company that worked on the Zephyr–a solar-powered drone capable of flying for two weeks straight.
The lab’s work will build on work the company has already done in the Philippines and Paraguay, Zuckerberg said in a Facebook post. And, like the company’s Open Compute project, there is a possibility that the lab will seek partnerships with outside countries once the bulk of the technology has been developed.”
How Cities Can Be Designed to Help—or Hinder—Sharing
Jay Walljasper in Yes!: Centuries before someone first uttered the words “sharing economy,” the steady rise of cities embodied both the principles and promise of that phrase. The reason more than half the people on earth now live in urban areas is the advantages that come from sharing resources, infrastructure, and lives with other people. Essential commons belonging to all of us, ranging from transportation systems to public health safeguards to plentiful social connections, are easier to create and maintain in a populated area.
Think about typical urban dwellers. They are more likely to reside in an apartment building, shared household, or compact living unit (saving on heating, utilities, original construction costs, and other expenses), walk or take transit (saving the environment as well as money), know a wide range of people (expanding their circle of friends and colleagues), and encounter new experiences (increasing their knowledge and skills).
Access to these opportunities for sharing offers economic, social, environmental, and educational rewards. But living in a populated area does not automatically mean more sharing. Indeed, the classic suburban lifestyle—a big, single-family house and a big yard isolated from everything else and reachable only by automobile—makes sharing extremely difficult….
“The suburbs were designed as a landscape to maximize consumption,” Fisher explains. “It worked against sharing of any kind. People had all this stuff in their houses and garages, which was going unused most of the time.”
Autos replaced streetcars. Kids rode school buses instead of walking to school.
Everyone bought their own lawn mower, shovels, tools, sports equipment, and grills.
Even the proverbial cup of sugar borrowed from a neighbor disappeared in favor of the 10-pound bag bought at the supermarket.
As our spending grew, our need for social connections shrank. “Mass consumption was good for the economy, but bad for our well-being,” Fisher notes. He now sees changes ahead for our communities as the economy evolves.
“The new economy is all about innovation, which depends on maximizing interaction, not consumption.”
This means redesigning our communities to bring people together by giving everyone more opportunities to “walk, live close together, and share.”
This shift can already be seen in farmers markets, co-working spaces, tool libraries, bike sharing systems, co-ops, credit unions, public spaces, and other sharing projects everywhere.
“Creative people in cities around the world are rising up…” declares Neal Gorenflo, co-founder of Shareable magazine. “We are not protesting, and we are not asking for permission, and we are not waiting—we are building a people-powered economy right under everyone’s noses.”
Excited by this emerging grassroots movement, Shareable recently launched the Sharing Cities Network to be an independent resource “for sharing innovators to discover together how to create as many sharing cities around the world as fast as possible.”
The aim is to help empower and connect local initiatives around the world through online forums, peer learning, and other ways to boost collaboration, share best practices, and catalyze new projects.”
Visualizing Health IT: A holistic overview
Andy Oram in O’Reilly Data: “There is no dearth of health reformers offering their visions for patient engagement, information exchange, better public health, and disruptive change to health industries. But they often accept too freely the promise of technology, without grasping how difficult the technical implementations of their reforms would be. Furthermore, no document I have found pulls together the various trends in technology and explores their interrelationships.
I have tried to fill this gap with a recently released report: The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. This posting describes some of the issues it covers.
Take a basic example: fitness devices. Lots of health reformers would love to see these pulled into treatment plans to help people overcome hypertension and other serious conditions. It’s hard to understand the factors that make doctors reluctant to do so–blind conservatism is not the problem, but actual technical factors. To become part of treatment plans, the accuracy of devices would have to be validated, they would need to produce data in formats and units that are universally recognized, and electronic records would have to be undergo major upgrades to store and process the data.
Another example is patient engagement, which doctors and hospitals are furiously pursuing. Not only are patients becoming choosier and rating their institutions publicly in Yelp-like fashion, but the clinicians have come to realize that engaged patients are more likely to participate in developing effective treatment plans, not to mention following through on them.
Engaging patients to improve their own outcomes directly affects the institutions’ bottom lines as insurers and the government move from paying for each procedure to pay-per-value (a fixed sum for handling a group of patients that share a health condition). But what data do we need to make pay-per-value fair and accurate? How do we get that data from one place to another, and–much more difficult–out of one ungainly proprietary format and possibly into others? The answer emerging among activists to these questions is: leave the data under the control of the patients, and let them share it as they find appropriate.
Collaboration may be touted even more than patient engagement as the way to better health. And who wouldn’t want his cardiologist to be consulting with his oncologist, nutritionist, and physical therapist? It doesn’t happen as much as it should, and while picking up the phone may be critical sometimes to making the right decisions, electronic media can also be of crucial value. Once again, we have to overcome technical barriers.
The The Information Technology Fix for Health report divides these issues into four umbrella categories:
- Devices, sensors, and patient monitoring
- Using data: records, public data sets, and research
- Coordinated care: teams and telehealth
- Patient empowerment
Underlying all these as a kind of vast subterranean network of interconnected roots are electronic health records (EHRs). These must function well in order for devices to send output to the interested observers, researchers to collect data, and teams to coordinate care. The article delves into the messy and often ugly area of formats and information exchange, along with issues of privacy. I extol once again the virtue of patient control over records and suggest how we could overcome all barriers to make that happen.”
Public Procurement as a Means to Stimulate Innovation for a Better World: A Matter of Knowledge Management
Paper by Max Rolfstam: “Public procurement is the central sourcing mechanism evoked to directly secure the delivery of public services. It may however also be used to achieve certain social outcomes and secondary effects. This paper attempts to contribute with knowledge regarding a particular secondary effect, the role of public procurement as a means to stimulate innovation. The paper discusses public procurement of innovation as a knowledge policy in the learning economy, and scrutinizes it from a knowledge management perspective, eventually to connect aspects of learning to institutional levels.”
Public interest labs to test open governance solutions
Kathleen Hickey in GCN: “The Governance Lab at New York University (GovLab) and the MacArthur Foundation Research Network have formed a new network, Open Governance, to study how to enhance collaboration and decision-making in the public interest.
The MacArthur Foundation provided a three-year grant of $5 million for the project; Google’s philanthropic arm, Google.org, also contributed. Google.org’s technology will be used to develop platforms to solve problems more openly and to run agile, real-world experiments with governments and NGOs to discover ways to enhance decision-making in the public interest, according to the GovLab announcement.
Network members include 12 experts in computer science, political science, policy informatics, social psychology and philosophy, law, and communications. This group is supported by an advisory network of academics, technologists, and current and former government officials. The network will assess existing government programs and experiment with ways to improve decision-making at the local, national and international government levels.
The Network’s efforts focus on three areas that members say have the potential to make governance more effective and legitimate: getting expertise in, pushing data out and distributing responsibility.
Through smarter governance, they say, institutions can seek input from lay and expert citizens via expert networking, crowdsourcing or challenges. With open data governance, institutions can publish machine-readable data so that citizens can easily analyze and use this information to detect and solve problems. And by shared governance, institutions can help citizens develop solutions through participatory budgeting, peer production or digital commons.
“Recognizing that we cannot solve today’s challenges with yesterday’s tools, this interdisciplinary group will bring fresh thinking to questions about how our governing institutions operate and how they can develop better ways to help address seemingly intractable social problems for the common good,” said MacArthur Foundation President Robert Gallucci.
GovLab’s mission is to study and launch “experimental, technology-enabled solutions that advance a collaborative, networked approach to re-invent existing institutions and processes of governance to improve people’s lives.” Earlier this year GovLab released a preview of its Open Data 500 study of 500 companies using open government data as a key business resource.”
Coke Creates Volunteering App For Local Do-Gooders
PSFK: “If you’ve ever wanted to volunteer some time but didn’t know where to look, Coke Romania has the app for you. After teaming up with digital marketing company McCann Bucharest, Coke just created a new app that shows good Samaritans local volunteer opportunities. ‘Radar For Good‘ scans your location and brings up NGO’s, soup kitchens, orphanages, or libraries that want help right now.
Any opportunity that “Radar For Good’ discovers is a site that is definitely looking for volunteers at that moment. The app shows company names, websites, and contact information, as well as directions from where you are. It even allows you to save your favorite organizations for future reference, and has options to receive notifications from those companies.
Coca-Cola has numerous iOS apps, most of which deal with their soda products, but ‘Radar For Good’ is the first of its kind. While the app currently only works in Romania, Coke’s innovative creation has opened doors for similar mobile apps to get started in the United States.”
Why Are Rich Countries Democratic?
Ricardo Hausmann at Project Syndicate: “When Adam Smith was 22, he famously proclaimed that, “Little else is requisite to carry a state to the highest degree of opulence from the lowest barbarism, but peace, easy taxes, and a tolerable administration of justice: all the rest being brought about by the natural course of things.” Today, almost 260 years later, we know that nothing could be further from the truth.
The disappearance of Malaysia Airlines Flight 370 shows how wrong Smith was, for it highlights the intricate interaction between modern production and the state. To make air travel feasible and safe, states ensure that pilots know how to fly and that aircraft pass stringent tests. They build airports and provide radar and satellites that can track planes, air traffic controllers to keep them apart, and security services to keep terrorists on the ground. And, when something goes wrong, it is not peace, easy taxes, and justice that are called in to assist; it is professional, well-resourced government agencies.
All advanced economies today seem to need much more than the young Smith assumed. And their governments are not only large and complex, comprising thousands of agencies that administer millions of pages of rules and regulations; they are also democratic – and not just because they hold elections every so often. Why?
By the time he published The Wealth of Nations, at age 43, Smith had become the first complexity scientist. He understood that the economy was a complex system that needed to coordinate the work of thousands of people just to make things as simple as a meal or a suit.
But Smith also understood that while the economy was too intricate to be organized by anybody, it has the capacity to self-organize. It possesses an “invisible hand,” which operates through market prices to provide an information system that can be used to calculate whether using resources for a given purpose is worthwhile – that is, profitable.
Profit is an incentive system that leads firms and individuals to respond to the information provided by prices. And capital markets are a resource-mobilization system that provides money to those companies and projects that are expected to be profitable – that is, the ones that respond adequately to market prices.
But modern production requires many inputs that markets do not provide. And, as in the case of airlines, these inputs – rules, standards, certifications, infrastructure, schools and training centers, scientific labs, security services, among others – are deeply complementary to the ones that can be procured in markets. They interact in the most intricate ways with the activities that markets organize.
So here’s the question: Who controls the provision of the publicly provided inputs? The prime minister? The legislature? Which country’s top judges have read the millions of pages of legislation or considered how they complement or contradict each other, much less applied them to the myriad different activities that comprise the economy? Even a presidential executive cannot be fully aware of the things that are done or not done by the thousands of government agencies and how they affect each part of society.
This is an information-rich problem, and, like the social-coordination challenge that the market addresses, it does not allow for centralized control. What is needed is something like the invisible hand of the market: a mechanism for self-organization. Elections clearly are not enough, because they typically occur at two- or four-year intervals and collect very little information per voter.
Instead, successful political systems have had to create an alternative invisible hand – a system that decentralizes the power to identify problems, propose solutions, and monitor performance, such that decisions are made with much more information.
To take just one example, the United States’ federal government accounts for just 537 of the country’s roughly 500,000 elected positions. Clearly, there is much more going on elsewhere.
The US Congress has 100 senators with 40 aides each, and 435 representatives with 25 aides each. They are organized into 42 committees and 182 subcommittees, meaning that there are 224 parallel conversations going on. And this group of more than 15,000 people is not alone. Facing them are some 22,000 registered lobbyists, whose mission is (among other goals) to sit down with legislators and draft legislation.
This, together with a free press, is part of the structure that reads the millions of pages of legislation and monitors what government agencies do and do not do. It generates the information and the incentives to respond to it. It affects the allocation of budgetary resources. It is an open system in which anybody can create news or find a lobbyist to make his case, whether it is to save the whales or to eat them.
Without such a mechanism, the political system cannot provide the kind of environment that modern economies need. That is why all rich countries are democracies, and it is why some countries, like my own (Venezuela), are becoming poorer. Although some of these countries do hold elections, they tend to stumble at even the simplest of coordination problems. Lining up to vote is no guarantee that citizens will not also have to line up for toilet paper.”
Open Data: What Is It and Why Should You Care?
Jason Shueh at Government Technology: “Though the debate about open data in government is an evolving one, it is indisputably here to stay — it can be heard in both houses of Congress, in state legislatures, and in city halls around the nation.
Already, 39 states and 46 localities provide data sets to data.gov, the federal government’s online open data repository. And 30 jurisdictions, including the federal government, have taken the additional step of institutionalizing their practices in formal open data policies.
Though the term “open data” is spoken of frequently — and has been since President Obama took office in 2009 — what it is and why it’s important isn’t always clear. That’s understandable, perhaps, given that open data lacks a unified definition.
“People tend to conflate it with big data,” said Emily Shaw, the national policy manager at the Sunlight Foundation, “and I think it’s useful to think about how it’s different from big data in the sense that open data is the idea that public information should be accessible to the public online.”
Shaw said the foundation, a Washington, D.C., non-profit advocacy group promoting open and transparent government, believes the term open data can be applied to a variety of information created or collected by public entities. Among the benefits of open data are improved measurement of policies, better government efficiency, deeper analytical insights, greater citizen participation, and a boost to local companies by way of products and services that use government data (think civic apps and software programs).
“The way I personally think of open data,” Shaw said, “is that it is a manifestation of the idea of open government.”
What Makes Data Open
For governments hoping to adopt open data in policy and in practice, simply making data available to the public isn’t enough to make that data useful. Open data, though straightforward in principle, requires a specific approach based on the agency or organization releasing it, the kind of data being released and, perhaps most importantly, its targeted audience.
According to the foundation’s California Open Data Handbook, published in collaboration with Stewards of Change Institute, a national group supporting innovation in human services, data must first be both “technically open” and “legally open.” The guide defines the terms in this way:
Technically open: [data] available in a machine-readable standard format, which means it can be retrieved and meaningfully processed by a computer application
Legally open: [data] explicitly licensed in a way that permits commercial and non-commercial use and re-use without restrictions.
Technically open means that data is easily accessible to its intended audience. If the intended users are developers and programmers, Shaw said, the data should be presented within an application programming interface (API); if it’s intended for researchers in academia, data might be structured in a bulk download; and if it’s aimed at the average citizen, data should be available without requiring software purchases.
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4 Steps to Open Data
Creating open data isn’t without its complexities. There are many tasks that need to happen before an open data project ever begins. A full endorsement from leadership is paramount. Adding the project into the work flow is another. And allaying fears and misunderstandings is expected with any government project.
After the basic table stakes are placed, the handbook prescribes four steps: choosing a set of data, attaching an open license, making it available through a proper format and ensuring the data is discoverable.
1. Choose a Data Set
Choosing a data set can appear daunting, but it doesn’t have to be. Shaw said ample resources are available from the foundation and others on how to get started with this — see our list of open data resources for more information. In the case of selecting a data set, or sets, she referred to the foundation’s recently updated guidelines that urge identifying data sets based on goals and the demand from citizen feedback.
2. Attach an Open License
Open licenses dispel ambiguity and encourage use. However, they need to be proactive, and this means users should not be forced to request the information in order to use it — a common symptom of data accessed through the Freedom of Information Act. Tips for reference can be found at Opendefinition.org, a site that has a list of examples and links to open licenses that meet the definition of open use.
3. Format the Data to Your Audience
As previously stated, Shaw recommends tailoring the format of data to the audience, with the ideal being that data is packaged in formats that can be digested by all users: developers, civic hackers, department staff, researchers and citizens. This could mean it’s put into APIs, spreadsheet docs, text and zip files, FTP servers and torrent networking systems (a way to download files from different sources). The file type and the system for download all depends on the audience.
“Part of learning about what formats government should offer data in is to engage with the prospective users,” Shaw said.
4. Make it Discoverable
If open data is strewn across multiple download links and wedged into various nooks and crannies of a website, it probably won’t be found. Shaw recommends a centralized hub that acts as a one-stop shop for all open data downloads. In many jurisdictions, these Web pages and websites have been called “portals;” they are the online repositories for a jurisdiction’s open data publishing.
“It is important for thinking about how people can become aware of what their governments hold. If the government doesn’t make it easy for people to know what kinds of data is publicly available on the website, it doesn’t matter what format it’s in,” Shaw said. She pointed to public participation — a recurring theme in open data development — to incorporate into the process to improve accessibility.
Examples of portals, can be found in numerous cities across the U.S., such as San Francisco, New York, Los Angeles, Chicago and Sacramento, Calif.
Visit page 2 of our story for open data resources, and page 3 for open data file formats.