Instruction: create a high quality summary of the given input

Input:
Total buys 23% stake in renewable energy company Eren
 French oil and gas group Total SA (EPA:FP) has agreed to acquire a 23% indirect stake in compatriot company EREN Renewable Energy (EREN RE) as it steps up its push into renewables.

Total will take the stake by subscribing to a EUR-237.5-million (USD 284.9m) capital increase that will help EREN RE speed up its business in the coming years. The renewables firm currently has 650 MW of wind, solar and hydro capacity in operation or under construction globally and aims to reach more than 3 GW within five years. It is developing a number of projects in Asia-Pacific, Africa and Latin America.

The deal includes an option for Total to take over control of EREN RE after five years. Following completion, which is subject to approval from competition regulators, EREN RE will be renamed Total Eren.

Philippe Sauquet, President Gas, Renewables and Power, said the EREN RE investment will allow Total to accelerate its growth in solar energy and enter the wind power market, as well as help it reach its goal of achieving 5 GW of installed capacity in five years.

Total is the majority owner of US solar company SunPower (NASDAQ:SPWR) and this year set up Total Solar to develop solar power plants in developed countries and distributed solar systems for industrial and commercial customers. Development of EREN RE's solar farm business will be mainly focused on emerging countries where electricity demand is growing, according to today's joint statement from the companies.

"In line with the Group's integrated strategy along the oil and gas value chains, we are rebalancing our portfolio in renewables between the upstream manufacturing with SunPower and the downstream power production with EREN RE," said Sauquet.

(EUR 1 = USD 1.199)

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Output: French energy company Total is set to enter the wind power market and expand into the renewables sector by taking a 23%, €237.5m ($284.9m) stake in EREN Renewable Energy. The deal, which is subject to regulatory approval, is part of EREN RE's push to achieve up to 5 GW of installed capacity in five years and will also allow Total to enter the wind power market. In a joint statement, the firms said EREN's solar farm business will be mainly focused on emerging countries. Upon completion, the company will be renamed Total Eren.


Instruction: create a high quality summary of the given input

Input:
Direct-debit payments start-up GoCardless taps backers for $22.5m
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GoCardless, a fintech startup that’s setting out to make it easier for companies to collect recurring payments from customers, has raised $22.5 million in a round of funding from existing investors, including Balderton Capital, Accel Partners, Notion Capital, and Passion Capital.

Founded out of London in 2011, Y Combinator alum GoCardless wants to create a global bank-to-bank network that makes collecting money via direct debit as frictionless and automated as possible.

Subscriptions have emerged as a popular monetization model in the internet era, with consumer-focused services such as Spotify and enterprise-focused SaaS companies such as Salesforce proving popular with millions. Some estimates suggest that 35 percent of Fortune 2000 companies generate revenues via subscriptions, and managing these payments is where companies such as GoCardless come into play.

Others operating in the recurring payments realm include San Francisco-based Recurly, which has significant venture capital backing, and heavily funded Stripe, which also caters to subscription-based businesses.

One issue many of these companies are striving to fix relates to cross-border transactions. With anyone now able to carry out business globally through the web, the need for a “global” solution to collect money from customers is greater than ever. But many existing direct debit providers weren’t built with global commerce in mind, which is why GoCardless is working to create what it calls a “new international payments network,” one that works irrespective of country or currency.

GoCardless is currently limited to businesses in a handful of countries in Europe, with support for euros, U.K. pounds, and Swedish krona. But it is actively seeking to broaden its horizons. The company claims that it currently processes £3 billion ($4 billion) worth of transactions for 30,000 organizations in Europe, including in the U.K., France, Germany, Sweden, and Spain. And it is currently accepting registrations of interest for companies based in the U.S., Canada, Brazil, and New Zealand. Australia is expected to be GoCardless’s first non-European launch.

“As more and more businesses become international, they face endless frustrations in managing payments across multiple territories,” explained GoCardless CEO and cofounder Hiroki Takeuchi. “What we have engineered is a way to simply plug recurring payments into their existing systems, across the world, so they can focus on the challenges that really matter.”

GoCardless customers include Box, the U.K. government, and the Guardian newspaper, and the company also claims a number of third-party software integrations via its API, including Sage, Xero, and QuickBooks.

Output: Fintech company GoCardless has raised $22.5m from existing investors to further develop its global direct-debit payments service. The London-based firm's backers include Balderton Capital, Accel Partners, Notion Capital and Passion Capital. GoCardless is seeking to link banks in a global network to enable smooth direct-debit payments, especially in the subscriptions and other recurring payments space. The company claims to handle $4bn of transactions for organisations across Europe, including the UK government and the Guardian newspaper.


Instruction: create a high quality summary of the given input

Input:
Brighton and Hove council looks at buying back ex public housing
 Scheme to buy back former council homes

A proposal for a trial scheme to enable Brighton & Hove City Council to buy back former council homes is to be considered by councillors.

The idea is aimed at providing more affordable rented housing for people on the housing register by bringing homes sold under Right to Buy back into council ownership.

Members of the council’s Housing and New Homes Committee will consider the proposal at a meeting soon.

If the proposed one year trial goes ahead, the council could buy back four homes, each costing up to a maximum of £250,000. Properties would be independently valued and people selling would benefit from a quick sale with no chain. The scheme would be reviewed the following year.

Money for purchasing homes would come from the council’s Housing Revenue Account and the properties could be used to provide temporary accommodation or permanent homes.

The proposed Home Purchase Policy provides the council with the formal policy and budget framework to be able to buy back council properties sold within the last 10 years, and longer, if they come onto the market.

Anne Meadows, chair of the Housing and New Homes Committee, said: “We are already building new council homes in the city, and this proposal is another way in which we could provide more homes to rent.

“Anything that brings us more social housing is fantastic for the city. Even if only a small number of properties is involved, it all adds up, and for four families on our housing register it could mean a new home.”

Output: Brighton and Hove city councillors are considering a proposal to buy back former council homes bought under right-to-buy in an attempt to offer additional affordable rented housing. If the trial goes ahead, the council will be able to buy up to four homes, costing a maximum of £250,000, with the trial reviewed a year after the purchases. The home purchase policy would enable the council to buy back homes sold under right-to-buy if they come on to the market.


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Input:
California Drug Price Bill Sweeping In Scope, Lacking In Muscle
 About Capitol Desk Capitol Desk delivers the latest in health care policy and politics from Sacramento and around the state. Have an idea? Let us know.

A California bill headed to the governor’s desk may be the most sweeping effort in the nation to shine a light on drug pricing, but it lacks the muscle being applied in other states to directly hold those prices down.

The idea behind the law is that if everyone knows when and why prices are rising, political leaders eventually will be more empowered to challenge those increases.

“Transparency is a longer-term play. It’s about building political will, getting more information and helping build the case for the changes that we need” in order to have more sustainable drug prices, said Ted Lee, a senior fellow at Yale University’s Global Health Justice Partnership, which recently released a report on steps states can take to reduce drug prices.

Some experts have said transparency alone is not enough to bring down drug prices, and more extensive changes are needed.

“We need really far-reaching reforms that say ‘sorry, pharma, we’ve had enough. We’re not going to do it your way. We’re going to do it our way,’” said Peter Maybarduk, director of the Global Access to Medicines Program at Public Citizen, a consumer watchdog group. The group wants sweeping changes at the federal level that would reduce spending on drugs, such as allowing Medicare to negotiate prices with drug companies and limiting market exclusivity on certain pharmaceuticals.

The California measure would put a spotlight on drug prices from different angles, imposing reporting obligations on both insurers and drug manufacturers.

The campaign for the bill brought together some unlikely political allies in the California State Capitol this year: Consumer advocates, insurers, employer groups, labor unions and even a prominent billionaire environmentalist shared the same platforms at press conferences, urging legislators to force drug manufacturers to disclose and justify their high prices.

Gov. Jerry Brown has about a month to decide whether to sign the bill. Brown rarely comments publicly about legislation before he takes action, but a spokesman, Brian Ferguson, said the governor’s office had worked closely with legislative staff on the bill.

The pharmaceutical industry remains fiercely opposed to the legislation and has vowed to lobby the governor against it.

The measure “will not improve the accessibility or affordability of medicines for patients,” Priscilla VanderVeer, deputy vice president of public affairs for the Pharmaceutical Research and Manufacturers of America (PhRMA), said in an email.

Under the proposed law, pharmaceutical companies would be required to give state agencies and insurers 60 days’ notice if they planned a price increase of more than 16 percent over two years on drugs with a wholesale cost of $40 or higher. And they would have to explain the reasons for the increase.

Manufacturers would also have to report the introduction of certain high-priced drugs to market, explain their marketing plans for the product and say if it is an improvement on drugs that are already available.

Health plans would be obliged to report to state regulators on the drugs with the highest annual cost increases and document how much drug spending factored into their premiums.

Yale’s Lee said both price control and transparency laws play important roles in regulating prescription drug costs. Ellen Albritton, a senior policy analyst at Families USA, said transparency measures such as California’s bill are a “key part” of what is needed for the U.S. to get drug prices under control. She said various actions by states, taken together, build the case for federal action.

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This year, at least two states have passed laws that tackle high drug prices head-on and may have a more immediate effect on consumer costs than the California measure, Lee said.

Maryland and New York, for example, passed laws this year that use a variety of legal levers to impose financial penalties or require discounts if prices are too high.

Maryland’s law empowers the state’s attorney general to take legal action if it determines drugmakers are “price gouging” on generic drugs. A violation by the company could trigger refunds to consumers and a fine for the manufacturer.

The New York law introduces a drug price cap in the state’s Medicaid program and would require rebates on drugs that exceed their limits, according to a Yale University analysis.

The California bill’s author, Sen. Ed Hernandez (D-Covina), said he didn’t believe price controls were the right approach. “I still believe in the basic tenet of free enterprise,” he said. “The market should play itself out.”

But California’s bill is more comprehensive in some ways than other states’ laws. It requires new reporting in the private and public insurance markets and encompasses generic, brand-name and specialty pharmaceuticals. Other state laws affect only one payer, as in New York, or one subset of drugs, as in Maryland.

Vermont has a transparency measure, passed last year, that mandates reporting on a narrower subset of drugs than California’s proposal. Nevada’s recently passed drug price law requires disclosures from insulin makers.

Hernandez, who chairs the state Senate’s health committee, said the California bill could be a national model for drug price policy because transparency works to bring costs down. Consumers across state lines will benefit from California’s law, he said.

“I encourage the federal government, especially California’s representatives in the U.S. House and Senate, to consider similar legislation as we continue this discussion at a national level,” Hernandez said.

He said industry opposition to his bill has been fierce, with “legions” of lobbyists clogging Capitol hallways and full-page ads in local newspapers during the final days of the legislative session, which ended Friday.

Despite the industry’s resistance, Hernandez said, the effort to address high drug costs had bipartisan support and rallied players who are usually at odds on other matters.

“It has become a huge coalition because it’s impacting everybody,” he said.

Output: A California bill headed to the governor’s desk may be the most sweeping effort in the nation to shine a light on drug pricing, but it lacks the muscle being applied in other states to directly hold those prices down.


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Input:
State Lawmakers Tackle Public Smoking And Lead Poisoning, But Punt On Single-Payer
 About Capitol Desk Capitol Desk delivers the latest in health care policy and politics from Sacramento and around the state. Have an idea? Let us know.

California lawmakers approved several key health care proposals — and stalled on others — in their mad dash toward last Friday’s do-or-die legislative deadline.

They adopted a bill that would require drugmakers to give 60 days’ notice on big price hikes, but pushed off a decision on single-payer health care. They banned smoking at state parks and beaches, but delayed a proposal that would have established staffing requirements for dialysis clinics.

Some state legislators faced dual health care challenges this year: They lobbied to get their own bills passed while pushing back against attempts in Congress to repeal and replace the Affordable Care Act.

State Sen. Ed Hernandez, chairman of the Senate Health Committee, said his priority was “to make sure we secured what we have … and that no consumer was going to be left without insurance.”

As a result, the focus of his legislative work this year became “mostly consumer protection and a lot of defense,” the West Covina Democrat said. He cited the example of his bill to protect access to Planned Parenthood and other reproductive health clinics, which passed last week.

Democratic Gov. Jerry Brown has until Oct. 15 to sign or veto the bills adopted by the Legislature. Other health policy proposals were shelved for now, and may be resurrected next year.

HEADED TO THE GOVERNOR’S DESK

Keeping Your Doctors

In response to the impending departures of Anthem Blue Cross and Cigna from portions of California’s individual insurance market next year, lawmakers agreed to a measure that would allow some seriously ill patients to continue seeing their current providers for a limited time if their insurer discontinued their plan. Under SB 133, introduced by Hernandez, an eligible patient’s coverage would continue even if her doctors didn’t contract with the new health plan, so long as they were willing to accept the new plan’s reimbursement rates.

Reproductive Bias

The Legislature gave the green light to a measure by Assemblywoman Lorena Gonzalez Fletcher (D-San Diego) to prohibit institutions with religious affiliations from firing workers because of their reproductive choices, such as becoming pregnant out of wedlock or having abortions. AB 569 would bar a religion-based employer such as a Christian school from requiring workers to sign a code of conduct that waived their reproductive health rights.

Prescription Drug Costs

After a similar proposal fizzled last year, lawmakers last week supported a hotly contested bill by Hernandez that would require drugmakers to report and explain big price hikes. SB 17 directs pharmaceutical companies to notify state agencies and insurers 60 days in advance if they plan to raise prices more than 16 percent over two years on drugs with a wholesale cost of at least $40.

Lawmakers also approved AB 265 by Assemblyman Jim Wood (D-Healdsburg), which would ban drugmakers from giving consumers coupons for brand-name drugs when a generic equivalent was available, with some exceptions.

Open Enrollment

Legislators agreed that Californians who buy insurance for themselves should continue to have a three-month open enrollment period, during which they can choose or switch health plans. By adopting AB 156, also authored by Wood, lawmakers are exempting the Golden State from a Trump administration rule that shortens the sign-up period to 45 days. If endorsed by the governor, the law would apply to people who purchase plans from Covered California and in the open market for coverage in 2019 and beyond. These Californians already are assured a three-month open enrollment period for next year, which will run from Nov. 1 to Jan. 31.

Smoking At State Parks And Beaches

Lawmakers approved AB 725 by Assemblyman Marc Levine (D-San Rafael) to ban smoking at state beaches and parks. Violators would face fines of up to $50 per incident. Gov. Brown vetoed a similar effort last year, calling it “too broad.” A similar bill by Sen. Steve Glazer (D-Orinda), which proposes a fine of up to $100, also awaits the governor’s decision.

Childhood Lead Poisoning

Legislators adopted AB 1316 by Assemblyman Bill Quirk (D-Hayward), which would strengthen the state’s screening for lead poisoning in children. The bill calls for all California kids to be evaluated by their doctor during regular checkups, and for those deemed “at risk” to undergo a blood screening. Currently, children who receive government assistance such as Medi-Cal must be screened for lead, but that requirement doesn’t extend to other children.

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SEE YOU NEXT YEAR

Regulating Dialysis Clinics

A proposal by Sen. Ricardo Lara (D-Bell Gardens) would have required minimum staff-to-patient ratios at dialysis centers, such as one nurse for every eight patients or one technician for every three. The stalled bill, SB 349, also would have mandated more time for staff to prepare between patient appointments. A bill by Assemblyman Rob Bonta (D-Oakland) would have required dialysis centers to spend at least 85 percent of their revenue primarily on direct patient care.

Both measures were backed by a large labor union, Service Employees International Union-United Healthcare Workers West (SEIU-UHW), which has threatened to take the issue directly to voters if the Legislature does not act.

Single-Payer Health Care

The ambitious attempt to create one government-administered or “single-payer” health care system in California has been tabled until next year. SB 562 by Lara and Assemblywoman Toni Atkins (D-San Diego) would provide comprehensive health coverage to all Californians, regardless of immigration status. Private insurance companies would be barred from the system, and enrollees would not be charged copayments or premiums. A legislative committee estimated that the program would require $200 billion annually in additional tax revenue.

Supporters of universal health care hope to put a measure on the statewide ballot that would make it easier to fund a single-payer system.

Pediatric Dental Anesthesia

A bill that would have required oral surgeons to have a specially trained staff member with them to monitor a child under anesthesia stalled in committee. Current law allows an oral surgeon to perform surgery and monitor the unconscious child at the same time. AB 224 , by Assemblyman Tony Thurmond (D-Richmond), would have built on last year’s “Caleb’s Law,” named after Caleb Sears, a 6-year-old boy who died in 2015 after oral surgery under anesthesia.

Containing Drug Costs

A measure by Assemblyman David Chiu (D-San Francisco) would have brought together administrators from 17 state agencies to devise ways to reduce state drug costs. AB 587 would have expanded an existing state purchasing collaborative that buys drugs for a handful of public health programs, and directed the new group to develop cost controls, such as creating a uniform drug formulary for state agencies.

SB 790 by Sen. Mike McGuire (D-North Coast/North Bay) sought to restrict the pharmaceutical industry’s marketing to doctors, limiting their spending to mostly educational or scientific purposes, which McGuire said could reduce unnecessary prescriptions of pricey drugs.

Output: California lawmakers approved several key health care proposals — and stalled on others — in their mad dash toward last Friday’s do-or-die legislative deadline. They adopted a bill that would require drugmakers to give 60 days’ notice on big price hikes, but pushed off a decision on single-payer health care.


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Input:
Reinventing Utilization Management (UM) to Bring Value to the Point of Care
 How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden?

The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models).

Providers and payers must operate across a transparent, administratively simple, shared ecosystem. This giant leap from today’s world might appear impossible; however, as providers take on greater accountability for cost, and share more risk with payers, there is a real urgency for change.

The good news: the technological capabilities needed to affect change are available today. What’s missing: an effective bridge between the current volume-based systems, where communication between providers and payers happens after the care decision (with the limited exception of pre-authorization), and a value-based system, where rich data and enhanced intelligence are automatically shared in real-time to inform decision making.

Such a bridge can be built by starting with the current, albeit flawed, pre-authorization model as a foundation, enhancing current core systems and investments rather than trying to completely rebuild healthcare. The result is a new form of utilization management (UM) that shifts the balance of interactions from post-care decision with claims to pre-care decisions.

This can be done through multiple layers of seamless automation that use existing medical information systems (i.e., electronic health records (EHRs), care management portals, etc.) to minimize or even eliminate routine administrative tasks, and empower providers and payers to focus manual medical necessity and authorization review efforts only on cases that require their clinical expertise.

This exception-based approach increases the value of review and authorization processes by adding evidence-based decision support to their roles. By driving communication around evidence-based practices and appropriate care at the point of decision, the industry starts to bring value-based care delivery and, ultimately, value-based payment together.

Solving this practical challenge will foster genuine collaboration between payers and providers based on a shared priority to ensure that quality care for value is delivered, while significantly reducing their administrative burdens.

The limits of traditional utilization management

The shift to value-based care would seem so logical and promising that nearly all stakeholders would want to support it. The reality is that current payer-provider relationships, their technological systems, and their organizational infrastructures are only now becoming ready to accommodate the transition.

In the new world of value, payers and providers should be able to collaborate effortlessly at the point of care. A patient entered into the system by the provider should automatically trigger the relevant data, processes and tools needed to deliver cost-effective, evidence-based quality care.

Providers and payers should know the patient’s relevant care history, which approaches and treatments are supported by the evidence, and whether those are included in the patient’s insurance benefits package and provider network. The payment of care should be administered under the appropriate reimbursement model, and providers should have shared access to the data and actionable intelligence needed to deliver the right care in the right setting.

This is decidedly not the case in the traditional volume-based healthcare system. Pre-authorization and admission review are limited and often flawed examples of opportunities for payers and providers to interact and determine the clinical and financial impacts of care.

Under the current approach to UM, providers must seek approval from payers for care through a cumbersome, manual and often retrospective process. This puts payers in the position of serving as guardians of cost, medical necessity, network utilization and reimbursement rules.

Traditional utilization management also fails to deliver rich data on provider utilization patterns and network performance that can be shared between payer and provider. This hinders the development of improved policies, high performing networks and effective, targeted provider interventions.

Not surprisingly, payers and providers view this relationship as adversarial and the traditional utilization management function as a burdensome but necessary evil, fraught with the potential for conflict.

According to a study from the American Medical Association1:

About 64 percent of physicians reported difficulty determining which tests, procedures and drugs require authorizations.

About 63 percent of physicians reported waiting several days for authorization responses on tests and procedures, while 13 percent waited more than a week.

Nearly all of physicians reported that eliminating authorization hassles was “very important” (78 percent) or “important” (17 percent).

The percentage of medical claims reporting prior authorization increased on average by 2.3 percent from 2011 to 2013, with some payers doubling and tripling the number of care events that require authorization.5 Additional studies found each preauthorization costs payers and providers between $50 and $100, adding to the $74 billion annually2 in administrative costs to payers, and increasing the estimated $31 billion in annual administrative costs burdening providers (roughly $68,274 per physician).3

While the complexity and uncertainty created by the shift from volume to value-based care is significant, the opportunities created by reform are promising. It is estimated, for example, that enhanced collaboration can lead to a significant reduction in the $800 billion lost to administrative inefficiencies, provider inefficiencies and error, medically unnecessary and duplicative care, unwarranted use, and overutilization and fraud and abuse.4

Shifting to a collaborative exception-based model

Although traditional utilization management tends to be universally disliked, if transformed into a new collaborative model, it could serve as a bridge to the future.

Utilization management already drives the collection and aggregation of clinical and financial performance data, although it is generally not available for analyses until long afterward when claims and care management data has been retrieved and reported. That said, it is precisely this aggregation of clinical data that provides an opening for collaboration and for enhancing decision support in advance of care.

While the administrative burden of conducting a manual review is high, it is possible to automate the authorization process by integrating it into both the payer’s and provider’s workflows. This would lead to a significant reduction of the manual work involved in following up on authorization requests as well as helping to eliminate redundant medical reviews.

This process could be further streamlined by programmatically extracting data directly from the electronic health record (EHR) to automatically populate the medical review. Querying the clinical record directly in this way brings obvious advantages to the UM process, reducing the administrative work required for the medical review, and reducing human errors introduced when clinicians manually copy information between multiple systems.

Significantly, from the payer’s perspective, automating this process increases the trustworthiness of the review because the clinical data came directly from the EHR—the source of truth—without human intervention. And when the automated process transfers the clinical values into the medical review, that additional transparency further enhances trust.

In this scenario, immediate approval could be generated based on medical review results coupled with the payer’s business rules. Automated decisions could also take into account data on provider utilization patterns and network performance.

The ability to configure options based on the utilization patterns of a provider or care event is important to developing a collaborative win-win relationship between a payer and its providers. The more the provider’s practices are in line with evidence and policy, the lower the administrative burden.

Both the payer and provider can see this practice data—the provider can demonstrate proficiency, and the payer can monitor and incentivize provider participation without the burden of a manual discussion. In the process, the provider will know automatically if care events are covered, what the appropriate medical and network polices are, and whether they require a deep manual review or simply a notification as they are making their decisions and before the care is delivered.

To drive optimal provider adoption, this must be done across care events—diagnostics, procedures, specialty drugs, DME, etc.—and across their various payers, bringing a familiar, common workflow to the user, which is much more attractive than having to go to multiple systems for multiple payers.

Optimizing utilization processes with analytics

How does a payer continue to manage authorizations that are approved the majority of the time, without intervening in the care delivery process excessively? The data generated by automation must be gathered in a cloud-based shared ecosystem, measured and smartly managed by exception.

In this way, the payer intervenes only to the degree necessary. If the provider is delivering appropriate, evidence-based care, then the burden of scrutiny should be minimized and it should be easier for the provider to deliver and be reimbursed for care. That is the formula for a collaborative payer-provider relationship and one needed for value-based care.

To understand when interventions can be minimized, payers must measure and manage utilization patterns, while refining policies and processes.

Measure Measuring utilization data requires examining it in aggregate as part of an overall trend, rather than in terms of individual authorizations. Doing so makes apparent which requests are being automatically approved and which are automatically reviewed or canceled, and how frequently such interventions happen. This can be done based on the plan, product, provider, patient or care event. Manage Drilling down, payers can compare utilization patterns of different networks and providers, and observe variations in care events and procedures. Accordingly, the health plan can identify outliers where requests are higher volume compared to the peer-set norm, in or out of network, or not in line with evidence-based approaches. In addition, it can also see when requests are routine and do not warrant additional scrutiny that would waste administrative resources. Based on this data analysis, the health plan can build a nuanced exception-based approach by refining and optimizing its rules of authorization to facilitate the approval of requests that are aligned with quality and cost objectives while triggering notification in the system to scrutinize requests that are outside of their set parameters. Refine Once a system is in place to automate routine requests and signal alerts about outliers, the health plan and the provider can work together to understand the root causes of the outliers and intervene as appropriate. Ultimately, this collaboration can result in improved performance for the system from both administrative and medical cost perspectives that benefit the provider and the payer alike. This can also serve as key performance data for value-based relationships between them.

The more providers can align their care practices with the benefits and policies of the payer, the more providers will avoid the administrative burden of utilization management and be better able to demonstrate their value to a payer’s narrow network.

Performance-driven collaboration

In a value-based system, we are striving toward collaboration. How can exception-based utilization management be implemented, and what are the benefits of this model for both parties?

In this system, payers and providers communicate about care delivery in near real-time and learn to develop a more nuanced understanding of utilization patterns and variations in care. Over time, payer rules and actionable content can be infused into the many points of decision that are being made by the provider. This will help determine the appropriateness of medical care while also reducing administrative burdens. Most significantly, it creates a traversable pathway to a value-based care system.

This approach engages providers and payers with a common language. They are using a shared technology to measure, manage and refine quality care delivery in line with coverage policy. It reduces barriers internally, and between payers and providers, so that the various functions can communicate across traditional silos. Eventually, this also opens the door to integrate shared rules into the provider’s workflow.

This is an essential bridge from volume to value. When utilization patterns and the benefits of improved performance are shared openly, the provider can organize its care delivery to drive value, and the health plan can incent or support such efforts by paying for value. Over time, payers will direct more care to the best performing providers, as defined by their ability to meet quality and cost goals in accordance with evidence. The best providers will work to increasingly align their practices to meet the payer’s definition of value.

Making the vision real

A transformative system is well within reach. It starts with the technology tools and platforms being developed today, and the collaborative ecosystem forming among the network of payers, providers and vendors across the healthcare space.

By fully automating the authorization process, redundancy—where both payers and providers perform the same medical reviews—can be eliminated, and authorizations can be provided without needing to manually handle the request. This helps reduce administrative costs, speed authorizations, and helps ensure appropriate care.

Exception-based UM is now a reality, and the elimination of the adversarial relationship heralds better days ahead for payers, providers and patients.

About the Author:

Nilo Mehrabian: Vice President, Product Management, Decision Support, Change Healthcare

Nilo Mehrabian has more than 25 years of experience in the healthcare market, serving the last 20 years in healthcare IT. She is responsible for the Decision Support products at Change Healthcare.

Footnotes

1American Medical Association, AMA Survey of Physicians on Preauthorization Requirements (May 2010)

2Medical Economics, Curing the prior authorization headache (October, 2013)

3McKinsey & Company, Preauthorization sizing, McKesson report (2008)

4Health Affairs, What Does it Cost Physician Practices to Interact with Health Plans? (July/August 2009)

5Thomson Reuters report, http://www.reuters.com/article/usa-healthcare-waste-idUSN2516799520091026 (October, 2009)

6American Hospital Association, Study: 75% of hospitals have at least a basic EHR (November, 2015)

Output: How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to value-based care requires the deft combination of value-based delivery (enabled through actionable intelligence and new care delivery models) and value-based payment (enabled through select provider networks and new reimbursement models).


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Input:
The Latest Health Care Repeal Plan Would Give States Sweeping Discretion
 In a new Republican effort to repeal the Affordable Care Act, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have released a plan that would essentially allow states to come up with their own health care plans using a federal block grant.

The grant money would replace federal dollars currently being spent on Medicaid expansion and on subsidies to help people afford insurance under the health law, also known as Obamacare. All of this funding would expire in 2027.

Like earlier Republican health care overhaul bills, the new bill would also make permanent, structural changes to the Medicaid program for beneficiaries who qualified before the expansion, converting it from an open-ended federal health care program to one that caps federal spending on each beneficiary.

How the bill would alter major parts of Obamacare

Repeal Change Keep Medicaid expansion Taxes created under Obamacare Dependent coverage until 26 Subsidies for out-of-pocket costs Essential health benefits Tax credits for premiums Prohibitions on annual and lifetime limits Individual mandate Pre-existing conditions policy Employer mandate Restrictions on charging more for older Americans Health savings account

Repeal Medicaid expansion Subsidies for out-of-pocket costs Tax credits for premiums Individual mandate Employer mandate Change Taxes created under Obamacare Essential health benefits Prohibitions on annual and lifetime limits Pre-existing conditions policy Restrictions on charging more for older Americans Health savings account Keep Dependent coverage until 26

Repeal

Medicaid expansion

OBAMACARE Changed Medicaid’s eligibility requirements to allow more people to enroll if a state chose to expand the program. The federal government pays at least 90 percent of the costs for newly eligible beneficiaries.

SENATE BILL The Cassidy-Graham bill would repeal Medicaid expansion. And instead it would create a big block of money for health coverage that states could use as they saw fit. The money would be used for residents who are currently eligible for the Medicaid expansion or the Affordable Care Act markets.

Money would be redistributed among states, using a complex formula, and the funding would expire entirely in 2027. Over all, states that expanded Medicaid would receive less money than they would under the Affordable Care Act.

Repeal

Subsidies for out-of-pocket costs

OBAMACARE Provides subsidies to help people with lower incomes pay for out-of-pocket costs like deductibles and co-payments.

SENATE BILL Would repeal the subsidies in 2020. States could use money from their block grants to lower cost-sharing for low-income beneficiaries, but they would not be required to do so.

Repeal

Tax credits for premiums

OBAMACARE Gives tax credits to middle-income Americans to offset the cost of premiums, based on their income and the cost of insurance in their area.

SENATE BILL Would repeal premium tax credits in 2020. But states could use the new block grant money to create their own subsidy programs.

Change

Taxes created under the Affordable Care Act

OBAMACARE Imposed new taxes to help pay for expanding coverage to more people. They include taxes on investment income, wages above $200,000, medical devices, prescription drugs and indoor tanning.

SENATE BILL The measure would repeal the tax on medical devices but leave most other Obamacare taxes in place.

Change

Essential health benefits

OBAMACARE Requires all insurers to offer 10 categories of essential health benefits, like maternity treatment and hospital care.

SENATE BILL States would be allowed to obtain waivers to eliminate the essential health benefits.

Change

Prohibitions on annual

and lifetime limits

OBAMACARE Bars insurers from setting a limit on how much they have to pay to cover someone.

SENATE BILLThe provision would not technically be repealed. But the caps would be less meaningful in states that pursued waivers and did not choose to guarantee coverage for essential health benefits. That’s because the annual and lifetime limits and essential health benefits are interrelated.

Change

Pre-existing conditions

OBAMACARE Requires insurers to cover people regardless of pre-existing medical conditions and bars them from setting prices based on a person’s health history.

SENATE BILL The requirement that insurers must cover people with pre-existing conditions would not be eliminated everywhere, but states would be able to obtain waivers to charge different premiums based on health status. Such waivers would effectively eliminate Obamacare’s protections, since people with prior health problems could be priced out of the market.

Change

Restrictions on charging more for older Americans

OBAMACARE Bans insurers that sell policies directly to individuals from charging their oldest customers more than three times what they charge their youngest ones.

SENATE BILL While it would not eliminate the restriction, the bill would allow states to obtain waivers that let insurers charge different premiums based on age.

Repeal

Individual mandate

OBAMACARE Requires all Americans to buy health insurance or pay a tax penalty, with exceptions for people who have experienced hardships.

SENATE BILL Would eliminate the penalties retroactive to 2016.

Repeal

Employer mandate

OBAMACARE Requires larger companies to provide affordable insurance to their employees, or face financial penalties.

SENATE BILL Eliminates the penalties retroactive to 2016.

Change

Health savings account

OBAMACARE In 2017, allows an individual to put $3,400 and a family to put $6,750 into a tax-free health savings account.

SENATE BILL The bill would increase the amounts people could put into their health savings accounts. It would also allow people to use health savings account money to pay insurance premiums, a change from current law.

Keep

Dependent coverage until 26

OBAMACARE Allows children to stay on their parents’ insurance policies until age 26.

Output: In a new Republican effort to repeal the Affordable Care Act, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana have released a plan that would essentially allow states to come up with their own health care plans using a federal block grant.


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How this 72-year-old weightlifter is lifting expectations
 WILLIAM BRANGHAM:

Finally, to our NewsHour Shares, something that caught our eye that might be of interest to you as well.

Staying in shape is difficult for many people, no matter their age. But one Virginia grandmother is raising the bar, literally.

The NewsHour's Julia Griffin has this profile.

Output: A 60-year-old grandmother from Fairfax, Virginia, developed a love for weightlifting and garnered up to 12 world records in her age and weight categories. Now 72, Linda Leightley can deadlift 273 pounds and is breaking preconceptions about the limitations of age and gender.


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Analyst values Google's travel business at around $100bn
 by Laurie Sullivan @lauriesullivan, September 18, 2017

Google's plan to dominate the travel business with search, referrals, recommendations and online advertising buys through AdWords seems to be working. One analyst firm suggests Google's travel business worth is about $100 billion.

Google's U.S.-booked air volume rose 13.6% year-over-year to $159 million, according to one report.

At $100 billion, Google’s travel business contributes about 15% to Google’s $650 billion market cap, according to Skift Research.

Here's how analysis from Skift Research comes to this conclusion by analyzing financial disclosures for the first half of 2017 and full-year 2016, and estimating how much these companies spent on Google.

The research group estimates that metasearch engines like Kayak and Trivago will spend 25% more, helping Google's travel business to generate about $14 billion in revenue in 2017.

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Priceline spent 23.5% more on advertising during the six months of 2017 compared with the prior year, which puts digital ad spend on pace to reach $4.3 billion in 2017, according to the research. And while Expedia does not disclose quarterly ad spend, the research note mentions it does disclose direct marketing costs -- which rose 28%, putting Expedia's digital ad spend at about $2.9 billion.

Priceline, which broke down its online and offline advertising in 2016 filings, recently changed to performance advertising from brand advertising such as TV. The research firm uses performance metrics as a proxy for online spend. Figures suggest that Priceline spent 92% of its ad budget online.

And with a few numbers on hand within Expedia's footnotes in its financial statement, Skift analysts estimates Expedia spent 85%. Factored into that number, research from Skift analyzed Expedia's exposure to Trivago’s television push.

Combined, Priceline and Expedia likely spent $5.8 billion on digital advertising in 2016.

The analysis also factors in hotels -- with Airbnb specifically at about $1 billion, and other travel agencies amounting to about $5 billion in Google ad spend in 2016, which includes AdWords.

Output: Google's travel business is worth $100bn, according to Skift Research. Skift arrived at this conclusion by assessing financial disclosures from the first half of the year and projecting client's estimated spends: it guessed that Kayak and Trivago will up their spend by 25%, letting Google's travel business take $14 billion in 2017. Hotels are factored into the analysis, with Airbnb accounting for $1 billion, and other travel agencies amounting to around $5 billion in ad spend in 2016.


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Rich American seniors are getting healthier, not poor ones
 The U.S. has seen substantial improvements in life expectancy over the past century, particularly for those who are better-educated and more affluent.

Our study, out today, looks at the health of older Americans in recent years, using data collected by the U.S. Department of Health and Human Services on more than 50,000 seniors age 65 and older. Seniors in 2014 were 14 percent more likely to report that they were in very good or excellent health, compared to seniors in 2000.

However, a closer look tells a worrisome story: The health divide is widening across socioeconomic groups. Gains in good health primarily went to more advantaged groups.

Our work reveals a health disparity echoed in reports by others. In 1980, a wealthy 50-year-old man could expect to live an additional 5.1 years longer than a poor man of the same age. Thirty years later, the life expectancy of two similar men differs by more than a dozen years.

Measuring older Americans’ health

Health can be measured in many different ways. While physical measures such as weight, blood pressure and cholesterol level are excellent markers, it simply isn’t practical to obtain such information in studies that include many thousands of subjects.

Most research to date looks at trends in older adults who are frail or in otherwise poor health. These studies show that disability rates among older adults have declined by 1 to 3 percent every year since the 1980s.

Since seniors have such complex health needs, it may seem to make intuitive sense to track poor health. But this provides only one perspective. In our opinion, examining only those in poor health neglects to consider how good health — the goal of public health initiatives — is distributed in the population. Using disability trends to evaluate the health of older Americans is analogous to making conclusions about the U.S. economy based solely on the poverty rate.

In fact, when disability is used to examine health disparities, it leads to mixed conclusions. For instance, in comparing whites to blacks, one report showed a decline in the disability gap throughout the 1990s, while another showed an increase starting in the 1990s and extending to 2006.

Our work

It turns out that a single question about health is actually very accurate at estimating an individual’s likelihood of dying: “In general, would you say that your health is excellent, very good, good, fair or poor?”

By focusing on good health rather than poor health, we can think of health as an asset much like wealth, where the goal is to be at higher levels. We found that, by taking this new approach, health disparities among seniors became strikingly clear.

We identified seniors who reported “excellent” or “very good” health from 2000 to 2014. Our results show that seniors are more likely to report being healthy in recent years. In 2014, there were 8.4 million more healthy seniors in the U.S. than in 2000.

However, the gains in health were primarily among non-Hispanic whites and those of higher educational backgrounds or high family income. For instance, between 2000 to 2014, the number of seniors reporting good health increased by 21 percent among non-Hispanic whites. Meanwhile, during the same period, good health decreased 17 percent among non-Hispanic blacks.

Likewise, good health increased by 10 percent among seniors who possess a graduate degree. It also increased by 23 percent among seniors of high family income — that is, whose income was greater than or equal to four times the federal poverty level. Less advantaged counterparts — including those of high school education or less and with family income near or below the federal poverty level — were not so fortunate.

What explains these growing disparities? Given that the individuals in our study were all eligible to participate in Medicare, our results suggest that the influence of social, economic and environmental factors extends beyond access to health insurance.

This suggests that public health initiatives may miss some intended audiences. For instance, the U.S. government’s Healthy People 2020 initiative aims to manage risk factors associated with cardiovascular disease, a leading cause of mortality. However, a recent report shows that public health gains have benefited the wealthy more than the poor.

The idea that higher education may affect an individual’s personal “investment” in themselves by partaking in healthy behaviors can be traced back to the concept of human capital described by Nobel laureate Gary Becker. Income and education are closely related, and their effect on health can last for a lifetime.

Why these disparities matter

By 2050, the population of older adults is expected to nearly double. Older adults’ health will have a significant impact on the national economy, as they will use more health care resources and may stay in the workforce longer.

Furthermore, the growing divide in health suggests that there are at least two different Americas. Depending on where an individual sits on the socioeconomic spectrum, he might expect a different length and quality of life.

Differences in life expectancy are particularly important as policymakers consider potentially raising retirement age for Social Security or the eligibility age for Medicare. In light of this disparity, such efforts to make federal programs financially sustainable would pay out less in the long run to lower income groups.

Indicators point to greater improvements in the length and quality of life among the most privileged groups in the U.S. This raises important questions regarding how we might design better health systems so that all members of society can benefit.

Matthew A. Davis, Assistant Professor, University of Michigan and Kenneth Langa, Professor of Medicine and Health Policy, University of Michigan

Output: The U.S. has seen substantial improvements in life expectancy over the past century, particularly for those who are better-educated and more affluent. Our study, out today, looks at the health of older Americans in recent years, using data collected by the U.S. Department of Health and Human Services on more than 50,000 seniors age 65 and older. Seniors in 2014 were 14 percent more likely to report that they were in very good or excellent health, compared to seniors in 2000.


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Apple users turn to Siri for emotional support
 Perhaps you’ve stumped Siri before, asking Apple’s automated assistant things like, “What is the meaning of life?” or “How can I be healthier and happier?”

If so, you’re not alone in turning to your phone for existential guidance and serious, practical life advice. According to an Apple job posting, lots of people do it. That’s why the company is seeking software engineers with feeling—and a background in psychology and peer counseling—to help improve Siri’s responses to the toughest questions.

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“People talk to Siri about all kinds of things, including when they’re having a stressful day or have something serious on their mind. They turn to Siri in emergencies or when they want guidance on living a healthier life,” states the April ad for a “Siri Software Engineer, Health and Wellness” in Santa Clara, California. The job posting was unearthed by CNBC reporter Christina Farr, who shared it on Twitter on Sept. 14.

The position requires a unique skill set. Basically, the company is looking for a computer scientist who knows algorithms and can write complex code, but also understands human interaction, has compassion, and communicates ably, preferably in more than one language. The role also promises a singular thrill: to “play a part in the next revolution in human-computer interaction.”

The post doesn’t note this, but it’s obvious from the job description that it also offers lots of fodder for a science fiction writer with a Ballardian bent. If this talented, compassionate, emotionally intelligent computer scientist also happens to be literary, we can look forward to a great but creepy tale someday, too, apart from a more intelligent assistant.

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Computer scientists developing artificial intelligence have long debated what it means to be human and how to make machines more compassionate. Apart from the technical difficulties, the endeavor raises ethical dilemmas, as noted in the 2012 MIT Press book Robot Ethics: The Ethical and Social Implications of Robotics.

Even if machines could be made to feel for people, it’s not clear what feelings are the right ones to make a great and kind advisor and in what combinations. A sad machine is no good, perhaps, but a real happy machine is problematic, too. In a chapter on creating compassionate artificial intelligence (pdf), sociologist, bioethicist, and Buddhist monk James Hughes writes:

Programming too high a level of positive emotion in an artificial mind, locking it into a heavenly state of self-gratification, would also deny it the capacity for empathy with other beings’ suffering, and the nagging awareness that there is a better state of mind.

The job at Apple has been up since April, so maybe it’s turned out to be a tall order to fill. Still, it shouldn’t be impossible to find people who are interested in making machines more understanding. If it is, we should probably stop asking Siri such serious questions.

Output: Users are increasingly asking Apple's voice-activated assistant Siri questions about their mental well-being, according to the company. In response, Apple is seeking a software engineer with a background in psychology and peer counselling. "People talk to Siri about all kinds of things, including when they’re having a stressful day or have something serious on their mind. They turn to Siri in emergencies or when they want guidance on living a healthier life", the ad reads.


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Swedish mobile payment start-up iZettle raises $36m to explore AI
 Missed the GamesBeat Summit excitement? Don't worry! Tune in now to catch all of the live and virtual sessions here.

European mobile payments processor iZettle has raised a €30 million ($36 million) debt round to fund a host of research and development (R&D) initiatives covering areas including machine learning and artificial intelligence.

The latest financing, which arrives via the E.U.’s European Investment Bank (EIB), comes just nine months after the Swedish startup raised $63 million in funding, which constituted a mix of debt and equity. The company has some big-name backers already too, including Intel’s investment arm Intel Capital, American Express, and Mastercard.

“It’s the type of offer [EIB funding] you can’t refuse, and it will allow us to further accelerate our growth and continue to level the playing field for small businesses, giving them access to tools to take on the big corporations,” noted iZettle CEO and cofounder Jacob de Geer.

The story so far

Founded out of Sweden in 2010, iZettle is similar to Square, insofar as it targets small to medium-sized businesses with hardware and software that makes it easier to accept card payments from customers through mobile devices.

Image Credit: iZettle

iZettle has so far mainly been focused on Europe, including Scandinavia, Germany, Spain, and the U.K., but it has also expanded into Latin America via Brazil and Mexico. While iZettle recently intimated that it has no intentions to encroach on Square’s home turf in the U.S., Square recently launched its service in the U.K., with plans to roll out in further European markets in the future.

However the mobile payments battle plays out between these two companies, iZettle clearly hopes that investing in its R&D efforts can give it a competitive advantage in the long term. The four main areas of investment will cover: developing next-gen payments infrastructure; harnessing machine learning and artificial intelligence; scaling legislative and compliance systems; and digitalization of commerce processes.

Output: European mobile payments processor iZettle has completed a $36m debt round to fund research and development into areas including artificial intelligence (AI). The Swedish start-up's technology makes it easier for smaller businesses in Europe to accept card payments through mobile devices. It has also expanded into Latin America, but is understood to have no plans at present to take on Square in the US. The company intends to use the funding from the European Investment Bank to develop next-generation payments infrastructure.


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Bots may replace humans in four million UK roles
 Four million jobs in the British private sector could be replaced by robots in the next decade, according to business leaders asked about the future of automation and artificial intelligence.

The potential impact amounts to 15% of the current workforce in the sector and emerged in a poll conducted by YouGov for the Royal Society of Arts, whose chief executive, Matthew Taylor, has been advising Downing Street on the future of modern work.

Jobs in finance and accounting, transport and distribution and in media, marketing and advertising are most likely to be automated in the next decade, the research says.

The RSA’s prediction of the impact of robotics on working lives is lower than some other estimates. Four years ago, academics at the University of Oxford predicted 35% of jobs could be rendered obsolete by new technology, while the Bank of England predicted in 2015 that up to 15m jobs in Britain were at risk from robots “hollowing out” the workforce.

The RSA is also more optimistic about the potential of robots and artificial intelligence than US tech billionaire Elon Musk, who has said AI was “the scariest problem” and “our biggest existential threat” because, he predicts, they will be able to do everything better than humans.

Research by the University of Oxford and Deloitte last year predicted more than 850,000 public sector jobs could be lost by 2030 through automation.

Asda operates a fully automated distribution warehouse in west London; white-collar tasks are being automated by PwC, the accountancy firm, and Linklaters, the law firm, which have been developing software robots that use artificial intelligence to learn to do research tasks usually undertaken by junior accountants and lawyers.

The RSA warns that artificial intelligence and robotics will “undoubtedly cause the loss of some jobs, whether it is autonomous vehicles pushing taxi drivers out of business or picking and packing robots usurping warehouse workers”. But it argues that new technologies could phase out mundane jobs, raise productivity levels and so deliver higher wages and “allow workers to concentrate on more human-centric roles that are beyond the reach of machines”.

It found that business leaders largely believed that new technologies were more likely to alter jobs rather than eliminate them and that this, combined with the creation of new types of jobs, would lead to greater prosperity in the long run.

Care homes are also trialling robots. One in Lincoln plans to use one to help residents remember daily necessities such as taking medication. The robot will also monitor their movements and habits as a nurse would. A care company in London, Three Sisters Home Care, will soon trial the use of robots for lifting people so only one care worker will be needed rather than two.

Three Sisters’ chief executive, Jobeda Ali, told the researchers: “If I don’t have to send a person to do a transfer job [lifting], I can send them to have a cup of tea and a chat. This is a much better use of their time than carrying patients or cooking meals.”

The prediction that millions of jobs will be lost to robots led the Trades Union Congress to warn against “shredding good jobs”.

“The UK must make the most of the economic opportunities that new technologies offer,” said Frances O’Grady, general secretary of the TUC. “Robots and AI could let us produce more for less, boosting national prosperity. But we need to talk about who benefits – and how workers get a fair share. The productivity gains must be used to improve pay and conditions for workers.”

Benedict Dellot, the author of the report, said the technical limitations on robots, evidenced so far by driverless cars crashing and the difficulty of getting robots to read at an adult level, would restrict the speed with which jobs will be automated.

The RSA has also warned that Britain needs to invest more in robots or risk falling further behind countries including the US, France, Germany, Spain and Italy where companies are buying more robots than in the UK.

“AI and robotics could solve some of the gaps and problems in the labour market with low-paid, dull, dirty, dangerous jobs that nobody really wants to fill,” Dellot said. “The technology has the potential to fundamentally improve productivity levels in the UK.”

The report also warns that increasing automation could deepen economic inequality and “demographic biases could become further entrenched”. It argues that to avoid this policymakers should take control of the development of the technology by creating an ethical framework to guide the behaviour of AI and to encourage investment in “benevolent technology that enriches the worker experience”.

Output: A survey by the Royal Society of Arts (RSA) has suggested that, in the next decade, robots could replace up to four million British private sector jobs. The RSA also posits that its findings point, for the large part, to improved roles for workers, having their roles altered rather than eradicated. However, trade unions have warned against the "shredding (of) good jobs", illustrating a widespread fear that bots will leave many humans unemployed.


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Singaporean commercial cybersecurity R&D receives $16m funding
 More than $16 million will be invested to strengthen Singapore's cyber-security research and development, under two separate programmes that aim to produce more commercial cyber-security solutions.

Speaking at the opening of the second Singapore Week of Innovation and Technology (Switch) yesterday, Finance Minister Heng Swee Keat announced the move, and said it would further public- private partnerships in areas of advanced cyber security.

Nine research projects were granted funding of $15.6 million under a grant call by the National Cybersecurity R&D Programme, which was set up in November last year to develop capabilities to meet Singapore's cyber-security needs.

Each project is a collaboration between a cyber-security company and academic researchers, and falls under one of the nation's three key cyber-security priorities: national security, critical infrastructure and Smart Nation.

For example, local cyber-security start-up Attila Cybertech is working with researchers from the Singapore University of Technology and Design to use machine learning in the software for critical infrastructure in order to detect strange, out-of-the-ordinary behaviour that might indicate a cyber attack.

Such partnerships mean that new research findings can be brought to market faster as there is already a company available to market the research.

"Should our cyber-security researchers arrive at new findings, industry leads... will stand ready to develop them into game-changing solutions," said Mr Heng.

Output: Singaporean Finance Minister Heng Swee Keat has announced more than $16m in funding to boost Singapore's cybersecurity research and development. The investment will go to nine individual projects, each aiming to bolster national cybersecurity and reinforce critical infrastructure. The funds may also help new developments to reach the market faster. "Should our cybersecurity researchers arrive at new findings, industry leads... will stand ready to develop them into game-changing solutions," said Heng.


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Access to devices biggest barrier to digital learning
 Research

Biggest Barriers to Digital Learning: Lack of Time, Lack of Devices

The biggest barrier to digital learning for teachers is gaining student access to technology. That's followed by a lack of time during the school day. For administrators, the top concern is providing relevant and effective professional development to their staff, followed by limitations and problems with the technological infrastructure, such as WiFi and security. Overall, across both roles, the main obstacle to integrating technology into the classroom was lack of time and an insufficient number of devices to do so.

Those findings surfaced in a survey undertaken for the first time by education technology company Schoology.

Schoology produces a web-based learning management system with tools for creating content, designing lessons and assessing student learning, primarily used in K-12 environments, but also adopted by higher ed. A free version is available for classroom use; a subscription version is intended for school, district or institutional adoption.

The survey went beyond getting input from Schoology customers. Responses came from 2,846 education professionals specifically in K-12, a quarter of whom were users of the company's online service. Although the response was worldwide, a high volume came from the United States.

Perhaps unsurprisingly (for a survey undertaken by a tech company), almost everybody said digital learning had a positive impact on student achievement (95 percent) and teaching effectiveness (92 percent). However, most of the time, the resources they said they use tend to be "static" — PDFs and Word documents (cited by 90 percent of respondents) and videos (cited by 70 percent). This suggests, the report noted, that institutions "may be digitizing traditional learning instead of enhancing it." Online games came in third, referenced by 42 percent of participants, and publisher content and open educational resources ranked lower (39 percent and 37 percent, respectively).

Teachers and administrators specify their major obstacles to integrating technology into teaching and learning. Source: "The Global State of Digital Learning in K-12 Education," Schoology

Among other results:

Six in 10 respondents (61 percent) work in institutions that have dedicated instructional technologists.

The most common hardware set-up is the shared cart of devices. Those are in place at 33 percent of respondent schools. A quarter of respondents run 1-to-1 programs where students can't take devices home; a similar number have 1-to-1s where they can take them home.

Not quite half of participating schools (46 percent) have an LMS in place; 20 percent don't; and a solid third (34 percent) don't know. Among those with LMSes, the larger the institution, the less likely they are to mandate LMS use in the classroom. Whereas 39 percent of education entities with 50,000 or more students required LMS use, the share rose to 54 percent in organizations with fewer than 2,000 students.

The survey found that frequency of LMS use also corresponded to level of student engagement. The highest proportion of "very engaged" students were found in schools where the LMS was used daily.

The survey also examined instructional approaches that integrate technology. The ones used most by respondents were differentiated instruction (75 percent), blended learning (54 percent), and individualized learning (45 percent). The report pointed out that three biggies that "command the most press" aren't being "practiced as much as one might think." For example, flipped learning was mentioned by 35 percent of participants; personalized learning by 32 percent and gamification by 16 percent. Schoology's thinking: that "these approaches require more time and resources than many of the others."

The complete results, which also cover professional development and the use and types of educator collaboration, are available with registration on the Schoology website.

Output: Education professionals believe that a shortage of devices and a lack of time are restricting the educational potential of digital systems, according to a study by edtech Schoology. Roughly 95% of teachers believe digital learning has improved education, according to the report, which warned that given 90% of respondents were using non-interactive resources, this could mean traditional teaching methods are being digitised rather than overhauled. The study also revealed that blended learning, flipped classrooms and gamification were not practised as much as might be thought.


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JPMorgan advertises for blockchain project manager
 JP Morgan reveals they are looking for a “Technical Project Execution Manager – (Blockchain) Distributed Ledger Technology” despite a very recent vehement attack on Bitcoin, which originated the very blockchain technology the financial services giant seeks to adopt.

In a move that many are finding ironic, if not downright hypocritical, JP Morgan is on the hunt for an experienced blockchain technician. The job posting comes just days after CEO Jamie Dimon called Bitcoin “a fraud” – the same fraud whose core open source technology the company has appropriated.

The job listing on JP Morgan’s website reads:

The Blockchain Center of Excellence (BCOE) leads efforts for applications of distributed ledger technology (DLT) within J.P. Morgan. We are exploring Blockchain use cases and piloting solutions across business lines. We are active in the Blockchain ecosystem: developing technology, investing in strategic partnerships, and participating in industry consortia.

Bitcoin to the Rescue

It is no secret that big banks are heavily investing in blockchain technology, however, part of Bitcoin’s success is in how it has rewarded miners for building and maintaining a decentralized blockchain infrastructure which is essential to security, while also making the system accountable to everyone.

Bitcoin was born as a response to poor financial management after the largest banks, including JP Morgan, contributed to the 2008 world financial crash, leaving a pressing need for a better system. It is no coincidence that Bitcoin came to fruition in the same year when the world was looking for alternatives, Bitcoin was presented.

Jamie Dimon’s Blockchain History

Dimon’s recent anti-Bitcoin diatribe is hardly a new position for the JP Morgan CEO. During an appearance on CNBC’s coverage of the World Economic Forum meetings in February 2016, he made his feelings about Bitcoin quite clear:

Bitcoin the currency, I think, is going to go nowhere […] There is nothing behind a Bitcoin, and I think if it was big, the governments would stop it…

At the time of Dimon’s pronouncement, the price of Bitcoin was somewhere in the neighborhood of $400. Four short months later the cryptocurrency nearly doubled in value to $780 and by December 2016 had reached the then-unprecedented value of $1200. Since then, the value of Bitcoin has continued to climb, reaching its all-time high in August of this year at just under $4980. From this perspective, it is easy to see why one former JP Morgan executive told Dimon to STFU about Bitcoin.

Do you think that JP Morgan is sending mixed messages? Is it hypocritical to reject Bitcoin while embracing the core technology that it is built upon? Let us know in the comments below?

Images courtesy of Wikimedia Commons, Reuters/Mike Segar

Output: JPMorgan is recruiting a specialist to undertake research and development work on blockchain technology. The bank is advertising for a technical project manager to work in its Blockchain Centre of Excellence (BCOE), a unit that it said is exploring uses of blockchain and distributed ledger technology across its business. The bank's CEO, Jamie Dimon, recently called the pioneer blockchain currency bitcoin a "fraud", but many traditional banks are known to be investing in developing uses for the technology.


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Dublin-based team creates 3D medical devices for disaster zones
 In developing nations during a disaster, quick access to medical equipment can often be left wanting, but 3D printing is trying to bridge the gap.

For more than a decade now, 3D printing as a concept has promised a revolution in everything from construction to food production but, on the surface, you might think things haven’t changed much.

This couldn’t be further from the case, however, particularly in medicine where 3D printers have set in motion a future where many of us are already cyborgs – humans with replacement body parts specifically printed to suit our individual needs.

Perhaps one of the most striking examples of its potential was recently seen at Inspirefest 2017 when NUI Galway research fellow Dr Ellen Roche showed her ingenious solution to print a soft robotic silicone sleeve to keep a heart pumping inside the body.

But not everything needs to be as complex as this, as the team from Med3DP at Trinity College Dublin (TCD) has shown time and again.

Founded by Dr Michael Monaghan and Dr Conor Buckley, the centre was set up to develop on-demand medical devices for humanitarian healthcare using 3D-printing technology.

Since it began, the group has built a wide range of projects complete with ready-to-print files, documentation and other helpful information for anyone else in an affected disaster zone, so that they can jump right in and start printing devices.

Anyone who visited Inspirefest this summer may have seen some of their creations first-hand, including a working stethoscope to let people listen to their own heartbeat.

One of those from Med3DP was Pooja Mandal from India, who is undertaking an MSc in bioengineering at TCD with a specialisation in tissue engineering and stem cells.

Speaking with Siliconrepublic.com, Mandal said that the device templates they are creating can be vital when second-hand medical devices get broken during transit or are lost.

In many cases, medical devices sent to countries in dire need of equipment are often obsolete or left with no instructions on how to operate them – but not so with 3D-printed devices.

One of the projects Mandal and her team in Med3DP worked on that she is particularly proud of is a 3D-printed breast pump, but she admits it’s still at a starting point, with design improvements needed to make it ideal for women in developing countries.

“What I would like is to be able to make it into a single component that is easily accessible, so that not much printing time goes into it,” she said.

This is just one of dozens of other devices the Med3DP team has already designed and built, including an umbilical cord clamp, pocket mask and valve, finger splint kit, and even a neck brace.

It shows, Mandal said, that 3D printing is certainly not simply a pursuit of makers and designers, but also for scientists like her who see it as making a substantial difference in the field of medicine.

“It has really revolutionised science as people are trying to get donor-matching organs, but now people can get a proper treatment without any immunogenic response [using 3D printing] … by building them with their own cells,” she explained.

So, aside from the impressive output of the group, what would she say is one of its greatest qualities?

The answer: a diverse team of 14 men and women from multiple nations, not your typical image of a group of exclusively Irish students who might not really understand the complexities of the problems they are trying to solve.

“We can all talk to each other, hear each other’s ideas, with everyone able to bring in their own scenarios from their countries,” Mandal said.

“Everything played a bigger role into the programme and helped us achieve our ultimate goal of getting into designing proper medical devices, especially from me as someone from a developing country.

“It was really good for me to see that and I felt that maybe someday I could revolutionise [3D-printing technology] in India.”

3D printing in action. Image: OlegDoroshin/Shutterstock

Output: Researchers at Trinity College Dublin are using 3D printing to create a range of medical devices for disaster relief situations. The team has established the Med3DP project to pursue the research and has already developed a number of device templates including a stethoscope, a breast pump, an umbilical cord clamp and a neck brace. The devices are intended to assist in providing fast access to vital medical equipment in disaster-affected countries where traditional supplies can be difficult to obtain.


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Decentralised exchange Kyber Network raises $60m in ICO
 The token sale by Kyber Network has reached its full funding cap of 200,000 ETH, worth about $60 million at an Ethereum Ethereum Ethereum is an open source, blockchain-based distributed computing platform and operating system featuring smart contract functionality. Created in 2014, Ethereum now stands as the second largest cryptocurrency by market cap at the time of writing.As a decentralized cryptocurrency network and software platform, Ethereum represents the most prominent altcoin. Ethereum also enables the creation Distributed Applications, or dapps. Understanding EthereumEthereum boasts its own programming language, Ethereum is an open source, blockchain-based distributed computing platform and operating system featuring smart contract functionality. Created in 2014, Ethereum now stands as the second largest cryptocurrency by market cap at the time of writing.As a decentralized cryptocurrency network and software platform, Ethereum represents the most prominent altcoin. Ethereum also enables the creation Distributed Applications, or dapps. Understanding EthereumEthereum boasts its own programming language, Read this Term price level of $300. The service is a decentralized and trustless exchange for instant conversions between crypto-assets.

Learn how to buy Bitcoin and Ethereum safely with our simple guide!

Through KyberNetwork, a user can send one token to a recipient who wishes to receive the payment in another token in a single transaction. It will also introduce a new Smart Contract Smart Contract A smart contract is a piece of software that automatically executes a pre-determined set of actions when a certain set of criteria or met. One of the key tenets of smart contracts is their ability to perform credible transactions without third parties and are self-executing, with their conditions written into the lines of code that form themAdditionally, these transactions are both trackable and irreversible. For example, a smart contract could be used to give royalty payouts to a musical artist A smart contract is a piece of software that automatically executes a pre-determined set of actions when a certain set of criteria or met. One of the key tenets of smart contracts is their ability to perform credible transactions without third parties and are self-executing, with their conditions written into the lines of code that form themAdditionally, these transactions are both trackable and irreversible. For example, a smart contract could be used to give royalty payouts to a musical artist Read this Term interface that would allow existing wallets, which only accepts certain specific tokens, to receive any existing or future token without having to modify the token contract code.

Prior to the ICO, Kyber Network CEO and co-founder Loi Luu sat down to talk with Finance Magnates about the project ahead of its token sale. Listen to the interview on SoundCloud or watch it on YouTube:

Following the completion of the token sale Luu commented: "I would like to thank the Kyber Network team members and advisors for getting the company to successfully raise a good round. Not forgetting the community moderators and volunteers who have been extremely diligent in keeping the community safe and secure for all members, and in keeping the communication from Kyber Network to fellow members succinct. Lastly, this token sale wouldn’t have been possible if not for the enthusiastic support from all of you.

This marks the end of one phase and the beginning of another. Moving forward, we will channel our energy and resources to product and business development. We promise that we will continue our effort in creating a world-class and highly usable platform that everyone has access to."

Output: Cryptocurrency exchange Kyber Network has raised $60m in its initial coin offering. The platform is a decentralised exchange service which allows users to send and receive payments in different currencies, without having to go through a centralised exchange. The company plans to introduce a smart contract interface to allow existing electronic wallets to accept new types of cryptocurrency without requiring a modification of the contract code.


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Mobile devices lower hospitalisations in rural India
 Update: This story has been updated to include additional quotes from the study's researchers.

Heart disease patients visiting mobile health clinics outfitted with pocket-sized, smartphone-connected ECGs and other point-of-care medical devices are more quickly referred for therapy, and less frequently experience hospitalization or death.

According to a recent study, published in the Journal of the American College of Cardiology, the benefits of these portable devices could be especially key in transforming healthcare delivery in regions strapped for resources.

“Such areas have the highest rates of chronic diseases, [yet] have the lowest availability of diagnostic tests,” lead author Dr. Sanjeev Bhavnani, of the Scripps Clinic and Research Foundation, told MobiHealthNews. “By way of their portability, new mobile health devices such as pocket ultrasound and the smartphone-iECG maybe uniquely poised to improve healthcare access and lead to earlier treatment decisions, especially for high risk patients.”

In the study, researchers enrolled Indian outpatients with new or established diagnoses of rheumatic and structural heart disease. The patients were randomly assigned to receive either standard care (n=114), or were referred to a clinic equipped with a suite of wireless point-of-care devices (n=139), including pocket-echocardiography (General Electric’s VScan); smartphone-connected oximetry and blood pressure monitors (iHealth); activity monitors (Ozeri); a smartphone-connected ECG (AliveCor); and fingerstick B-type natriuretic peptide tests (Alere Triage).

Over a 12-month observational period, the researchers found that patients who initially visited a mobile health clinic were significantly more likely to be referred for a valvuloplasty, valve replacement, or both procedures and, to a less significant extent, undergo the therapies. Furthermore, those assessed with the mobile health devices were also at significantly less risk of hospitalization or death, which the researchers attributed to the mobile health clinic’s improved characterization of structural heart disease and more prompt referral to care.

The researchers lamented the smaller and unequal sample sizes of the treatment groups, but noted in their study that the use of readily available technologies, hard clinical outcome measurements, and real-world implementation add validity to their results.

"To our knowledge this is the first randomized study that shows how modern cardiology clinics can be organized for triaging symptomatic patients efficiently and how decision making can be accelerated using a combination of mHealth technologies that look at different dimensions of a disease,” principal investigator Dr. Partho Sengupta, of the West Virginia University School of Medicine, told MobiHealthNews. “The outcomes suggest potential substantial cost-savings and cost-efficacy studies are needed to evaluate the impact on health-economics using such strategies."

The opportunities and need for more data regarding mobile phone-connected health devices outside of resource-rich settings was previously explored in a 2015 review, in which the authors argued that “priorities should be set for investments and guidance in evaluation disseminated by the scientific community to practitioners and policymakers.”

Output: Patients in rural India fitted with wireless mobile health devices have lower incidences of hospitalisation and death, according to a study. Led by Dr. Partho Sengupta of the West Virginia University School of Medicine in the US, the study enrolled patients in remote parts of India diagnosed with rheumatic and structural heart disease. Those who were given mobile health devices were found to have better outcomes, although the researchers noted the small and unequal sample sizes used in the trial.


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Use of virtual reality growing in nurses' training in the US
 Research

Nursing Ed Using More Virtual Simulation, Other New Tech

A recent survey of thought leaders in the nursing field revealed that nursing education programs are accelerating adoption of virtual simulation and other cutting-edge technologies.

The study, conducted by Wolters Kluwer Health and the National League for Nursing Center for Innovation in Simulation and Technology, found that 65 percent of nursing education programs currently use virtual simulation to train students, 84 percent use instructional video for skill development and 75 percent employ online/distance learning. Rounding out the technology landscape:

Adaptive quizzing and testing (used by 64 percent of nursing programs);

Electronic health record applications (60 percent);

Integrated digital curriculum (49 percent);

Mobile apps (41 percent);

Social media (37 percent);

Facetime/videoconferencing (35 percent); and

E-portfolios of student work (31 percent).

The survey also identified technologies where adoption is expected to increase significantly in the near future. Use of virtual reality will jump from 10 percent to 45 percent over the next five years; mobile apps will go from 41 percent to 59 percent; and data analytics tools and predictive analytics will go from 14 percent to 34 percent, the researchers predicted.

The top three reasons for all that change, according to the study:

Changes in technology being used in practice; Nursing schools are adapting to meet the way incoming students learn; and Reduction in the number of available clinical sites.

"This survey confirms the important role nurse educators play in advancing the use of technology in the classroom through their willingness to act as early adopters and trailblazers," commented Julie Stegman, vice president and publisher, Nursing Education, Wolters Kluwer Health Learning, Research & Practice, in a statement. "By seeking out innovative technologies like adaptive quizzing and virtual simulation, nurse educators are helping to overcome resource challenges and pave the way for their peers in other areas of higher education to also benefit from these advances."

For more information on the survey, visit the Wolters Kluwer Health site.

Output: The use of virtual reality (VR) and other new technology in educating nurses in the US is increasing, according to a study by health tech firm Wolters Kluwer and the National League for Nursing's Center for Innovation in Simulation and Technology. The survey found 65% of nursing education programmes use virtual simulation to train students, and 75% use online and distance learning. The use of full VR is predicted to grow from 10% to 45% over the next five years, while the use of mobile apps will jump from 41% to 59%.


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US launches drive to compose standards for offshore wind industry
 The U.S. has launched a new initiative to develop a set of standards for the offshore wind sector.

The three-year project is a collaboration between the the Department of Energy, the National Renewable Energy Laboratory (NREL), Bureau of Ocean Energy Management (BOEM), Bureau of Safety and Environmental Enforcement, Business Network for Offshore Wind and the American Wind Energy Association (AWEA).

An Offshore Wind Technical Advisory Panel comprising industry stakeholders has been formed and will guide the scope of activities for a group of new technical sub-working groups, which will develop the standards.

According to a release from the Governors’ Wind & Solar Energy Coalition, the proposed sub-groups cover the updating of the AWEA’s 2012 offshore compliance recommended practices, floating offshore turbines, geotechnical data requirements and met-ocean requirements for US waters.

The standards, which will be recognized by the American National Standards Institute, will allow BOEM to “adopt better requirements that reflect the latest industry best practices.”

“These standards and guidelines will form the basis for BOEM to establish transparent compliance requirements that will help industry in turn provide safe and reliable offshore wind facilities that serve the US electric supply,” said Walt Musial, NREL principal engineer and chairman of the Offshore Wind Standards working group.

NREL will host a webinar on September 26 to provide information on the work to stakeholders and potential working group participants.

Output: A three-year project to develop a set of standards for the offshore wind sector has been launched by US government and energy organisations. The Department of Energy, National Renewable Energy Laboratory, Bureau of Ocean Energy Management, Bureau of Safety and Environmental Enforcement, Business Network for Offshore Wind and the American Wind Energy Association are collaborating on the initiative. Technical sub-working groups overseen by a panel of industry stakeholders are to draw up the guidelines -- which should reflect industry best practices -- ready for recognition by the American National Standards Institute.


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Milrem Robotics partners with QinetiQ on battlefield robot system
 In an effort to give soldiers new robotic systems for defense applications, Milrem Robotics, which is a provider of defense technologies, will expand the capabilities of its THeMIS UGV.

One of Milrem Robotics’ goals is to enhance the situational awareness of warfighters, so several systems are being developed, including the TITAN SENTRY concept, which was developed in collaboration with QinetiQ.

The TITAN SENTRY concept, which includes the Milrem Robotics-designed THeMIS UGV, along with a suite of sensor systems integrated by QinetiQ, is an “exploration of manned/unmanned teaming where the cognitive burden on the warfighter is vastly reduced through the fusion of sensor data and advanced battlespace management systems.” It is meant to operate in high threat areas, as it can identify and fix enemy locations while reducing the risk of casualties.

Milrem Robotics has also started developing an unmanned system that combines the THeMIS UGV with UAS. The company is also working with Eli, which is an Estonian UAV manufacturer, to develop a UAS nest, and they have also begun a tethered multirotor UAS integration project with Threod Systems.

These systems can be used during high risk situations or in remote areas where a larger area needs oversight, without the need of a human operator to be present.

Kuldar Väärsi, the CEO of Milrem Robotics, says that robotic systems are very important for keeping soldiers as safe as possible.

“Remotely controlled robotic systems that keep our soldiers in a safe distance are crucial to the next generation of battlefield effects that will give asymmetric advantage to the warfighter,” Väärsi says.

Output: Milrem Robotics has partnered with security technology firm QinetiQ for its TITAN SENTRY battlefield robot system. The setup features Milrem's THeMIS unmanned ground vehicles (UGV) fitted with QinetiQ sensors that the company said will feed soldiers in-the-field data to help them identify and fix enemy locations while reducing the risk of casualties. Milrem is also seeking to link THeMIS with aerial drones for use in higher-risk or remote areas. The TITAN SENTRY system was exhibited at the Defence and Security Equipment International exhibition in London.


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Chinese robot performs first autonomous dental surgery
 World first autonomous dental implant robot put into use in China

Tech & Sci CGTN

Output: The world’s first fully autonomous dental implant robot has successfully completed a surgery in under an hour. The robot, developed in China, must perform a CT scan of the patient's mouth before proceeding, allowing it to calculate the exact motions required to perform the operation. The machine is capable of fitting 3D-printed cavity fillings, tailored to patient's individual needs.