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In the Republican Party establishment, Trump finds tepid support

For the past three years the Republican Party leadership have stood by the president through thick and thin. Previous harsh critics and opponents in the race for the Republican nomination like Senator Lindsey Graham and Senator Ted Cruz fell in line, declining to say anything negative about the president even while, at times, taking action…

       




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Health Policy Issue Brief: How to Improve the Medicare Accountable Care Organization (ACO) Program


Contributors: Alice M. Rivlin and Christine Dang-Vu

Recent data suggest that Accountable Care Organizations (ACOs) are improving important aspects of care and some are achieving early cost savings, but there is a long way to go. Not all ACOs will be successful at meeting the quality and cost aims of accountable care. The private sector has to date allowed more flexibility in terms of varying risk arrangements—there are now over 250 accountable care arrangements with private payers in all parts of the country—with notable success in some cases, particularly in ACOs that have been able to move farther away from fee-for-service payments. Future growth of the Medicare ACO program will depend on providers having the incentives to become an ACO and the flexibility to assume different levels of risk, ranging from exclusively upside arrangements to partial or fully capitated payment models.

Given that the first three year cycle of Medicare ACOs ends in 2015 and more providers will be entering accountable care in the coming years, the Centers for Medicare and Medicaid Services (CMS) has indicated that they intend to release a Notice of Proposed Rulemaking (NPRM) affecting the Medicare ACO program.

In anticipation of these coming changes, the Engelberg Center for Health Care Reform has identified the "Top Eight ACO Challenges" that warrant further discussion and considerations for ensuring the continued success of ACOs across the country. To support that discussion, we also present some potential alternatives to current Medicare policies that address these concerns. These findings build on the experiences of the Engelberg Center’s ACO Learning Network members and other stakeholders implementing accountable care across the country.  In some cases, the alternatives might have short-term costs, but could also improve the predictability and feasibility of Medicare ACOs, potentially leading to bigger impacts on improving care and reducing costs over time.  In other cases, the alternatives could lead to more savings even in the short term. In every case, thoughtful discussion and debate about these issues will help lead to a more effective Medicare ACO program.

Top Eight ACO Challenges

1. Make technical adjustments to benchmarks and payments
2. Transition to more person-based payments
3. Increase beneficiary engagement
4. Enhance and improve alignment of performance measures
5. Enable better and more consistent supporting data
6. Link to additional value-based payment reforms
7. Develop bonus payments and other incentives to participate
8. Support clinical transformation

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The State of Accountable Care: Evidence to Date and Next Steps

Event Information

October 20, 2014
9:00 AM - 12:30 PM EDT

Falk Auditorium
Brookings Institution
1775 Massachusetts Avenue, N.W.
Washington, DC 20036

Register for the Event

Over the past few years, more than 600 Accountable Care Organizations (ACOs) have formed across the country, charged with the dual goals of improving health while also reducing health care costs. Increasingly, evidence on how public and private ACOs are progressing toward these goals is beginning to emerge. Based on these results, major regulatory changes are anticipated in the months ahead that will impact accountable care programs in Medicare, as well as future uptake within the private sector.

On October 20, the Engelberg Center for Health Care Reform hosted a half day forum to assess the latest evidence on accountable care, discuss strategies to overcome unique ACO challenges, and provide an overview of accountable care reforms. Sean Cavanaugh of the Centers for Medicare and Medicaid Services (CMS) provided keynote remarks on the latest Medicare ACO results and potential changes to the Medicare Shared Savings Program (MSSP). Panel sessions featured leading experts in ACO research, implementation and health care policy.

 Join the conversation on Twitter using #ACOFuture or follow @BrookingsMed

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Turkey’s unpalatable choices in Syria

Syria’s northwestern province of Idlib is experiencing a deepening humanitarian crisis. As the Russia-backed Syrian regime pushes to retake this last major enclave of the Syrian opposition, hundreds of thousands of people have fled towards Turkey’s borders. According to the United Nations, 700,000 people have fled Idlib since December 1. As the main backer of…

       




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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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In the Republican Party establishment, Trump finds tepid support

For the past three years the Republican Party leadership have stood by the president through thick and thin. Previous harsh critics and opponents in the race for the Republican nomination like Senator Lindsey Graham and Senator Ted Cruz fell in line, declining to say anything negative about the president even while, at times, taking action…

       




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Unpredictable and uninsured: The challenging labor market experiences of nontraditional workers

As a result of the COVID-19 pandemic, the U.S. labor market has deteriorated from a position of relative strength into an extraordinarily weak condition in just a matter of weeks. Yet even in times of relative strength, millions of Americans struggle in the labor market, and although it is still early in the current downturn,…

       




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Macri’s macro: The meandering road to stability and growth

Summary Federico Sturzenegger reviews the various macroeconomic stabilization programs implemented under the Macri presidency, seeking to shed light on what went wrong and what monetary and fiscal policy lessons can be learned from the experience in Argentina. Citation Sturzenegger, Federico. 2019. "Macri's Macro: The meandering road to stability and growth" BPEA Conference Draft, Fall. Conflict…

       




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(De)stabilizing the ACA’s individual market: A view from the states

The Affordable Care Act (ACA), through the individual health insurance markets, provided coverage for millions of Americans who could not get health insurance coverage through their employer or public programs. However, recent actions taken by the federal government, including Congress’s repeal of the individual mandate penalty, have led to uncertainty about market conditions for 2019.…

       




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From strong men to strong institutions: An assessment of Africa’s transition towards more political contestability

As President Obama said during his recent address at the African Union, "There's a lot that I'd like to do to keep America moving. But the law is the law, and no person is above the law, not even the president." This sentence, uttered during his speech to the African Union last month, summarizes President…

      
 
 




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The U.S.-ROK alliance: Projecting U.S. power and preserving stability in Northeast Asia

The powerful deterrent provided by the U.S.-Republic of Korea (ROK) security alliance has kept the peace on the Korean Peninsula for over 63 years. Today, with the rising threat of a nuclear-armed, aggressive North Korea, growing friction in U.S.-China relations, and rapidly changing security dynamics in the Asia-Pacific region, the U.S.-ROK security alliance is more […]

      
 
 




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Unpredictable and uninsured: The challenging labor market experiences of nontraditional workers

As a result of the COVID-19 pandemic, the U.S. labor market has deteriorated from a position of relative strength into an extraordinarily weak condition in just a matter of weeks. Yet even in times of relative strength, millions of Americans struggle in the labor market, and although it is still early in the current downturn,…

       




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In the Republican Party establishment, Trump finds tepid support

For the past three years the Republican Party leadership have stood by the president through thick and thin. Previous harsh critics and opponents in the race for the Republican nomination like Senator Lindsey Graham and Senator Ted Cruz fell in line, declining to say anything negative about the president even while, at times, taking action…

       




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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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The Senate Trial Will Be Totally Predictable—With One Potential for Surprise

       




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Why authorizations of force against terrorists are inevitably troubled

The draft that the Obama administration submitted to Congress to authorize the use of military force against ISIS seems to be pleasing almost no one, and that was bound to be. Some of the strongest early criticism is coming from doves, including people who support Mr. Obama on most other issues, but hawks are complaining…

      
 
 




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Judiciary in the 21st century: Ideas for promoting ethics, accountability, and transparency

On June 21, 2019, Brookings Vising Fellow Russell Wheeler testified at a hearing of the House of Representatives Judiciary Subcommittee on Courts, Intellectual Property, and the Internet. Wheeler argued in his testimony and response to members’ questions that: 1.  The U.S. Supreme Court should create a code of conduct to serve, as does the Code…

       




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Internal Displacement and Development Agendas: A Roundtable Discussion with Sadako Ogata


Event Information

May 14, 2013
9:00 AM - 10:30 AM EDT

St. Louis Room
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

Around the world today, there are more than 15.5 million refugees and over 28.8 million internally displaced persons (IDPs) uprooted by conflict, in addition to some 32.4 million displaced in 2012 from their homes due to natural disasters. These displacement crises are not simply humanitarian concerns, but fundamental development challenges. Forced migration flows are rooted in development failures, and can undermine the pursuit of development goals at local, national and regional levels.

Linking humanitarian responses to displacement with longer-term development support and planning is not a new concern. Beginning in 1999, for example, the “Brookings Process” – under the leadership of Sadako Ogata and James Wolfensohn – sought to bridge humanitarian relief and development assistance in post-conflict situations. But the challenge remains unresolved, and has acquired new urgency as displacement situations are becoming more protracted, and situations such as the Syrian crisis show no signs of resolution.

The Brookings Global Economy and Development Program and the Brookings-LSE Project on Internal Displacement held a roundtable on these issues on May 14, 2013 with Sadako Ogata, former UN High Commissioner for Refugees, former Director of the Japanese International Cooperation Agency, and Distinguished Fellow at the Brookings Institution. Megan Bradley, Fellow with the Brookings-LSE Project on Internal Displacement, facilitated the roundtable, which followed Chatham House rules.

The roundtable addressed several key topics including:

  • The relevance of the concept of human security to addressing displacement and development challenges
  • Displacement as a development challenge in fragile states
  • Protracted displacement
  • Contrasts in the approaches and processes adopted by humanitarian and development actors

The event report provides a brief overview of the discussion.

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The Inequitable Impact of Health Shocks on the Uninsured in Namibia


ABSTRACT

The AIDS pandemic in sub-Saharan Africa puts increasing pressure on the buffer capacity of low- and middle-income households without access to health insurance. This paper examines the relationship between health shocks, insurance status and health-seeking behaviour. It also investigates the possible mitigating effects of insurance on income loss and out-of-pocket health expenditure. The study uses a unique dataset based on a random sample of 1769 households and 7343 individuals living in the Greater Windhoek area in Namibia. The survey includes medical testing for HIV infection which allows for the explicit analysis of HIV-related health shocks. We find that the economic consequences of health shocks can be severe for uninsured households even in a country with a relatively well-developed public health care system such as Namibia. The uninsured resort to a variety of coping strategies to deal with the high medical expenses and reductions in income, such as selling assets, taking up credit or receiving financial support from relatives and friends. As HIV-infected individuals increasingly develop AIDS, this will put substantial pressure on the public health care system as well as social support networks. Evidence suggests that private insurance, currently unaffordable to the poor, protects households from the most severe consequences of health shocks.

Read the full article on Oxford Journals »

Publication: Oxford Journals
Image Source: © Kevin Lamarque / Reuters
      
 
 




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Using extractive industry data to fight inequality & strengthen accountability: Victories, lessons, future directions for Africa

With the goal of improving the management of oil, gas, and mineral revenues, curbing corruption, and fighting inequality, African countries—like Ghana, Kenya, Guinea, and Liberia—are stepping up their efforts to support good governance in resource-dependent countries. Long-fought-for gains in transparency—including from initiatives like the Extractive Industries Transparency Initiative (EITI)—have helped civil society and other accountability…

       




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Can the financial sector promote growth and stability?


Event Information

June 8, 2015
8:30 AM - 2:00 PM EDT

Saul/Zilkha Rooms
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

Register for the Event

The financial sector has undergone major changes in response to the Great Recession and post-crisis regulatory reform, as a result of the Dodd-Frank Act and Basel III. These changes have created serious questions about the sector’s role in supporting economic growth and how it affects financial and overall economic stability.

On June 8, the Initiative on Business and Public Policy at Brookings explored the intersection of the financial system and economic growth with the goal of informing the public policy debate. The event featured a keynote address by Richard Berner, director of the Office of Financial Research and other participants with a wide range of views from a variety of backgrounds. Among other issues, the experts considered the changing landscape of the financial sector; growth-promoting allocation and investment decisions; credit availability for low- and moderate-income households; the ideal balance between growth and stability; and the impact of the 2014 midterm elections on regulatory reform.

 Follow the conversation at @BrookingsEcon or #Finance.

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The future of school accountability under ESSA

With the Every Student Succeeds Act (ESSA) replacing No Child Left Behind as the new federal education law, states have gained greater freedom to personalize their education policies. ESSA’s promise of decentralization is a victory for state education leaders, but also transfers to them the responsibility of ensuring that school systems are held accountable. During…

       




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FRANCE - 1 Euro = 1.325 U.S. Dollars: The Surprising Stability of the Euro

Publication: Think Tank 20: New Challenges for the Global Economy, New Uncertainties for the G-20
      
 
 




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Danish climate movement taken over by the establishment

This article was written before the COVID-19 pandemic resulted in lockdowns throughout the world, including Denmark. However, the points it raises about the co-option of the climate movement by the forces of the establishment remain unchanged – and are all the more relevant given the global health emergency posed by COVID-19.




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Lucirmás Turns Single Wine Bottles into 3-Piece Table Sets

Spanish company Lucirmás debuts Pure-Bottle, a fully recycled and recyclable table set which consists of a glass, lantern and spoon.




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Eco Wine Review: Hahn SLH Estate 2010 Chef's Table Viognier

Hahn SLH Estate's 2010 Chef's Table Viognier is one of the most interesting whites you'll ever smell. It's completely intoxicating with notes of white peach, banana, honeydew and jasmine. Only 100 cases were made, so get this one quickly!




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Tiny 355 sq. ft. micro-apartment is expanded with adaptable mini-loft

A small apartment gets enlarged by knocking some walls down and adding a multi-functional staircase and mini-loft.




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10 Amazing MRI Stills of Fruits and Vegetables

Check out these amazing MRI images of our favorite fruits and vegetables.




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How to freeze summer vegetables

There’s no need to resort to insipid produce from across the globe once the local growing season has ended.




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How big business can drive vegetable consumption

Forty companies just pledged to do their part to serve more veggies, helping the environment in the process.




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UPP fuel cell gadget charger: Personal portable power from hydrogen (Review)

This small hydrogen fuel cell charger promises a week of clean power for your gadgets. But is it ready for prime time?




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On Parentables: Christine the Chemist Explains The Problems With PVC And Vinyl

Should the stuff be kept away from kids? The American Public Health Association thinks so.




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It's not womens' metabolism that keeps them cool in the office; it's the men in suits.

And Steven M. Johnson has the answer to the problem.




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Endangered Species List on the Periodic Table?

It sounds ridiculous: how could an element on the periodic table be an endangered species? The scientist, James Elser of Arizona State University, who is asking if we need a 'Red List' for phosphorous uses the




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From toilet to table: Peecycling research at U of M investigates urine as fertilizer

Could human urine be used on a commercial scale to fertilize the food we eat?




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Madrid co-working space is an adaptable playground for grown-ups

This flexible interior design for a collaborative workspace has plenty of hammocks and giant exercise balls to keep its co-working members happy.




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Modular Drop Box is a prefab portable suite for stays in nature

This compact, wood-clad cabin is made as a comfortable eco-hotel suite in natural settings.




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ETSY Employees Haul 600lb of Compostables Each Month By Bike

Taking responsibility for their own waste, ETSY team members haul biodegradable trash to their local community farm by cargo bike.




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Allbirds' woolen running shoe is said to be most comfortable in the world

Wool is an ideal material for footwear, with its odor-reducing and moisture-wicking properties, so why hasn't it caught on?




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Spot the retractable stair in this brilliant tiny house (Video)

This modern home is chock full of clever space-maximizing ideas.




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'Nude shopping' boosts vegetable and fruit sales dramatically

When a New Zealand supermarket chain ditched plastic packaging, produce sales skyrocketed.




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Florida lifts ban on front-yard vegetable gardens

One couple's infamous battle over the right to grow vegetables has resulted in a new bill.




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"As If From Nowhere" Hides Table and Chairs In Plain Sight

Designer Orla Reynolds Designs a Bookcase Like a Stage Set for Small Spaces




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Aluminum Lume travel trailer sports retractable roof for stargazing (Video)

This stylish and durable trailer looks like a cross between a mini-Airstream and a horse trailer, and has a kitchen in the back.




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Eating off the floor: Modern Paris apartment's floor becomes the dining table

It gives another meaning to 'eating off the floor.'




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From table to tank: Neste will turn Finland's Christmas ham waste fat into renewable diesel

Just think what the waste fat from 46 million Thanksgiving turkeys could fuel.




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This portable standing desk is lighter than your laptop

For people like me who work all over the place, portable standing desks can be pretty useful




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New study confirms that adjustable standing desks make you happier, healthier and more productive

Because people gotta move.




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New York State lawmakers want to ban walking with portable electronic devices

There are all kinds of distracted and compromised people in our roads. Some of them cannot help it. So why are phones a problem?




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Stadium in Qatar is demountable and relocatable and even has shipping containers

It makes a lot of sense in a country with no workers and five other permanent stadia.