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The ABCs of the post-COVID economic recovery

The economic activity of the U.S. has plummeted in the wake of the coronavirus pandemic and unemployment has soared—largely the result of social distancing policies designed to slow the spread of the virus. The depth and speed of the decline will rival that of the Great Depression. But will the aftermath be as painful? Or…

       




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Making sense of the monthly jobs report during the COVID-19 pandemic

The monthly jobs report—the unemployment rate from one survey and the change in employer payrolls from another survey—is one of the most closely watched economic indicators, particularly at a time of an economic crisis like today. Here’s a look at how these data are collected and how to interpret them during the COVID-19 pandemic. What…

       




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Oil Markets Provide a Glimpse of the Post-Pandemic Future

Henry Kissinger warns that many existing domestic and international institutions that have helped govern the past decades will not survive the Covid-19 crisis. He is surely correct.




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Transatlantic Dialogue: The Missing Link in Europe’s Post-Covid-19 Green Deal?

This policy brief emphasizes that the European Green Deal's effectiveness in a post Covid-19 world will require the involvement of strategic partners, especially the US. In the context of a potential US withdrawal from the Paris Agreement and the consequential vacuum, it will be even more important to engage the US in implementing the GD. In light of divergence between the US and the EU during past climate negotiations (e.g. Kyoto, Copenhagen, and Paris), we suggest a gradual approach to US engagement with GD initiatives and objectives.




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No, COVID-19 Isn’t Turning Europe Pro-China (Yet)

Ever since the World Health Organization declared Europe the new epicenter of the coronavirus pandemic on March 13, China has seized the opportunity to provide relief to some of the worst-hit European countries as part of a concerted PR offensive aiming at polishing up the Communist Party’s image internationally and — above all — domestically. Although China’s aid offers have generally been welcomed by those leaders struggling to contain the outbreak, it is still far too early to conclude that Beijing is actually winning over any European hearts and minds




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How COVID-19 is Testing American Leadership

Joseph Nye suggests that a new U.S. administration might take a leaf from the success of the post-1945 American presidents that are described in Do Morals Matter? Presidents and Foreign Policy from FDR to Trump. The United States could launch a massive COVID-19 aid program like the Marshall Plan.




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What Caused the COVID-19 Testing Deficit?

As the divergent experiences of the US and South Korea show, testing can be the difference between disease containment and catastrophe. Rather than relying on national governments to ensure the rapid development, production, and deployment of diagnostics during outbreaks, the world needs a global coordinating platform.




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COVID in the Maghreb: Responses and impacts

       




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COVID-19's Painful Lesson About Strategy and Power

Joseph Nye writes that while trade wars have set back economic globalization,  the environmental globalization represented by pandemics and climate change is unstoppable. Borders are becoming more porous to everything from drugs to infectious diseases to cyber terrorism, and the United States must use its soft power of attraction to develop networks and institutions that address these new threats.




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Getting Smart on Pandemics: Intelligence in the Wake of COVID-19

This episode of Horns of a Dilemma touches on whether the failure to properly anticipate and warn about the novel coronavirus constitutes an intelligence failure, what changes might be required in the intelligence community in the wake of the pandemic, and what type of investigation or inquiry might be appropriate in order to learn lessons and incorporate changes for both the intelligence community and the whole of government moving forward.




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This Virus Is Tough, but History Provides Perspective: The 1968 Pandemic and the Vietnam War

Nathaniel L. Moir recounts the events of 1968: The war in Vietnam and extensive civil unrest in the United States — and yet another big problem that made life harder. In 1968, the H3N2 pandemic killed more individuals in the United States than the combined total number of American fatalities during both the Vietnam and Korean Wars.




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Moving to the Cloud: How the Public Sector Can Leverage the Power of Cloud Computing

Event Information

July 21, 2010
10:00 AM - 12:00 PM EDT

Falk Auditorium
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

Register for the Event

The U.S. government spends billions of dollars each year on computer hardware, software and file servers that may no longer be necessary. Currently, the public sector makes relatively little use of cloud computing, even though studies suggest substantial government savings from a migration to more Internet-based computing with shared resources.

On July 21, the Center for Technology Innovation at Brookings hosted a policy forum on steps to enhance public sector adoption of cloud computing innovations. Brookings Vice President Darrell West moderated a panel of experts, including David McClure of the General Services Administration, Dawn Leaf of the National Institute for Standards and Technology, and Katie Ratte of the Federal Trade Commission. West released a paper detailing the policy changes required to improve the efficiency and effectiveness of federal computing.

Audio

Transcript

Event Materials

     
 
 




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New Federal Government CIO is Key to Improving Government Performance


The appointment of new federal chief information officer Steven VanRoekel comes at a challenging time for President Barack Obama. The national economy continues to be weak. Congress plans to cut trillions from the federal budget. And in the time leading up to the 2012 election, American voters remain cynical about the ability of the government to address important policy problems in an effective manner.

In an era of deficit reduction and public cynicism, the tasks facing federal officials are to determine how to do more with less and persuade voters the government can become smarter and more effective. There are going to be fewer dollars for virtually every federal program so it is important to figure how ways to innovate and perform more efficiently.

Former CIO Vivek Kundra sought to do this through encouraging agencies to move software applications to the cloud, consolidating federal data centers, improving transparency, and improving the information technology procurement process. It is important to continue this progress even as agencies are forced to downsize their operations.

As shown in the private sector, government administrators should use technology to cut costs, improve worker productivity, and streamline operations. This is not just a matter of using technology in more innovative ways, but changing the operations and culture of the public sector. Public officials must improve its data mining activities to identify fraud and abuse in Medicare, Medicaid, the Defense Department, and other domestic programs.

New software gives managers better tools to evaluate how money is being spent and whether it is fulfilling intended goals. If it is not, programs need to be modified or eliminated. The most important weapon in Mr. VanRoekel’s arsenal may be the scalpel as he goes through the federal government’s $80 billion IT budget.

Authors

Image Source: © Hyungwon Kang / Reuters
      
 
 




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FedRAMP to Monitor Cloud Service Providers


As of today, the federal government will require that all cloud service providers have Federal Risk and Authorization Program (FedRAMP) approval. FedRAMP is a program meant to standardize the security of cloud services, thus reducing the time and effort that independent cloud providers would need to spend ensuring cloud security. According to a 2013 annual report by the General Services Administration, agencies that use FedRAMP could save 50 percent on staffing and $200,000 in costs overall. FedRAMP will operate under similar rules as the Federal Information Security Management Act (FISMA), which helps maintain security of federal IT systems, applications and databases. Both FISMA and FedRAMP will provide enhanced protection and scrutiny for federal and independent agencies.

To learn more about cloud computing, read Darrell West’s papers Saving Money Through Cloud Computing and Steps to Improve Cloud Computing in the Public Sector. Visit the FedRAMP website here.

MaryCate Most contributed to this post.

Authors

  • Hillary Schaub
Image Source: © Navesh Chitrakar / Reuters
      
 
 




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COVID-19 and military readiness: Preparing for the long game

With the saga over the U.S.S. Teddy Roosevelt aircraft carrier starting to fade from the headlines, a larger question about the American armed forces and COVID-19 remains. How will we keep our military combat-ready, and thus fully capable of deterrence globally, until a vaccine is available to our troops? It will also be crucial to…

       




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Webinar: What role will the Army play in great power competition after COVID-19?

Two years after the National Defense Strategy was published, it’s time to take stock of where the Army stands. On an immediate level, the age of COVID-19 presents the Army with an unprecedented set of challenges. From ensuring high levels of readiness to keeping up recruitment, the pandemic has forced the Army to adapt quickly…

       




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Webinar: Policing in the era of COVID-19

The consequences of the novel coronavirus pandemic stretch across the entirety of government services. Major police agencies have reported absentee rates as high as 20% due to officers who are either themselves afflicted with the virus or in need of self-quarantine. Reported crimes are generally down in America’s cities as a result of the many…

       




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Turning back the Poverty Clock: How will COVID-19 impact the world’s poorest people?

The release of the IMF’s World Economic Outlook provides an initial country-by-country assessment of what might happen to the world economy in 2020 and 2021. Using the methods described in the World Poverty Clock, we ask what will happen to the number of poor people in the world—those living in households with less than $1.90…

       




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Addressing COVID-19 in resource-poor and fragile countries

Responding to the coronavirus as individuals, society, and governments is challenging enough in the United States and other developed countries with modern infrastructure and stable systems, but what happens when a pandemic strikes poor and unstable countries that have few hospitals, lack reliable electricity, water, and food supplies, don’t have refrigeration, and suffer from social…

       




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Webinar: The impact of COVID-19 on prisons

Across America, incarcerated people are being hit hard by COVID-19. The infection rate in Washington, D.C., jails is 14 times higher than the general population of the city. In one Michigan correctional facility, more than 600 incarcerated people have tested positive — almost 50% of the prison's total population. In Arkansas, about 40% of the…

       




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How instability and high turnover on the Trump staff hindered the response to COVID-19

On Jan. 14, 2017, the Obama White House hosted 30 incoming staff members of the Trump team for a role-playing scenario. A readout of the event said, “The exercise provided a high-level perspective on a series of challenges that the next administration may face and introduced the key authorities, policies, capabilities, and structures that are…

       




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Removing regulatory barriers to telehealth before and after COVID-19

Introduction A combination of escalating costs, an aging population, and rising chronic health-care conditions that account for 75% of the nation’s health-care costs paint a bleak picture of the current state of American health care.1 In 2018, national health expenditures grew to $3.6 trillion and accounted for 17.7% of GDP.2 Under current laws, national health…

       




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How to increase financial support during COVID-19 by investing in worker training

It took just two weeks to exhaust one of the largest bailout packages in American history. Even the most generous financial support has limits in a recession. However, I am optimistic that a pandemic-fueled recession and mass underemployment could be an important opportunity to upskill the American workforce through loans for vocational training. Financially supporting…

       




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COVID-19 misinformation is a crisis of content mediation

Amid a catastrophe, new information is often revealed at a faster pace than leaders can manage it, experts can analyze it, and the public can integrate it. In the case of the COVID-19 pandemic, the resulting lag in making sense of the crisis has had a profound impact. Public health authorities have warned of the…

       




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Africa in the news: Debt relief in Somalia, government efforts to combat COVID-19, and new Boko Haram attacks

Debt relief in Somalia and other African countries On Wednesday, the World Bank and International Monetary Fund (IMF) jointly announced that Somalia is now eligible for debt relief under the Heavily Indebted Poor Countries (HIPC) initiative. Successfully completing the HIPC program will reduce Somalia’s external debt from $5.2 billion currently to $557 million in about…

       




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After COVID-19, Taiwan will have to navigate a world that will never be the same

Unlike virtually every country in the world, Taiwan has weathered the first wave of the COVID-19 pandemic admirably well. Taiwan’s governance system has stood firm in the face of crisis, gaining international acclaim for the competence and efficiency of its response to the outbreak. And the people of Taiwan have garnered goodwill through their generosity,…

       




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Physician payment in Medicare is changing: Three highlights in the MACRA proposed rule that providers need to know


Editor’s Note: This analysis is part of The Leonard D. Schaeffer Initiative for Innovation in Health Policy, which is a partnership between the Center for Health Policy at Brookings and the USC Schaeffer Center for Health Policy and Economics. The Initiative aims to inform the national health care debate with rigorous, evidence-based analysis leading to practical recommendations using the collaborative strengths of USC and Brookings.

The passage of the Medicare Access and CHIP Reauthorization Act (MACRA) just over a year ago signaled a strong and unique bipartisan agreement to move towards value-based care, but until recently, many of the details surrounding how it would be implemented remained unknown. But last week, the Centers for Medicare and Medicaid Studies (CMS) released roughly 1,000 pages that shed more light on how physician payment will hopefully dramatically change for the better.

Some Historical Context

Prior to MACRA, how doctors were paid for providing care to Medicare patients was subject to a reimbursement formula known as the Sustainable Growth Rate (SGR). Established in 1997 to control the rate of increase in spending on physician services, the SGR pegged total spending among all Medicare-participating physicians to an overall budget target. Yet in this “tragedy of the commons,” no one physician benefitted from her good stewardship of health care resources. Total physician spending often exceeded the overall budget target, triggering reimbursement rate cuts. However, lawmakers chose to push them off into the future through what were called “doc fixes,” deferring the rate cuts temporarily. The pending cut rose to over 21 percent before MACRA’s passage as a result of compounding doc fixes.

Moving Forward with MACRA

When it was signed into law on April 16, 2015, MACRA ended the SGR, its cuts, and many previous payment incentive programs. In their place, MACRA established two overarching payment incentive schemes for providers to choose from:

  1. the Merit-Based Incentive Payment System (MIPS) program, which supplants three previous payment incentives and makes positive or negative adjustments to a physician’s payment based on her performance; or

  2. the Alternative Payment Model (APM) program, which awards a 5 percent bonus through 2024—with higher annual payment updates thereafter—for having a minimum percentage of Medicare and/or all-payer revenue through eligible APMs. Base physician fee rates for all Medicare providers would be updated 0.5 percent for each of the first four years, followed by no increases until 2026, when base fees would increase at different rates depending on the payment incentive program in which a physician participates.

MIPS addresses providers’ longstanding complaints that reporting that reporting under the existing programs—the Physician Quality Reporting System, the Value-Based Modifier, and Meaningful Use — is duplicative and cumbersome. Under the new MIPS program, physicians report to the government payer directly (CMS) and receive a bonus or penalty based on performance on measures of quality, resource use, meaningful use of electronic health records, and clinical practice improvement activities. The bonus or penalty physicians may see starts at 4 percent of the fee schedule in 2019 (based on their performance two years prior—in this case 2017) and increases successively to 5 percent in 2020, 7 percent in 2021, and 9 percent from 2022 onward. From 2026 onward, MIPS providers would receive an annual increase of 0.25 percent on their base fee schedules rates.

In contrast, the APM incentive program awards qualifying physicians a fixed, annual bonus of 5 percent of their reimbursement from 2019- – 2024, and provides that their fee schedule rates grow 0.5 percentage points faster than those of MIPS in 2026 and beyond, in recognition of the risk they assume in these contracts.

Yet, according to MACRA, not all APMs are created equal. APMs eligible for this track must use quality measures similar to those of MIPS, ensure electronic health records are used, and either be an approved patient-centered medical home (PCMH) or require that the participating entity “bears more than nominal financial risk” for excessive costs. Then, in order to receive the APM track bonus, physicians must have a minimum of 25 percent of their revenue from Medicare come through eligible APMs in 2019, with the minimum increasing through 2023 up to 75 percent. In 2021, a new all-payer Advanced APM option becomes available, allowing providers in APM contracts with other payers to participate in the Advanced APM incentive. To do so, they must meet the same minimum thresholds—50 percent in 2021, 75 percent in 2023—but through all provider contracts, not solely Medicare revenue, while still meeting a significantly lower Medicare-specific threshold. By creating an all-payer option, CMS hopes to enable greater provider participation by allowing all payer revenue to count toward the same minimum threshold. Under the all-payer model in 2021, for example, providers must have no less than 25 percent of Medicare revenue through Advanced APMs and 50 percent of all revenue through Advanced APMs.

MACRA Implementation Details Revealed

The newly released proposed rule provides answers to significant questions that had been left unanswered in the law surrounding the specifics of implementation of MIPS and the APM incentives. At long last, providers are gleaning insight into how CMS intends to implement MIPS and the APM track. Given the fast-approaching MIPS performance period in January 2017, here are three key highlights providers need to know:

  1. Qualifying for the APM incentive track—and getting out of MIPS—will be difficult. In order to qualify for the bonus-awarding Advanced APM designation, APMs must meet the “nominal financial risk” criteria, which will be measured in three ways: an APM’s marginal rate sharing for losses, minimum loss ratio (the threshold above which providers would begin sharing in losses), and total potential risk as a percent of expected costs. Clinicians must further have a minimum share of revenue that comes in through the designated APMs.

  2. Providers will have fewer opportunities to see and improve their performance on MIPS. Despite calls from provider groups for more frequent reporting and feedback periods, MIPS reporting periods will be annual, not quarterly. This is true for performance feedback from CMS, as well, though they may explore more frequent feedback cycles in the future. Quarterly reporting and feedback periods could have made the incentive programs more “actionable” for providers, alerting them to their performance closer to the time the services were rendered and providing more opportunities to improve performance.

  3. MIPS allows greater flexibility than previous programs. Put simply, MIPS is the performance incentive program clinicians will participate in if not on the Advanced APM track. While compelling participation, the proposed MIPS implementation also responds to stakeholder concerns that earlier performance incentive programs were onerous and sometimes irrelevant—MIPS reduces the number of measures required in some categories and allows physicians to select from a set of measures to report on based on relevancy to their practice.

With last week’s release of the proposed rule, the Leonard D. Schaeffer Initiative for Innovation in Health Policy is kicking off a series of work products that will focus dually on further MACRA implementation issues and on translating complex policy into providers’ experience. In the blogs and publications to follow, we will dive into greater detail and discussion of the pieces of MACRA implementation highlighted here, as well as many other emerging physician payment reform issues, as the law’s implementation unfolds.

Authors

Image Source: © Jim Bourg / Reuters
       




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Africa in the news: COVID-19 impacts African economies and daily lives; clashes in the Sahel

African governments begin borrowing from IMF, World Bank to soften hit from COVID-19 This week, several countries and multilateral organizations announced additional measures to combat the economic fallout from COVID-19 in Africa. Among the actions taken by countries, Uganda’s central bank cut its benchmark interest rate by 1 percentage point to 8 percent and directed…

       




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Preventing violent extremism during and after the COVID-19 pandemic

While the world’s attention appropriately focuses on the health and economic impacts of COVID-19, the threat of violent extremism remains, and has in some circumstances been exacerbated during the crisis. The moment demands new and renewed attention so that the gains made to date do not face setbacks. Headlines over the past few weeks have…

       




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The next COVID-19 relief bill must include massive aid to states, especially the hardest-hit areas

Amid rising layoffs and rampant uncertainty during the COVID-19 pandemic, it’s a good thing that Democrats in the House of Representatives say they plan to move quickly to advance the next big coronavirus relief package. Especially important is the fact that Speaker Nancy Pelosi (D-Calif.) seems determined to build the next package around a generous infusion…

       




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Responding to COVID-19: Using the CARES Act’s hospital fund to help the uninsured, achieve other goals

       




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Webinar: A short- and long-term approach to COVID-19

As the COVID-19 pandemic nears 2 million confirmed infections, scientists and doctors are working on treatments for the sick as well as preventive measures to stop the spread of infection. Dr. William A. Haseltine, known for his groundbreaking work on HIV-AIDS and pioneering application of genomics to drug discovery with Human Genome Sciences, joined USC-Brookings…

       




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After COVID-19—thinking differently about running the health care system

       




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Webinar: Telehealth before and after COVID-19

The coronavirus outbreak has generated an immediate need for telehealth services to prevent further infections in the delivery of health care. Before the global pandemic, federal and state regulations around reimbursement and licensure requirements limited the use of telehealth. Private insurance programs and Medicaid have historically excluded telehealth from their coverage, and state parity laws…

       




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Estimating potential spending on COVID-19 care

The COVID-19 pandemic is causing large shifts in health care delivery as hospitals and physicians mobilize to treat COVID-19 patients and defer nonemergent care. These shifts carry major financial implications for providers, payers, and patients. This analysis seeks to quantify one dimension of these financial consequences: the amounts that will be spent on direct COVID-19…

       




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Removing regulatory barriers to telehealth before and after COVID-19

Introduction A combination of escalating costs, an aging population, and rising chronic health-care conditions that account for 75% of the nation’s health-care costs paint a bleak picture of the current state of American health care.1 In 2018, national health expenditures grew to $3.6 trillion and accounted for 17.7% of GDP.2 Under current laws, national health…

       




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Cities and states are on the front lines of the economic battle against COVID-19

The full economic impact of the COVID-19 pandemic came into sharp relief this week, as unemployment claims and small business closures both skyrocketed. Addressing the fallout will require a massive federal stimulus, and both Congress and the White House have proposed aid packages exceeding $1 trillion. But as we noted on Monday, immediate assistance to…

       




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We don’t need a map to tell us who COVID-19 hits the hardest in St. Louis

On April 1, the City of St. Louis released the number of confirmed cases of the coronavirus disease (COVID-19) by zip code. Although the number of COVID-19 tests conducted by zip code has not yet been disclosed by officials—which suggests that the data are not fully representative of all cases—we do see stark differences in…

       




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COVID-19 can augment violence to Mexican women

On March 8, some 80,000 women in Mexico marched to protest violence against women. A day later, many women stayed home away from work and public places to demand the Mexican government and society take actions to protect women from femicides and domestic violence. Then, as the coronavirus (COVID-19) started sweeping through the United States…

       




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Moving on up: More than relocation as a path out of child poverty

The U.S. scores below many industrialized nations in rates of child poverty, lagging behind France, Hungary, and Chile, among others. Dramatically different social safety net and health care systems, population diversity, economic and political stability, and capitalist society values with purported opportunities are only a few of the many explanations for the disparities that play…

       




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Protecting our most economically vulnerable neighbors during the COVID-19 outbreak

While we are all adjusting to new precautions as we start to understand how serious the COVID-19 coronavirus is, we also need to be concerned about how to minimize the toll that such precautions will have on our most economically vulnerable citizens. A country with the levels of racial and income inequality that we have…

       




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Removing regulatory barriers to telehealth before and after COVID-19

Introduction A combination of escalating costs, an aging population, and rising chronic health-care conditions that account for 75% of the nation’s health-care costs paint a bleak picture of the current state of American health care.1 In 2018, national health expenditures grew to $3.6 trillion and accounted for 17.7% of GDP.2 Under current laws, national health…

       




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How to increase financial support during COVID-19 by investing in worker training

It took just two weeks to exhaust one of the largest bailout packages in American history. Even the most generous financial support has limits in a recession. However, I am optimistic that a pandemic-fueled recession and mass underemployment could be an important opportunity to upskill the American workforce through loans for vocational training. Financially supporting…

       




ovi

COVID-19 misinformation is a crisis of content mediation

Amid a catastrophe, new information is often revealed at a faster pace than leaders can manage it, experts can analyze it, and the public can integrate it. In the case of the COVID-19 pandemic, the resulting lag in making sense of the crisis has had a profound impact. Public health authorities have warned of the…

       




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Turkey and COVID-19: Don’t forget refugees

It has been more than a month since the first COVID-19 case was detected in Turkey. Since then, the number of cases has shot up significantly, placing Turkey among the top 10 countries worldwide in terms of cases. Government efforts have kept the number of deaths relatively low, and the health system so far appears…

       




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Can the US sue China for COVID-19 damages? Not really.

       




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Clouded thinking in Washington and Beijing on COVID-19 crisis

In 2015, an action movie about a group of elite paratroopers from the People’s Liberation Army, “Wolf Warrior,” dominated box offices across China. In 2020, the nationalistic chest-thumping spirit of that movie is defining Chinese diplomacy, or at least the propaganda surrounding it. This aggressive new style is known as “wolf warrior diplomacy,” and although…

       




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A modern tragedy? COVID-19 and US-China relations

Executive Summary This policy brief invokes the standards of ancient Greek drama to analyze the COVID-19 pandemic as a potential tragedy in U.S.-China relations and a potential tragedy for the world. The nature of the two countries’ political realities in 2020 have led to initial mismanagement of the crisis on both sides of the Pacific.…

       




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Africa in the news: South Africa looks to open up; COVID-19 complicates food security, malaria response

South Africa announces stimulus plan and a pathway for opening up As of this writing, the African continent has registered over 27,800 COVID-19 cases, with over 1,300 confirmed deaths, according to the Africa Centers for Disease Control and Prevention. Countries around the continent continue to instate various forms of social distancing restrictions: For example, in…

       




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Africa in the news: COVID-19, Côte d’Ivoire, and Safaricom updates

African governments take varying approaches to mitigate the spread of COVID-19 As of this writing, Africa has registered over 39,000 confirmed COVID-19 cases and 1,600 deaths, with most cases concentrated in the north of the continent as well as in South Africa. African countries have enacted various forms of lockdowns, external and internal border closures,…