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05.11 Why We Can't Find The Health Care Info We Want

Thursday, May 11th, 2017 |

At Public Agenda, we’re helping build pathways out of poverty, a stronger middle class and a democracy that works for everyone. We fuel progress on tough issues like K-12 education, higher education, jobs, health care and other critical components of social mobility, thriving communities and a healthier democracy.

Americans remain burdened by rising out-of-pocket medical costs. And while there is no quick fix to the broken health care system, understanding public perspectives on the solutions that are on the table is a step in the right direction. Last month, we released new research that examined how people are finding and using health care price information and whether that information can help them save some money.

Our friend Parie Garg, Ph.D., Partner, Health & Life Sciences, Oliver Wyman, shares in this guest blog post findings from her research on health care price information included in her report “Right Place Right Time.” Parie offers insight into why the health care industry is not taking steps to provide people with better cost information at the right place and at the right time.

While the health care consumer is increasingly seeking price information prior to seeking care (as reported in the recent, insightful Public Agenda report), the industry lags behind in the provision of that information. For many health care consumers, obtaining cost information that is trustworthy, usable and easily compared across providers is a significant challenge.

In fact, the “Right Place Right Time” study conducted by Oliver Wyman and Altarum Institute, with support from the Robert Wood Johnson Foundation, found that many health care consumers are not getting the cost information they want or need. According to the survey, which encompassed over 4,000 respondents, approximately 50 percent of respondents are not satisfied with the level of cost information available.

These findings, taken together with the Public Agenda research, reveal a wide gap between what consumers want—when it comes to cost information—and what consumers actually get. But the results likely do not come as a surprise to the health care industry. As published in the “Right Place, Right Time” companion study that surveyed about 100 stakeholders across the health care ecosystem, payers and providers are aware of the challenges that consumers face as they seek cost information.

So why isn’t the industry taking steps to provide better cost information at the right place, at the right time? There are a few reasons that stand out:

  1. Exact cost of procedures is a closely-guarded secret: Most providers negotiate specific rates with their contracted health plans. These rates are not publicly available, however, as releasing this information would have ramifications in terms of market competition, as well as payer leverage during negotiations.
  2. Lack of an ROI: While it is clear that consumers are looking for cost information, providing that information at the right place and at the right time is not easy. And (perhaps most significantly), there is no clear ROI established as a result of providing this information. Consumers can be fickle, and health care decisions can often be based on emotion as much as cost. As an example, a cancer diagnosis often leads to a patient seeking out the best care, with or without a price comparison. Consequently, cost comparison tools may not provide the best return on investment.
  3. Competing priorities: Over the past several years, the health care market has been in a constant state of upheaval. With the American Health Care Act just having been passed through the House of Representatives, there is likely to be continued uncertainty over the next two years. In times like this, payer and providers have a lot to be worried about, and, unfortunately, consumer engagement tools are often on the bottom of their priority list.

Despite these significant roadblocks, it should be noted that payers and providers are realizing that patients are behaving more like consumers than ever before. The technology-savvy younger generations have little patience for industries that cannot quickly tell them how much things are going to cost. And with the possibility of the American Health Care Act nearly doubling contribution limits of Health Savings Accounts, providers and payers have more of a mandate to consider provisions of cost oriented tools and information. Individuals will hopefully have a leading role to wholesale change in the usability and reach of cost transparency tools in the future.


05.05 Engaging Ideas - 5/5/2017

Friday, May 5th, 2017 | PUBLIC AGENDA


The Johnson Amendment In 5 Questions And Answers (NPR)
Conservative groups that favor a greater role for religion in the public space, such as the Alliance Defending Freedom, have long sought to repeal the amendment, arguing that it restricts free speech by censoring the content of a pastor's sermon. Overturning the law, however, would also have major implications for campaign finance. If churches or clergy are allowed to participate in political campaigns, tax-free donations to the churches could go to support a political candidate. Religious organizations could become bigger money players in politics.

Three-fourths of Americans regularly talk politics only with members of their own political tribe (Washington Post)
As politics has become more partisan in recent decades, it gets harder to talk to people across the political divide. Research on the 2016 election underscores how common this has become, with three-quarters of voters most often talking about politics only to people who shared their views.


Why people are rich and poor: Republicans and Democrats have very different views (Pew Research)
The public overall is about evenly divided over which has more to do with why a person is rich: 45% say it is because he or she worked harder than most people, while 43% say it is because they had more advantages in life than others, according to a survey conducted April 5-11 among 1,501 U.S. adults.

Poor Rich Kids? The Mysterious Decline in Mobility at the Top (Forbes)
A new research study on economic mobility from the Equality of Opportunity Project has the remarkable finding that absolute economic mobility—the likelihood that children will out-earn their parents—has declined dramatically over the last 40 years.

Seven Ways to Think Like a 21st-Century Economist (The Brian Lehrer Show)
The ideas that shape mainstream economic thought are out of date. Kate Raworth, senior visiting research associate and advisory board member at Oxford University’s Environmental Change Institute and author of Doughnut Economics: Seven Ways to Think Like a 21st-Century Economist (Chelsea Green, 2017), sets out to move beyond the way economics is currently taught and reliance on measurements like GDP. She's working with some of the world's best stop-motion animators to bring new economic thinking to life on screen.


Inequality and the Fracturing of American Democracy (National Review)
Where underlying inequality expands we can see the development of increasingly intense grievances at both ends of the spectrum: Those at the bottom feeling less and less competitive in important areas, while those at the top feel increasingly resentful about the proportion of tax coming from them and insist that those below start paying more. If the bidding-power gap grows wide enough it is possible to imagine the system crumbling through a combination of frustration, illiberal measures, populist demagoguery, repression, and stagnation — the sorts of cycles that Latin American countries, with the highest inequality levels in the world, go through regularly. So what should policymakers do?

To Help Tackle Inequality, Remember the Advantages You’ve Had (The New York Times)
A psychological quirk leads us to remember headwinds more than tailwinds. But if we recall our advantages, we will be closer to reducing inequality.


The New Faces of Activism (Rhode Island Monthly)
Are first-time activists making a difference in Rhode Island?

Immigrants, the Economy and Civic Engagement (Western City)
California cities use a variety of strategies to engage their residents in civic life and foster inclusive, welcoming communities. Cities with policies and practices focused on inclusion build trust and relationships that lead to increased economic and civic engagement of immigrants and the broader community.

K-12 Education

School Vouchers Aren’t Working, but Choice Is (The New York Times)
Hard-core reformers, like DeVos, support vouchers and charters. Hard-core traditionalists oppose both. The rest of us should distinguish between them, because their results differ. Vouchers have been disappointing. They are based on the free-market theory that parents will choose good schools over bad ones. It’s a reasonable theory, and vouchers can have benefits, like allowing children to leave dangerous schools.

AERA: What Do We Mean When We Talk About Teacher Shortages? (Education Week)
Debates over perceived teacher shortages often conflate different problems and make it more difficult to find sustainable ways to get every student a good teacher. That was the consensus at one of the opening symposiums of the American Educational Research Association's (AERA) annual conference last Thursday. Linda Darling-Hammond, founder of Learning Policy Institute, a think tank, led researchers debating how educators and policymakers can better understand what influences teacher shortages from state to state.

A Path Out Of Poverty: Career Training + Quality Pre K (NPR)
A new study on the first year impact of Tulsa's Career Advance shows that, so far, Career Advance is working well for both parents and their children. In fact, the study says, CAP Tulsa's program is working better than similar combined job training and pre-K programs elsewhere in terms of job certification, employment, income and overall well-being for the parent. And, the report shows, the program has boosted attendance and reduced absenteeism among participating children.

Higher Education & Workforce Development

Working Paper: Strengthening Transfer Paths to a Bachelor's Degree: Identifying Effective Two-Year to Four-Year College Partnerships (Community College Research Center)
The goal of improving transfer outcomes cannot be fully achieved until colleges nationwide are provided with commonly accepted metrics and methods for measuring the effectiveness of transfer partnerships. Using the individual term-by-term college enrollment records from the National Student Clearinghouse for the entire 2007 fall cohort of first-time-in-college community college students nationwide, this paper introduces a two-stage, input-adjusted, value-added analytic framework for identifying partnerships of two- and four-year institutions that are more effective than expected in enabling community college students to transfer to a four-year institution and earn a bachelor’s degree in a timely fashion.

From For-Profits to Community Colleges (Inside Higher Ed)
A new paper by researchers at the Federal Reserve Bank of Philadelphia found that many of for-profit students don’t abandon postsecondary education altogether -- instead, they enroll at community colleges.

A 'Playbook For Trustees' Highlights Innovative Practices for Campus Change Initiatives (EdSurge)
The report from the American Council of Trustees and Alumni offers examples from different universities, including Arizona State University, University of Colorado and Purdue University, colleges referred to as “Blueprints of Reform.” With each campus, the guide details efforts around affordability and administrative changes all targeting “improved student outcomes and efficiency without compromising academic quality and student options,” a press announcement reads.

When a Southern State Led the Nation on Free College (OZY)
This isn’t the story of the free-tuition plan passed by New York last month, but that of another ambitious program that aimed to greatly reduce the cost for in-state students. Georgia’s HOPE Scholarship, created in 1993, revolutionized schools in the Peach State and now serves as a telling example of both the possibilities and pitfalls that await the Empire State.

Health Care

5 things to watch while awaiting a Senate health care bill (USA Today)
There are still some key developments to watch out for that could have a dramatic effect on the debate over repealing and replacing the Affordable Care Act. Does CBO issue a terrible score of the House bill? Does the administration withhold cost-sharing subsidies? Does the Senate start over? Do more insurers drop out? Will there be more angry town halls?

Surprising benefits of price transparency and how to utilize them (Medical Economics)
The days of being a doctor or outpatient facility and passively waiting for referrals is waning. As patient networks narrow and deductibles grow, the mindset of the consumer is changing. They're beginning to understand that sometimes costs are lower even if they disregard their network and find an equally qualified provider.

Doctors Prescribe More Generics When Drug Reps are Kept at Bay (NPR and ProPublica)
When teaching hospitals put pharmaceutical sales representatives on a shorter leash, their doctors tended to order fewer promoted brand-name drugs and used more generic versions instead, a study published Tuesday in JAMA, the journal of the American Medical Association, shows.

How the Affordable Care Act Drove Down Personal Bankruptcy (Consumer Reports)
Expanded health insurance helped cut the number of filings by half.


05.05 Thursday 5/11: Webinar on Price Transparency in Health Care

Friday, May 5th, 2017 |

Whether you consider yourself a health care policy expert or not, conversations about the price of health care are happening all around you. The research we’ve done focuses on the nuances of who is looking for price information (half of all Americans) before getting medical care and what sources they are going to (see the shortlist here). It’s also shown that people want more of this information and they want an easy, accessible and reliable way to get to it.

Most Americans believe there is not enough information out there on the price of medical services, and some are dissatisfied and even distrusting of sources of this information. What are the policies and marketplace fixes that will address these issues?

Next week, Director of Research David Schleifer will present the latest survey data on how people find and use prices in their decisions before getting medical care. He’ll join a group of experts in the health care consumer research and advocacy realm to discuss some promising ideas that can help Americans save money.

You’re invited to join the webinar next Thursday, May 11th at 2pm Eastern Time. You can also follow the conversation with #PriceTransparency. We hope to see you there!

Speakers include:

  • Suzanne Delbanco, Catalyst for Payment Reform
  • Chris Duke, Altarum Institute
  • Doris Peter, Consumer Reports Health Ratings Center
  • David Schleifer, Public Agenda
  • Amy Shefrin, New York State Health Foundation

Moderated by:

  • Andrea Ducas, Robert Wood Johnson Foundation

Register for the webinar here.


04.28 How PB Analytics Helps Build Neighbourhood Engagement in Hamilton, Canada

Friday, April 28th, 2017 |

Public Agenda has been building a network of researchers and evaluators who are working locally with participatory budgeting (PB) sites to better understanding how PB in the US and Canada is growing, how it is working, what impacts it may have on local communities and also to learn more from year to year about how to best improve PB implementation. Evaluators and researchers of PB in the US have a strong collective interest to support and produce research and evaluation findings that are practical and relevant to the work of the people who are actually implementing PB processes in their cities and districts. But how do findings from evaluation and research get used by the implementers of PB processes in their work to help improve their processes in real time?

Sonja Macdonald, co-founder and a Principal with Civicplan, a community planning and public engagement firm, tells how data helps drive process improvements in the PB process in Hamilton’s Ward One process, “forWard one.”

Since 2012, residents of Ward 1 in Hamilton, Canada have worked together to determine how approximately $7.5 million (CAD) would be spent on local infrastructure projects. The ward’s participatory budgeting (PB) process, “forWard one,” has grown in popularity year after year. In its first year (2012), just over 400 residents participated. The 2016 process recorded the highest levels of participation yet with over 2,100 residents participating. There are many reasons for the success of this process, one of which is how data is used to focus improvements in participation.

Civicplan has built into the design of the process PB analytics, which provides detailed tracking of metrics that help assess whether and how forWard one is meeting its goals. Neighbourhood equity has always been one of these central pillars, given that the ward encompasses a diversity of communities with different challenges and pressures.

Two key metrics that Civicplan measures year over year are designed to help determine progress toward this goal. The first metric measures the distribution of voting by neighbourhood as compared to the total number of votes for the Ward. The second metric illustrates the changes in actual participation within each neighbourhood year over year.

The data captured under these metrics provides the Ward Councillor, the members of PBAC (the PB Advisory Committee, comprised of community members) and the community at large with insights into where to improve the process to approach greater neighborhood equity. This was the case in the 2016 process in the neighbourhood of Ainslie Wood.

This neighbourhood sits opposite the major local post-secondary institution, McMaster University, and as such has many related pressures including a large student population, absentee landlords and high turnover in residents. All of this contributes to challenges in participation. In 2014, Ainslie Wood represented 15 percent of the vote distribution, one of two neighbourhoods with the lowest rates of participation. In order to improve this, the forWard one team took specific steps to improve participation from Ainslie Wood in the following ways.

  • New members from Ainslie Wood were welcomed onto the PBAC, including long-time residents with strong connections to neighbourhood institutions.
  • These individuals identified and encouraged new community champions to generate and submit ideas for community focused projects.
  • The community champions engaged in promoting their projects, and the forWard one process, to a more diverse resident base to improve voting.

The results of taking a targeted approach to improve Ainslie Wood’s involvement in forWard one paid off. While the voting participation for all neighbourhoods increased in 2016, the growth in the Ainslie Wood neighbourhood was the most significant, with voter participation increasing by three times previous years, from 186 in 2014 to 566 in 2016. More pointedly though, this resulted in the success of four significant Ainslie Wood projects in the final funded projects list. These included dedicating additional funds to create a recreation centre and community hub at a former elementary school site, funds to develop complete streets throughout the neighbourhood, as well as funding for improving two park areas, new facilities for one and naturalizing the other space.

Hamilton’s Ward 1 participatory budgeting process has been underway for a number of years now, and offers a number of lessons about engaging residents in municipal decision making. To achieve the goals of the process, including neighbourhood equity, forWard one needs to be flexible and adaptable in targeting concrete improvements annually. Civicplan’s PB analytics are a valuable tool employed in improving neighbourhood participation year over year. The success of improved participation in the Ainslie Wood neighbourhood in 2016 demonstrates the importance of data to inform targeted change, which may also result in increasing the reach of participatory budgeting to more diverse communities in the ward, leading to better investment for the whole of Ward 1.

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04.28 Engaging Ideas - 4/28/2017

Friday, April 28th, 2017 | PUBLIC AGENDA


Social media may not be to blame for our political divisions (Market Watch)
Never before have Americans seemed so politically divided. You can hear the divisions in conversations at restaurants (particularly if you live in a swing state). You can see the divisions via protest signs on the evening news. You can look at the final outcome of the U.S. presidential election. And sometimes, you can witness acrimony in the conversations on Facebook.

Unlikely Political Allies: Urban Democrats and GOP Governors (Governing)
Most states now are run by Republicans. Virtually all big cities, by contrast, have Democratic mayors. That has led to a lot of conflict and a considerable number of state laws preempting local initiatives. But while many Democratic mayors are struggling to get a hearing from Republican legislators, a fair number have been able to forge working partnerships with GOP governors.

How political nuance could save America (The Guardian)
Many progressives trade in stereotypes about Kansas with childlike pride, writes Sarah Smarsh. But to use geography to separate the righteous from the scourge is dangerously simplistic.

Wikipedia’s founder launched a fake-news fighting site. (The Guardian)
Jimmy Wales’ Wikitribune is an independent site for journalists and an army of volunteer community contributors to work together to report, edit, and fact check stories. The idea is that people who donate to the site will have a say in coverage.


Participatory Budgeting: The People’s Budget (WNYC)
“The people's budget is an opportunity for community residents to decide how a million dollars or more is spent in their community.”


Escaping Poverty Requires Almost 20 Years With Nearly Nothing Going Wrong (The Atlantic)
The MIT economist Peter Temin argues that economic inequality results in two distinct classes. And only one of them has any power.

'Fight Inequality!' Is a Poor Rallying Cry (Bloomberg View)
Inequality, of income or wealth, is one of the most frequently invoked ideas in policy discussions today. Yet a study of the concept reveals uncomfortable truths, namely that most Americans don’t mind inequality nearly as much as pundits and academics suggest.

K-12 Education

Student Voice Plays a Key Role in Townsend Harris Shakeup (WNYC)
Reporters for the school paper, The Classic, exposed problems and discontent with the interim principal for months. Now, the school is getting a new principal.

With New York City expected to unveil school diversity plan soon, advocates want the public to have a say (Chalkbeat NY)
“What we want the DOE to do is create an actual planning process that is inclusive of stakeholders across the city. That has not been the case,” said Matt Gonzales, who leads school integration efforts for the nonprofit New York Appleseed and is a member of ASID. “Any efforts towards integration or desegregation always, historically, have required local buy-in.”

Teacher-Powered Schools Take Root (Education Week)
Impact Academy at Orchard Lake in Minnesota is among a growing number of public schools where teachers have a say in what goes on, from the learning approach to staffing and scheduling.

Educators Share Their #BestPD, #WorstPD (Education Week)
We asked educators to share on Twitter the professional development that inspired them or that left them scratching their heads.

Higher Education & Workforce Development

ASAP Expands North and West (Inside Higher Ed)
Westchester Community College, which is part of the State University of New York System, and Skyline Community College in California are the latest campuses that are gearing up to try ASAP for the first time. At Skyline, officials are estimating the cost per student will fall between $1,200 and $1,400 a year. If the program goes full scale, or grows to about 500 students, the college estimates it will cost $1.5 million a year. Westchester estimates its ASAP model will cost between $3,000 and $4,500 a student. But with outside grants, funding from the college and tuition from increasing student persistence, Westchester is hopeful the program will become sustainable.

One possible solution for the future of career and technical education (Hechinger Report)
The 26 students, from four local public high schools, report to school at the Volkswagen plant, a major new employer in the region. (The program, which started in August, is expected to grow to include more students and other employment tracks.) Students spend the morning in “lab time,” a flexible period during which they are taking courses, such as algebra or trigonometry, through the Edgenuity platform on a computer.

Policy Snapshot: Guided Pathways to College Completion (Education Commission of the States)
Based on a review of 2016 legislative activity that encourages or requires higher education institutions to develop guided pathways strategies: At least six states considered guided pathways legislation. Ten bills were introduced. Two bills were enacted, six bills died and two bills are pending.

Health Care

Behind The Health Care Reform Eight Ball (Forbes)
The core issue dividing GOP factions focuses on driving down the cost of insurance premiums only. This narrow approach is a recipe for public relations and policy failure. But if you couple insurance reforms to transparency in our costs of actual care, a potent dynamic is unleashed. Our health care marketplace is missing actual price tags.

America’s Other Drug Problem (ProPublica)
Every year nursing homes nationwide flush, burn or throw out tons of valuable prescription drugs. Iowa collects them and gives them to needy patients for free. Most other states don’t.

It’s Almost Impossible to Find Out the Cost of a Medical Procedure. This Company Is Trying to Change That. (The Daily Signal)
Amino mines data from billions of health insurance claims from the private and public sectors. Amino then gives patients access to information on the cost of various procedures and how much experience doctors nationwide have in those procedures.


04.21 Engaging Ideas - 4/21/2017

Friday, April 21st, 2017 | PUBLIC AGENDA


Five hacks for digital democracy (Nature)
Beth Simone Noveck urges researchers to work out how technology can improve public institutions. There is a dearth of research on how public organizations engage with civil servants and the public online, and thus a lack of insight into how to design successful online engagement processes and institutions.

What Excellence Looks like in Local Government (Data Smart)
What Works Cities, an initiative of Bloomberg Philanthropies, pairs midsized cities with expert partners – the Government Performance Lab at Harvard Kennedy School, the Behavioral Insights Team, the Center for Government Excellence at Johns Hopkins University (GovEx), Results for America and the Sunlight Foundation – for technical assistance in better using data and evidence. After two years of work with 77 cities across the United States, the program identified the key characteristics of a city devoted to using data to comprehensively identify, well, what works.

Poll: Only One-Third Of Americans Know The Rich's Tax Rates Have Not Climbed (NPR)
Results of a new Ipsos poll conducted for NPR suggest Americans may be sending a garbled message when they voice their opinions on taxes.


Smart governments are crowd-sourcing community solutions (Quartz)
Take Singapore and San Diego: By making data open and accessible, city and state governments are inviting fresh thinking by firms, data scientists, and start-ups. Experts from Singapore’s Lee Kuan Yew School of Public Policy offer perspective about how
the resulting insights are helping make economic development smarter.

The Moment for Participatory Democracy (Stanford Social Innovation Review)
Where are these citizens? Where, precisely, are people congregating in public life in 2017 America?


Earth 2.0: Is Income Inequality Inevitable? (Freakonomics)
In a perfect economy, no one would be poor. Does that mean everyone should receive a basic income? Or would that lead to disaster? The "Earth 2.0" podcast series looks at whether rebooting the planet and designing our civilization from scratch would give us something better than what we’ve blundered our way into thus far.

K-12 Education

This Islamic School Helps Students Build Their American And Muslim Identity (NPR)
The Al Fatih Academy in Virginia is one of about 270 Islamic schools in the U.S. The staff aim to give their students a well-rounded education and promote civic awareness.

Making America whole again via civics education (Hechinger Report)
To harness student passion without bogging down in partisan muck, teachers are wielding a bevy of ed-tech tools — ranging from online role-playing games and issue quizzes to social media platforms where teachers share strategies for leading political discussions and students collaborate to try to influence public policy.

Report: Economic impact of NYC's "school-to-prison pipeline" is $746M (Center for Popular Democracy)
This report, released by the Center for Popular Democracy and Urban Youth Collaborative, reveals the staggering yearly economic impact of the school-to-prison pipeline in New York City, $746.8 million. In addition, it presents a bold “Young People’s School Justice Agenda,” which calls on the City to divest from over-policing young people, and invest in supportive programs and opportunities for students to thrive. New evidence of the astronomical fiscal and social costs of New York’s school-to-prison pipeline demand urgent action by policymakers.

Higher Education & Workforce Development

Report: Implementing Guided Pathways (Community College Research Center)
This report is intended to provide insight into how colleges are planning and implementing guided pathways reforms. It is based on CCRC research on the early work of 30 colleges across the country that are part of the American Association of Community Colleges’ (AACC) Pathways Project. These colleges have committed to redesigning their programs and student support services at scale following the guided pathways model adopted by AACC based on CCRC’s research.

Report: Even One Semester: Full-Time Enrollment and Student Success (Center for Community College Student Engagement)
Students with fluid attendance patterns frequently fall between the two extremes—and they often look more like always-full-time students than like always-part-time students. These findings indicate that any experience as a full-time student provides a benefit.

Community college presidents surveyed on enrollment, recruitment, pipeline (Inside Higher Ed)
Six in 10 leaders of community colleges say their enrollments have declined in the past three years, including 21 percent who say enrollment is down by 10 percent or more, according to Inside Higher Ed’s 2017 Survey of Community College Presidents conducted by Gallup.

Report: Sunshine Laws in Higher Education (Association of Governing Boards)
Arguably, there is no more important governance challenge for college and university leaders than dealing effectively with what diplomat and educator Harland Cleveland termed the “trilemma” posed by sunshine laws: respecting the public’s legitimate right to know, protecting individual privacy, and serving the public good. It seems no exaggeration to suggest that institutional effectiveness depends on deftly balancing these three imperatives.

Report: Framing the Opportunity: Eight State Policy Recommendations That Support Postsecondary Credential Completion for Underserved Populations (Jobs for the Future)
Includes eight recommendations for policy levers that improve access and success.

Health Care

A Focus on Health to Resolve Urban Ills (The New York Times)
Discrimination, poverty, inequality and violence create unbearable stress, and stress kills.

Montana Lawmakers Push Bills on Health Costs, Transparency (US News & World Report)
Congress may not know what to do about former President Barack Obama's Affordable Care Act, but Montana lawmakers are pushing through legislation they believe will bring down health care costs and increase price transparency regardless of what happens in Washington.

3 traits of good value-based payment programs (Fierce Health Care)
In order for value-based payment models to live up to their hype, they must generate more consistent benefits than they have so far, argue Jessica Farmer and Michael Hochman, M.D., of the Keck School of Medicine.


04.13 Engaging Ideas - 4/13/2017

Thursday, April 13th, 2017 | PUBLIC AGENDA


Tech Creates Our Political Echo Chambers. It Might Also Be A Solution (NPR)
The Pew Research Center has found that about two-thirds of adults get news from social media. Analysts have blamed technology for creating an online echo chamber.

Our Addiction To Elections Is Killing American Democracy (The Nation)
It’s time to embrace other avenues of political engagement.


Report: Economic Mobility in America: A State-of-the-Art Primer (Archbridge Institute)
The estimates constitute a comprehensive suite of mobility measures. The report also discusses the strengths and weaknesses of summary measures in assessing the extent of equal opportunity. An up- to-the-minute literature review on levels of American economic mobility is included in an appendix.

Can the American republic survive extreme economic inequality? (Washington Post)
Ganesh Sitaraman wrote his new book, “The Crisis of the Middle-Class Constitution,” before voters went to the polls in November. But he saw enough in the Donald Trump and Bernie Sanders primary campaigns to assess the significance of the election. “After thirty years of a collapsing middle class,” he writes, “after thirty years of an economy designed to stack the deck in favor of the big guys; after thirty years of a political and constitutional system increasingly rigged to work for economic elites — after all this, the people revolted.”

K-12 Education

Merit Pay for Teachers Can Lead to Higher Test Scores for Students, a Study Finds (EdWeek)
Teacher participation in a merit-pay program led to the equivalent of four extra weeks of student learning, according to a
new analysis of 44 studies of incentive-pay initiatives in the United States and abroad.

How I Learned to Take the SAT Like a Rich Kid (The New York Times)
I realized that they didn’t just want to score exceptionally well on the SAT. They were gunning for a score on the Preliminary SAT exams that would put them in the top percentile of students in the United States and make them National Merit Scholars in the fall. It was disconcerting. The majority of low- and middle-income 11th graders I know in Michigan didn’t even sit for the preliminary exams. Most took the SAT cold.

How Are Charters and District Schools Working Together? In Many Ways (EdWeek)
The number of school districts and charter schools that are interested in actively working together is on the rise, according to Robin Lake, the director of the Center on Reinventing Public Education at the University of Washington, which researches district-charter collaborations and provides technical assistance to districts and charter schools looking to work together.

Idaho gives education money directly to teenagers to manage themselves (Hechinger Report)
Every seventh grader gets $4,125 to spend on early college credits. “If the money was the thing that stopped you, that’s not going to stop you anymore, unless you’re just being lazy,” Senior Cassandra Madrigal, 17, said. With her allotment, she’ll easily cover the cost of this year’s AP tests and her Boise State University-certified statistics class..

Higher Education & Workforce Development

An Interstate Transfer Passport: Its Time Has Come (New England Journal of Higher Education)
The early results for the Interstate Passport program are beginning to come in. As of February 2017, 21 institutions in six states were formal members of the Interstate Passport Network. Institutions in an additional 10 states are exploring or preparing to apply for membership. A total of 9,082 student passports were issued in fall 2016—the first term they could be awarded.

New York Adopts Free Tuition (Inside Higher Ed)
SUNY and CUNY students from families with incomes up to $125,000 will not pay tuition. But some aid experts are alarmed by requirement that graduates stay in state for same number of years they receive the benefit.

Health Care

Survey: 1 in 5 patients comparison-shop for healthcare (Fierce Health Care)
Many Americans want access to price transparency tools for healthcare, but they continue to run into roadblocks when they seek information on costs for services. A nationwide survey conducted by Public Agenda found that about half of patients in the U.S. have tried to find how much their healthcare would cost before going to get care, but 63% said that there is not enough information on costs available.

Think tank finds little transparency in Massachusetts hospital prices (Mass Live)
Massachusetts state law requires doctors and hospitals to tell patients how much a procedure costs, if a patient asks. By and large, the providers are not complying, according to a study released Monday by the Pioneer Institute.

The real metric for fixing health care (American Thinker)
Patients in Tennessee are seeing insurers drop out of the Obamacare exchanges like flies – another reminder that America's signature health care program has serious problems with dire consequences. Both major political parties acknowledge Obamacare's woes, but different metrics for fixing these problems have made civil and rational discussion impossible.


04.07 Engaging Ideas - 4/7/2017

Friday, April 7th, 2017 | PUBLIC AGENDA


The dangers of partisan animosity (Vox)
There has been a lot of talk lately, from all political corners, about threats to democracy. Arguably chief among these is the growing hostility between Republicans and Democrats. Parties serve vital functions in our government and politics, and the lack of competition between parties, in part due to antagonistic perceptions between partisans, disrupts parties’ ability to function.


Research: Making It in America Depends on Where You Work (Harvard Business Review)
Imagine you’re a middle class American, with an average education and average skills. You’re employed. What are the chances that next year you’ll vault into the top third of earners? It depends quite a bit on the company you work for.


In our opinion: Town halls work best with civil dialogue (Deseret News)
The current political climate has given rise to a surge of citizen engagement in the public square, as witnessed by the large crowd attending a town hall meeting recently staged by Utah Rep. Chris Stewart. Though such participation is healthy in the democratic process, the nature of the engagement has often left much to be hoped for in the way of well-reasoned, civil dialogue.

Participatory budgeting volunteers get word out amid skepticism (Triad City Beat)
Tony Wilkins, a Republican who represents suburban District 5 on Greensboro City Council, is one of the most vocal opponents of participatory budgeting, a process that carves out $500,000 from the city’s multi-million dollar annual budget and allows residents 14 years and older to vote directly on how the money is spent.

How Seattle Is Dismantling a NIMBY Power Structure (Next City)
At a time when rents are soaring and development is more contentious than ever before, a little-known city agency is rethinking its role in neighborhood planning.

K-12 Education

The Power of One: New Research Shows Black Students See Big Benefits From a Single Black Teacher (The 74)
To determine how exposure to a black teacher impacts black students, the researchers — including Lindsay, Seth Gershenson of American University, Cassandra Hart of the University of California Davis, and Nicholas Papageorge of Johns Hopkins University — used an extensive data set from the early 2000s in North Carolina.
They examine whether students attended a school and had a class with a black teacher in third, fourth, or fifth grade, and then link that to whether students dropped out of high school and if they said they intended to go to college.

Who Needs Charters When You Have Public Schools Like These? (The New York Times)
The truth is that school systems improve not through flash and dazzle but by linking talented teachers, a challenging curriculum and engaged students. This is the not-so-secret-sauce of Union Public Schools district in the eastern part of Tulsa, Okla.: Start out with an academically solid foundation, then look for ways to keep getting better.

Higher Education & Workforce Development

6 Reasons You Won't Graduate on Time (The New York Times)
We asked educators to identify the biggest obstacles to a timely graduation. They talked about students who aim for a four-year finish but fail to take the right courses in the right order. Other students conclude that graduating in four years isn’t so important, and cut back on classes to make more time for play. Here are the six roadblocks most cited, and ways to tackle the problem.

States Want More Career and Technical Training, But Struggle to Find Teachers (Stateline)
Nationally, career and technical education (CTE) isn’t the area with the worst teacher shortage — that’s special education. But two-thirds of states are currently reporting a shortage of CTE teachers in at least one specialty, according to a Stateline analysis of federal data. Many states, such as Minnesota and South Dakota, have had a shortage of CTE teachers for a decade. Some states, such as Maine, Maryland and New York, have had a shortage for almost 20 years.

To Ease The Student Debt Crisis, Hold Colleges Responsible (FiveThirtyEight)
College, like any investment, involves risk — and that risk doesn’t pay off for everyone. Roughly three out of every five individuals nationally are not making any progress paying down the principal balance of their student loans three years after they leave school (the numbers improve a bit in later years, but are still strikingly high). And because student loans are usually not dischargeable in bankruptcy, this particular form of debt can follow people for the rest of their lives, even resulting in the garnishment of Social Security checks.

Policy Memo: The Power of Career- and Employer-Focused Training and Education (MDRC)

Health Care

Blood test: $522 or $19? MRI: $750 or $495? Tell us what health care is costing you (
"Cracking the Code: The real cost of health care," a joint project that | The Times-Picayune and WVUE Fox 8 News launched on April 5 to help consumers navigate the increasingly murky waters of modern day health care pricing, and to explore what providers, insurers and regulators could do to improve the system.

Fight over a state healthcare transparency bill goes mostly uncovered (Columbia Journalism Review)
In Ohio, 3rd Rail Politics—a blog that pledges to show “the side of politics other publications ignore”—recently detailed the political hardball that has blocked the implementation and enforcement of a patient protection law.

Research Brief: Consumer-Centric Healthcare: Rhetoric vs. Reality (Health Care Value Hub)
From patient-centered care to consumer-directed health plans, changes in the delivery, financing, and organization of healthcare and health coverage are increasingly touted as consumer- or patient-centered. But does today’s system accurately reflect consumers’ true needs and preferences?

Will 2017 Be the Year for Major Healthcare Price Transparency Reform? (The SSI Group)
Primary goals of healthcare reform include the core principles of reducing healthcare spending and providing cost-effective, high-quality care. Healthcare pricing transparency is a key piece to this puzzle, and it comes in the form of estimation tools that allow consumers to compare prices for healthcare services among multiple providers.


03.31 Engaging Ideas - 3/31/2017

Friday, March 31st, 2017 | PUBLIC AGENDA


Study: 60 percent of rural millennials lack access to a political life (The Conversation)
Like older voters, young ones were divided by the 2016 presidential election. A recent study of millennial voters by Tufts University found that young people had starkly different opinions about politics and civic institutions based on race, gender and social class. One important dividing line separated rural and urban youth.

Opinion: Why Democrats Should Work With Trump (The New York Times)
Would Mr. Trump accept Democrats’ help on these terms? If he really wants to start racking up “wins” for his voters, he would. He’d have to share credit — a novel experience — with Democrats, who’d get points from swing voters for being pragmatic and competent. And they wouldn’t be constrained from fiercely opposing Mr. Trump on just about everything else. America doesn’t have room for two parties of “no.”


America's explosion of income inequality, in one amazing animated chart (The Los Angeles Times)
The best graphical illustration of the economic trend we've seen is this animation, showing the shift in "middle income" households from 1971 to 2015.

Re-Capturing the American Dream: How to Restore Middle Class America (Harvard Political Review)
For most middle class Americans, the dream of a stable, well-paying job is a fiction of a past long-departed. With the arrival of the modern system of flexible labor, working class America has waved goodbye to the economic prosperity championed by its forefathers—and begrudgingly welcomed an economy marked by stagnant income levels.

Is Trump Making America Great Again? The American Dream Index Is Keeping Score (Forbes)
To gauge whether Trump is delivering on his promise to Make America Great Again, Forbes is introducing the American Dream Index. The index strives to capture whether the economy is strong enough to deliver middle-class prosperity, or put another way, the American Dream.


Hartford Decides: Empowering Residents To Choose How To Improve Their City (Hartford Courant)
Hartford's initiative, called Hartford Decides, is the first of its kind in Connecticut. It is part of a growing trend in what's known as participatory budgeting, an approach to civic engagement that is cropping up across the country, including Boston and New York City.

Can Austin innovate itself out of long meetings? (Austin Monitor)
Given the recent tilt toward performance art at City Council meetings – those poor eggs! – and running times that are the longest among major cities in Texas, it seems like the last thing Austin needs is more citizen participation on civic matters big and small.

K-12 Education

The Challenge of Creating Schools That Work for All (EdWeek)
One high-achieving school works to get a handle on the racial- and income-based disparities that continue to divide its students.

Report: Teachers’ Voices: Work Environment Conditions That Impact Teacher Practice and Program Quality (Center for the Study of Child Care Employment)
To facilitate the process of bringing teachers’ voices into quality improvement strategies, CSCCE developed Supportive Environmental Quality Underlying Adult Learning, or SEQUAL, as a tool to document contextual information about workplace conditions that impact teacher practice and program quality and to build a vocabulary for the field around teachers’ needs for workplace supports.

Higher Education & Workforce Development

Report: Performance Requirements in Need-Based Aid: What Roles Do They Serve, and Do They Work?  (CAPSEE)
Our impact analyses in both states/studies confirm that SAP failure can act as an encouragement or a discouragement, depending upon the student: overall we find a negative effect of SAP failure on persistence, but we also find that students who do return modestly improve their GPAs, at least in the short term.

At College, a Guided Path on Which to Find Oneself (The New York Times)
Colleges use different parts of the strategy and give it different names, although it often goes by “guided pathways.” The underlying idea is to give students firm guidance in choosing the right courses, along with structured, clear course sequences that lead to graduation. Colleges also monitor students’ progress closely and intervene when they go off track. One college has used guided pathways from the start: the City University of New York’s Guttman Community College.

Google Hopes To Hire More Black Engineers By Bringing Students To Silicon Valley (KQED)
Howard, the historically black university in Washington, D.C., is sending computer science students to study at Google's headquarters in California, as part of an effort called Howard West.

Google Maps for Degrees? How One College Plans to Chart Out Student Pathways (EdSurge)
The goal, says Randi Harris, assistant to the vice provost for academic innovation and student success, is to incorporate a degree audit tool into the map software so students can plan and see the courses they need to graduate, as well as how that path might change if they decide to switch majors. And when they make those decisions, it could point students in the direction of the services they might need, like an academic or financial aid advisor.

This Time, With Feeling: Integrating Social and Emotional Development and College- and-Career-Ready Standards (Aspen)
This report draws directly from states' standards in English, Science, and Math to demonstrate that the standards themselves require more than academic content knowledge. For example, giving and receiving critical feedback—one of the hallmarks of rigorous academic discourse, and a skill emphasized in state standards—clearly requires the development of skills beyond academic content.

Health Care

Effectively Moving Toward Value-Based Care (AJMC)
The move away from fee-for-service (FFS) has driven some health plans to embrace value-based care contracts and accountable care organizations (ACOs). During a session at the Academy of Managed Care Pharmacy Annual Meeting, held March 27-30, 2017, in Denver, Colorado, panelists outlined how the marketplace has evolved.

State and local lawmakers call for more transparency on health care costs (KTVA Alaska)
The price of health care in Alaska is higher than anywhere else in the nation. With national reform on the back burner, state lawmakers in Juneau are joining with the Anchorage Assembly in demanding more transparency from health care providers.

Telehealth Doctor Visits May Be Handy, But Aren't Cheaper Overall (KQED)
Many patients like the convenience of being able to quickly consult a doctor by text or phone or webcam instead of heading to an urgent care clinic. But the cost of consultations can add up.

Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much. (The New York Times)
Hospitals have learned to manipulate medical codes — often resulting in mind-boggling bills.

What a Bipartisan Approach to U.S. Health Care Could Look Like (Harvard Business Review)
The ACA (or Obamacare) remains a flawed law. But rather than allow it to “implode” or “collapse,” as some suggest it will (e.g., President Trump), a group of Republican and Democratic leaders in Washington should take action and fix the broken elements of the ACA for the good of the millions of Americans who depend on it. It is time for a compromise. What might such a bipartisan agreement look like? Here are some ideas.


03.30 How 4 States are Tackling Health Care Price Transparency

Thursday, March 30th, 2017 | PUBLIC AGENDA

With out-of-pocket medical costs continuing to rise in the form of high deductibles and insurance premiums, as well as copayments and even coinsurance, many Americans are feeling the squeeze. There is no quick fix, as the hastily introduced and quickly withdrawn American Health Care Act Bill showed, but potential solutions do exist that can help individuals and families obtain more affordable health care.

In recent years, insurers, state governments, employers and other entities have been trying to make health care price information more easily available. The belief is that with increased price transparency, Americans will be more aware of how much their medical care costs, leading them to “shop around” to save money. In 2015, Public Agenda conducted the first nationally representative survey of how Americans seek and use health care price information. Since then, what has been done to make health care price information more transparent? And are these initiatives effective?

New Hampshire was one of three states that received a grade of “A” for its price transparency laws from Catalyst for Payment Reform in 2016. Health insurers in New Hampshire must disclose price information to their members. The state also runs a free website providing price information that is specific to each resident’s insurer, deductible size and coinsurance.

Florida, on the other hand, was one of 43 states that received a grade of “F.” But the state passed price transparency legislation in 2016. Just this year, the state selected a vendor to create a more robust online price information tool and began implementing an all-payer claims database—a crucial building block of price transparency efforts.

Also receiving a grade of “F” for its price transparency laws in 2016 was Texas. There has been little recent price transparency legislation in Texas, according to the National Conference of State Legislatures, which documents state actions in health and other policy areas. The state runs a website that aggregates some types of financial data from insurers, but it does not provide Texans with information about how much they have to pay out of pocket for specific services or providers. Texas does not currently have an all-payer claims database but is reportedly considering whether and how to develop one.

New York also received a grade of “F.” The state is, however, planning to create an online platform to disseminate price and quality information to its residents based on an all-payer database.

So what is (or isn’t) working?

On April 6, Public Agenda will release new findings based on an updated nationally representative survey and on representative surveys in New York State, Texas, Florida and New Hampshire, all conducted in 2016. This research, funded by the Robert Wood Johnson Foundation and the New York State Health Foundation, will shed new light on how Americans are finding and using health care price information, and on how people use price transparency in New York State, Texas, Florida and New Hampshire.

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