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.
Monday, September 8th, 2014 | JEAN JOHNSON
Would eating less margarine reduce the divorce rate in Maine? Could we increase the number of graduate engineering degrees by upping mozzarella consumption? Some correlations are ridiculous, which is exactly the point of the very clever web site “Spurious Correlations."
In K-12 education, though, the link between parent involvement and student achievement makes intuitive sense, and it is backed by extensive research. According to Education Week, multiple studies have shown that "students with involved parents” get better grades and test scores and are more likely to go to college.
You don’t need to convince parents that what they do matters. Nearly 8 in 10 say that parents are more important than schools in determining whether children learn. Teachers are on board too. The vast majority say they’d rather work in a school with strong parent support and good student behavior than in one where they could earn more money.
Monday, August 25th, 2014 | Public Agenda
We were saddened to learn that a long-time friend of Public Agenda, Arthur White, died over the weekend after a long and deeply fruitful life. Arthur was a co-founder of Yankelovich Partners with Dan Yankelovich, Public Agenda’s co-founder.
Arthur White and his wife, Vivien White stand in front of the sculpture screen in Whitey Heist Park in Stamford, Conn. on Wednesday June 29, 2011. (Photo: Kathleen O'Rourke / The Stamford Advocate)
A life-long advocate for equal opportunity, Arthur also founded Jobs for the Future and Reading Is Fundamental. He worked closely with us on a series of studies of young adults’ views on higher education and college completion. And he was a warm and wise presence at Public Agenda events, a valued adviser to the organization, and a wonderful “connector,” always ready to introduce people to one another when mutual benefit and public good could result.
We will miss his insights, his enthusiasm, and his dedication to making our country better.
08.14 When Curiosity Reigns
Thursday, August 14th, 2014 | Monica Foust, Ph.D.
Public Agenda is partnering with AAAS to facilitate a series of dialogues between scientists and evangelical Christian pastors throughout the summer. 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.
Small group discussion moderated by Public Agenda.
As we make the final preparations for the next set of Perceptions Project dialogues, I can’t help but think back to our first dialogues in Pasadena.
We spent considerable time preparing for those conversations, between evangelical pastors and scientists. We worked with our partners on the project, AAAS, thinking about who should participate and how the dialogues might unfold. We anticipated the tensions that might emerge – tensions that could stall conversation between the two communities. And we thoughtfully planned ways to surface areas of common ground and shared understanding.
Yet despite the many hours of planning that led up to the dialogues, I was unable to foresee what it would feel like to be in them. What I hadn’t, and perhaps couldn’t, anticipate was how eager participants would be to talk to one another and ask questions about each others’ experiences. While there was some tension between the groups, the overarching theme was curiosity.
Wednesday, July 30th, 2014 | WILL FRIEDMAN, PH.D.
Reprinted from The Huffington Post (The Blog) - July 28, 2014
Are we becoming a more polarized people, as a new and important study from the Pew Research Center seems to demonstrate? In spite of the hype surrounding this new research, I argue that the public is not as polarized as a cursory reading of the Pew study would suggest.
Certainly, this research reflects an important problem, but that problem is less about the public and more about our political system.
The vast majority of participants in the research (about 8 in 10) do not actually fit Pew's definition of ideological polarization. Further, as Stanford political scientist Morris Fiorina explains in an excellent analysis of the research, the methodology used -- forcing respondents to choose between two dichotomies -- leads to a result that can exaggerate the ideological consistency of respondents.
Fiorina also examines the wider body of public opinion toward specific policy issues. He finds that most Americans are not either/or thinkers. Rather, they see merits in various points of view and are open to compromise.
In a related vein, a new public opinion analysis from the organization Voice of the People finds "remarkably little difference between the views of people who live in red (Republican) districts or states, and those who live in blue (Democratic) districts or states on questions about what policies the government should pursue."
Certainly, there is some evidence in the Pew research of a hardening of positions among the ideologically minded, and we don't deny that there are important disagreements among the American public. Still, this evidence does illustrate that common ground is not only attainable but, on many counts, already exists.
Even among those who take an ideological stance toward Beltway politics, many are much more pragmatic and open to compromise when it comes to local issues.
I say this with the confidence of 20 years facilitating conversations around the country with everyday Americans from across the political spectrum. During these discussions, there will often be a handful of participants who come off, at first, as rigidly partisan, voicing talk-radio-like rhetoric. But this rhetoric is almost always superficial and falls away quickly. When the conversation digs into concrete local issues such as improving schools or making streets safer, these participants become much more flexible and less dogmatic.
The Way Forward
There is indeed a serious problem of political polarization, but its source is not the American public. Rather, political parties have realigned and are much more consistently partisan than they've been in our lifetime. Activists on both ends of the ideological spectrum are much more influential via primaries and campaign donations than are average citizens. And media coverage generally reinforces what is most conflicted about our politics. All of this adds up to a highly polarized and dysfunctional national politics.
How then can we make progress?
Fortunately, there's a lot we can do at the local level - and we don't have to wait for national politics to get its act together to do so. Broad-based public engagement can support and even drive local progress on a host of issues that people care about and are willing to work together on. When it comes to education reform, jobs, climate change, public safety and a host of other concrete challenges, we can and should get on with it locally.
In fact, metropolitan regions are already getting it done, and have become the locus for progress on public policy issues.
On matters of national policy, however, we still have some work to do before we can make real progress on difficult challenges like immigration reform or climate change. First, we need to work through the tricky issues that are making effective problem solving practically impossible.
Unfortunately, we can't expect current office-holders on the national stage to fix things like money in politics or partisan and distorting gerrymandering; they've thrived in the current system and are therefore unlikely to champion needed reform. And in any event, they can't get anything done!
Instead, some form of people power will be necessary to drive reforms that enable us to collaborate and solve national problems rather than fragment, polarize and sink into stalemate.
Citizens must mobilize to demand practical, bipartisan progress on the issues that challenge our future as a nation. Those who fight for such progress must be rewarded at the ballot box and those who undermine it must be punished. Support must build for measures that protect our national politics from interest group and partisan manipulation.
Helping the public come to terms with these prerequisites for national progress is among the central political projects of our time. The Pew study does nothing to dissuade us from this fundamental point. Rather, now more than ever, we should get to work.