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3D printed artificial skull bone saves life
 How Medtronic uses nitinol to improve the structure and effectiveness of heart devices Tim Laske, VP of research and business development for Medtronic‘s cardiac ablation solutions business, discusses the challenges of designing devices for the heart and explores the properties of nitinol. The heart is often one of the most underappreciated aspects of human anatomy, and its atrial appendages are often overlooked even in cardiac anatomy. These delicate… […]

A new dimension of manufacturing With ACOPOS 6D, B&R heralds a new era of manufacturing. Shuttles carry individual products freely through the machine, powered by magnetic levitation. Gone are the days when conventional transport systems imposed rigidly defined timing on the production process. ACOPOS 6D enables economical small-batch production with frequent changeover between products of different designs and dimensions. ACOPOS… […]

LVADs save lives: So why aren’t more available? Kyree Miller, a 30-year-old college student, navigated seven long years of heart failure with the assistance of an Abbott HeartMate left ventricular assist device (LVAD). “Before I got my LVAD, there was no way I was getting on a plane. Before I got my LVAD, there was no way I was going back to work.… […]

Q&A with John Mazzola, Vicarious Surgical’s first chief operations officer Capping off a medtech career spanning more than three decades, John Mazzola had only been retired from Becton Dickinson for about a week when Vicarious Surgical co-founder and CEO Adam Sachs hired him to lead strategic manufacturing planning. One year later, the surgical robotics developer has promoted Mazzola to the newly created position of chief… […]

New ethylene oxide rules could trigger sterilization consolidation — and new options The largest commercial sterilizers will likely absorb the costs of new ethylene oxide (EtO) regulations — and could consolidate smaller competitors, according to a new analysis from Moody’s Investors Services. Tighter controls on EtO emissions would increase capital spending and operating costs for all commercial sterilizers who use the toxic gas, which is the most… […]

Contract manufacturer PDC partners with David Schnur Associates NEWS RELEASE: PDC Announces Partnership with David Schnur Associates Collaboration to enhance access to precision micro injection molding, delivering innovative manufacturing solutions for minimally invasive medical devices Scottsdale, AZ: PDC, a leading contract manufacturer specializing in micro injection molding and supported by Vance Street Capital, is excited to announce its partnership with David Schnur Associates… […]

Spine device developer taps 3D printers for guides and bone models NEWS RELEASE: Mighty Oak Medical Revolutionizes Spinal Surgery Outcomes with 3D Printing HP Multi Jet Fusion Technology Enables Personalized 3D Printed Models and Tools to Improve Pedicle Screw Placement and Spinal Fusion Procedures Mighty Oak Medical and HP collaborating on patient-specific 3D printed models and guides manufactured using HPs Jet Fusion printers. Mighty Oak Medical… […]

Sterilization startup Phiex adds ex-Medtronic chief medical and scientific officer as advisor Retired Medtronic Chief Medical and Scientific Officer Dr. Rick Kuntz has joined Phiex as an advisor as the medical device sterilization startup works toward commercialization. Phiex is developing a new method for medical device sterilization using a dry powder that generates chlorine dioxide gas inside product packaging. The company sees a big opportunity to offer… […]

Google Cloud partners with Mayo Clinic on generative AI Google Cloud and Mayo Clinic will team up on generative AI for healthcare, the two organizations said today. They intend to develop new capabilities for healthcare organizations to increase productivity, automate repetitive tasks and make administrative processes more efficient. Mayo Clinic and Google Cloud said they are also working with several unidentified healthcare organizations through… […]

MGS Manufacturing buys Technolution A/S NEWS RELEASE: MGS MFG. Group acquires Danish product design firm Technolution GERMANTOWN, Wis. (June 6, 2023) – MGS Mfg. Group, Inc. (MGS), a global provider of integrated manufacturing solutions for complex, high-precision plastic components for Healthcare and Pharma applications, announced today that it has acquired Denmark-based Technolution A/S (Technolution), a fast-growing consultancy and development company within… […]

Output: A physician from New Jersey, Dr. Guarav Gupta, used 3D printing to replace a patient's missing skull bone during an emergency surgery. The doctor requested a 3D printed implant from Johnson & Johnson’s DePuy Synthes company, saving a patient who was suffering from swelling on his brain’s frontal lobe that required immediate intervention.


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Speedy Hire Speedy Hire collaborates with cricket club chasing a world record
 A cricket club in Rodley will bowl through the night in an attempt to smash its own Guinness World Record tomorrow (Saturday August 12).

Following last year, which saw Rodley Cricket Club successfully set the Guinness World Record for the most overs bowled in 8 hours (they achieved 734), the team will be attempting an even bigger challenge this year.

The club, which is in the Bradford and District Cricket League, will make the attempt at its home ground in Rodley during the club’s open weekend, which is taking place from today (Friday August 11) through to Sunday August 13.

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The team will attempt to break the Guinness World Record for the most overs bowled in 24 hours. For the club to beat the record, they will have to complete an incredible 2,000 overs – equating to consistently bowling six balls every 45 seconds over the 24-hour period.

Alex Riddell, organizer and Rodley Cricket Club Social Secretary, said:

“We love a challenge here at Rodley Cricket Club. After smashing last year’s amazing Guinness World Record we thought ‘how can we top that this year’? The answer was obvious to me – go bigger and better! We will be bowling and batting through the night, under lights provided by our fantastic event sponsor Speedy Hire, to try and beat the ridiculously tough record of 2,000 overs. It’s going to be a huge challenge, but we’re lining up some cricket legends to come down and help us break the record – watch this space!”

Steve Bradbury, Chairman at Rodley Cricket Club, added:

“It’s amazing that Rodley Cricket Club could be double Guinness World Record Holders. How huge our annual open weekend has become is another sign of how far the club has come. Until three years ago we had no clubhouse, 30 players and no junior teams. We’re now proud to have a cracking clubhouse, three senior teams and five junior sides with more than 80 kids playing cricket regularly! We are really excited to give all 60 of our youngsters a chance to take part in something really fun and become double Guinness World Record holders.”

The Guinness World Record attempt will begin at around 6pm tomorrow and will be opened by England and Yorkshire cricket players.

Rodley Cricket Club’s 2017 Open Weekend, which this year is held in collaboration with Speedy Hire, aims to raise the profile of the club and raise vital funds to support their ever-growing junior cricket setup.

As well as the Guinness World Record attempt, the Club will put on a fun and family-friendly weekend full of live music, the ‘Scruffs Dog Show’, food and drink stalls, and junior cricket activities. The event expects to bring around 1,000 visitors to the club throughout the weekend.

Output: This year, Rodley Cricket Club's Open Weekend, starting Friday 11 August, is being held in collaboration with Speedy Hire, and aims to raise the club's profile and funds for its junior cricket setup. The team is looking to break its own Guinness World Record, to bowl the most overs in 24 hours, targeting 2,000 - six balls every 45 seconds. Last year it broke the record for the most overs bowled in eight hours, achieving 734. The weekend is expected to attract around 1,000 visitors, and features live music, the ‘Scruffs Dog Show’, food and drink stalls, and junior cricket activities.


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Regus Spaces signs lease on first Midwest location in Chicago
 Thank you for supporting our journalism. This article is available exclusively for our subscribers, who help fund our work at the Chicago Tribune.

This four-story brick building on Halsted Street, which is across from the NewCity development, will be the site for a Spaces co-working office. Amsterdam-based Spaces has leased three floors in the building, in the Goose Island neighborhood. An Ethan Allen furniture store is planned for the ground floor. (SVN Chicago Commercial )

Amsterdam-based co-working company Spaces has leased three floors of a North Side loft office building, the first of as many as 10 Chicago-area locations it plans to open in the next 18 months.

Spaces has leased 27,110 square feet in the building on Halsted Street, the company said. The space, which is in the Goose Island neighborhood, will open in the first quarter of 2018, according to Michael Berretta, vice president of network development for Americas Spaces.

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The Netherlands firm is looking at other potential locations in Chicago's suburbs and in other areas of the city including the Fulton Market district, with plans to have six to 10 offices open in the area by the end of 2018, Berretta said.

Spaces is the newest entrant to a Chicago-area co-working market that continues to expand, even amid an expected consolidation of the industry.

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Co-working providers typically sign long-term leases with office landlords, and then lease out smaller portions — which can range from a single desk to a dedicated office for dozens of workers — on short-term deals.

Led by the industry behemoth WeWork, co-working firms have gobbled up Chicago office space in recent years.

There was more than 1.1 million square feet of Chicago-area space occupied by co-working firms in 2016, a number expected to rise above 1.5 million by the end of this year, according to data from Newmark Knight Frank and Chicago Creative Space. The total was just 48,619 square feet in 2007.

But as larger, well-capitalized providers have grown to provide vast networks of spaces throughout the country and world, some companies have scaled back. Already this year, New York-based Grind has closed down its space in the Loop, and California-based NextSpace shuttered its River North spot.

"The larger operators offer a scale that's hard to compete with," said leasing broker Matt Ward, a senior managing director at Newmark, who is not involved in the Spaces deal. "We think consolidation will continue to happen, and eventually there will be two or three large providers."

The Halsted Street deal is the first in the Midwest for Spaces, which plans to expand from 14 to 40 North American spaces by the end of 2018.

The brick building, where an Ethan Allen furniture store is planned on the ground floor, is across the street from the NewCity retail and apartment complex. It is just south of the intersection of Halsted and Clybourn Avenue, where there is a Red Line CTA station and an Apple store.

The four-story building is owned by Chicago-based developer Newcastle Limited. Newcastle bought the building from TASC for $8 million in 2014 and redeveloped the building. TASC is a nonprofit that provides services for people with substance abuse and mental health issues.

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Newcastle was represented in the lease by Chad Schroedl of SVN Chicago Commercial. Spaces was represented by Bill Rogers and Kerry Gilar of Jones Lang LaSalle.

Spaces is controlled by the same holding company that owns Luxembourg-based Regus, which acquired Spaces in 2015. Regus also provides short-term offices, but it provides corporate-style suites rather than the open, loft-style feel found in most co-working spaces.

Spaces members also can use Regus offices for meetings in other areas of Chicago, or when visiting other cities. Regus has 46 Chicago-area locations, Berretta said.

"What differentiates us from other co-working companies is, we've already got a network of 3,000 locations globally, and almost 1,200 in North America alone," Berretta said. "We've found our customers, whether it's a large corporation or a small startup, want the flexibility to utilize spaces in several locations."

rori@chicagotribune.com

Twitter @Ryan_Ori

Output: Spaces is entering the Chicago market, leasing 27,110 sq ft over three floors in a four-storey loft office block on Halsted Street, which is owned by developer Newcastle Limited. The location is expected to open in Q1 2018, and the firm plans to open six to 10 locations in the Chicago area over the next 18 months. While data from Newmark Knight Frank and Chicago Creative Space predicts co-working firms in Chicago will occupy over 1.5 million sq ft by year end, up from 1.1 million sq ft in 2016, smaller operators are said to have found it difficult to scale and compete with larger firms, and consolidation in expected. Spaces members can also use Regus' offices for meetings, including the firm's 46 Chicago area locations.


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Sapply signs deal with Maestro and Falcom to push IoT devices
 The new deal is part of a strategic push into the IoT space.

Sapply has inked a distribution agreement with Maestro and Falcom in Australia to bring its range of IoT solutions to market. Falcom became a part of Maestro in 2014, forming a global group of machine to machine specialists.

The new distribution agreement is part of the valued-added distributor’s technology strategy to make a bigger push into the IoT space.

According to Sapply, having established itself in the enterprise market has allowed it to build its expertise in IoT products, having identified both the need and the growth potential.

Specifically, it mentioned that its partnership with DIGI International two years ago, caused it to experience increasing demand to be able to provide a broader range of solutions that meet a wider variety of usage situations.

Sapply added that the new distribution deal with Maestro and Falcom is a “perfect complement” to the DIGI International portfolio.

“Maestro and Falcom meet a specific need in the industrial automation, utilities and transportation. Sapply is currently engaged in conversations to broaden the offering further with ranges of accessories such as antennae,” it said.

Sapply sales director, Gordon Taylor, said the deal is part of its IoT strategy, having recently also formed an IoT division.

“We are excited to invest in this growing market,” he said.

“Our experience to date has strongly reinforced the need for value added distribution in IoT as we spend a large amount of our time educating our partner resellers so they can more effectively operate in this market, as well as actively engaging in conversations with end users to position the various solutions so they end up with the best solution for their needs.”

Taylor added that even though the market varies from its enterprise solutions, it will utilise its skills and experience in this new field.

“Whilst it’s a different market to our established enterprise solutions, what we have found is that the skills we have used to build our partner enterprise brands are exactly the skills we need to use in this new and exciting market,” he added.

Output: IT company Sapply has signed a deal with payments enabler Maestro and wireless solutions firm Falcom to offer a range of internet of things (IoT) solutions. The distribution agreement will help spread Sapply’s technology across the IoT market. “Maestro and Falcom meet a specific need in industrial automation, utilities and transportation. Sapply is engaged in conversations to broaden the offering further with ranges of accessories such as antennae,” Sapply said.


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Liability unclear after palm oil spill at sea closes HK beaches
 Hong Kong has cleaned nearly 90 tonnes of palm oil from the beaches of Lamma Island after a collision last Thursday August 3rd between two ships in the Pearl River Delta estuary, “a few tens of miles” southwest of Hong Kong. The white blobs of palm oil started showing up on the coast on Sunday August 6th, mostly on the southern shores of Hong Kong Island and outlying Lamma Island. There appears to have been a significant delay between the time of accident, which happened in China, and the Hong Kong authorities being notified. Guangdong province authorities told local officials of the spill at noon on Saturday August 5th, two days after the accident.

However, Chinese officials asserted that, because it was not known on Thursday or Friday that the spill would affect Hong Kong, technically there had been no delay in the notification. Guangdong authorities said that they only realized it might affect Hong Kong after it had begun cleaning up the mess. Hong Kong authorities claimed that around 1,000 tons of the solidified oil had spilled from a cargo ship involved in the collision and that between 200t and 300t had hit the beaches of Hong Kong. The water at a popular tourist destination fishing village was photographed as covered in palm oil and rubbish. A total of 13 beaches in Hong Kong have been shut down. The Environment Bureau said that the government was discussing the legal liability for the disaster with the shipping company involved, which it declined to identify.

Although palm oil is non-toxic, and preliminary government laboratory results from water samples taken at 11 of the affected beaches showed that oil content in the water was extremely low, the decaying matter could harm marine life by triggering the growth of algae and fuel red tides when temperatures start to rise next week. If the oil has been contaminated by toxins, it could also harm endangered green sea turtles or dogs who eat it.

Marine pollution law expert Zhu Ling, of Polytechnic University, told South China Morning Post that information on the ownership of the boats involved would be important in deciding which jurisdiction would handle damages claims. Zhu said that, if the owners were mainland China companies, the Hong Kong government could claim damages through the mainland legal system. http://www.scmp.com/news/hong-kong/health-environment/article/2105996/whatyou-need-know-about-oil-spill-affecting-hong

Output: Liability for a palm oil spill that closed 13 beaches in Hong Kong has yet to be established after the slick spread to the city's shores following a collision between two vessels in China's Pearl River Delta. About 1,000 tonnes of the oil was shed and 90 tonnes has been removed from Hong Kong's beaches, including tourist hotspots. Hong Kong authorities were not alerted for two days about the crash, which happened within 50 miles of the city. The shipping company involved has not been identified, creating uncertainty about which jurisdiction would handle damages claims.


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Japanese tuna farm uses AI and IoT to improve accuracy
 - Memorandum Concluded with NTT DOCOMO and Information Services International-Dentsu -

Sojitz Corporation has signed a memorandum with NTT DOCOMO, INC. (“NTT DOCOMO”) and Information Services International-Dentsu, Ltd. (“ISID”) through Sojitz’s subsidiary Sojitz Tuna Farm Takashima (“STFT”), to conduct tests verifying the use of IoT and AI in improving efficiency within their tuna aquaculture business. They will begin testing feed optimization with NTT DOCOMO and automated fish-counting technologies with ISID.

STFT buys juvenile tuna, shipping them as adults after 3 years of maturation in an ocean pen. As conditions inside the pen can change dramatically by the day, STFT must determine feeding amounts, methods, and timing accordingly. They currently do this based on experience alone, and this has led STFT to seek ways of raising accuracy for these aspects of the feeding process.

Now with NTT DOCOMO’s assistance, STFT will introduce sensors equipped with IoT technology to obtain readings on water temperature and other data, visualize that data using an application, and utilize AI to fully analyze correlation and relationships between data. In this way, they aim to figure out the optimal conditions for raising tuna in the wild, optimize feed amounts and timing, and improve the pen environment.

Additionally, STFT will work with ISID to more efficiently and accurately ascertain the number of fish present at the farm, creating an automated fish counting system using deep learning-based image analysis technology. STFT needs to know the number of fish in order to decide feeding amounts, raising methods, shipment loads, and shipment timing, as well as raise productivity, cut costs, and estimate sales. Presently, STFT relies on video cameras to count the fish, and they have been struggling with how to reduce labor and raise accuracy. STFT hopes this automated counting technology will solve both of these problems.

Through these verification tests, Sojitz aims to better visualize STFT’s tuna-raising expertise through the use of IoT and AI, developing systems with NTT DOCOMO and ISID to raise efficiency of their aquaculture business and contribute to the advancement of Japan’s aquaculture industry.

Related Information:

NTT DOCOMO, INC. – Company Overview

Established 1991 Head Office 11-1, Nagatacho 2-chome, Chiyoda-ku, Tokyo

Sanno Park Tower Representative Director Kazuhiro Yoshizawa, President & CEO Main business Communications business, “smart life”

Information Services International-Dentsu, Ltd. – Company Overview

Established 1975 Head Office 17-1, Konan 2-chome, Minato-ku, Tokyo Representative Director Setsuo Kamai, President & CEO Main business Consulting services; custom system development; sales and support of software; outsourcing, operation and maintenance services; IT equipment sales and others

Sojitz Tuna Farm Takashima – Company Overview

Output: Japanese tuna farmer Sojitz Corporation has signed an agreement with tech firms NTT DOCOMO and Information Services International-Dentsu to begin testing the use of internet of things (IoT) and AI in their tuna fish farm business. The facility will be optimised using automated fish-counting technology and other devices to monitor feeding. The farm will be equipped with sensors connected to the IoT to read data, with AI programmes used to analyse the correlations between the data sets collected.


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IBM to offer IoT courses to telecoms professionals in India
 NEW DELHI: Technology major IBM has joined hands with the Telecom Sector Skill Council (TSSC) to upskill students and young professionals in the telecom industry to prepare them for new emerging technologies such as big data, cloud, Internet of Things (IoT), mobile application development, data science and business analytics.IBM and TSSC will offer paid courses designed by technology experts from IBM and domain specialists from TSSC.These one-week courses will offer access to relevant IBM software and platforms, including IBM Cloud, IBM Watson IoT platform, Big Data Solutions as well as mobile application development tools.Upon successful completion of the programme, students and young professionals will be certified by IBM Career Education and TSSC.“The partnership with TSSC is an attempt to bridge the capability gap in the marketplace. It is impossible for a company like to do us individually. For the scale, we are doing this with TSSC. This is the initiative to take those capabilities on scale in the India’s telecom market,” Karan Bajwa, Regional General Manager, IBM India / South Asia, told ETin an interaction.

Output: IBM has paired with India's Telecom Sector Skill Council (TSSC) to provide training in the internet of things (IoT) to young professionals and the wider telecoms industry. The partnership will provide one-week courses taught by experts from both organisations covering IBM software such as IBM Cloud, Big Data Solutions, IBM Watson's IoT platform and mobile app tools. Students will be awarded certification from IBM Career Education and TSSC on successful completion of the training.


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Texas power market may need rethink as renewables hurt profits
 This is the time of year power generators make their money.

Much like retailers that depend on a short holiday season to keep them in the black, power generators in Texas rely on the hottest days of summer, when air conditioners run flat-out, electricity supplies become short and prices in wholesale markets spike hundreds of times above their normal levels.

But those spikes are fewer and further between as new sources of electricity, particularly wind, enter the market, shaving peak prices and squeezing profits of power companies. As a result, companies say, they are cutting investments in maintaining and modernizing plants and starting to plan shutdowns - developments that have analysts, regulators and the state's grid manager, the Electric Reliability Council of Texas, concerned about future shortages that could affect the power system's reliability.

"Nobody saw this coming," said Ed Hirs, an energy economist and professor at the University of Houston. "What ERCOT is concerned about is … not having enough electricity for when you need it, for whatever reason."

The threat has become serious enough that the Public Utility Commission will launch a workshop Thursday on what changes the state might need to make to protect the reliability of the power grid - that is, ensuring the lights go on when people flip the switch. The issue is the design of the state's wholesale electricity market, adopted 15 years ago, hasn't kept up with changes in the power industry, which relies more on intermittent renewable sources, particularly wind and increasingly solar, and less on traditional generation.

The state needs coal, natural gas and nuclear plants to meet electricity demand, but the problem for power companies is they only make money when their plants are running, not while waiting for the wind to stop blowing and the sun to stop shining. In the past, earnings from summer price spikes more than covered the costs of maintaining plants that operated at less than full capacity and kept companies profitable.

But that's no longer the case as spikes come less frequently, reducing the incentives for companies to keep plants operating or ready to operate. ERCOT has had to invoke its emergency authority to postpone the shutdown of a power plant - a rare move - and negotiated an agreement with NRG last year to keep operating its Greens Bayou plant east of Houston to protect system integrity.

"There is a lot of uncertainty," said Robbie Searcy, ERCOT's spokesperson. "We do expect that some plants will retire. We don't know which ones or when."

Reliability is not only becoming an issue in Texas, but also in Washington where the Trump administration, pledged to revive the fortunes of coal, has ordered studies on the impact renewable energy has on reliability of the power grid. All this reflects one of the challenges of deregulating electricity: finding market mechanisms that not only increase choice and lower prices, but keep the system reliable.

Lone state

In regulated systems, the costs of keeping plants on the sidelines until needed are built into rates set by utility commissions. But deregulated markets have to find other incentives to ensure enough generation is available if demand spikes.

The most common method is a capacity market, in which companies get paid, based on competitive bidding, for keeping idle generation ready to run. Think of it like a pro sports team, in which players get paid for sitting on the bench.

Texas has the only competitive electricity market in North America without a capacity market. Since 2002, when the state deregulated electricity, Texas has relied on price spikes, euphemistically called "scarcity pricing," to make it worthwhile for companies to keep extra generating capacity at the ready.

On the hottest days of summer, soaring demand can create temporary shortages in wholesale markets, driving prices from an average of $25 a megawatt hour into the thousands of dollars, leading to a lucrative payoff for generators able to quickly supply the market. Consumers are often insulated from these spikes, but the higher costs eventually filter down to their bills.

This system has shown cracks over the years, leading the Public Utility Commission to lift a cap on wholesale prices three times - from $3,000 in 2013 to $9,000 in 2015 - to provide incentives to power generators to invest in their plants and maintain back-up generation. In 2014, the PUC approved an additional surcharge to be paid to power companies when supplies are scarce.

"ERCOT'S market only works if the price is right," said William Hogan, director of the Harvard Electricity Policy Group, which studies competitive electricity markets.

Consumers gain, but …

But power companies, struggling to remain profitable in an era of low electricity prices, say even the higher cap and surcharge are proving inadequate, in large part because scarcity pricing kicks in less often as wind and solar, as well as new transmission, brings more supply into the market. This can be good for consumers' electric bills, but the danger comes if power companies don't make enough money to justify the costs of operating their plants.

Power executives say they are approaching that point.

NRG lost $891 million in 2016, following a $6.4 billion loss in 2015, which the company blamed in part on its significant operations in Texas. Calpine's profit fell more than 60 percent to about $90 million.

Chris Moser, NRG's senior vice president of operations, said he expected far more plant closures in coming years than expected by ERCOT, which estimates companies will shut down plants with a total capacity of 840 megawatts, enough to power about 17,000 Texas homes. ERCOT, he noted, received notices that companies would retire 354 megawatts between 2009 and 2016, but power companies shut down at least 10,800 megawatts.

It's difficult to make such a forecast because in Texas, plants only need to give 90 days notice before shutting down. ERCOT, whose system is not connected to other grids by traditional transmission, updates its reports as companies submit notices of plant shutdowns.

"The market was literally built for a different world than we have today," Moser said.

Capacity limit

Texas' major merchant power companies - among the largest in the nation - have been forced to transform themselves in the face of persistently low natural gas prices, the rise of renewable energy and the high costs of operating coal and nuclear power plants. They have announced mergers, sales, spinoffs and a greater focus on retail electric subsidiaries in an attempt to stay profitable.

Years ago, Texas companies like NRG, Calpine, Luminant and Exelon pushed the Public Utility Commission to adopt a capacity market, without which, they warned, power companies would lack incentives to build plants or maintain old ones, possibly resulting in reliability problems.

In 2012, a consulting company hired by ERCOT suggested that Texas adopt a capacity market, among other options. Later that year, former Chairwoman Donna Nelson issued a memo agreeing with the report and the companies, and suggested the agency consider adopting a capacity market.

"Two years ago, we started this discussion because investment in generation was not keeping pace with increasing demand," Nelson wrote. "If the wholesale electric market within ERCOT fails to attract sufficient investment, the electric reliability of Texans is threatened."

Exaggerated claims

But after more than a year of debate, the issue fizzled in the face of strong objections from industrial power users, who said such a market would unnecessarily raise rates. They claimed that future demands on Texas' electric grid were exaggerated and ERCOT has been able to find plenty of power.

Meanwhile, wind continues to shatter power generation records, accounting for about 20 percent of ERCOT region's power capacity in 2016 and projected increase to around 23 percent by the end of this year. In a report released in June, the PUC warned power companies they should expect to operate their plants less in the future as more wind and solar come online.

Paying power companies to act as backups for renewable sources would keep Texas' power mix diverse and stave off a reliability crisis, said Tom Alley, the vice president of research at the Electric Power Research Institute, a Washington nonprofit funded by the electric utility industry.

"But there is no economic driver to do that other than the capacity fleet," he said, referring to reserve energy that companies in other states get paid to run, like getting paid for time sitting on the bench. "The greatest challenge is that we don't have a way to value diversity and we don't have a way to value flexibility."

Output: Texas power companies are cutting investment in modernising their plants and considering shutting down facilities in response to competition from new sources of electricity. The state's grid manager, the Electric Reliability Council of Texas, along with analysts and regulators have become increasingly concerned that there could be future shortages. Power stations have relied on "scarcity pricing" – hiking prices during periods of peak demand – to maintain profits. However, spikes in pricing are becoming less common because of extra competition from renewable energy. The Public Utility Commission is to launch an inquiry into the reliability of the power grid and the design of the wholesale electricity market.


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Apple patent suggests iPhones to be used to gather health data
 Using CB Insights’ patents search engine, we surfaced a newly granted patent that suggests the iPhone cameras of the future may help users detect health data and measure physiological conditions.

Where is this data coming from? Start your free trial today Email Where is this data coming from? Start your free trial today Email

Earlier this week, Apple won approval for its patent application for a new “Electronic Device That Computes Health Data.” But the technology depicted in the patent renderings isn’t a new wearable health tracker or medical device – it’s an iPhone.

The filing, which describes how Apple devices may be utilized as health sensors, lists applications such as tracking blood hydration, body fat content, oxygen saturation, and many others.

Coming on the heels of the Apple’s Q3’16 acquisition of personal health data platform Gliiimpse, the newly-granted patent is yet another sign of Apple’s ambitions to turn the iPhone – or any of its consumer devices – into a health device.

Get the 76-page APPLE IN HEALTHCARE Report Download the free report to see how Apple is revolutionizing the healthcare market and where it’s headed next. Email

The patent says the new health-computing technology could be equipped to “a smart phone, tablet computer, mobile computer, digital media player, wearable device, or other electronic device” to detect health data “without making the user obtain access to a dedicated fitness and/or wellness device.”

The filing describes how a camera, an ambient light sensor, and a proximity sensor can work together in Apple’s technology to glean information on changes in blood from the user’s touch. (A finger is illustrated throughout the renderings, but the filing notes that an ear, palm, or other body part could be used as well).

The blood data, specifically blood-volume, can then be used to compute health data on the user’s pulse rate, “perfusion index,” and more – enabling users to track information on areas such as heart function, body fat, and blood pressure. Noting that some of technological implementations may use “electrical contacts” for more advanced electrical measurements, the filing mentions health-detection capabilities ranging from electrocardiogram (ECG) readings to measuring a user’s “emotional state.”

Apple’s interest in medical devices and health-data management aren’t new: The company recently partnered hearing assistance company Cochlear to launch the first iPhone-compatible cochlear implant sound processor (hearing aid), and the HealthKit app, which comes pre-loaded on iOS, includes tools to help users log body measurements, health records, sleep patterns, and health records.

The newly granted patent suggests that the HealthKit could be integrated with more verifiable, trackable personal data to make iOS into a personal health record – especially now that the Apple Watch is running Core Bluetooth, enabling it to seamlessly communicate with bluetooth-powered glucose monitors and other specialized medical tools. Taken together, these initiatives fuel Apple’s potential to capture more new opportunities in the clinical healthcare and insurance markets.

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Output: Apple has gained approval for a patent application for an “electronic device that computes health data”. The filing describes Apple devices potentially being used for health monitoring purposes, such as tracking body fat, oxygen saturation, blood hydration and more, using a finger or other part of the body to give readings. Apple recently acquired personal health data platform Gliiimpse, which could be incorporated into new capabilities for the tech firm’s products.


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Canadian Solar and EDF partner for solar project in Brazil
 PV power company Canadian Solar and EDF Energies Nouvelles announced Thursday that both companies have partnered to develop the 92.5MW Pirapora III photovoltaic project in Brazil — through the sale of 80% interest in the site by Canadian Solar to EDF EN do Brasil, EDF Energies Nouvelles’ local subsidiary.

The 92.5MW installation has started construction and is expected to reach commercial operation by the fourth quarter of 2017.

Canadian Solar will supply modules for the project from its 380MW modules factory set in Brazil, while EDF EN do Brasil will manage both construction and operations phases of the site.

EDF EN do Brasil previously acquired an 80% interest from Canadian Solar in both the 191.5MW Pirapora I and 115 MW Pirapora II project. Once commissioned in 2018, the three projects will form the largest solar PV installation in operation in Latin America with a combined generation capacity of 400MW.

The 92.5MW project will generate 188 GWh per year and will contribute to Brazil’s goal of obtaining 23% of its energy from non-hydro renewable sources by 2030.

Dr. Shawn Qu, chairman and chief executive officer of Canadian Solar, said: “We are proud to be working with EDF EN on a third project in Brazil. We have now partnered with EDF EN on all three of our projects in Brazil that were awarded long-term PPAs, totaling close to 400 MWp. We value our strategic partnership with EDF EN and look forward to continuing our successful collaboration on other opportunities in the future, as we expand our quality solar project pipeline globally.”

Output: Photovoltaic company Canadian Solar has partnered with EDF Energies Nouvelles to develop a 92.5 MW solar facility in Brazil. Canadian Solar will sell an 80% interest in the site to EDF's local subsidiary, EDF EN do Brasil, and supply modules from its factory in Brazil.


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LG to release home IoT applications in India next year
 LG Electronics India (LGEI) is in talks with several mobile network service operators to form a partnership to roll out IoT-based products. LG Electronics India (LGEI) is in talks with several mobile network service operators to form a partnership to roll out IoT-based products.

South Korean consumer electronics major LG plans to introduce products based on Internet of Things (IoT) technology in the home appliances segment by early next year, says a top official of the company’s Indian arm.

LG Electronics India (LGEI) is in talks with several mobile network service operators to form a partnership to roll out IoT-based products.

“May be by the end of this year or early next year our first IoT product would be introduced in India,” LGEI Managing Director Ki Wan Kim told PTI.

Output: Electronics business LG aims to roll out internet of things (IoT) home appliance products in India by early 2018. LG Electronics India is in discussions with mobile network service operators to provide IoT products in India, following the launch of similar ranges in South Korea. LG Electronics India will offer appliances that are equipped with LG HomeChat and SmartThinQ, which allow the operation of home devices through smartphones.


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Engie deal to prepare Indian rooftops for solar panels
 France’s Engie, a global energy firm intent on ramping up its renewable footprint, is reportedly in talks with a leading Indian roofing manufacturer to develop a new suite of solar-ready rooftop designs as it seeks to explore opportunities in India’s all-but stagnant rooftop PV market.

According to Live Mint, Engie and Everest Industries Ltd are holding discussions on how best to plug India’s solar rooftop blackhole. Despite ostensibly working towards a 2022 target of 40 GW of rooftop PV, India currently has little more than 1 GW distributed generation (DG) solar installed.

The problems facing the sector are manifold, but perhaps the most obvious drawback is the lack of suitable rooftops capable of supporting a stable and profitable PV array. According to Live Mint, some 60% of all rooftop space in India is unsuitable for solar given their sub-par design and construction, while last year at the Renewable Energy India Exhibition, pv magazine learned that in cities up to 80% of rooftop space is flat and/or shaded by other buildings.

Exact details of Engie’s plan are sketchy – the company has refused to comment on the ‘rumors’ – but Everest Industries did say that it has begun a solar roofing business and is in talks with a number of companies regarding this.

One mooted approach would be the development of integrated solar roofs, where the cells are embedded into rooftop shingles. Tesla recently unveiled such a model in the U.S., and while the technology is not really new, the lower price points are.

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“We are still some time away from solar roofs in India,” an anonymous source with information on the discussions told Live Mint. “What Everest and Engie are looking at now are solar-ready roofs that are suitable for solar rooftop projects from the viewpoint of design, load and angle. There is a lot of opportunity in this space given the government’s push for solar.”

Engie’s solar subsidiary Solairedirect has built up an 810 MW portfolio in India already, while Engie itself is hoping to expand its Indian solar footprint to 2 GW by 2019. The ambition from India’s government is bold, but despite setting that 40 GW target, few experts currently operating in India believe that it can feasibly be met on time, not least a parliamentary standing committee, which expressed its doubts last week about the “unrealistic” target.

Despite the introduction of net metering policies issued by all state electricity regulatory commissions across India, there has so far been very little in the way of DG PV uptake, particularly at the residential level. This reluctance is also due to a lack of viable financing options for homeowners and – despite a growing middle-class – a lack of awareness of the need for privately owned solar energy.

Residential PV in India needs to first reach the “nice to have” stage, before it can truly fulfil its potential, other industry experts believe.

Output: French energy firm Engie is said to be in talks with Indian company Everest to develop rooftops that can accommodate solar panels. India has a target of 40 GW of rooftop solar by 2022, up from 1 GW today. That goal is hindered by a lack of suitable rooftop space, with between 60% and 80% either unsuitable for construction or in shade. Engie, whose subsidiary Solairedirect has already built up an 810 MW portfolio in India, aims to expand its solar footprint in the country to 2 GW by 2019.


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Here's why competitiveness in generic drug market is at Risk
 In this video

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Here's why competitiveness in generic drug market is at risk: Industry expert

CNBC's Meg Tirrell speaks with Chip Davis, Association for Accessible Medicines president, about generic drugs facing pricing pressures.

Output: CNBC's Meg Tirrell speaks with Chip Davis, Association for Accessible Medicines president, about generic drugs facing pricing pressures


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Medi-Cal Sued For Pushing Patients Into Managed Care Despite Judges’ Orders
 Alondra Diaz can’t get enough of Elmo and Barney, and she adores picture books.

The 14-year-old, who will enter high school next week, has several complex and debilitating medical conditions, including epilepsy, microcephaly and a mitochondrial disorder. Her long-standing team of doctors — a neurologist, geneticist, orthopedist, pediatrician and others — is primarily based at Cedars-Sinai Medical Center in Los Angeles, where Diaz lives.

But Diaz may lose access to that team because of a recent move by the state agency that administers Medi-Cal, California’s version of the Medicaid health insurance program for low-income residents.

Like Medicaid programs in many states that want more budgeting certainty or hope to save money, Medi-Cal is shifting many patients like Diaz, with complex conditions, into managed care plans. The plans agree to cover enrollees for a fixed amount per month. But in doing so, they often rely on narrow networks of physicians that do not include the patients’ doctors.

Use Our Content This story can be republished for free ( details ).

“The care and the attention that she gets and has been getting would not be the same,” said Diaz’s mother, Maria Colin, 45, who spoke through a Spanish-language interpreter. “Instead of going forward, she would be going backward in her development.”

Thirty-nine states use managed care to cover all or part of their Medicaid populations, according to the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, an editorial independent publication of the foundation.)

In 28 of those states, at least 75 percent of Medicaid beneficiaries were enrolled in managed care last year, and those numbers are likely to increase. About 80 percent of California’s 13.5 million Medi-Cal members are now in managed care.

In January, the California Department of Health Care Services (DHCS) overturned a ruling by an administrative law judge that would have allowed Diaz to stay in the traditional form of Medi-Cal — known as fee-for-service — and keep her doctors. Instead, the department said she must switch to a managed care plan with which her doctors do not contract.

Two health consumer advocacy groups, Neighborhood Legal Services of Los Angeles County and Western Center on Law and Poverty, sued DHCS Tuesday to help Diaz and the dozens of other Medi-Cal members who’ve had similar rulings overturned by the state.

The lawsuit, filed in Los Angeles Superior Court, alleges that the department is contradicting doctors’ opinions and illegally reversing decisions by administrative law judges that would allow patients with complex medical conditions to remain in fee-for-service Medi-Cal.

“As a result, they’re putting our clients at great medical risk,” said Mona Tawatao, senior attorney for Western Center.

The department said it does not comment on pending litigation.

In fee-for-service Medi-Cal, patients can see any doctor who accepts them, and providers are reimbursed for each medical service or visit. Under managed care, the state contracts with health plans to deliver benefits to enrollees and pays them a fixed monthly premium to cover the expense of doing so — a payment system known as “capitation.”

Managed care encourages providers to offer preventive care and to scrutinize every test or treatment, since they bear financial risk if they go over budget.

“A [monthly] capitation payment provides a relative amount of budget certainty,” said Matt Salo, executive director of the National Association of Medicaid Directors.

But budget concerns are not the only reason to move patients to managed care, he said. Medicaid enrollees “tend to be the sickest, the frailest, the most medically complex and most expensive patients in the country,” and their medical care needs to be managed, he said. “You really want some kind of entity or some kind of organized involvement in how to best provide comprehensive, holistic care to that patient.”

But shifting to managed care comes at a price for some patients: They must remain within the plan’s network of providers, and that can mean losing their medical team.

That is the case with Diaz.

In California, Medicaid patients who are slated to move into managed care can appeal by filing a “Medical Exemption Request.”

As part of that process, the enrollee’s doctor must submit “evidence that [the patient] is unstable and that … treatment cannot safely be transferred to a managed care plan physician(s) of the same specialty or specialties,” according to DHCS.

An exemption lasts up to 12 months when approved, “and is dependent on an individual’s unique situation,” said department spokeswoman Carol Sloan.

From October through December 2016, the most recent quarter for which data are available, the department approved 66 percent of exemption requests and denied 34 percent.

When Medical Exemption Requests are rejected, members can then take their case to an administrative law judge, as Diaz’s family did.

For several years, Diaz’s Medical Exemption Requests had been approved by the department. But it rejected her latest request in July 2016, her mother, Colin, said.

Colin appealed to an administrative law judge on behalf of her daughter, and the judge ultimately agreed that Diaz should remain in fee-for-service Medi-Cal under the care of her existing medical team.

Diaz’s “treating physician certified that she has not stabilized to a level that would enable her to change physicians and begin receiving care from a plan provider without deleterious effects,” the judge wrote.

But the health care department, in its January order reversing the judge’s decision, asserted that “there is no evidence of clinical or physical instability. … The beneficiary is currently stable for transfer to a managed care plan.”

The lawsuit targets such reversals, arguing that in overturning the judges’ decisions, the department is not abiding by its own rules.

In the past two years, roughly 130 Medi-Cal patients — primarily in Los Angeles County — have had decisions in their favor overturned by the department, said Ella Hushagen, a staff attorney for Neighborhood Legal Services.

“When there’s evidence from the treating physician that the patient is too unstable to move into a managed care plan, the department is not following that standard,” Tawatao said. “The department should follow the rules.”

The suit seeks redress for Medi-Cal recipients who have already had judges’ decisions overturned, as well as those who may appeal in the future. It covers most Medi-Cal recipients, including those in Los Angeles County, Tawatao said. Some beneficiaries may not be affected because they live in counties with different medical-exemption rules, she said.

“These are people who are very fragile, with rare diseases and conditions for which there appear to be very few specialists,” Tawatao said.

Diaz and her family are working separately with Neighborhood Legal Services to contest the department’s reversal. The soon-to-be ninth-grader remains in fee-for-service this month while that appeal is pending, Hushagen said.

Diaz was placed in managed care for a few days earlier this month before advocates got her out. During that time, she couldn’t get her epilepsy medication refilled, and the mobile nurse who visits her three times a week didn’t have authorization to help.

Meanwhile, Diaz’s medical needs mount. She had to start using a wheelchair last year after she kept falling and doctors discovered her right leg was longer than her left.

Her doctors are now investigating whether she has petit mal seizures every night when she sleeps. Her last grand mal seizure landed her in the hospital in October.

If she moves to managed care, “we would have to start all over again with new doctors. It’s like starting from scratch,” Colin said. “That’s time wasted that she needs to be spending with her doctors receiving treatment.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Output: Alondra Diaz can’t get enough of Elmo and Barney, and she adores picture books. The 14-year-old, who will enter high school next week, has several complex and debilitating medical conditions, including epilepsy, microcephaly and a mitochondrial disorder. Her long-standing team of doctors — a neurologist, geneticist, orthopedist, pediatrician and others — is primarily based at Cedars-Sinai Medical Center in Los Angeles, where Diaz lives.


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From Home Alone to the CARE Act: Collaboration for Family Caregivers
 This spotlight discusses the Caregiver Advise, Record, and Enable (CARE) Act, which became law in 40 US states and territories in four years. The groundbreaking 2012 report, Home Alone: Family Caregivers Providing Complex Chronic Care, funded by The John A. Hartford Foundation, drove policy adoption and is still currently underway in several states.

In addition to the CARE Act, the Home Alone report inspired the creation of the Home Alone AllianceSM, and the creation of key resources and tools to improve outcomes and experiences for family caregivers as they navigate the health system and providing care at home.

Previous Report:

From Home Alone to the CARE Act: Collaboration for Family Caregivers (PDF)

Output: The 2012 report Home Alone: Family Caregivers Providing Complex Chronic Care, funded by The John A. Hartford Foundation, broke new ground by uncovering the complex medical/ nursing tasks that family caregivers are performing with little guidance or support.


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BlackBerry unveils strategy to become secure IoT provider
 JAKARTA -- For a decade or so before the market for touchscreen smartphones took off around 2010, BlackBerry's hand-held communication devices were ubiquitous among thumb-jockeying executives trying to keep in touch with the office outside working hours.

After several recent failed attempts to launch new phones and operating systems to compete against Apple, Google and Samsung Electronics products, the company that "made the modern cellphone," as BlackBerry's CEO John Chen puts it, is hoping to become the main supplier of secure applications and software for the next generation of internet-linked devices -- the much- touted "internet of things" -- from web-connected self-driving cars to "smart" domestic appliances that are expected to take off over the coming decade.

Output: BlackBerry is seeking to become a supplier of secure applications and software to support the internet of things (IoT), from connected cars to smart domestic appliances, according to CEO John Chen. Speaking at an event in Jakarta organised by the American and Canadian chambers of commerce, Chen revealed the firm had inked a seven-year deal with car maker Ford and wanted BlackBerry to become "the number one secure communications [provider] in IoT", adding that "a car without proper security or anti-hacking [systems] will become a weapon".


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Chronic Care Management Gets Mixed Reviews
 More than 2 years after Medicare launched its Chronic Care Management (CCM) payment policy, researchers are finding mixed reviews.

The program that began in January 2015 reimburses providers for CCM components that happen outside an office visit, but providers have been slow to get on board, and early uptake was less than 5%.

Findings from a new study published online July 28 in the Journal of General Internal Medicine shed light on what is holding them back.

Ann S. O'Malley, MD, a senior fellow at Mathematica Policy Research in Washington, DC, and colleagues report that during the first 15 months, uptake was 4.5%. Of 224,187 noninstitutional primary care providers that billed Medicare, only 10,022 billed for CCM services.

Researchers conducted semistructured telephone interviews from January to April 2016, with 71 respondents (60 billing and nonbilling providers and staff knowledgeable about their practices' CCM participation and 11 professional society representatives), to find out where they saw strengths and weaknesses of the program.

The interviews occurred with practices of varying sizes, urban vs rural status, ownership type, and specialty. They indicated many plusses, including mostly positive feedback from patients. CCM encourages patients to adhere to treatment, improves access to care team members, and improves continuity of care. Patients like having a specific point of contact, according to the findings.

"Although some providers had initial concerns that CCM might hinder patient–primary care provider continuity (if other specialists billed for CCM services), only one provider had experienced this problem," the researchers write.

Reimbursement for Upfront Costs Falls Short

But interviewers also heard about considerable barriers. Professional society representatives and both billing and nonbilling providers said reimbursement was not enough to cover upfront costs of staffing, particularly those for hiring a care manager, modifying workflow, and the time needed to care for complex patients.

Under CCM payments policy, providers may bill for 20 minutes of clinical staff time once per month per patient for out-of-office care management and coordination.

"Some respondents reported that practice staff usually spent 45 to 60 minutes on each CCM patient each month — and several hours on the most complex patients," the researchers write.

Others said infrastructure problems held back the exchange of health information among providers, and electronic health records were not able to adequately document and update care plans.

To bill, practices must have a certified electronic health record, assign a clinician to each patient, maintain a care plan in collaboration with the patient, communicate with other health professionals, and manage medications.

Potential Is There

Ari Hoffman, MD, from the Department of Medicine at the University of California, San Francisco, writes in a related commentary published August 7 that the program has unrealized potential.

"[W]e know that CCM, done right, can decrease hospitalization and [emergency department] visits over time, with an estimated $101-per-participant reduction in Medicare spending."

He says negatives for providers include substantial documentation and active billing, instead of the automatic per member/per month payments used in patient-centered medical homes. Under CCM, providers must bill for each beneficiary each month that they deliver CCM services.

Negatives for patients include part B coinsurance payments, he notes.

"One in seven Medicare beneficiaries have no supplemental coverage, and they are disproportionately black, poor, and disabled," Dr Hoffman writes. "Not only is the coinsurance ineffective at achieving the goal [of using effective services], but it contributes to health inequity."

He points out that a limitation of the study is that researchers interviewed only four nonbilling providers.

"[T]hese findings suggest that further improvements in the CCM payment policy that reduce barriers to uptake and ensure best practices have the potential to reduce costly utilization, improve outcomes, and save money, the holy grail of healthcare value," Dr Hoffman concludes.

Funding for data collection and analysis was provided under a contract with the Centers for Medicare & Medicaid Services. The authors and Dr Hoffman have disclosed no relevant financial relationships.

J Gen Intern Med. Posted online July 28, 2017. Article full text. Published online August 7, 2017. Commentary full text

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Output: More than 2 years after Medicare launched its Chronic Care Management (CCM) payment policy, researchers are finding mixed reviews. The program that began in January 2015 reimburses providers for CCM components that happen outside an office visit, but providers have been slow to get on board, and early uptake was less than 5%.


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On Health Care, Who Needs Congress?
 Two years ago, a small number of corporate chief human resources officers, led by American Express, Verizon and Macy’s, met to figure out if they could come up with a better way to provide coverage for their workers at more affordable rates. Individual companies had done all they could to improve the system, but each hit a wall. There was only so much one company could accomplish on its own. One year later, 21 companies with a total of four million employees began an effort to change the way they paid for health care.

Now 41 major corporations that represent over six million workers and retirees have joined together to reform the private-sector health care system. Our companies are diverse, representing pretty much every sector of the economy. Known as the Health Transformation Alliance, we’re troubled by the number of middlemen who drive up the price of care, and by the soaring costs of prescription drugs.

The members of the alliance spend $25 billion on health care and, as a result, have a lot of data that helps us identify trends. By studying where the money goes and its impact on patient health, we can see what treatments, which doctors and hospitals, and which medical networks get the best results. Data analysis from IBM is turning what used to be a blizzard of paperwork into a road map for the future.

There are things data can tell us that individuals have a hard time learning on their own. For example, if data tell us that 50 percent of patients who visit a particular hospital suffer a relapse for a particular medical condition while only 25 percent of patients who visit a crosstown hospital have a relapse for the same illness, we want our employees to know that — and if possible, to use the hospital with the better results. The data can save lives.

Output: Regardless of whether Congress enacts health care reform, the private sector isn’t waiting. Health care for our employees is too expensive, and the employer-based system must be reformed.


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Only Half of Medicare Advantage Members Understand Their Plan
 Integration and care coordination are key dissatisfiers for members of Medicare Advantage plans, and insurers are missing a huge opportunity for growth, says a J.D. Power study.

Although members are more satisfied overall with their Medicare Advantage plans in 2017, still only slightly more than half of members (54%) completely understand how their plan works, according to a newly released J.D. Power study on Medicare Advantage plans.

And even though enrollment has been growing steadily—more than 33% of all Medicare beneficiaries are now enrolled in Medicare Advantage--the study found that health plans are missing a significant pre-marketing opportunity for the over-60 age group, many of whom will transition to Medicare by age 65.

In fact, the proportion of the population age 65+ in the U.S. is projected to increase from 14% to 21% over the next 20 years, which represents an opportunity for plans to capture market share as more people become Medicare-eligible. However, the survey found that only 11% of members in the 60+ age cohort had received any communications from their health plan regarding moving from current coverage to a Medicare Advantage plan.

Among the 11% who have received premarketing contact from their health plan, overall satisfaction scores are 52 index points higher than among those who received no marketing contact (762 vs. 710, respectively, on a 1,000-point scale). Also, fewer members understand how their prescription drug coverage works than they did last year.

“Medicare Advantage plans represent a significant growth opportunity, but many health plans are not maximizing that potential,” said Valerie Monet, senior director of the insurance practice at J.D. Power, in a press release.

Member responses indicated that progress can be made in satisfaction levels in part by better coordination of care by health plans. Only 34% of members indicated that their plan was able to effectively help them with care coordination.

Another big factor in member satisfaction is the degree to which members see their doctor as a trusted partner in their medical care. Though health plans may have limited impact on this factor, the issue is related not so much to the soft skills of the clinician, but with assistance in navigating the myriad of healthcare providers involved in their care and managing the associated costs, suggesting a role for health plans.

Overall member satisfaction in 2017 held steady with an average score of 799, which is nine points higher than the same study found in 2016. This is the third year of the study for the global market research company, which is based on survey responses from 3,442 Medicare Advantage members from the 12 largest Medicare Advantage plans from around the country.

It measures satisfaction based on six factors (in order of importance): coverage and benefits (25%); customer service (19%); claims processing (15%); cost (14%); provider choice (14%); and information and communication (12%).

Kaiser Permanente ranks highest in Medicare Advantage member satisfaction for a third consecutive year, with a score of 852, which is 49 points higher than the second-ranked plan.

Kaiser outperforms all other plans across five of the six factors that comprise the overall satisfaction index. Highmark ranks second with a score of 803 and Humana ranks third with a score of 794.

Output: Although members are more satisfied overall with their Medicare Advantage plans in 2017, still only slightly more than half of members (54%) completely understand how their plan works, according to a newly released J.D. Power study on Medicare Advantage plans.


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Senior citizens aren't pulling any punches at their weekly boxing program
 Residents in a senior living community in Rancho Santa Margarita are proving they can pack a punch.

For nine months, the senior living community in Park Terrace has held a weekly boxing program with Gary Ballard, a former professional boxer who once fought for the IBF World super middleweight title.

Ballard, who has fought professionally in South Africa and the U.S., retired from his boxing career in 1998 and focused on becoming a personal trainer.

Since then, he has formed Ballard Fitness, his personal training and kickboxing gym that operates one mile from Park Terrace.

Ballard also founded Rock Steady Boxing of Orange County after becoming an affiliate of Rock Steady Boxing, a national nonprofit that provides boxing programs for people battling Parkinson’s disease.

“I’ve seen the benefits of boxing for people with Parkinson’s and then I got connected with the people at Park Terrace because someone told me I should go check it out,” Ballard said.

Each week at Park Terrace, Ballard sees about a dozen residents arrive to lace on gloves and start swinging.

“Every great boxer has a story about how he or she achieved victory, and our residents are no different, as they are able to overcome hurdles and shape their own triumphs in the ring,” Park Terrace executive director Jerry Church said in a statement. “Typically, you wouldn’t think of seniors boxing at a senior living community, but we’re proud to offer such a unique program.”

At a class last month in Park Terrace, a row of chairs in a large room were set up for residents in a semi-circle and piles of boxing gloves lay in one corner.

Resident Russ Walvoord stepped inside with his own pair of black boxing gloves.

His wife, Lori Walvoord, also a Park Terrace resident, said he’s been there for the classes since the beginning.

“At this point in time, his capability is limited,” Lori said during a phone interview. “He still does some artwork and he walks a lot, but one of the highlights of his week is boxing. He’s one of those who remains on his feet and spars with Gary.”

After residents took a seat, Ballard said he would begin leading everyone through a few warm-ups.

“It’s not so much about doing a killer workout as it is about just getting them moving,” Ballard said. “They certainly feel empowered. It’s a morale booster.”

Together, the trainer and his prospective boxers began lifting their knees and rolling their shoulders.

Ballard tapped Walvoord in his seat and said,“Come on, Russ! Come on!”

Walvoord rose to his feet, balled his bare hands and began to throw jabs at Ballard’s core.

“With the gloves on, Russ!” Ballard said with a smile. “With the gloves!”

Lori Walvoord said she sometimes attends the programs to see her husband and the others box with Ballard.

“I like to see the focused energy,” she said. “It gives a certain amount of release for people with whatever is going on with them. Gary’s doing a wonderful job.”

After warm-ups, Park Terrace staff helped everyone strap on their gloves while Ballard put on a pair of boxing mitts and showed them how to jab with just their left hand.

The boxer got on his knees to meet the seated residents at eye level. As he moved from person to person, each took turns swinging into his mitt.

Some who were lounging back in their seats suddenly sat up straight when Ballard came in front of them.

“Haa! Haa!” they would holler with each punch.

He moved to the final seat in the row where his last boxer gave him a blank stare. He pounded his mitts together twice before turning them to face her.

After a few seconds, she threw her left hand into his mitt. Her lips cracked into a smile.

“You better watch out for me,” she told Ballard.

Ballard demonstrated a few more boxing moves with Park Terrace resident Harry Dismuke, who volunteers to help Ballard during the program.

The group took up the rest of class by learning how to jab with their right hands and how to deliver a one-two punch with both hands.

“For some, things can feel really mundane and uninspired, and they probably didn’t feel like coming here,” Dismuke said. “But when they get out, they’re probably glad they came.”

After class, residents emerged from their seats, smiling.

Dismuke waited for everyone else to exit the room before he walked toward the door.

“Well, time for my yoga class,” Dismuke said.

He turned and said, “I’m only kidding.”

Alexandra.Chan@latimes.com

Twitter: @AlexandraChan10

Output: Residents in a senior living community in Rancho Santa Margarita are proving they can pack a punch. For nine months, the senior living community in Park Terrace has held a weekly boxing program with Gary Ballard, a former professional boxer who once fought for the IBF World super middleweight title.


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Neither bills nor advancing age can dim the glow of a drummer's dream
 Steve Hideg moves through his small East Hollywood apartment with tiny shuffle steps, as if to avoid a fall. His slacks are creased, his shirt pressed. It doesn’t cost money, he says, to hold your head high.

Hideg, almost 86, is blind in one eye and deaf in one ear. He’s carried that burden since a childhood injury, when he and his family took cover in the cellar of their home as bombs thundered down on Budapest. Lately the good eye isn’t so good, so he keeps a big magnifying glass handy, but Hideg has bigger challenges than that.

His rent is roughly $1,000 a month, and his Social Security income is about $900 a month.

“It’s a total miracle how he exists,” says one friend.

The secret is disciplined austerity, occasional help from buddies, and a once-weekly job as a jazz drummer — a job that feeds Hideg’s soul. When the DWP shut off his power briefly, Hideg borrowed a camping light from a friend. A $300 gas bill gathered dust until a buddy covered it.

“Hello, my angel,” Hideg called out one day to a woman who knocked at his door and delivered a tray of food from St. Vincent Meals on Wheels.

Sometimes, that’s his only food in a day.

Left: Steve Hideg, 85, lays out three suits in his apartment in East Hollywood. Right: Hideg shaves in the bathroom of his apartment where he has lived for 25 years. (Francine Orr / Los Angeles Times)

California is robust in countless ways, its economy ranked among those of the richest nations in the world, and yet millions struggle to survive the double blow of flat wages and high housing costs. It’s the great Golden State paradox, an escalating calamity and public policy failure with no fixes on the near horizon as the retiree population explodes.

And yet Hideg, unbowed, has risen above it all by remaining faithful to a dream and honoring a different measure of prosperity. As one friend of his put it, in his mind, he’s a rich man.

Istvan “Steve” Hideg was hungry, shoeless, scared, brave, a child of war. He was just a boy in 1943, when his father was killed on military duty. Hideg and his mother, brother and sister struggled through bleak, lean years of economic and political upheaval, and a meal often was nothing more than a smear of lard on a scrap of bread.

“We put a little salt and paprika on it,” Hideg says. “I kind of learned how to survive.”

It’s a skill, or maybe a frame of mind, that has endured.

“Even when I have only one meal in a day,” Hideg says, “I’m never hungry.”

As a teen, Hideg worked at the concession stand of a Budapest movie theater and ducked in, at every opportunity, to catch a glimpse of the films. There, in black and white, was a world he’d never imagined.

Jozsi Baky, left, helps Steve Hideg at the Alpine Village Swap Meet in Torrance to sell some of his belongings for food and medicine. (Francine Orr / Los Angeles Times)

“I saw Louie Armstrong!” Hideg says of the jazz giant. “He sang ‘Jeepers Creepers’ to a horse!”

That was in the 1938 movie “Going Places.” Another American classic, the 1941 hit “Sun Valley Serenade,” made Hideg ache with desire to become a musician and to escape iron-fisted postwar Hungary. In “Serenade,” the Glenn Miller Orchestra played “Chattanooga Choo-Choo” and the swinging “In the Mood.”

“Whewwwww, that did it for me,” Hideg says, still jazzed 70 years later. “I fell in love with this whole country and its music. To me, it was the sound of freedom.”

His brother bought him a snare drum like the one Hideg had seen in the village his parents grew up in. There, with no newspapers and scant communication with the outside world, the drum was a siren call to villagers who gathered to hear the messenger deliver the news of the day.

Hideg studied the moves of drummers Buddy Rich and Gene Krupa, got a job in an electronics factory and joined all three of the company bands. He later became a full-time musician and worked with a circus band for a while, but the songbook wasn’t to his liking and the government deemed Western music the enemy of the people.

In 1956, blood spilled as Hungarians revolted against Soviet control. Hideg and his wife, a pianist, risked execution as they fled Budapest under cover of darkness. They sneaked past Russian infantry and escaped first to Austria and then New York City in early 1957. Hideg got a job as a janitor, and after work he’d race to Birdland and other Manhattan jazz clubs to see his heroes.

In 1961, he and his wife loaded up their old DeSoto and headed west, flat broke, stopping at bars along the way to play for food and gas money, Hollywood or bust.

Steve Hideg, 85, on drums and Tom Pedrini on bass at their Saturday morning workshop in Hollywood on July 29. Hideg gets together with his friends and has a music workshop each Saturday morning. (Video by Francine Orr / Los Angeles Times)

He hustled, schmoozed, hung out at the musicians’ union, started at the bottom.

And he made it.

A young man who had grown up with so many restrictions was playing a kind of music with no rules.

In the good years, there was the Steve Hideg big band and Steve Hideg and The Continentals. When TV game shows had live music, Hideg played in the “Truth or Consequences” band. He toured for several years with Pat Collins, a hypnotist with a popular show. He played in Florida and put in several years in Vegas.

He never made great money or played with big stars. But to his own astonishment, Hideg was living out his fantasy in the city that had manufactured the dream. He developed a talent as a contractor, stringing together bands for all occasions. In his scrapbook is a copy of a check he got after playing a birthday party for Dustin Hoffman.

There were struggles along the way — no musician gets through the grinder unscathed. When Hideg’s wife became ill and they couldn’t afford to pay for her care, she went back to Europe to live with family in Austria, where she died young. Hideg himself fought through cancer and now battles macular degeneration.

He never married again, which made it easier to grab road jobs when they came up and he was young enough to handle the toll. He has lived in the same apartment now for 25 years, a time in which the market for live music — especially big band and straight-ahead jazz — has withered. Hideg was getting by just fine when he served as live-in manager at his apartment building, but he got too old for the job a few years back, and the bills keep coming.

But his pride is undiminished.

Wearing a suit and tie Steve Hideg, 85, carries his drums into Callender’s Grill before his gig in Los Angeles. (Francine Orr / Los Angeles Times)

“I did not come to this country to be a burden on the state,” says Hideg, who has resisted signing up for many entitlements available to seniors.

He chose the musician’s life, he says, and has no regrets. If he has a message for others, Hideg tells me, it’s that doing something you love will serve you well. And another thing: Don’t hesitate to ask friends for help if you need it.

“He’s not a shy guy, but it’s not easy for him” to accept money, says Hideg’s longtime buddy Laszlo Cser, a retired musician and L.A. City College professor. “Lately he’s more willing to go along.”

Louis Kabok, a local bass player who knew Hideg in Hungary, fled at about the same time. He says his friend’s high spirits in the face of hardship and advancing age don’t appear to be an act.

“To tell you the truth, I never met another person in my life who has his kind of attitude,” says Kabok. “He just has an idea of the way he wants to live his life, and he’s doing it.”

Indeed, for all his troubles, Hideg glows. His silver hair is as thick as his Hungarian accent. His grin is young, timeless and broad, the grin of a man who’s in on a secret.

Whatever day it is, the weekend is coming soon, and Hideg lives for Friday and Saturday.

He can’t bang the skins in the quiet environs of his apartment building, so every Saturday, he stays drummer fit with a two-hour workout at Stein on Vine in Hollywood, the legendary music shop where he jams with gray-bearded buddies and it’s the 1950s all over again.

Better yet, Hideg’s Friday night gig is coming up, and he knows, without doubt, that the music he loves will live forever.

Top left: Sometimes, a tray from St. Vincent Meals on Wheels is his only food for the day. But Hideg has stays faithful to a different measure of prosperity. Top right: I can't believe I m still doing what I love, says Hideg, carrying his drums out of his apartment as he heads to a gig. He lives for Fridays and Saturdays. Bottom: A woman walks past Hideg's drums sitting outside Callender's Grill in Los Angeles. (Francine Orr / Los Angeles Times)

Phillip Williams, a pianist and singer, met Hideg at a party eight years ago and asked if he wanted to sit in with his band on Friday nights at Callender’s Grill. That’s a high-end, mid-city Marie Callender’s with live jazz several nights a week.

Hideg has been with Williams ever since.

The Hungarian octogenarian they call “Cool Cat” is old school in his respect for the art and the audience. Before his gig, Hideg showers and shaves, puts on a suit, cinches the tie and arranges the pocket square hanky just right, like one of the pros in the big bands he once saw in the movies.

“I love getting ready, I love carrying the drums, I love setting them up, I love everything about it,” Hideg tells me.

He drives to work in a 1992 Mazda van that Williams gave him when his old Aerostar conked out, and he is smiling when he walks into the restaurant and begins setting up.

Typically, several terrific local musicians drop by and sit in with the band. Williams knows the lyrics and music to hundreds of songs and plays what strikes him, from pop to serious jazz, and he generously features each of his sidemen. He likes calling “Satin Doll” because there’s a short solo in it for Hideg, who is twice the age of the others in the band and always seems to be having twice the fun.

On an up-tempo number, Williams motions for me to circle behind the piano so he can whisper me something.

“Look at this guy go,” Williams says as Hideg taps out an elegant patter, never loud, never showy, riding the groove just right and always in the service of bandmates and the music.

“This is adding minutes to his life,” says Williams. “I feel like I’m his doctor.”

Hideg plays jazz drums at Callender’s Grill in Los Angeles. “I love getting ready, I love carrying the drums, I love setting them up, I love everything about it,” Hideg said. Top: Hideg plays jazz drums at Callender's Grill in Los Angeles. “I love getting ready, I love carrying the drums, I love setting them up, I love everything about it,” Hideg said. Bottom left: Enrique Mendoza, 6, left, talks with Hideg during a break Friday night at Callender's Grill in Los Angeles. Right: Bill Melendres, Gary Urwin, Hideg, center, and Allan Walker on sax play jazz Friday night at Callender's Grill in Los Angeles. (Francine Orr / Los Angeles Times)

In the quiet of his apartment, I had asked Hideg if he worries about anything. What if the rent goes up? What if his good eye can’t be saved? What if he can’t drive much longer?

“I live my life by three principles I learned as a Boy Scout. Faith, hope and love,” he said before reminding me he has everything he ever wanted.

“And I can’t believe I’m still doing what I love.”

His struggle is real, said Hideg.

“But it’s a beautiful struggle.”

Hideg looks though papers in his apartment in East Hollywood. He gets by on disciplined austerity, occasional help from friends and his once-weekly job as a drummer. (Francine Orr / Los Angeles Times)

steve.lopez@latimes.com

francine.orr@latimes.com

Output: Steve Hideg moves through his small East Hollywood apartment with tiny shuffle steps, as if to avoid a fall. His slacks are creased, his shirt pressed. It doesn’t cost money, he says, to hold your head high.


Instruction: create a high quality summary of the given input

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Let's end ageism
 Ashton Applewhite | Networked Books, 2016 | Book This Chair Rocks: A Manifesto Against Ageism My book explains where ageism comes from, describes the damage it does, shows what an all-age-friendly world might look like, and concludes with a call to action. You’ll find what one reader dubbed "lightbulb moments" on almost every page, and it’s fun to read. Don’t take my word for it; check out the reviews.

Margaret Morganroth Gullette | University of Chicago Press, 2011 | Book Agewise: Fighting the New Ageism in America Written by the renowned cultural critic who coined the term "age studies," this book that radicalized me by placing ageism in a social and economic context. Two favorite quotes: "Enticements to look younger—like enticements to look whiter or thinner—could finally be rejected as bigotry," and “Cultures truly interested in pleasure don’t romanticize inexperience.”

Margaret Cruikshank | Rowman & Littlefield, 2009 | Book Learning to Be Old: Gender, Culture, and Aging "Aging is a process socially constructed as a problem," writes age scholar Peg Cruikshank, who examines the class bias behind terms like "successful" and "productive" aging, debunks the myth that an aging population threatens the non-old, and critiques the medicalization of old age. We don’t reduce childhood and middle age to physical conditions; why do it later on?

Robert N. Butler | PublicAffairs, 2008 | Book The Longevity Revolution Geriatrician Bob Butler, who coined the term "ageism," won the Pulitzer Prize for his first book, Why Survive: Being Old in America. This book, his last, offers a social and economic blueprint for making the most of the 20th century’s longevity boom.

Generations, the Journal of the American Society on Aging | Fall 2015 | Article "Ageism in America: Reframing the Issues and Impact" Mainstream takes on ageism in the US today, how it affects our well-being and our wallets, and which research and policy agendas would reduce age discrimination.

Output: It's not the passage of time that makes it so hard to get older. It's ageism, a prejudice that pits us against our future selves -- and each other. Ashton Applewhite urges us to dismantle the dread and mobilize against the last socially acceptable prejudice. "Aging is not a problem to be fixed or a disease to be cured," she says. "It is a natural, powerful, lifelong process that unites us all."


Instruction: create a high quality summary of the given input

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4 Ways Going to the Doctor Is Radically Changing
 The future of health care in the U.S. is far from settled, but how people receive it now is also undergoing a revolution. Health records are antiquated, there’s a shortage of primary care physicians and access to birth control and emergency contraception is limited in some places.

Health and technology companies operating largely outside of the standard health care system are attempting to solve these and other problems with alternative approaches. Whether they have staying power remains to be seen, but here are four compelling methods on the rise.

Video chatting your doctor

It can take more than three weeks to get an appointment with a new doctor, but now, people in all 50 states can visit a physician through their smartphone. “Telemedicine has been touted as the next big thing for several years, and I think it’s finally getting to a stage where adoption is kicking in,” says Hill Ferguson, CEO of Doctor On Demand, an online video chat app. The app provides a platform for more than 1,000 doctors and more than one million users, Ferguson says.

Whether that means obtaining a prescription from your couch or chatting with a therapist for 10 minutes at the office, video chat visits are becoming increasingly common: By 2020 there could be an estimated 45.6 million virtual consultations performed in the U.S., according to data and analysis company IHS Markit. Adoption of telemedicine in health care has increased from about 54% in 2014 to 71% in 2017, and the use of telemedicine in health care increased 9% from last year, according to April 2017 research from HIMSS Analytics, a global healthcare IT market research group.

Get our Health Newsletter. Sign up to receive the latest health and science news, plus answers to wellness questions and expert tips. Please enter a valid email address. * The request timed out and you did not successfully sign up. Please attempt to sign up again. Sign Up Now An unexpected error has occurred with your sign up. Please try again later. Check here if you would like to receive subscription offers and other promotions via email from TIME group companies. You can unsubscribe at any time. By signing up you are agreeing to our Terms of Service and Privacy Policy Thank you! For your security, we've sent a confirmation email to the address you entered. Click the link to confirm your subscription and begin receiving our newsletters. If you don't get the confirmation within 10 minutes, please check your spam folder.

Telemedicine is also becoming a greater part of health care treatment in rural areas, and more hospitals are embracing video consultations. A May 2017 study found that from 2004 to 2014, use of telemedicine for mental health visits among rural Americans on Medicare increased an average of 45% per year. Virtual medicine is becoming more specialized, too; Maven, a digital clinic catering to women that launched in 2015, offers lactation specialists and midwives, for example.

There are some downsides to telemedicine. Rather than seeing a consistent doctor or team of health care providers, telemedicine apps connect people with physicians that happen to be available, though some allow users to chat with specific doctors they like. Some research suggests that virtual visits may not necessarily reduce health care spending, since more people may obtain care for minor illnesses they wouldn’t have otherwise, and some doctors argue that reimbursement in some states isn’t enough to invest in the technology. But while it may never fully replace in-person appointments, telemedicine could help cut down on unnecessary and costly trips to the emergency room, especially now that more insurance companies are covering digital appointments. Medicaid offers some level of reimbursement in 48 states including D.C., and most private insurers do as well.

Birth control delivered to your door—even without a prescription

Several online services are making it easier for people to get access to birth control and other reproductive health needs, like Plan B or PrEP, by delivering them. Companies like Nurx allow people to order birth control online without a visit to a doctor’s office. (Instead, a doctor remotely reviews the request.) Nurx prescribes and delivers more than 40 brands of birth control pills, as well as the ring, patch and emergency contraception. Shipping is free, and if people have insurance, the service is free. For people without insurance, it’s priced at $15 per month.

MORE: Getting an Abortion With Telemedicine Is Safe, Study Says

Hans Gangeskar, the CEO of Nurx, says that while they’re trying to lower the price, Nurx is still a cheaper option than paying for a doctor’s appointment and contraception. “It’s a two-to-three minute online interaction,” says Gangeskar. Other similar services include PRJKT RUBY and The Pill Club.

Pay-per-month personalized care

Medical centers that accept cash, rather than insurance, are on the rise, and they now number in the thousands. These primary care practices are a way for Americans to get around high-deductible insurance plans. While some centers charge flat fees for each procedure, another model is gaining popularity. A clinic in San Francisco called Forward offers comprehensive health exams and around-the-clock access to doctors for a monthly membership fee.

MORE: Why (Almost) Everyone Is Embracing the Digital Doctor

Forward does not accept insurance. Instead, members pay $149 a month for access to doctors’ appointments, vaccines, generic medications, blood tests, genetic screenings, around-the-clock chat privileges with a doctor and other services provided on site. By working outside the insurance model, Adrian Aoun, the CEO and founder of Forward, says the company is beholden to patients instead. “We are the opposite of traditional health care,” he says. “You can come in as often as you need—instead of seeing your doctor once or twice a year, they’re in your pocket.”

Some experts take issue with Forward’s use of full-body imaging scanners, due to the negative consequences of over-screening where there is always a risk for false positive results and over-treatment. But Roeen Roashan, a senior analyst for digital health at IHS Markit, says he believes that if the cost could be brought down to closer to $99, the approach could take off. “More people will disconnect from institutional health care and go to these independent providers who have nothing to do with the government,” Roashan says.

The return of house visits

A centuries-old health care approach is popular again. Concierge medicine, where a doctor visits patients at their home, is regaining traction.

Heal, a medical concierge company available in California, Washington D.C. and Northern Virginia, has been called the “Uber for Doctor Housecalls.” Users download the Heal app and schedule an appointment with a primary care physician who will visit them in their home (or wherever they are). “Traditional healthcare is mired in bureaucracy, inefficiency and overload, so doctors push papers rather than see patients,” says Nick Desai, CEO and co-founder of Heal. “Patients either overuse the ER or avoid doctors altogether. Understanding the home environment and having more time with patients translates to savings for all.”

Heal doctors are available seven days a week, and the service accepts insurance from major providers. Without insurance, an appointment is not cheap, at a flat fee of $99. Heal is currently available in 200 cities, and over the next year, Desai says he plans for Heal to be launched in 8 to 10 more. Other medical groups are taking advantage of the concierge model, too. In August, the Home Centered Care Institute announced that it is launching an education program to train 5,000 new doctors how to care for elderly people in their homes. Training programs include prominent hospitals like the Cleveland Clinic and Northwestern University Feinberg School of Medicine.

Contact us at letters@time.com.

Output: The future of health care in the U.S. is far from settled, but how people receive it now is also undergoing a revolution. Health records are antiquated, there's a shortage of primary care physicians and access to birth control and emergency contraception is limited in some places.


Instruction: create a high quality summary of the given input

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Amazon pays £15m in tax on European revenues of £19.5bn
 Amazon has defended its tax payments after publishing figures showing that it spent just £15m in tax across the entire European continent in 2016, despite posting revenues of £19.5bn.

Amazon defends paying a mere £15m in tax across Europe on revenues of £19.5bn

In the UK meanwhile Amazon succeeded in halving its HMRC tax bill to just £7.4m from £15.8m on a year-on-year basis in 2016, defying a rise in turnover which increased from £946m to £1.46bn.

Output: Online retail giant Amazon has defended its European tax payment of £15m ($19.4m) in 2016, despite posting revenues of £19.5bn, blaming its slim profit margins for the discrepancy. In the same year in the UK, Amazon paid £7.4m in tax on year-on-year revenues of £15.8m. The payments have sparked another debate over whether large multinational corporations are bending the rules surrounding tax avoidance. Last year, a judge ruled Amazon's use of a tax haven in Luxembourg was legal, saving the company $1.5bn.


Instruction: create a high quality summary of the given input

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Obamacare Premiums Are Set to Rise. Thank Policy Uncertainty.
 The increases are not just about Mr. Trump and policy uncertainty. Insurers are also raising rates for the reasons they usually do. Health care costs are expected to go up in 2018, as they do every year. And an Obamacare tax on health insurance plans that was temporarily postponed is scheduled to kick in next year.

The sticker price of insurance matters to a minority of Americans. Only about 10 percent of Americans buy their own insurance, and most of those receive government subsidies that shield them from price increases. Kaiser estimates that in most of the places where prices are going up, the amount people with subsidies will pay for insurance will go down. Still, hefty premium increases are a big pocketbook hit to the approximately 10 million Americans who buy their own insurance and are ineligible for subsidies. And they are a good indication of the health of the Obamacare market, which Mr. Trump frequently assails as failing or dying.

The study looked at only one city in each state, and cities tend to be the places where Obamacare works best, because of larger populations and more choices of doctors and hospitals. Many of the most expensive and shaky markets tend to be in rural areas. It will take time before we know what their prices will be. But there are still a few rural counties with no insurer willing to offer coverage next year.

The proposed rates aren’t yet final. Regulators in some states may force them lower — or, in rare cases, higher. And insurance companies could have some flexibility to make last-minute changes if policy certainty emerges soon. Insurers still have several weeks to decide if they wish to exit Obamacare’s markets for next year altogether.

After failing to pass a big health care overhaul bill last month, congressional leaders have begun discussing possible steps to stabilize the Obamacare markets, steps that could calm insurer worries and cause more to stick around. But Ms. Cox is skeptical that such action would have a big impact on next year’s prices. Insurers are locked into a process of rate calculations and approvals that make it hard for them to change their prices substantially at this point.

“It’s getting to be very late in the game for there to be changes to premiums,” she said.

Output: Insurers are making final decisions about their Obamacare rates for next year. So far, it looks as if many of them will be building in an uncertainty tax. The Kaiser Family Foundation has compiled proposed insurance prices for coverage in 21 large American cities next year.