Thursday, May 21st, 2015 | Allison Rizzolo
Earlier this month, for-profit giant Corinthian Colleges officially declared bankruptcy, after having gradually closed its campuses over the past year. The high-profile failure of Corinthian – once a Wall Street darling – has cast a shadow on the for-profit college industry.
As the collapse of Corinthian dominates headlines, we worry that narratives that underscore controversy or oversimplify the higher education system may harm efforts to foster a healthier, more inclusive conversation.
For-profits may be a top concern for some of our legislators and education leaders. However, our research suggests that expert-level policy conversations about these schools are not meaningful to students and employers, two groups directly affected by the success or failure of for-profit schools.
For example, nearly half of undergraduate students currently attending a for-profit school and 41 percent of for-profit alumni are not familiar with the term "for-profit college."
Wednesday, April 1st, 2015 | JEAN JOHNSON
Tuesday, March 31st, 2015 | Public Agenda
J.J. Baskin, 1966 - 2015
We're saddened to share the news that Public Agenda Board Member JJ Baskin passed away last week. With JJ's passing, the country has lost a great man and a force for good. JJ's deep commitment to improving education was matched by his boundless energy, and that energy stayed with him to the end.
We first met JJ two years ago down in Austin, Texas -- his home state. JJ's energy, dedication and optimism inspired us, and we invited him to join the Public Agenda board soon after.
JJ had so much faith in the Public Agenda mission and team. He was constantly working to advance our mission by contributing ideas and cultivating relationships. As JJ's obituary points out, he was a world-class connector who took enormous joy in serving others.
While we didn't know him long, it was long enough to know he was one of the finest people we'd ever meet. His dedication to good work and his fellow humans was a genuine inspiration, and we were lucky to experience his creativity and kindness firsthand. We at Public Agenda hope we can honor JJ's memory by capturing and channeling a little bit of his spirit, goodness and commitment to making the world a better place.
When JJ was first diagnosed with cancer, not even a year ago, he formed JJ's Fight Club. He called it a "team of optimists" and asked its members to "inspire us and remind us of what we are fighting for."
We may have lost JJ, but he will continue to inspire and remind us of what we are fighting for.
Thursday, March 26th, 2015 | David Schleifer and Andrea Ducas
Originally published at Health Affairs Blog on March 26th, 2015.
Most insured Americans pay health care deductibles and coinsurance, with cost-sharing rates that seem to be continually increasing. At the same time, millions of uninsured people face unpredictable and often high charges for medical care.
In other words, Americans have a significant amount of “skin in the game” when it comes to health care. That said, it’s not easy for most people to find out how much their health care will cost—let alone to find lower-priced care. The opacity of health care prices is one major reason for this. Despite the fact that so many Americans must pay for so much of their medical care out of pocket, easy access to accurate price information remains far from routine.
This month, Public Agenda, with support from the Robert Wood Johnson Foundation, released the results of a national survey finding that 56 percent of American adults say they have tried to find out their out-of-pocket costs (excluding a copay) before getting the care they needed, or have tried to find out how much their insurance would pay a doctor or hospital. In other words, despite the opacity of price information, the majority of Americans have at least tried to find out how much their care would cost.
The survey also found that the majority of Americans do not believe that higher prices are typically a sign of better quality. Together, these findings suggest that Americans are open to looking for better-value care.
But just because people are looking for price information does not necessarily mean they are comparing prices. Looking more closely at the 56 percent of Americans who have tried to find out how much their care would cost, 33 percent of all Americans checked prices from just one provider, and only 21 percent of all Americans compared prices across multiple providers (for the remaining 2 percent, our survey could not determine whether they had checked or compared). However, the majority (62 percent) of those who did compare prices say they saved money by doing so.
So why aren’t more people shopping around? Our survey suggests one possible reason: a substantial number of insured (57 percent) and uninsured (47 percent) Americans are not aware that physicians might actually charge different prices to different people for the same services. Our follow-up interviews also indicate that people may not compare prices because they are unable or unwilling to change providers.
In our report, we highlight a number of recommendations for insurers, employers, policy makers, and providers who want to make price information more easily available to patients and families, including the following:
- Strengthen the capacity of providers, staff, and insurance company personnel to discuss prices. Some of the most common ways that people try to find price information are asking receptionists or other staff in their doctors’ offices, calling their insurers, and looking on their insurers’ websites. Enhancing the availability and quality of price information at these and other potential access points could help ensure that consumers are able to find out how much they will have to pay out of pocket.
- Help people understand that prices vary. Our survey found that many Americans are not aware that providers’ prices vary. While policy experts, price information vendors, and journalists have devoted considerable attention to health care prices, more can be done to help people better understand price variation.
- Help people understand how to find price information. Fifty percent of Americans who had never sought price information said they did not know how to find it. This suggests a need for more outreach and education about reliable sources of price information.
- Focus on people who care for others and on those who receive regular medical care. Americans who compare prices are more likely than others to be helping another adult family member make health care decisions or to be receiving regular medical care themselves. Those working to engage more people in comparing prices may therefore wish to focus on, and tailor their outreach and support to, caregivers and those getting regular care.
- Recognize the obstacles to seeking and comparing prices and to choosing better-value care. Follow-up interviews with survey respondents who checked but did not compare prices suggest that many people are not comparing because of issues of convenience, access, or trust. For example, one man insisted he would never consider going anywhere besides his local academic medical center where he feels comfortable, where he knows the doctors, and where his medical records are kept. One woman told us she did not compare providers’ prices for a surgical procedure because she felt the surgeon she had chosen was the only person in her rural area she trusted to do the procedure she needed. Some people may see comparing prices as a burden on patients. For example, a focus-group participant who had never sought price information felt that expecting people to compare prices would be yet another obligation in the already-confusing health care system. In fact, our survey found that 43 percent of Americans say it is not reasonable to expect people to compare prices before getting care.
While seeking out and comparing prices may not be appropriate for everyone or for every medical situation, many Americans are open to using price information to choose better-value care.
We invite you to dig into our full report and its implications here.
Wednesday, February 11th, 2015 | Allison Rizzolo
In late January, the Obama administration announced a plan to drastically change the way Medicare reimburses doctors and hospitals for health care services.
Traditionally, Medicare has paid providers using a fee-for-service model. In this model, doctors and hospitals receive payment based on the number of services they provide – surgeries performed or tests administered, for example.
The White House is proposing a move toward a performance-based model in which doctors and hospitals are paid based on the quality of their service. In short, they will be paid more if patients get healthier and less if patients stay sick.
This experiment may encourage other payers to change the way they reimburse providers as well. As Jason Millman noted on Wonkblog, "Because Medicare is such a huge part of health care spending, the hope is that these changes will trickle out to doctors' offices and hospitals across the country."
In health policy wonk circles, changing the way doctors and hospitals are paid is called payment reform. It's one of several approaches experts have proposed to help bring down the cost of our country's health care system. (Costs are soaring: we paid an average of $8,917 per person for health care in 2010, up from $4,878 just a decade earlier.)
It's clear we need to do something, but any approach to bringing down costs, including payment reform, raises many complex and difficult questions. In the case of performance-based payment reform, the most important is: How do we measure quality in health care?
This is a difficult question to answer in any sector, and policy and decision makers have certainly stumbled on measuring quality before. Take teacher quality, for example, an issue close to my own heart. When re-vamping teacher evaluation systems, states and districts often did not include the educators and administrators on the ground in decisions. Now, many states and districts not only have to go back to the drawing board, they also have to rebuild frayed relationships and trust.
Engaging hospitals and doctors is crucial to making payment reform work for Medicare, and to proving to private insurers that it can work for them too. It's to policymakers' advantage to include patients in the conversation about payment reform as well. This is particularly important now, as the public is, for better or worse, taking on more and more responsibility as consumers of health care.
Thursday, December 4th, 2014 | Allison Rizzolo
Our local public officials are thirsty for better and deeper ways to engage the people they serve. This is a sentiment I heard again and again during last month's National League of Cities Congress of Cities in Austin.
Public officials brainstorm hypothetical projects during a mock participatory budgeting exercise at the NLC's Congress of Cities.
The sentiment was cast in sharp relief during a workshop on participatory budgeting that I attended as part of the conference. Our partners at the Participatory Budgeting Project (PBP for short) presented to a variety of elected and appointed officials from cities across the country.
Participatory budgeting is a process through which residents are active partners in local budget decisions. We are partnering with PBP on research and evaluation of participatory budgeting processes in communities across the country.
During the workshop in Austin, PBP's Josh Lerner and Maria Hadden provided participants with practical tools and training to launch participatory budgeting in their communities and better engage their constituents in local budget decisions.
Josh and Maria opened the workshop by asking participants about the barriers to constituent engagement that they face in their communities. Participants also talked about what they were hoping to get out of the conference to address those challenges. This conversation revealed a number of difficulties that local officials share when it comes to engaging their constituents in better and deeper ways, regardless of the size or demographics of their city, town or county.
Friday, November 7th, 2014 | Allison Rizzolo
Public Agenda's President Will Friedman and NYPR's President and CEO Laura Walker discuss the inaugural Wadsworth Fund project.
Public Agenda is pleased to announce a new partnership with WNYC – New York’s premier public radio broadcaster and producer – on the inaugural project for the Deborah Wadsworth Fund. This first project will provide an unprecedented look into what's really on the minds of residents of New York City and the tri-state region.
"Public Agenda's mission and the mission of public media are so much in sync," said Laura Walker, president and CEO of New York Public Radio, in a conversation with Public Agenda President Will Friedman during the launch of the partnership.
The collaboration was announced on November 5th, at a celebration of the Deborah Wadsworth Fund, a new initiative from Public Agenda that honors our former president and board member. Donations to the Fund will enable Public Agenda to help New York area residents have a greater voice in the public issues they care about most. (You can learn more about the Fund here and support it here.)
Former Senator Bill Bradley and Public Agenda Board Member Betty Sue Flowers greet Teal Arcadi and Janet Fernandez of Public Agenda.
The first Deborah Wadsworth Fund project will consist of focus groups and a major survey with residents of the New York region. Through this research, Public Agenda and WNYC will illuminate the concerns, priorities and aspirations of local residents when it comes to the public policy issues our region faces. This research will provide a basis for WNYC programming and ensure that subsequent Deborah Wadsworth Fund projects address issues that area residents are concerned with.
Thursday, October 16th, 2014 | Katie Barth
Public Agenda is partnering with AAAS to facilitate a series of dialogues between scientists and evangelical Christian pastors throughout the summer and fall. The purpose of the project is to improve dialogue, relationships and collaboration between these two communities, often viewed as staunchly divided. This blog is one in a series from our public engagement team, who write to reflect on their experiences moderating the dialogues. Read more about this project here and here, and download the discussion guide used during these conversations here.
Katie Barth takes notes during a Perceptions Project dialogue.
AAAS/ Christine A. Scheller
A few weeks ago in Atlanta, I found myself in a room surrounded by church pastors, evolutionary biologists, theology professors, mathematicians and a former Vietnam veteran turned evangelical Christian. I was there for the third dialogue in the Perceptions Project, which brings together individuals who self-identify as belonging to the evangelical Christian community or (though in some cases “and” is more appropriate) the scientific community.
Many of the participants seemed nervous at the start of the dialogue. Though I served as a co-facilitator and was not technically a participant, I admit that I too approached the conversation with a hint of reticence. Before boarding my plane to Atlanta, a friend told me to “watch myself” since he claimed that there was “no way those two groups could manage to be civil toward one another, especially down in the Bible belt.”
What I found, however, was quite the opposite of that presupposition.
Wednesday, September 24th, 2014 | Allison Rizzolo
Back when I taught high school Spanish, September was a time ripe with anxiety. I was worried about maintaining strict discipline during the crucial first month, navigating curricula and textbooks for new classes, and setting up my classroom so I could keep a semblance of organization throughout the year (I've never quite figured that last part out).
I had it easy. These days, teachers have a lot more on their minds, especially with the trifecta of new teacher evaluation systems, new Common Core learning standards, and new assessments that often have high stakes attached to them.
Isaac Rowlett leads a discussion on focus group facilitation with Hope Street Group teacher fellows.
It is our belief at Public Agenda that education policy – as with any policy – is stronger, more sustainable, and better aligned with over-arching goals when those affected by policy are key partners in its design and implementation. For this reason, we joined forces a few years ago with the American Institutes for Research to develop Everyone at the Table (EATT), an initiative devoted to boosting teacher agency in education reform.
EATT pursues this mission by providing clear methods and strategies, practical materials and tailored trainings to help teachers engage their colleagues in productive, solutions-oriented dialogue about teacher evaluation and other education reform issues. We provide these resources and trainings directly to educators, schools, districts and education leaders. We also partner with other organizations and associations dedicated to improving teacher practice or boosting teacher voice in policy. (We also wrote a book about the project that explores the theory and methodology behind teacher and other stakeholder engagement in depth.)
Monday, September 22nd, 2014 | ALISON KADLEC, PH.D.
This post is written for readers working in higher education reform and was originally published on the Completion by Design blog. Completion by Design is a national initiative, funded by the Bill & Melinda Gates Foundation, that works with community colleges to significantly increase completion and graduation rates. Read more about our work with Completion by Design.
“Competency-based education” (CBE) is one of the most ubiquitous buzz phrases in higher education today. But what it is and what it means for the student success and completion movement remains to be seen. Most simply, “competency-based” is used to describe any model or approach that substitutes the assessment of student learning for seat-time measures when determining a learner’s progress toward a degree or credential. There are a few facts and trends that, when taken together, help account for the incredible rise of interest in CBE in recent years:
- The basic “currency” of higher education, the credit hour, was invented to solve an administrative problem and was never intended to serve as a proxy for student learning. Yet here we are today with 60 credit hours and 120 credit hours generally defining the boundaries of an associates and bachelors degree respectively.
- The amount of student-loan debt has passed $1.2 trillion (with $1 trillion of that debt in the form of federal loans), but the amount of learning remains unclear.
- 34 million Americans (more that 20% of the working-age population) have some college credits but no degree.
- Colleges and universities supplement the credit hour with grades as a way to connect time and learning, yet a majority of employers are dissatisfied with the quality of recent graduates and research suggests that student learning outcomes are questionable.
- The tremendous difficulties students face as they try to transfer credits between institutions only demonstrates that colleges and universities themselves don’t believe that the credit hours can be used as a proxy for student learning. If institutions had confidence that earning credits equal learning, then seamless transfer would be the norm.
Competency-based models aren’t exactly new – some have been around for decades, with first-generation innovators like Excelsior College in existence for more than 40 years. And a new generation of innovators at public institutions, those like Kentucky Community College and Technical System and University of Wisconsin-Extension, have built and launched a new generation of models that they hope will scale to a wide range of learners not well served by traditional models.
But there are real and serious questions to be asked about the conditions under which competency-based models are appropriate and for what types of learners. There are also fundamental questions about what constitutes high-quality when it comes to CBE programs.