deliv Deputy Attorney General James M. Cole Delivers Remarks at the “Pills to Needles: the Pathway to Rising Heroin Deaths” Event By www.justice.gov Published On :: Tue, 10 Jun 2014 09:55:16 EDT As the Attorney General recently observed, heroin and opiate addiction and abuse “is impacting the lives of Americans in every state, in every region, and from every background and walk of life.” Full Article Speech
deliv Attorney General Holder Delivers Remarks at the Focus: Hope “Heroes for Hope” Event By www.justice.gov Published On :: Fri, 13 Jun 2014 15:52:46 EDT Ultimately, as your history reminds us, these efforts will be successful only if we take responsibility not just for ourselves, but for our families, our neighbors, our friends, and our fellow citizens. Among them are the future “heroes for hope” that this city, this state, and this country desperately need. Full Article Speech
deliv Attorney General Holder Delivers Statement on the Arrest of Ahmed Abu Khatallah for His Role in Attack in Benghazi, Libya By www.justice.gov Published On :: Tue, 2 Sep 2014 11:41:25 EDT Attorney General Eric Holder released the following statement Tuesday regarding the arrest of Ahmed Abu Khatallah for his role in the attack on the U.S. facilities in Benghazi, Libya Full Article OPA Press Releases
deliv Attorney General Holder Delivers at the ONDCP Summit on Heroin and Prescription Drugs By www.justice.gov Published On :: Thu, 19 Jun 2014 09:34:45 EDT You know as well as anyone that the challenges we face are daunting. You’ve shown us that, as we seek to address the problem of substance abuse, it makes sense to focus on the most dangerous types of drugs. And right now, few substances are more lethal than prescription opioids and heroin. Full Article Speech
deliv Associate Attorney General West Delivers Remarks at the International Conference on Access to Legal Aid in Criminal Justice Systems By www.justice.gov Published On :: Wed, 25 Jun 2014 09:58:25 EDT And equally important, I want to thank all of you -- the gathered Ministers, Deputy Ministers, Attorneys General, Supreme Court Justices, and criminal legal aid providers and experts -- for participating in this conference. Your presence here epitomizes the dual truths that all free people, wherever they may live, lay valid claim to equality in the eyes of the law, and that the majesty of the law finds its best and highest use in the service of justice. Full Article Speech
deliv Attorney General Holder Delivers Remarks at Press Conference Announcing Significant Law Enforcement Action By www.justice.gov Published On :: Mon, 30 Jun 2014 17:57:50 EDT Today, the Department of Justice submitted to the United States District Court a criminal information against BNP Paribas, one of the largest banks in the world, for conspiring with other entities to deliberately and repeatedly violate longstanding U.S. sanctions against Sudan, Cuba, and Iran. Full Article Speech
deliv Associate Attorney General West Delivers Remarks at Mount Vernon Naturalization Ceremony By www.justice.gov Published On :: Tue, 8 Jul 2014 14:19:33 EDT George Washington himself conceived and designed them, but it was Mount Vernon’s other residents -- the hundreds of men and women who worked for Washington -- it was their hands that built and tended this splendor. Like you, those men and women had origins that stretched around the globe. They were Christians and Muslims; Africans and Europeans. Full Article Speech
deliv Attorney General Eric Holder to Deliver Keynote Address at Justice Department and Howard University Celebration of the 50th Anniversary of Civil Rights Act of 1964 By www.justice.gov Published On :: Fri, 29 Aug 2014 12:31:56 EDT Attorney General Eric Holder will deliver the keynote address at the Department of Justice’s 50th anniversary celebration of the Civil Rights Act of 1964. Secretary of Labor Thomas Perez, Secretary of Education Arne Duncan, Congresswoman Eleanor Holmes Norton, Deputy Attorney General James Cole, Associate Attorney General Tony West, Ambassador Andrew Young and Howard University Interim President Dr. Wayne A.I. Frederick will also deliver remarks at the event co-hosted by Howard University, on TUESDAY, JULY 15, 2014, at 10:00 a.m. EDT, to honor the civil rights movement and celebrate the groundbreaking act Full Article OPA Press Releases
deliv Remarks as Prepared for Delivery by Attorney General Holder at the Community Relations Service 50th Anniversary of the Civil Rights Act of 1964 Ceremony By www.justice.gov Published On :: Mon, 14 Jul 2014 15:44:04 EDT "We must recommit ourselves to the legacies of visionary leaders and courageous citizens who made the passage of the Civil Rights Act, and the creation of this agency, possible. And we must resolve to keep moving forward together – as one nation and one people – driven by the needs that remain unfulfilled, determined to transcend the barriers that still divide us, and dedicated to the enduring promise of equal justice under law." Full Article Speech
deliv Attorney General Holder Delivers Remarks at Howard University for the 50th Anniversary Celebration of the Civil Rights Act By www.justice.gov Published On :: Tue, 15 Jul 2014 10:26:33 EDT That, at its core, is what defines us as Americans: a people born of revolution and tested by civil war. A nation founded on equality but built by those in chains. A country first imagined, centuries ago, by imperfect people driven by a near-perfect vision – a vision conceived by patriots who dared to reach beyond themselves and defended later by activists who fought for equal justice – and who challenge us, even today, to make this promise real. Full Article Speech
deliv Associate Attorney General Tony West Delivers Remarks at Howard University for the 50th Anniversary Celebration of the Civil Rights Act By www.justice.gov Published On :: Tue, 15 Jul 2014 18:06:27 EDT Today, we are privileged to be joined by two national leaders who have worked tirelessly to "pay it forward" by devoting their lives to promoting justice, fairness, and equality. Full Article Speech
deliv Deputy Attorney General James M. Cole Delivers Remarks at the 50th Anniversary of the Civil Rights Act of 1964 Howard University Event By www.justice.gov Published On :: Wed, 16 Jul 2014 13:58:08 EDT History is not just a series of events; it is the people who create those events. It is the impact of the stories—told and untold—of the many trailblazers and unsung heroes whose tireless sacrifices and relentless dedication have resulted in justice, equality, opportunity, and freedom for all. Full Article Speech
deliv Attorney General Holder Delivers Remarks at a Naturalization Ceremony Held at the Department of Justice By www.justice.gov Published On :: Tue, 22 Jul 2014 14:42:18 EDT I am honored to join you in this pursuit. I congratulate you, once again, on this extraordinary occasion. And I thank you for allowing me to share it with you. Full Article Speech
deliv Deputy Attorney General James M. Cole Delivers Remarks at Department of Homeland Security Press Conference on Human Smuggling Along the Southwest Border By www.justice.gov Published On :: Tue, 22 Jul 2014 14:43:34 EDT As the Secretary has so poignantly described, the conditions for these migrants en route to the United States are horrible. Human smuggling ventures lead to extremely dangerous circumstances that pose a threat to public safety and are serious humanitarian concerns. We have encountered smuggled aliens that have been, kidnapped, taken hostage, beaten, sexually assaulted, threatened with murder or have died as a result of dangerous conditions. Full Article Speech
deliv Associate Attorney General Tony West Delivers Remarks at the Progressive National Baptist Convention By www.justice.gov Published On :: Tue, 5 Aug 2014 11:43:35 EDT "Because if a government of, by and for the people means anything at all, it means that a ballot has the power to give equal voice to the high and the low; the weak and the strong; those at the bottom as well as the top. It means that in the polling place, the line is just as long for the richest among us as it is for those who often work the hardest but have the least." Full Article Speech
deliv Deputy Assistant Attorney General Mark Kappelhoff Delivers Opening Statement at the Convention on the Elimination of Racial Discrimination By www.justice.gov Published On :: Wed, 13 Aug 2014 09:53:56 EDT Mr. Chairperson, distinguished Members of the committee, and representatives of civil society. My name is Mark Kappelhoff and I serve as a Deputy Assistant Attorney General in the Civil Rights Division of the U.S. Department of Justice. It is an honor to be a member of the U.S. delegation and to share with you some of the Justice Department’s work to address racial discrimination and to fulfill our obligations under the convention. Full Article Speech
deliv U.S. Attorney Loretta Lynch for the Eastern District of New York Delivers Remarks at the Convention on the Elimination of Racial Discrimination By www.justice.gov Published On :: Wed, 13 Aug 2014 11:24:10 EDT Mr. Chairperson, distinguished members of the committee, and representatives of civil society, it is an honor to be a part of the U.S. delegation and share some of the highlights of the Department of Justice’s efforts to eliminate racial discrimination and uphold human rights in the area of criminal justice. Full Article Speech
deliv Attorney General Eric Holder Delivers Remarks at the St. Louis FBI Field Office By www.justice.gov Published On :: Wed, 20 Aug 2014 23:14:58 EDT We have brought to this area very experienced prosecutors, we have very experienced agents who are handling this matter, and doing so, I think, in a fine way. I'm going to get briefed on more of the details about the investigation. I've been kept up to date, but there's nothing that can replace actually coming to the office that's handling the matter, and being able to look in the face the people who are, I think at this point, very ably handling this investigation. Full Article Speech
deliv Attorney General Holder Delivers Remarks at Press Conference Announcing Major Financial Fraud By www.justice.gov Published On :: Thu, 21 Aug 2014 09:18:50 EDT "We are here to announce a historic step forward in our ongoing effort to protect the American people from financial fraud – and to hold accountable those whose actions threatened the integrity of our financial markets and undermined the stability of our economy." Full Article Speech
deliv Associate Attorney General West Delivers Remarks at Press Conference Announcing Major Financial Fraud By www.justice.gov Published On :: Thu, 21 Aug 2014 09:28:29 EDT "Yet in addition to accountability, this historic resolution is also significant for what it achieves in terms of restoration: it requires those we are holding accountable to shoulder some of the responsibility for repairing the damage caused by their conduct." Full Article Speech
deliv Attorney General Holder Delivers Remarks at Press Conference Announcing Pattern or Practice Investigation into Ferguson Police Department By www.justice.gov Published On :: Thu, 4 Sep 2014 14:39:31 EDT "These anecdotal accounts underscored the history of mistrust of law enforcement in Ferguson that has received a good deal of attention. As a result of this history – and following an extensive review of documented allegations and other available data – we have determined that there is cause for the Justice Department to open an investigation to determine whether Ferguson Police officials have engaged in a pattern or practice of violations of the U.S. Constitution or federal law." Full Article Speech
deliv Attorney General Holder Delivers Remarks at Farewell Ceremony for Associate Attorney General West By www.justice.gov Published On :: Wed, 10 Sep 2014 15:15:58 EDT "At every level, Tony West has come to exemplify what it means to be a public servant in the truest sense. To many who are at risk and in need, he has become known as a champion. To those who have broken the law and victimized others, he has been a fierce and determined guardian of the public trust. And to me, he has been a trusted advisor, a dedicated colleague, and a dear friend." Full Article Speech
deliv Associate Attorney General West Delivers Farewell Remarks By www.justice.gov Published On :: Wed, 10 Sep 2014 15:18:00 EDT "I love this department because of its unique mission. It's an audacious one -- I suppose with a name like “Justice” audacity is appropriate. It's a mission that speaks to the fundamental importance of the Rule of Law, as represented by that statue on your far right, aptly named the “Majesty of Law,” a bundle of arrows in hand." Full Article Speech
deliv Associate Attorney General West Delivers Remarks at the Legal Services Corporation 40th Anniversary Kick-off Conference By www.justice.gov Published On :: Mon, 15 Sep 2014 15:25:55 EDT Thank you, John, not only for that kind introduction but also for your exemplary leadership as chair of the LSC Board. LSC really exemplifies that spirit Attorney General Robert Kennedy used to talk about – that as lawyers, we have an obligation to enlist our skills and ourselves in engagements that reach beyond the horizons of our parochial legal practices. And over the last five-and-a-half years I’ve served in this Administration, I’ve been fortunate to get to know John and LSC President Jim Sandman, and I know the movement for expanding access to justice in this country is better and stronger because they’re helping to lead this effort, so my thanks to them. Full Article Speech
deliv Deputy Attorney General Sally Quillian Yates Delivers Remarks at New York University School of Law Announcing New Policy on Individual Liability in Matters of Corporate Wrongdoing By www.justice.gov Published On :: Fri, 18 Dec 2015 11:45:41 EST Remarks as prepared for delivery Thank you, Professor [Jennifer] Arlen, for that kind introduction and for everything you and your colleagues have accomplished at NYU Full Article Speech
deliv Deputy Attorney General Sally Quillian Yates Delivers Remarks at American Banking Association and American Bar Association Money Laundering Enforcement Conference By www.justice.gov Published On :: Fri, 18 Dec 2015 11:45:40 EST Remarks as prepared for delivery Thank you, Buddy [Wilmer Parker], for that kind introduction Full Article Speech
deliv Who to tip and how much for doorstep deliveries during the COVID-19 pandemic By www.latimes.com Published On :: Fri, 8 May 2020 15:01:02 -0400 From cash and snacks to a verbal 'thank you,' there are options when it comes to showing your appreciation for delivery drivers. Full Article
deliv Oregon strip club now delivers food — and a dance on the side By www.nbcnews.com Published On :: Fri, 08 May 2020 19:06:00 GMT Lucky Devil's dancers put on a show in the parking lot when customers order takeout. Full Article
deliv Deliveroo’s Singapore GM departs, one quarter of employees in city-state laid off By www.dealstreetasia.com Published On :: Sun, 03 May 2020 08:26:52 +0000 It's SG growth & marketing director, Sarah Tan, will take over the reins as interim general manager. The post Deliveroo’s Singapore GM departs, one quarter of employees in city-state laid off appeared first on DealStreetAsia. Full Article Deliveroo Grab lalamove Siddharth Shanker Singapore
deliv S Korea’s grocery delivery startup Kurly nets $160m in Series E round By www.dealstreetasia.com Published On :: Fri, 08 May 2020 09:07:24 +0000 Kurly has to date raised a total of 420 billion won ($328 million). The post S Korea’s grocery delivery startup Kurly nets $160m in Series E round appeared first on DealStreetAsia. Full Article DST Global. Hillhouse Capital Kurly Sequoia Capital
deliv Natural polyphenol assisted delivery of single-strand oligonucleotides by cationic polymers By feeds.nature.com Published On :: 2020-05-04 Full Article
deliv Tumor-selective delivery of antisense oligomers (antimiRs) against oncogenic microRNAs By feeds.nature.com Published On :: 2014-12-18 miRNA-targeted antimiRs conjugated to a peptide with a low pH–induced transmembrane structure (pHLIP) could help treat solid tumors. Full Article
deliv Remaking urban transportation and service delivery By webfeeds.brookings.edu Published On :: Wed, 18 Dec 2019 05:01:29 +0000 Major changes are taking place in urban transportation and service delivery. There are shifts in car ownership, the development of ride-sharing services, investments in autonomous vehicles, the use of remote sensors for mobile applications, and changes in package and service delivery. New tools are being deployed to transport people, deliver products, and respond to a… Full Article
deliv Examining the financing and delivery of long-term care in the US By webfeeds.brookings.edu Published On :: Tue, 01 Mar 2016 10:15:00 -0500 Editor's note: On March 1, Alice Rivlin testified before the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Health on the financing and delivery of long-term care in the US. Chairman Pitts, Ranking Member Green: I am happy to be back before this Subcommittee, which is never afraid to take on complex issues of great importance to millions of Americans. I have worked on long-term services and supports (LTSS) for a long time and have recently had the privilege of co-chairing the Long-Term Care Initiative at the Bipartisan Policy Center (along with former Senators Bill Frist and Tom Daschle and former Governor and Secretary of Health and Human Services, Tommy Thompson). Our February 2016 report, Initial Recommendations to Improve the Financing of Long-Term Care, appended to my testimony, outlines a set of doable, practical changes in both public and private programs that could improve the availability and affordability of long-term services and supports. I don’t need to remind this committee that Americans are living longer, and many of us will need help with the ordinary activities of daily living and suffer cognitive impairments that make it dangerous for us to cope alone. The number of people needing LTSS is rising and expected to double in the next 35 years or so. Responsibility for LTSS is shared among seniors and people with disabilities themselves, family, friends, and volunteer care-givers; communities, state, and federal government. This shared-responsibility system is severely stressed, and will become increasingly unable to cope as the numbers needing care increase. Growing burdens fall on families, often daughters and daughters-in-law, who must manage daily conflicts between earning a living, caring for children, and meeting the needs of elderly or disabled relatives. Growth in Medicaid, the largest payer of long-term services and supports at about $123 billion per year, stresses state and federal budgets as spending for older Americans and individuals with disabilities competes with budgets for education and other investments in young people. Many efforts to find a comprehensive solution to long-term care financing have failed—evidenced by passage and subsequent repeal of the Community Living Assistance Services and Supports (CLASS) Act and failure of the federal Long-term Care Commission to reach consensus on financing recommendations. Recently, however, a growing consensus has emerged around a set of incremental steps, which, if taken together could greatly improve the availability and affordability of long-term services and supports to America’s most vulnerable populations and take some of the burden off families and Medicaid in a fiscally responsible way. In recent weeks, The Bipartisan Policy Center and The Long-term Care Collaborative have offered similar sets of recommendations, as has LeadingAge, a key provider association. While policymakers failed to agree on big legislative solutions, amazing progress has been made at the community level in finding new ways of keeping older Americans and people with disabilities out of institutions and in the community where they are happier and less isolated and can be served more effectively and cheaper. There has been an explosion of assisted living facilities, continuing care communities, senior villages, senior centers, senior daycare, and use of home health aides of various sorts. Growth in home and community-based services (HCBS) has been rapid, while the population served by traditional nursing homes has been virtually flat. Medicaid, with the support of both parties in Congress, has moved to increase the availability of home and community-based services. The group working on the Bipartisan Policy Center’s Long-Term Care Initiative addressed the question: Is there a set of practical policies that could command bipartisan support that would improve the care of older Americans with disabilities, take significant pressure off families and Medicaid, and not break the bank? We came up with four proposals. Make private long-term care insurance more affordable and available. Long term care ought to be an insurable risk. If more people bought Long-Term Care Insurance (LTCI) in their earning years, there would be less pressure on their savings and family resources and Medicaid when they became disabled. But both demand and supply of LTCI are weak and falling. Potential customers are reluctant to buy because it is costly and the need seems remote and hard to think about. Carriers find it difficult to price a product that will be used far in the future and fear losing money if customers live and use services for a long time. Many insurance companies have stopped offering LTCI. Our report recommends developing a new type of private insurance product: “retirement long-term care insurance,” which would cover long-term care for a limited period (2-4 years) after a substantial deductible or waiting period and would have coinsurance. The insurance would provide inflation protection, which helps to ensure benefits keep pace with the rising costs of care, and a non-forfeiture benefit, which allows lapsed policyholders to access a limited benefit. Employers would be encouraged to offer such policies as a default option as part of a retirement plan. These policies, if offered through employers and public and private insurance exchanges, could cut premiums in half according estimates done by Milliman, LLC, for the Bipartisan Policy Center and other organizations. Penalty-free withdrawals would be allowed from retirement plans, such as 401(k) plans and IRAs, beginning at age 45, exclusively for the purchase of retirement LTCI. Design a federal long-term care insurance option for those with catastrophic costs. Part of the reluctance of carriers to offer LTCI relates to the difficulty of predicting costs far in the future and the fact that a few policy holders may have extremely high costs for a very long time. A public program, covering truly catastrophic long-term care spending, could overcome this reluctance and reduce the cost of private LTCI. Catastrophic insurance, combined with retirement LTCI from the private market, could substantially relieve families and Medicaid. The cost of this program should be fully offset so as not to add to the deficit. Streamline Medicaid home and community-based care options to encourage more effective care in lower-cost settings. While Congress has been proactive in encouraging state Medicaid programs to shift care settings from institutions to home and community-based care, states continue to face a daunting federal waiver process and multiple state options. Securing waivers requires complex negotiations between states and the federal government, and each of the existing state options have disincentives. Home and community-based options should be simplified into a single streamlined state plan amendment process. Ensure that working people with disabilities in need of long-term services and supports do not lose access to their long-term services and supports as earnings increase. Individuals with modest employment incomes risk losing access to services that permit them to remain on the job. Existing Medicaid “buy-in” programs are often costly. Building on the “Achieving a Better Life Experience,” or “ABLE” Act, states could be given the option to offer a lower-cost, Medicaid buy-in for long-term services and supports designed to “wrap around” private health insurance or Medicare. Under this option, working individuals with disabilities would pay an income-related, sliding-scale premium. Mr. Chairman and members of the Committee, thank you again for the opportunity to share my thoughts on this issue. It is one of America’s big challenges, but it’s an even bigger opportunity for a constructive bipartisan policy process. I look forward to continued dialogue and will keep you apprised of forthcoming recommendations by BPC’s Long-Term Care Initiative in 2016 and 2017. Downloads Download Alice M. Rivlin's full testimony Authors Alice M. Rivlin Publication: U.S. House of Representatives Committee on Energy and Commerce Image Source: Kevin Lamarque Full Article
deliv Adapting approaches to deliver quality education in response to COVID-19 By webfeeds.brookings.edu Published On :: Thu, 23 Apr 2020 21:08:11 +0000 The world is adjusting to a new reality that was unimaginable three months ago. COVID-19 has altered every aspect of our lives, introducing abrupt changes to the way governments, businesses, and communities operate. A recent virtual summit of G-20 leaders underscored the changing times. The pandemic has impacted education systems around the world, forcing more… Full Article
deliv Higher power to deliver: The overlooked nexus between religion and development By webfeeds.brookings.edu Published On :: Tue, 25 Feb 2020 22:12:32 +0000 Why did some world-leading economists recently meet the Pope? It wasn’t, contrary to what one might think, to confess the sins of bad economic policy. Still, when such a meeting took place in early February, the conversation was serious. Invited by Pope Francis, thought leaders and decisionmakers in economics and global finance gathered for a… Full Article
deliv Emphasis on dialogue over deliverables at the U.S.-China S&ED By webfeeds.brookings.edu Published On :: Wed, 01 Jun 2016 09:00:00 -0400 The eighth and final Strategic and Economic Dialogue (S&ED) of the Obama administration will take place in Beijing next week. On the economic side, it will be difficult this year to make progress on specific outcomes; but it’s an important year for having a frank conversation about macroeconomic and financial policies. One reason that it will be hard to get specific outcomes is that the Chinese leadership has shown that economic reform doesn’t rank very high on its list of priorities. After laying out an ambitious reform agenda in its Third Plenum resolution in 2013, implementation of reform has been slow, except in some aspects of financial reform. Recent speeches have emphasized the need to close zombie firms and clean up non-performing loans in the banking system, but specific plans have been modest. In terms of the agenda between China and the United States, the most important issue is negotiating a Bilateral Investment Treaty (BIT). Many important sectors are still closed to inward direct investment in China. It would help China’s transition to a new growth model to open up these sectors to competition and to private investment, and a BIT is a smart way to commit to these reforms. However, China has been slow to produce a credible offer on the BIT because enterprises and ministries with vested interests have opposed opening up and the leadership is apparently not willing to take them on. Another factor affecting this S&ED is that it is the last for the Obama administration. I would argue that this is a good time for China and the United States to demonstrate that regular, high-level exchange produces results, increasing the likelihood that whatever administration comes next will want to maintain something similar. However, it is more likely that Chinese leaders will want to wait and see what administration they will be dealing with and to save deliverables for those future negotiations. S&ED is an opportunity for the top economic officials in the two countries to frankly discuss their policy choices and to avoid mistakes that can come from miscommunication. My experience with the first four S&EDs was that the conversation was more important than the deliverables, which have often been modest, incremental steps. This year, China will be very interested in hearing what the Federal Reserve thinks. May labor market data will be published on June 3, just in advance of the S&ED, so there may be more clarity about when the Fed is likely to raise interest rates. Regardless of when the Fed moves, both China and the United States have an interest in seeing a relatively stable exchange rate for the yuan. China’s central bank officials have emphasized that the country still has a large current account surplus, so depreciation of the trade-weighted exchange rate is not warranted. Depreciation would exacerbate imbalances and would work against the transformation of China’s growth model because it favors industry at the expense of services. But if the Fed continues to normalize interest rates and the dollar rises against other major currencies, China does not want to follow the dollar up. Hence, its emphasis on stable value of the currency relative to a basket. S&ED is an opportunity for the top economic officials in the two countries to frankly discuss their policy choices and to avoid mistakes that can come from miscommunication. The most important outcome of the S&ED may well be avoidance of policy mistakes, a subtle outcome that will not be reflected in headlines. Authors David Dollar Full Article
deliv Adapting approaches to deliver quality education in response to COVID-19 By webfeeds.brookings.edu Published On :: Thu, 23 Apr 2020 21:08:11 +0000 The world is adjusting to a new reality that was unimaginable three months ago. COVID-19 has altered every aspect of our lives, introducing abrupt changes to the way governments, businesses, and communities operate. A recent virtual summit of G-20 leaders underscored the changing times. The pandemic has impacted education systems around the world, forcing more… Full Article
deliv Higher power to deliver: The overlooked nexus between religion and development By webfeeds.brookings.edu Published On :: Tue, 25 Feb 2020 22:12:32 +0000 Why did some world-leading economists recently meet the Pope? It wasn’t, contrary to what one might think, to confess the sins of bad economic policy. Still, when such a meeting took place in early February, the conversation was serious. Invited by Pope Francis, thought leaders and decisionmakers in economics and global finance gathered for a… Full Article
deliv Delivering Tough Love to Ukraine, Georgia By webfeeds.brookings.edu Published On :: Fri, 24 Jul 2009 12:00:00 -0400 Steven Pifer joined Bernard Gwertzman to discuss Vice President Joseph Biden's recent trip to Ukraine and Georgia and how it was meant to balance President Barack Obama's Moscow summit earlier in the month. Bernard Gwertzman: Vice President Joseph Biden has just completed a trip to Ukraine and Georgia to reassure both of those former Soviet republics that the American desire to "reset" relations--Biden's words in Munich last February--with Russia were not meant at their expense. But he also had what one Biden aide called "tough love" for both of them. Could you elaborate on this trip? Steven Pifer: That was the first point of the trip: to reassure Kiev and Tbilisi that the United States remains interested in robust relations with Ukraine and Georgia, and that we will work to keep open their pathways to Europe and the North Atlantic community. When I was in Ukraine about five or six weeks ago, what I heard from the Ukrainians was a concern--and I suspect there is a parallel concern in Georgia--that the effort to reset relations with Russia would somehow come at Ukraine's expense. So part of the trip by the vice president was to assure both Ukraine and Georgia that the United States is not going to undercut relations with those two countries as it tries to develop relations with Russia. You've seen points made by this administration, indeed going back to the Munich speech itself, saying the reset of relations would not mean recognition of a Russian "sphere of influence" over the former Soviet states, and then repeated assurances that the United States supports the rights of countries such as Ukraine and Georgia as sovereign states to choose their own foreign policy course. Gwertzman: What was also interesting to me was that in his speech in Ukraine, Biden was virtually demanding that the Ukrainian leadership get their act together. In Georgia, I don't think he was publicly as tough. Can you elaborate on the "tough love" part of the visits? Pifer: Let me start with Ukraine. Certainly the primary goal of the visit was to reassure Ukraine, but there was also a tough message there. In Ukraine, it's not only due to the presidential election, but you've had a situation in the past year and a half where the government really hasn't functioned because of infighting between President Viktor Yushchenko and Prime Minister Yulia Tymoshenko. It's meant that Ukraine has passed up opportunities to accomplish some important things. A big part of the vice president's message in Kiev was to say, "You need to put aside political differences, come together as mature political leaders, find compromises, and get things done." He also singled out the importance of Ukraine getting serious about reforming its energy sector. This is a huge national security vulnerability for Ukraine because they have a distorted price structure where people buy natural gas at prices that don't begin to cover the cost of the gas that Ukraine buys from Russia. As a result, Naftogaz, the national gas company, is perpetually in debt to Russia and on the verge of bankruptcy. That creates vulnerabilities for Ukraine. Part of the vice president's message was, "You need to get serious about this." Part of the problem in Ukraine is if you are a household, you are probably paying a price that amounts to less than 30 percent of the actual cost of the gas bought from Russia. It's no wonder why Naftogaz is always in financial straits. But it's not just an economic problem because of the way it factors into the Ukraine-Russia relationship. It creates a national security issue for Ukraine. So there are two aspects to the tough message: One, the need for political leaders to get together, compromise, and produce good policy; and second, the special importance of tackling this energy security issue. Read the full interview » (external link) Authors Steven Pifer Publication: Council on Foreign Relations Full Article
deliv Payment and Delivery Reform Case Study: Cancer Care By webfeeds.brookings.edu Published On :: Mon, 07 Jul 2014 09:52:00 -0400 Editor’s note: This post is adapted from a forthcoming full-length case study; the second in a series from the Engelberg Center’s Merkin Initiative on Physician Payment Reform and Clinical Leadership designed to support clinician leadership of health care delivery, payment, and financing reform. The case study will be presented during the Merkin Initiative’s “MEDTalk” event on July 9 from 10:30 AM to 12:30 PM EDT, featuring live story-telling and knowledge-sharing from patients, providers, and policymakers. Oncology practices and hospitals across the nation struggle with providing sustainable, comprehensive, and coordinated cancer care. Clinical leaders with strategies and models to improve the quality and value of health care often don’t know how to navigate the landscape of payment and delivery reform options to sustain their innovations. We use a case study approach to investigate and tell the story of the New Mexico Cancer Center (NMCC), an independent cancer center that is experimenting with innovative ways to improve patient-centered oncology care. We identify challenges for creating sustainable and supportive payments models, and we share the broader strategic and policy lessons for adopting alternative payment models. The Clinical Scenario: Living With Cancer Vicky Bolton, a 58-year-old full-time medical legal coordinator from Albuquerque, has stage 4 adenocarcinoma lung cancer. She started chemotherapy in 2003 and has consistently received treatments over the last 11 years. Vicky is one of 13 million Americans currently living with cancer, with more than 1.6 million new diagnoses added each year. Although Vicky’s condition is currently stable, she is at high risk for venous thrombosis (blood clots), life-threatening infections, and other complications, which put her at high risk for repeated hospitalizations. In the past six months, she has taken advantage of “after hours” care on three occasions as an outpatient at NMCC. Fortunately, each of her providers and services — oncology, radiation therapy, labs, x-rays, and internal medicine — are centralized in a single location at NMCC, reducing the need for emergency room (ER) visits or hospitalizations for these episodes. The Challenge: Controlling Spending While Improving Patient-Centered Care Cancer is the second leading cause of death in the U.S. Forty-one percent of Americans will be diagnosed with cancer during their lives. Cancer care is also expensive, accounting for $125 billion of total health care spending annually. In 2011, Medicare alone spent nearly $35 billion in fee-for-service (FFS) payments for cancer care, representing 9 percent of all Medicare FFS payments. The high costs of cancer care are driven by issues that plague the entire health system: uncoordinated care delivery, duplication of services, fragmentation, and volume-based payments. A common impact of these drivers in oncology is the use of the ER to relieve symptoms associated with adverse effects of chemotherapy or other treatments that can also result in hospitalization. For example, research shows that the most common reasons for cancer patient ER admissions are pain, respiratory distress, nausea, and vomiting. More than half of the ER visits occurred on weekends or in the evening, and over 60 percent resulted in hospital admission. This suggests that if a patient’s symptoms could be managed at home or in the community, costly hospital admissions could be avoided. ER visits, where patients are exposed to germs and infections as they wait — often hours — to be admitted, can have catastrophic outcomes for patients that are actively in treatment since they have weakened immune systems and are more prone to infections. In addition to the inherent issues with fee-for-service (FFS) payments — with payments incentivizing volume of procedures rather than the value of care delivered — the current payment system further exacerbates problems: If a practice provides higher-value care to patients at a lower cost to the overall system (that is, they perform fewer services and have lower revenue), the financial winner is the payer who reimburses fewer services, not the practice (which merely has less revenue). This combination of the misaligned incentives of FFS and the lack of financial benefit for improving care while reducing costs means that many practices simply cannot afford to make the transformations needed without other funding mechanisms. The Real World: How Has An Independent Cancer Center Responded To These Challenges? NMCC delivers care to roughly 2,700 patients and provides care to one in three New Mexicans with cancer. The changes that the center has made have focused on reducing the impact of fragmentation of care on their patients (Table 1). A key innovation was enhancing comprehensive after-hours and weekend care on site and creating a telephone and urgent care triage program to avoid expensive emergency room and inpatient care, which NMCC termed the COME HOME model. As part of its redesign process in 2012, NMCC – along with six community oncology practices — secured a $20 million Center for Medicare and Medicaid Innovation (CMMI) Health Care Innovation Award (HCIA), for a three-year period. The award has an explicit aim of reducing ER visits by 50 percent and hospitalizations by 20 percent to justify the program costs. Table 1: Care Redesign Elements Undertaken by NMCC The Key Levers: How Can COME HOME Be Sustained? On the heels of the Affordable Care Act (ACA) and numerous quality and payment focused initiatives in the private sector, health care organizations need to enhance the competitiveness and efficiency of their systems in the marketplace. Alternative payment models (APMs) such as Accountable Care Organizations (ACOs), bundled payments, and patient-centered oncology medical homes (PCOMH) are just a few of the initiatives supported by public and private payers to align care redesign and payment reform and encourage continuous improvement. (Clinical pathways, a strategy recently embraced by WellPoint, offer PCOMH-like incentives to encourage adherence to practice guidelines, a strategy primarily geared to encourage higher-value chemotherapy practice.) Broader or larger case-based payments may also provide stronger incentives to limit costs, to help assure that promising delivery reforms actually lead to cost reduction, but this exposes oncologists to greater levels of financial risk, as shown in Table 2. Consequently, implementing payment reforms that are viewed as feasible and desirable by both providers and payers is difficult. Table 2: Comparison of Alternative Payment Models for Oncology The Path Ahead: How Can These Models Assist NMCC? NMCC currently receives approximately $70,000 per month from the CMMI grant and has not yet identified a clear strategy to sustain the delivery reforms in the COME HOME care model past the end of the grant (July 2015). As for payment reform options, NMCC has been unable to contract as part of a comprehensive ACO due to local health care market conditions. Clinical pathways are geared primarily to guidelines and chemotherapy adherence, and are not designed to provide funding for after-hours care or triage programs that are intended to achieve offsetting savings through avoiding costly complications. Possible remaining options include: PCOMH: Using the data it gathers, NMCC intends to quantify the additional costs the COME HOME model requires, and the savings that it achieves. Based on that estimate, NMCC could suggest a per-member per-month (PMPM) payment from a private insurer to cover the costs of providing higher quality care. To encourage participation, NMCC could also enter into a risk-sharing agreement, in which overall costs of inpatient care and ER visits would be compared against a target. The PMPM payment could be at-risk if the targets are not achieved after a certain period of time. Bundled Payments: NMCC could potentially use the medical home approach with risk sharing (described above) as a first, interim step toward a bundled payment system, NMCC’s long-term preferred model. Computing actuarially sound expected costs for the bundled payments would require merging claims data with clinical data (for example, ICD-9 codes fail to distinguish between subtypes of breast cancer that have radically different treatments). A bundled payment pilot might be performed for high volume cancers, such as breast and lung. Lessons Learned The experience of innovative pioneers like NMCC can shed some light on potential barriers to conceptualizing and implementing sustainable clinical redesign. The lessons learned have been sorted into three main categories: relationships with payers and networks, payment model selection, and data collection and quality improvement considerations. Relationships with payers and networks. Though counterintuitive, merely demonstrating significant value from care design, perhaps from lower utilization of inpatient and emergency department utilization, does not automatically create a financial pathway for sustainable delivery reform. To do so, innovative providers should consider involving lead payer partners early on to help identify end-points of interest to payers and potential payment strategies that may emerge later. Providing support for health care delivery reforms requires new activities by payers towards aligning their payments with value, rather than volume and intensity of services. However, fragmented health care markets face the challenge of the “free rider” problem: payers may be unwilling to shoulder delivery transformation costs that may benefit other payers’ clients while they wait for CMS or others to make the financial investment, pay for the program evaluation, and enact policy change). Other challenges include payer inertia and long lag times between care redesign and subsequent data demonstrating results. Large ACOs and other integrated payer-provider plans, including those large enough to form Medicare Advantage plans, are moving forward on negotiating payment and delivery reforms. This may be more difficult for innovative, smaller practices, even if they can provide higher-value clinical services. In turn, this may have anti-competitive consequences, such as discouraging delivery innovation that leads to “demand destruction” of high-cost hospital-based services. Private and public payers should be particularly interested in developing models that enable smaller, specialized providers like oncology practices to undertake key delivery reforms. Sustainable Payment Model Selection. While substantial attention has been paid to primary care focused APMs, specialty-focused APMs are needed for practices like NMCC. Their development should be a high priority for public and private payers. Clinical transformation grants, such as those offered by CMMI, should include clear pathways for transitioning to APMs if initial cost savings targets or projections are met. Otherwise, delivery system innovations are at high risk of failure despite evidence of improved value. Data Collection and Quality Improvement Considerations. Timely sharing of actionable information from claims and other administrative data remains a major challenge, with complex and varied procedures for obtaining claims from payers; smaller practices are particularly challenged in interpreting the claims data. Some states, such as Maryland, Massachusetts, Vermont, and Colorado (among others) are proceeding with creating all-payer claims databases. (Maryland, for example, offers almost instantaneous provider feedback from claims through their CRISP database.) Others, such as Minnesota, are using “distributed” approaches in which multiple payers and systems produce measures in consistent ways. As NMCC’s early efforts illustrate, practices can produce more clinically sophisticated performance measures. Strategies to achieve consistent methods for sharing key data on cost and quality need to be expanded to encourage quality improvement and payment reform. Authors Mark B. McClellanDarshak SanghaviKavita PatelKate Samuels Publication: Health Affairs Blog Image Source: © Jim Young / Reuters Full Article
deliv Can the Republicans deliver affordable health coverage? By webfeeds.brookings.edu Published On :: Wed, 12 Apr 2017 16:57:15 +0000 Is it really possible to provide market-based health coverage to all working Americans? Or is some form of public plan the only way to assure affordable coverage, as many liberals insist? The House replacement for the Affordable Care Act (ACA), or Obamacare, foundered in large part because Republicans could not agree on fundamental design issues… Full Article
deliv Remaking urban transportation and service delivery By webfeeds.brookings.edu Published On :: Wed, 18 Dec 2019 05:01:29 +0000 Major changes are taking place in urban transportation and service delivery. There are shifts in car ownership, the development of ride-sharing services, investments in autonomous vehicles, the use of remote sensors for mobile applications, and changes in package and service delivery. New tools are being deployed to transport people, deliver products, and respond to a… Full Article
deliv LA Residents Get Fresh Food Delivered by Bike to Their Doorstep By www.treehugger.com Published On :: Sun, 11 Dec 2011 11:00:00 -0500 LA Whole Foods shoppers now can have concierge-shopped groceries delivered to their door via solar powered electric bikes Full Article Living
deliv FedEx to test Nissan's electric e-NV200 delivery van in Washington DC area By www.treehugger.com Published On :: Thu, 23 Jan 2014 16:10:53 -0500 After pilot programs in international markets like Japan, Singapore, the United Kingdom and Brazil, FedEx will deploy a fleet of electric delivery vans in Washington DC. Full Article Transportation
deliv Will autonomous delivery robots soon be pushing pedestrians off the sidewalks? By www.treehugger.com Published On :: Thu, 07 Jul 2016 12:06:02 -0400 Nobody is actually asking the question, because pedestrians don't matter, do they? Full Article Transportation
deliv Photo: American pika delivers a spring bouquet By www.treehugger.com Published On :: Thu, 19 Mar 2020 06:00:00 -0400 Our photo of the day comes from Kananaskis, Canada. Full Article Science
deliv Something Old, Something New, Something Borrowed, Something...Green? Ritz-Carlton, Charlotte Delivers Eco-Friendly Weddings By www.treehugger.com Published On :: Tue, 19 Jan 2010 09:36:41 -0500 As more eco-conscious couples take their walk down the aisle, a growing green wedding industry has responded in kind. Enter "Something Green," a new service introduced by The Ritz-Carlton, Charlotte. "We are constantly looking for Full Article Business
deliv Even mail without an address gets delivered in Ireland By www.treehugger.com Published On :: Thu, 08 Mar 2018 15:27:36 -0500 In which snail mail provides a lesson in the loveliness of slow living. Full Article Living
deliv The Best Of TreeHugger Delivered To Your Inbox Daily or Weekly By www.treehugger.com Published On :: Fri, 20 May 2011 15:30:44 -0400 Is keeping up with TreeHugger too much work? Let us help with our newsletters. We have a daily, edited by me, and a weekly, edited by Warren McLaren. Today I muse about how Amazon is Now Selling More Digital Kindle Books Than Print Books. Have a look Full Article TreeHugger Exclusives