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The secret recipe behind the launch price of a drug
 Plenty of people have been talking about drug pricing, from the president to the media and pharmaceutical CEOs, but few talk about how companies determine these incredibly specific, and often incredible, price tags.

It raises many eyebrows when a company chooses to charge $750,000 a year for a drug. But even for those drugs with more down-to-earth prices, have you ever questioned how a drugmaker could come up with a wholesale acquisition cost (WAC) of, say, $9,548 per month?

While it may seem that pharma companies are "sticking their fingers in the air to check the wind," Sanofi’s Head of Policy Cybele Bjorklund asserted to BioPharma Dive that pricing is anything but arbitrary. It’s a bit of science, a dash of art and more than a few secret ingredients.

Sanofi is just one of the many companies that has come out and taken a proactive, transparent stance on drug pricing. Bjorklund, who joined Sanofi only several months ago after a previously life in Washington policy making, was an integral part of establishing the French drugmaker’s new pricing principles.

These principles have committed the company to being more transparent about drug prices, limiting the increases in prices on older drugs to match the national health expenditures (NHE) growth projection and providing a clear rationale for how drugs are priced at launch — all things the industry as a whole has been loathe to do.

While pricing principles like these are a step in the right direction, the ingredients baked into drug pricing are gathered much earlier in the process.

Mix in market research

The process all begins with market research, a term that encompasses a wide variety of techniques that pharma companies use to determine at which price point to launch their drug onto the market.

One of these many market research techniques includes mapping out both the current commercial landscape as well as the competitive pipeline.

"We look at the treatment landscape — what else is available or anticipated at the time of launch? This to me, put more simplistically, means are we a first-in-class or are we a "me-too" or even somewhere along the line of the continuum of care," said Bjorklund.

The presence of older, low-cost treatments or newer alternatives on the market for a certain disease is major factor in how a drug can be priced. Take the cholesterol market, for instance. Statins have been some of the best-selling drugs in the world for decades. These drugs work reasonably well and can be used in a majority of patients. They are also largely available as generics and don’t put a hurt on people’s wallets.

Enter: PCSK9 inhibitors. This new class of drugs provided a huge step up in innovation, as well as arguably better efficacy. But due to the availability and effectiveness of statins, the market simply hasn’t been willing to bear their $14,000-plus price tags, and these drugs have failed to gain much commercial traction.

Looking at the pipeline is important too. A battle is currently playing out in the migraine space as four drugs from a new class called CGRP inhibitors are making their way through the development and regulatory framework.

All four of these drugs have the potential to hit the U.S. market over the next two to three years, making pricing a tricky prospect for developers. While Amgen and Novartis' Aimovig (erenumab) is likely to be first of these drugs approved, the companies will have to be particularly careful how they price the drug, which could be undercut by a lower cost (and equally effective) offering within months of approval. They will also have to be careful about not pricing the drug too low, leaving money on the table.

This competitive landscape research, as well as tapping other stakeholders like patients, doctors and payers all begins around the start of Phase 2 testing — though it can vary depending on therapeutic area. By this time, companies typically know if they have a compound that should work and are ready to evaluate the value proposition.

This includes patient focus groups to see what the needs of patients are that have not been met — perhaps there are therapies that only address some symptoms of a disease but not others, or maybe current therapies have terrible side effects. Maybe patients just need a more convenient way to take a drug, or maybe there aren’t any treatments at all. These are all the sorts of questions that pharma companies want to know the answers to when thinking of a drug's added value.

Companies also begin engaging primary care doctors and specialists, inquiring about their current prescribing practices, asking about the most common complaints of patients and trying to find where treatment gaps are.

These are all necessary steps to determine what the differentiated value of a product will be — something that is particularly important to payers.

Sometimes companies get it wrong. Over a decade ago, Pfizer Inc. brought an inhalable insulin to market, dubbed Exubera. The pharma giant believed it had a blockbuster on its hands, and was thrilled to beat out competition from both tiny biotechs and other big pharmas.

But their excitement was short-lived. While type 2 diabetes patients aren’t especially eager about the daily injections needed to administer insulin, the mode of administration isn’t actually at the top of the list of complaints for these patients. Exubera flopped and Pfizer pulled it from the market after just 11 months of sales, admitting defeat.

Take the temperature of payers

The role of payers like insurance companies and pharmacy benefit managers (PBMs) has become increasingly important in recent years. Payers have largely become the gatekeepers to the market and their decisions to cover a drug on their formulary or include it as a preferred product can mean the difference between a blockbuster and a never-was.

For example, Novo Nordisk A/S has seen the market share of its blockbuster GLP-1 antagonist Victoza (liraglutide) drop by nearly 20% in recent quarters as major PBMs have opted to include a competitor from Eli Lilly & Co. instead.

For this reason, conversations with payers begin at the same time as those with patients and doctors. Payers often have their own panels of experts that will weigh in for pharmaceutical companies.

There is even an industry standard form that payers require to help them evaluate the value of a drug as well. The form — called the Academy of Managed Care Pharmacy Form for Formulary Submissions — is over 95 pages and addresses everything from clinical benefits to economic benefits to the place of therapy in treatment (as well as a variety of other concerns). It is not an easy form to fill out and often requires a team of people to complete.

But there are other factors that go into pricing as well — the things that Bjorklund refers to as the "unique factors bucket." This includes potential post-marketing regulatory commitments like large, costly cardiovascular outcomes trials or other things like special training for physicians.

Don’t mistake salt for sugar

One major misnomer about how drug prices are set at launch may actually be the fault of the industry. The industry line — from companies to lobbying groups — is that the cost of innovation is high and therefore drug prices need to be at a level to pay for the expense of research and development.

But pharmaceuticals aren’t like most other goods. Prices aren’t set based on what it cost to actually "make" the product. You, as a consumer, aren’t paying to help a pharma company directly recoup its cost of development.

Drugs often take more than a decade to go from concept to patient, a path typically termed as "bench to bedside." During that time, a product is likely to change hands a number of times, going from the lab bench of a researcher at a university to preclinical testing at a biotech to development at a big pharma and potentially even commercialization by another partner. All of this time and changing ownership makes determining the actual cost of developing a single drug nearly impossible to determine.

When the industry says they need drug prices to be high to pay for the cost of development, they really mean to support the future cost of innovation and drugs that may come to market years or even decades later.

The other major misconception when it comes to drug prices is that the price pharmaceutical companies set is the price patients pay for a drug — this is just not the case.

The wholesale acquisition cost, or WAC, is what pharma companies spend all this time and market research toiling over. But negotiations with payers apply often multiple layers of discounts to this price. Insurance co-pays further muddy the pricing waters.

So next time you read about the $9,500 drug, remember that there was a team of people who spent years trying to get the recipe just right.

Output: Plenty of people have been talking about drug pricing, from the president to the media and pharmaceutical CEOs, but few talk about how companies determine these incredibly specific, and often incredible, price tags.


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InternetQ Investors throw SoundCloud a much-needed lifeline
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Following up earlier reports of an imminent stockholder vote on a last-minute investment deal to keep SOUNDCLOUD afloat, the company has announced an agreement to secure significant investment from global merchant bank THE RAINE GROUP and investment company TEMASEK, VARIETY reports. Also in the deal, former VIMEO CEO KERRY TRAINOR is named CEO and ex-VIMEO exec MICHAEL WEISSMAN is named COO.

SOUNDCLOUD co-founder/CEO ALEXANDER LJUNG stays on as Chairman Of The Board, while co-founder ERIC WAHLFORSS remains Chief Product Officer.

A company statement announced: “The investment will ensure a strong, independent future for SOUNDCLOUD, funding deeper development and marketing of its core tools used by millions of audio creators — musicians, DJs, producers, labels, managers and podcasters — that fuel SOUNDCLOUD’s one-of-a-kind, creator-driven listener experience.”

“Now in its 10th year, I’m proud to say SOUNDCLOUD stands as an indispensable part of global music culture," LJUNG said. "I look forward to fully dedicating my time to leading the board and helping drive SOUNDCLOUD’s long term strategic vision, and forging strategic partnerships and connections with industry partners and our one-of-a-kind creative community. With KERRY’s love of music and sharp business acumen, I know SOUNDCLOUD is positioned for continued success for many years to come.”

“As a huge fan of the SOUNDCLOUD platform since its founding, I deeply admire what ALEX and ERIC have built," TRAINOR said. "There is only one SOUNDCLOUD and its importance to creators and music culture is undeniable. I’m very excited to join this talented team and build the next chapter of growth around SOUNDCLOUD’s mission to empower audio creators. I look forward to sharing more about our plan and path forward in the months ahead.”

“SOUNDCLOUD is a unique and essential music platform for new and developing artists,” RAINE GROUP partner FRED DAVIS said. “For 10 years, SOUNDCLOUD has been the birthplace of genre-breaking musical movements in Electronica and Hip-Hop. We are excited to partner with TEMASEK on this investment and are confident our involvement can ensure it remains the most artist-friendly music creation and streaming platform in the world.”

« see more Net News

Output: Troubled music-streaming community site, SoundCloud, has secured investment from The Raine Group and Temasek; ex-Vimeo execs Kerry Trainor and Michael Weissman, will become CEO and COO respectively as part of the deal. The platform is said to have burned through over $230m in funding and $70m in debt, as it failed to monetise its offering and shifted its focus to challenge Spotify. After laying off 40% of its staff in July, SoundCloud was seeking $169.5m at a pre-money valuation of $150m, compared to a $700m valuation in previous rounds.


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Mandatory bundled payment programs could be stopped
 UPDATE: The CMS released the proposed rule on Tuesday. The proposal reduces the number of mandatory geographic areas for the joint bundled payment program and cancels the cardiac bundled payment program model.

In reaction to the cancellation of the cardiac bundled payment program, American College of Cardiology President Dr. Mary Norine Walsh stated, “The [ACC] will continue to work with CMS on opportunities for clinicians to participate meaningfully in Advanced Alternative Payment Models. As we move from volume-based care to value-based care, the path forward is challenging and we must work together to find solutions.”

Dive Brief:

HHS is proposing to eliminate some mandatory bundled payment programs, including those for heart attacks and those for hip and femur fractures, according to a rule title posted late last week.

The bundled payment programs have been delayed multiple times, and the cardiac bundled payment program was set to begin in January 2018.

Eliminating the bundling programs would also remove one of the ways providers can qualify for MACRA’s 5% advanced payment model bonus, Axios reported.

Dive Insight:

The attempt to stop the programs isn’t much of a surprise, considering the frequent delays and HHS Secretary Tom Price’s multiple statements criticizing mandatory bundling programs. Price has said the programs are high-risk and take needed flexibility away from providers.

The American Hospital Association has resisted the mandatory programs, saying they are moving too quickly and have not been tested enough. The organization isn’t opposed to bundled payment in general, but many policy experts say the programs need to be mandatory for systemic change to be achieved, and for reliable research on the results. Those results have been mixed so far, but are mostly positive. Bundled payments have been shown to reduce costs without sacrificing care quality.

The bundled payment programs were a product of the Center for Medicare and Medicaid Innovation, which recently lost its director, Patrick Conway, to Blue Cross Blue Shield of North Carolina.

Still, the model isn’t likely to go away, Archway CEO David Terry recently told Healthcare Dive. Bundled payments are positive for providers and aligns their interests with those of payers and patients, he said.

“In this scenario, acute care will ultimately constitute a smaller component than currently, so hospital payments could well shrink," he said. "However, if hospitals take the appropriate action they can sustain and even grow their bottom lines by more coordinated and prudent use of resources.”

Output: HHS is proposing to eliminate some mandatory bundled payment programs, including those for heart attacks and those for hip and femur fractures, according to a rule title posted late last week.


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JPMorgan joins Vanguard, Jupiter in absorbing research costs
 JP Morgan Asset Management will pay for the cost of external research under MiFID II instead of passing on the costs to its clients.

The move was confirmed in a statement seen by The TRADE which said research costs will be "paid for by the business and not by MiFID II client accounts".

JP Morgan is the latest asset manager to choose this method of compliance ahead of MiFID II’s unbundling requirements, alongside Vanguard, M&G, Aberdeen and Jupiter.

The statement explained a ‘substantial’ amount of resources is already committed to the internal research department at JP Morgan Asset Management and there will be no changes to the internal teams due to the policy change.

"We also utilise external analyst research where we believe it can add value to client portfolios," JP Morgan added.

The majority of asset managers currently receive research paid for through execution commissions or commission sharing agreements, rather than paying for it directly.

This method is not allowed under MiFID II and unbundling could potentially see huge costs transferred to the buy-side.

Deutsche Asset Management recently created its own internal research division in a bid to control its research costs come January 2018.

Deutsche’s research unit will help fund managers identify investment opportunities and provide clients with regular analysis on macro-economic developments.

Last month, Barclays became one of the first investment banks to put a price on its research, through a tired structure costing anywhere between £30,000 and £350,000.

Output: JP Morgan is to join firms including Vanguard, M&G, Aberdeen and Jupiter in absorbing the costs of research following the implementation of European Union rules next year requiring the unbundling of research costs from fees charged to clients. The Trade has reported that it has seen a document that said research costs will be "paid for by the business and not by Mifid II client accounts". The note is also said to claim that substantial resources are already committed to the research department and that there would be no changes to internal teams after the change comes into effect.


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Trump Administration Extends Deadline For Insurers To Decide On Obamacare Markets
 The Trump administration is giving insurance companies an extra three weeks to decide whether to offer insurance plans through the Affordable Care Act markets, and how much to charge. The extension comes as insurance companies wait for President Trump to decide whether he will continue to make payments to insurance companies that are called for under the Affordable Care Act but that some Republicans have opposed.

The payments — known as cost-sharing reduction payments — reimburse insurance companies for discounts on copayments and deductibles that they're required by law to offer to low-income customers. The Congressional Budget Office estimates the payments this year would be about $7 billion.

Trump has said he may end the reimbursements, which he calls "bailouts," and has been leaving insurers to wonder month to month about whether they will receive a check.

A White House spokesman says Trump is "working with his staff and his Cabinet to consider the issues raised by the CSR payments."

The U.S. Department of Health and Human Services says it is offering the extra time so insurance companies can plan ahead in case the government decides to end the payments. In a memo Friday, the agency said many states are now requiring companies to file their rates for 2018 on the assumption that they won't be reimbursed.

Several companies say that without the cost-sharing payments, their rates will see double-digit increases. For example, Blue Cross Blue Shield of North Carolina says ending the payments would push its rates up 14.1 percent.

And Marc Harrison, CEO of Intermountain Healthcare, which covers 173,000 people in Idaho and Utah, says premium increases could be "astonishing."

Still, he says, his company will stick with the Obamacare markets. "These are our patients. We're not going anywhere. We're going to keep trying to figure this out."

The HHS memo says "there have been no changes regarding HHS's ability to make cost-sharing reduction payments to insurers."

But it then says the agency intends to change the ACA's risk adjustment program to compensate for the loss of cost-sharing payments.

The changes are technical and complex, but Timothy Jost, professor emeritus at Washington & Lee University's law school, says in a Health Affairs blog that the memo just deepens the confusion.

"We still do not know if all of this is needed or not — the Trump administration has not made up its mind," he says.

The cost-sharing payments have been at the center of a political battle over the Affordable Care Act since before President Trump took office.

House Republicans opposed to the health law sued then-President Barack Obama, saying the payments were illegal because Congress hadn't appropriated money for them. A judge agreed but allowed the administration to continue making the payments during an appeal.

Now that Trump is in the White House, and Republican efforts to repeal and replace the Affordable Care Act have failed, many Republicans are urging the president to continue the payments rather than undermine the health care markets.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

Output: The Trump administration is giving insurance companies an extra three weeks to decide whether to offer insurance plans through the Affordable Care Act markets, and how much to charge. The extension comes as insurance companies wait for President Trumpto decide whether he will continue to make payments to insurance companies that are called for under the Affordable Care Act but that some Republicans have opposed.


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Doctor Shortage Under Obamacare? It Didn’t Happen
 When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act. As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured.

Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.

The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.

Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.

Output: When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act.


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Behind the Scenes, President Trump Is Still Working to Dismantle Obamacare
 Don't want to wait? Click here.

Changed your mind? Visit TIME.com instead.

Output: Efforts to repeal and replace Obamacare may have fizzled in Congress — at least for now — but President Donald Trump is doing plenty to undermine the health care law as open enrollment approaches this fall.


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Health Invest Finland Raises $1.5M for Smart Wearable Device for Elder Care
 Health Invest Finland Oy, a digital health firm has raised $1.5 million in funding led by Finnish funds Kuus Invest Oü, Viavan Oy, and European business angel investors. The company plans to utilize the funding to accelerate the deployment of it’s My+Care™ (MyPlusCare) cloud-based health and wellbeing service solution targeted for the elderly care market globally.

According to the United Nations Department of Economic and Social Affairs, the number of elder persons (aged 65 years or over) is expected to more than double from 841 million people in 2013 to more than 2 billion in 2050. More than $30 billion is spent annually in the US on healthcare related to falls, which is the leading cause of death due to injury among the elderly.

Founded in 2014, Health Invest develops and deploys intelligent technologies and solutions for intelligent healthcare delivery. Based on patented innovations from Mostafa Hanifi, the chief technology officer of Health Invest, My+Care is a networked system that receives patient data from proprietary smart wearable device and wireless beacons that are networked to caregivers through a mobile app that details personalized reports to a network that can include hospitals, relatives, companies, doctors and clinics, and others. Using the My+Care™ Cloud, facilities can manage networked communication in real-time.

My+Care enables diverse, flexible IoT interaction of all Bluetooth devices within third-party IT environments. With machine learning, My+Care can learn from each specific user; the longer the wristbands are used, the more accurately they detect irregularities in human behavior or subtle changes that could indicate an underlying medical issue.

Health Invest is already operating in Europe and Asia, and has plans to expand in the US market later this year. Additionally, the company plans has 2018 expansion plans for China.

In addition to the funding, the company has announced a partnership with CellMark Medical, a division of CellMark AB, to accelerate deployments of Health Invest’s My+Care. CellMark’s expertise in medical device distribution, logistics and sales support will enable My+Care to gain traction with healthcare facilities around the world.

“The sign of a civilized society is how well it treats its weak and elderly citizens. We live in a world that cannot accommodate an aging population without adapting healthcare to readily available technology. The value of elder care, globally, needs to rise to meet a rapidly growing set of demands for more effective real-time care,” said Kalle Soderholm, CEO of Health Invest in a statement. “The development of our My+Care service-solution is specifically aimed at treating the needs of all stakeholders in the elder care market with an intelligent set of tools that can learn and adapt dynamically to the needs of patients and health organizations.”

Output: According to the United Nations Department of Economic and Social Affairs, the number of elder persons (aged 65 years or over) is expected to more than double from 841 million people in 2013 to more than 2 billion in 2050. More than $30 billion is spent annually in the US on healthcare related to falls, which is the leading cause of death due to injury among the elderly.


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Munich Re dismisses likelihood of total disruption by insurtech
 As a flurry of InsurTech and FinTech startups continue to enter the global insurance and reinsurance industry, undoubtedly some will be very good and should be promoted for the industry, however, they will not be able to disrupt the entire risk transfer space, according to Torsten Jeworrek, Munich Re’s Chief Executive Officer (CEO) of Reinsurance.

Speaking during the reinsurance giant’s half-year 2017 press conference, CEO of Reinsurance, Jeworrek, discussed the company’s partnership with the growing InsurTech and FinTech world, which is ultimately looking to disrupt the value chain and increase efficiency for both sides of the equation by incorporating new and innovative technology into the insurance and reinsurance value chain.

“So-called InsurTechs are mushrooming in this marketplace, and you see among the many thousands in existence there will be some which are very good,” said Jeworrek.

Despite the persistent influx of InsurTech startups Jeworrek explained that he doesn’t foresee that they will be able to disrupt the entire market, “I don’t think this will happen,” he said, citing difficult and complex coverage areas such as oil, or Mexico, for example.

However, “there are individual models for platforms, data models, service models for customers, which we should know and which we should promote. So, our line is that we are ready to take into account this disruption in our business, and even promote it, because this means we are going to create a business for the future,” he continued.

Joachim Wenning, Chairman of the Board of Management at Munich Re, explained that a digital transformation will impact the entire industry at some point, adding that the reinsurer is waiting for a good opportunity as it was more likely to acquire a FinTech or InsurTech startup to streamline its operations than expand its set of insurance entities.

Munich Re does invest in InsurTech and FinTech startups, but according to a Bloomberg article that cites Jeworrek, startups are currently generating premiums for the firm in the single-digit million euros. When you consider the scale, reach and size of the reinsurer, and the fact these startups are only generating single-digit million euros in premiums, it raises the question of how the reinsurer values these investments within its overall portfolio.

Undoubtedly, there will be winners and losers in the InsurTech game, on both the technology side and the re/insurance side, but it is becoming increasingly evident that technology and insurance will get closer and closer together in order to improve the market for carriers and consumers.

Output: Insurtech start-ups are providing valuable services to the insurance sector but they can never disrupt the entire value chain, Munich Re CEO Torsten Jeworrek has said. The reinsurance giant is keen to engage with those companies that can make a real difference, but Jeworrek doesn't believe they can fully replace established insurers, citing sectors such as oil and countries such as Mexico as particular challenges. Chairman Joachim Wenning said the company would consider investment in insurtech firms that can help streamline its existing business rather than expand its operations and the company does already invest in insurtech start-ups.


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A recorded do-not-resuscitate directive significantly increases the likelihood of dying where one chooses
 An end-of-life plan that includes a recorded do-not-resuscitate directive significantly increases a person's chances of dying where she chooses. A brief research report is published in Annals of Internal Medicine.

Most persons report that they would prefer to die at home or in hospice care, but more persons in England die in a hospital than in these settings (48 versus 29 percent). Researchers at The Royal Marsden NHS Foundation Trust and Imperial College London analyzed routinely collected electronic health records (EHR) to identify the determinants of achieving preferred place of death.

Initially developed as the Electronic Palliative Care Co-ordination System for London, United Kingdom, the Coordinate My Care (CMC) service enables persons to create a digital urgent care plan with their clinicians that is electronically accessible to all health and social care professionals involved in a patient's care. The researchers analyzed health records for more than 9,000 patients with CMC plans and found that more than 75 percent of them died in their preferred place and almost all of them (97.8 percent) preferred to be cared for and die outside of the hospital. In addition, clear limits to treatment were associated with achieving preferred place of death. Those with a recorded do-not-resuscitate order were 76 percent more likely to die in their preferred place than those with a recorded for-resuscitation status.

According to the researchers, these finding suggest that conversations about end-of-life care, including care limits, can be considered a positive gateway to achieving a patient's wishes for their future care.

Output: An end-of-life plan that includes a recorded do-not-resuscitate directive significantly increases a person's chances of dying where she chooses. A brief research report is published in Annals of Internal Medicine.


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CMS Must Ensure Seniors Have Access to Diabetes Prevention Resources
 The scourge of type 2 diabetes across the United States costs American taxpayers billions of dollars every single year. Diabetes and diabetes-related treatment is one of the biggest drivers of rising health care costs for every payer — with Medicare spending more on treating those with the disease every year. This is particularly true in rural America, as the prevalence of diabetes and coronary heart disease is approximately 17 and 39 percent higher in rural areas than urban areas.

Policymakers from both sides of the aisle recognize this reality, and have embraced the challenge of confronting a preventable, but devastating, epidemic. Last month, for the first time in the agency’s history, the Centers for Medicare and Medicaid Services laid out proposed rules to reimburse providers to proactively prevent chronic disease by paying for the evidence-based Diabetes Prevention Program for eligible beneficiaries. Last year, the CMS Actuary certified that this program both improved quality of care and reduced costs for Medicare.

But unfortunately, the proposed rule missed a huge opportunity to extend access to this benefit to the area most in need: rural America.

In the July 13 rule, CMS proposed only making in-person DPP providers eligible for reimbursement, despite enormous evidence that virtual providers can achieve equal, or even better, results with senior populations. In addition, CMS’ sister agency, the Centers for Disease Control and Prevention, has been recognizing digital programs for more than two years while also collecting data demonstrating these programs’ effectiveness.

By excluding virtual DPP from Medicare, CMS has tilted the scales in favor of seniors that reside in urban areas with easy access to brick and mortar programs; even urban and suburban seniors with transportation issues may not be able to access this critical benefit if the proposed rule goes unchanged. Seniors in rural areas may have no reasonable option to access a qualified DPP.

The disparity of access becomes abundantly clear when examining the list of in-person programs registered with the CDC.

In Texas, there are many in-person options for seniors in Dallas, San Antonio and Houston. A senior living in Abilene, however, would need to drive or find transportation to Fort Worth or Lubbock to participate in an in-person program, requiring at least four hours of driving for per week. Seniors in rural areas of states like Georgia, Nevada, New Mexico, South Dakota, Wyoming, Utah and Kansas will be in similar situations, many with a minimum of two hours of driving on a weekly basis to access an in-person location — if they can drive at all.

This formulation sets up unnecessary and prohibitive barriers to millions of Medicare beneficiaries who could benefit from DPP programs.

The distinction between in-person and virtual programs is not supported by the findings of the CMS Actuary. To determine whether DPP should be offered to all eligible Medicare patients, the CMS Actuary evaluated the ability of the DPP curriculum to reduce seniors’ risk of type 2 diabetes, not the setting in which the curriculum was offered. Medicare Advantage plans and dozens of commercial insurers have specifically examined the virtual delivery of DPP and found cost savings, reduced incidence of diabetes and very satisfied program participants. Even if the Actuary was unmoved by these facts, the office now has access to CDC data that would confirm virtual programs’ efficacy with seniors. The Actuary can and should consider this data when preparing the updated program certification needed prior to implementation of the expanded benefit.

There is still an opportunity for CMS to embrace tech-forward, patient-centered solutions to this problem.

In its final rule, CMS should include virtual DPP providers as eligible for reimbursement, to ensure that all eligible seniors have access to qualified programs.

Seniors in rural areas should not be required to travel long distances to participate in an in-person DPP, or forgo the service altogether. Instead, they should be empowered to access preventive care where they live, as long as that virtual DPP provider has met CDC and CMS standards. These seniors should be encouraged to remain active parts of the communities in which they reside, supplemented by online communities. From a system perspective, including these seniors via virtual programs will be necessary to achieve the scale necessary for the potential cost savings.

CMS has an opportunity to embrace technology, empower patient choice and expand access to preventive care for millions of American seniors. The agency should seize it.

Sean Duffy is the co-founder and CEO of Omada Health, a digital behavioral medicine company that is one of the country’s largest CDC-recognized providers of the National Diabetes Prevention Program. Sean holds a BS in neuroscience from Columbia University, was an MD/MBA candidate at Harvard, and worked at Google and IDEO before founding Omada Health.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Output: The scourge of type 2 diabetes across the United States costs American taxpayers billions of dollars every single year. Diabetes and diabetes-related treatment is one of the biggest drivers of rising health care costs for every payer — with Medicare spending more on treating those with the disease every year.


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Asset managers urged to put technology experts in C-suite
 The asset management industry must do more to have technologists in executive positions and leverage their skills to use technology strategically, rather than see it as a cost centre or an operational function.

Research from financial technology company Calastone found 40.4% of the top 100 ASX-listed companies have technologists in executive and board positions - a fourfold increase from 7.4% in 2011.

While the significant jump is positive, there are still gaps in the financial services sector - particularly in asset management, Calastone marketing director Andrew Tomlinson said.

Asset managers should do more to take advantage of the great opportunities and value technology presents to them, Tomlinson said.

If they don't, there are the potential threats on the horizon of other players that could disintermediate the market, he added.

Tomlinson said the asset management community has a core specialism in terms of how to manage and build funds and ascertain growth for clients investing in them - but how they reach investors is a different challenge.

Whether these businesses are running technology as a strategic or operational function, today it's seen as "a very big cost base."

Other research has demonstrated all too often the paradox of the more money sunk into technology, the less efficient the businesses become because they end up buying plug-ins and add-ons to core systems. This drives up maintenance costs and ultimately becomes "a huge overhead" that prevents businesses from growing, he said.

Empowering the right people with the IT background would mean having someone who knows how to leverage new technologies in terms of what to build, buy in, who to partner with, and steer some of those strategic decision for the organisation, Tomlinson added.

Particularly in financial services, companies are "buying and buying new services" as opposed to firstly having the foresight of understanding of how things will look in three to five years' time.

Calastone Australia and New Zealand managing director Sarah Hayward added: "For the managed funds segment, the scale and speed at which new technologies such as blockchain, robo-advice and machine learning are challenging business models makes adding technologists to strategic levels a corporate imperative."

"The industry has much to learn from other sectors including banking, music and retail in reassessing the structures, people and partners required to adapt and drive future competitiveness," Hayward said.

Output: The Australian asset management industry has been warned that it must do more to introduce technologists to their businesses as core personnel, rather than viewing them as cost centres or operational functions, fintech company Calastone has said. The speed of technological change means firms risk making costly mistakes without their expertise. Calastone’s research has found that 40.4% of top 100 ASX-listed firms have technologists in executive or board positions. While this is an improvement from 7.4% in 2011, there are still areas of the financial services sector, such as asset management, where they are underrepresented.


Instruction: create a high quality summary of the given input

Input:
WeChat campaign for Maxim mooncakes generates 100 times ROI
 Maxim's, one of the biggest mooncake retailers in Hong Kong, has tapped into WeChat moments ads to sell its mooncake products for the first time, and the result has been promising.Two hours after Maxim’s WeChat moments ad launch, over 7,000 boxes of Maxim’s mooncakes were sold, with an average sale of 3,500 boxes per hour versus 1,333 boxes before the launch of WeChat moments ads.The ad also achieved an 8% click-through rate (CTR) with 91% click-to-sale conversion rate, reaching a record-breaking business performance of 100x ROI.WeChat told Marketing that Maxim's winning formula includes the time which the promotion was rolled out, as well as the convenient buying and sharing experience it provided.The campaign aims to strengthen awareness of the mooncake products, and further converse users to actual sales on WeChat Pay.The promotion on the platform was rolled out before the official mooncake launch of Maxim's. The early-bird discount generated buzz on the platform.Customers were then encouraged to click on the link on the WeChat moments ads, in which they would be able to buy the mooncake through wallet purchase, or send mooncake e-coupons to friends and families.[gallery link="file" size="full" ids="188182,188181,188183,188177,188178,188179,188180"]"As a pioneer advertiser of WeChat moments ads in Hong Kong, we find this new digital advertising channel effective at building awareness of our mooncake products, successfully conversing users to actual sales on WeChat Pay and bridging the gap from ad awareness to business results,” said Raymond Tong, chief operating officer (headquarters and branded products) of Hong Kong Maxim's Group."Mobile social communication apps have become integral to our daily lives and we've seen enormous growth in WeChat's user base in Hong Kong," added Poshu Yeung, vice president of Tencent International Business Group. "With our social ads’ sophisticated targeting capabilities to reach consumers, we are proud to support Maxim's in rolling out its moments Ads campaign, helping to drive both awareness and business results of its signature products through WeChat moments."

Output: Hong Kong-based mooncake retailer Maxim received 100 times its return on investment for an advert for its products that it launched on WeChat moments. In the two hours after the launch Maxim sold 7,000 boxes, compared with 1,333 boxes an hour without the ad. The ad, which offered an early-bird discount, received an 8% click-through rate and a 91% click-to-sale conversion rate. The ad's success came from its timing and the convenient buying and sharing experience it provided, WeChat said.


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Input:
Eko Devices develops digital stethoscope
 BERKELEY, Calif. — He could have been surfing in Cabo. Instead, Tyler Crouch, then a 21-year-old mechanical-engineering student, spent spring break of 2013 building a digitized stethoscope and thinking, “This better be worth it.”

Since then, he and two classmates from the University of California, Berkeley, have formed a company — Eko Devices, which is based here — raised nearly $5 million and sold 6,000 digital stethoscopes, used in 700 hospitals. The wireless stethoscopes can transfer a patient’s heart rate and other vital signs directly to Eko’s secure portal, where it can, among other things, be shared with other doctors for a second opinion.

Now they have built something with a potentially larger market: It is the Duo, a digital stethoscope for home use, which could change how heart patients are monitored, the entrepreneurs say. It is scheduled to become available by prescription in the fall.

The product, which fits in your hand, combines electrocardiogram, or E.K.G., readings and heart sounds into a device that allows patients to monitor their health at home and send data to their physicians.

Output: California-based Eko Devices has developed a digital stethoscope and accompanying software for home use. Eko has already sold some 6,000 wireless stethoscopes to around 700 hospitals, capable of sending a patient's information directly to a secure portal. Duo, Eko's new product, combines electrocardiogram readings and heart sounds in one device, allowing patients to monitor their health at home and send readings directly to doctors. Duo is due to be available on prescription in the US by the autumn.


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Cheshire East Council to fine landlords for poor housing
 Cheshire East Council's housing enforcement policy is to be strengthened to try and ensure that residents in rented accommodation get the best housing standards with the right fire protection in place.

Private landlords, including social housing landlords, face civil penalties of up to £30,000 following the introduction of the 2016 Housing and Planning Act, which came into force in April this year.

Landlords can also be ordered to make rent repayments if inspections reveal sub-standard housing conditions or failures in safety protection measures, including fire protection.

The new legislation requires local authorities to develop and document their own policy on when to apply sanctions, with each case determined on its merits.

Civil penalties can be used as an alternative to prosecution for a number of offences under the 2004 Housing Act, including:

Failure to comply with an improvement notice for hazards such as excess cold, falls, domestic and personal hygiene and fire;

Offences relating to houses in multiple occupation;

Overcrowding.

The civil penalties are different from fixed penalties in that they are applied after the landlord has failed to carry out corrective actions and all other procedures, including appeals, have expired.

While £30,000 is the maximum fine, civil penalties can be as low as £1,000 but will be calculated on the degree of culpability and potential or actual harm.

Rent repayment orders can also be applied where a landlord has failed to obtain a licence for a property in multi-occupancy, has threatened a tenant, illegally evicted a tenant or failed to comply with a banning order.

Councillor Ainsley Arnold, cabinet member for housing and planning, said: "We want to make sure as a council that landlords in the borough, and their tenants, are aware of the measures that are being taken to ensure that housing in the rental market is of a high standard and meets the required criteria for health and safety.

"Poor housing can lead to health risks, especially from damp properties, and in some cases it is children who can be placed at risk.

"As a council we take our responsibilities for housing standards in all sectors very seriously."

Output: Cheshire East Council will fine landlords between £1,000 ($1289) and £30,000 for failing to meet housing standards outlined in 2016's Housing and Planning Act. The council will issue penalties for failure to comply with an improvement notice for hazards, offences relating to houses in multiple occupation, and overcrowding. In line with 2016's legislation, the council may also order landlords to pay back rent if inspections bring to light poor safety protection measures or inadequate conditions.


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Facebook uses Onavo app data to track rivals – and take them over
 You may have only recently discovered that Snap isn't having much luck attracting new users, but Facebook knew months before -- and there's a chance you helped it find out. The Wall Street Journal has learned just how Facebook has been using app usage data from Onavo Protect, the VPN-based security app from its Onavo team, to see how Snapchat adoption has changed over time. The social network looked at aggregated info about the frequency and duration of app use to determine that Snapchat use slowed down soon after Snapchat-like Instagram Stories became available. In other words, Facebook knew it could double down on its anti-Snap strategy within just a few months.

This isn't the first time Facebook has used Onavo's app usage data to make major decisions. The info reportedly influenced the decision to buy WhatsApp, as Facebook knew that WhatsApp's dominance in some areas (99 percent of Android phones in Spain had it) could cut it out of the loop. Likewise, it added live video after seeing how people used Meerkat and Periscope.

To be clear, Facebook isn't grabbing this data behind anyone's back. The company says Onavo Protect is explicit about what info it's collecting and how it's used, and that apps have incorporated market research services like this "for years." The odds are slim that many people read these disclosures before using Protect, but anyone who was concerned could have found them. The revelation here is more about how Facebook uses that information rather than the collection itself.

All the same, it's that collection that has some observers nervous. Former Federal Trade Commission CTO Askhan Soltani tells the WSJ that Facebook is turning customers' own data against them by using it to snuff out competitors. Meanwhile, tech lawyer Adam Shevell is concerned that Facebook might be violating Apple's App Store rules by collecting data that isn't directly relevant to app use or ads. Apple isn't commenting on whether or not it is.

No matter what, the news underscores just how hard it is for upstarts to challenge Facebook's dominant position. How do you compete with an internet giant that can counter your app's features (or simply buy your company) the moment it becomes popular? This doesn't make Facebook immune to competition, but app makers definitely can't assume that they'll catch the firm off-guard.

Output: Facebook turned to VPN-based security app Onavo Protect to see how Snapchat use changed after it launched Instagram Stories, according to the Wall Street Journal. Facebook was able to see that Snapchat use slowed after rival Instagram Stories was launched by using aggregated data on the frequency and duration of the app obtained from Onavo Protect. The data would have been useful to Facebook in helping it plan future investment in Stories. App usage data is also thought to have influenced Facebook's decision to buy WhatsApp by making it aware of the strong competition it posed in some territories.


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Robotics-focused ETF passes $1bn assets milestone
 ROBO, believed to be the first robotics and automation exchange traded fund, has reached a new milestone in terms of its assets under management.

Index provider ROBO Global, which has holdings in more than 100 listed companies, says investors have embraced its dedicated focus on robotics, automation and artificial intelligence.

The ROBO Global Robotics & Automation Index ETF recently surpassed $1 billion in assets under management, and its managers say it has achieved the psychologically significant benchmark less than four years after launching.

The ETF tracks the ROBO Global Robotics & Automation Index, which is the brainchild of a team that says it is “deeply entrenched in the robotics industry who created the innovative methodology”.

The Index and subsequent ETF aims to offer investors access to the entire value chain of robotics, automation and artificial intelligence.

The ROBO Global Robotics & Automation Index is comprised of 83 global companies from 14 countries in North America, Europe, Asia and the Middle East and is said to offer almost no overlap with traditional equity indices.

ROBO crossed the $1 billion assets under management mark last week, on August 8. Combined with a growing number of funds in Europe and Asia also tracking the ROBO Global Index total assets under management is now well over $1.6 billion, says the company.

Travis Briggs, CEO of ROBO Global US, says: “As the Index provider to ROBO, we’d like to sincerely thank the investors who have embraced our methodology and placed their trust in our boutique firm.

“We don’t take that lightly, and that’s why we have assembled the premier robotics investing team and advisory board to singularly focus on this sector and investor return.

“Our Index was carefully constructed to give our investors diversified access to the large, mid and small-cap companies that are at the forefront of the robotics revolution that is changing the way we consume goods and how companies conduct business.”

ROBO Global licensed its Index to leading turnkey ETF platform Exchange Traded Concepts to develop the ETF.

Briggs says: “We are grateful to ETC for their support and for a wonderful partnership over the years.”

J. Garrett Stevens, CEO of ETC, says: “Exchange Traded Concepts is fiercely supportive of our partners who come to us looking to take an innovative idea to the next level.

“The market has spoken, and there is clearly an appetite for pure play exposure to the robotics industry, a concept that appeals to retail investors and financial advisors, as well as institutional investors.”

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Output: An exchange-traded fund, thought to be the first dedicated entirely to investing in robotics and automation, has reached assets under management totalling $1bn. The ETF, which tracks the ROBO Global Robotics & Automation Index reached the benchmark four years after launching. The index comprises 83 companies that seem to offer no overlap with traditional indexes.


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Input:
Apple looking to push Apple Watch into health insurance market
 Apple and Aetna held a series of secret discussions last week to bring Apple's health and fitness-tracking smartwatch to millions more people connected to Aetna, according to three people familiar with the matter.

The insurer, which covers 23 million, offers an Apple Watch to its 50,000 employees as part of its corporate wellness program. Now, Aetna is negotiating with Apple on a plan to offer a free or discounted Apple Watch, Apple's wearable device, as a perk to its members.

The invitation-only meetings took place in Southern California on Thursday and Friday, according to the people. Those in attendance included executives from Aetna and Apple, as well as hospital chief medical information officers across the country.

Apple's Myoung Cha, who has the title "special projects, health," led the discussions, said one of the people. The move by Aetna is part of its push to increase customer interest in a healthier lifestyle and a better tracking of diet, said one of the people.

Output: Apple has met with health insurance company Aetna to discuss issuing a free or discounted Apple Watch to some of the insurer's 23 million customers, according to anonymous sources. The move would enable the insurer's customers to become more invested in a healthy lifestyle and improve their diet by tracking what they eat, said one of the sources. Meanwhile, Apple is working on introducing non-invasive blood sugar monitoring to its hardware. Aetna became the first insurer to offer its employees the Apple Watch in 2016.


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Input:
Brexit talks will impact ability to source building materials
 Top of the list for construction import and export are electrical wires. Credit: Shansekala Istock

For the working life of most architects in practice today, imported products have formed a large part of what they have eventually specified. Somewhere between 20% and 25% by value of the materials used in UK construction come from abroad. It’s not just specialist items that you can’t get at home that are imported. It’s not just exotic or fancy stuff. Sure, we imported £100 million worth of glazed ceramic tiles from Spain and £33 million of unglazed ceramic tiles from Italy in 2016. And timber makes up a large slice of what’s imported, which is fair enough as we don’t grow enough in the UK. Intriguingly though, the biggest building material category for imports is electrical wires. More than £1.7 billion worth was imported last year. China sells us the most (17% by value in 2016), but it comes from all over the world, Italy, Turkey, Germany, Poland, USA, Netherlands, even Egypt. And we see the stuff all over the world too. £720 million worth of electrical wires was exported. Lamps and fittings came in as the second largest category imported, at just under £1 billion, followed by sawn timber (thicker than 6mm) at £840 million. Steel and aluminium structures, paints and even relatively cheap stuff for its weight, like bricks and concrete blocks, are imported. The top 25 imports and exports of building materials can be seen in Table 1 (a and b).

Table 1 (a and b)

In cash terms the total amount of building materials imported is estimated at £15.5 billion for 2016, which is what you’d expect if you followed the historic trends. Construction’s demand for imported products is longstanding and relates directly to output. More or less, in each of the last 40 years, for every £10 of construction output roughly £1’s worth of building materials is imported. Not all is used by the construction industry, however, some will go to DIY stores and in-house maintenance teams.

Chart 1

The closeness of this relationship can be seen in Chart 1. It seems extraordinary that it has held so tight for so long given that over time there will have been significant variation in the mix of imports, what we build, the nations from which we imported, the costs of production of products and exchange rates. Leaving for another day curiosity over what binds this relationship so fast, the big thing that all the above shouts is that the UK’s construction industry is tied intimately into global trade. So what does this all mean for architects? Unless there are extraordinary (although what defines extraordinary today?) U-turns made in many quarters, from April 2019 onward the UK’s trade relationships will be fundamentally changed. The transition to a post-EU trade regime may all go smoothly. But there are distinct signs that there will be plenty of hiccoughs on the way. This may spell both temporary and long-term problems for those sourcing materials. Falling Sterling Meanwhile, in the shorter term UK firms have to deal with the consequences of the sudden fall in the value of the pound in the wake of the EU referendum. The effect has been to create large inflationary forces as the price of imports rise when paid for in Sterling. Chart 2 illustrates the scale of the fall in the pound relative to both the US dollar and the Euro.

Table 2

Working out the impact of weaker Sterling on import prices is far from straightforward. The data are a bit hit and miss and the speed at which inflation finds its way into the system is far from evenly paced within product streams, let alone between them. Terms of purchase will vary, some firms will hedge, while others will have bought well in advance. And the materials will be sourced from a range of countries operating in a range of currencies. Still, armed with some data kindly supplied by the Construction Products Association showing the volumes and values of imports of building materials in recent quarters, collected by HMRC, we can make a stab at gauging the overall jump in prices since the plunge in the pound. There are a number of ways we might do this. We could take averages (mean) for products over the latest two quarters, Q4 2016 and Q1 2017 to get an indication of roughly where prices stand three to nine months from the referendum and compared these with the average over pre-referendum quarters, for which we have six. Note we will ignore Q3 2016. We could possibly use the median of the six pre-referendum quarters to avoid volatility effects. Or we could do a straight Q1 2017 versus Q1 2016, which might take out some seasonal effects. These are all crude in purist terms but they will yield some indication, although we should note that there will always be some volatility in import prices, both up and down, for individual products categories, especially when they are linked strongly to energy prices. The three different approaches come up with different answers, but they all say the same thing. There has been a steep rise in prices since the EU referendum. You’d expect some inflation over what is effectively 15 months within the calculations. The Eurostat data tracks materials costs in local currencies for residential building. It shows the Euro countries experiencing inflation below 4% in construction materials. The UK saw rises of about 6%, significantly higher. If the differential is mainly down to imported materials this suggests the big leap in prices.

Chart 2

Output: Brexit talks are set to have a potentially damaging impact on the UK construction industry, according to the Royal Institute of British Architects. In a blog post, it warned that prices have already risen since the referendum decision in 2016, and average prices for raw materials could rise between 12% and 20%. The knock-on effect could force companies to buy cheaper alternative materials, while a bad Brexit outcome could impede the flow of goods between the UK and other countries, increasing pressure on the industry.


Instruction: create a high quality summary of the given input

Input:
UK mortgage lending holds steady so far this year
 First time buyer activity continued to grow in the UK in June with lending to this sector up by 26% compared to the previous month and up 9% year on year.

The latest figures from UK Finance show that this equated to 36,000 loans, up 22% month on month and 6% year on year.

The data also shows that home owner remortgage activity totalled £6 billion, up 5% by value on May and 7% year on year with loans totalling 34,300, up 5% month on month and 6% on a year ago.

Gross buy to let totalled £3 billion, up 3% on May and up 3% compared to June 2016. These equated to 19,700 loans, up 3% month on month and 6% year on year.

On a non-seasonally adjusted basis, UK Finance data shows that mortgage lending in the second quarter also rose. Home buyers borrowed £34.4 billion, up 18% quarter on quarter and 24% on the same quarter in 2016.

Within this, first time buyers borrowed £14.8 billion, up 18% and 10% while home movers borrowed £19.6 billion, up 19% and 21%. Home owner remortgage activity totalled £16.9 billion, down 11% by value on the first quarter but up 1% on a year ago.

Gross buy to let totalled £8.4 billion, down 6% compared to the first three months of the year but up 5% on the second quarter of 2016.

‘June’s figures show a busy month in the mortgage market, with home movers having their highest monthly activity levels for over a year and an especially high number of loans for first time buyers,’ said Paul Smee, head of mortgages at UK Finance.

‘Buy to let activity remains subdued compared to its 2015 peak but consistent month to month since stamp duty changes in April 2016. But there are also signs of a softening market and we are not anticipating that this performance will be sustained in the second half of 2017,’ he pointed out.

‘A slightly lop-sided market could well show some growth in house purchase lending but alongside reduced remortgage and buy to let activity,’ he added.

The figures also show that affordability metrics for first time buyers saw the typical loan size increase from £137,000 in May to £139,000 in June. The average household income increased to £41,000 from £40,500. This meant the income multiple went up from 3.58 to 3.59.

The average amount borrowed by home movers in the UK increased to £180,000 from £177,000 the previous month, while the average home mover household income increased month-on-month from £54,900 to £55,200. The income multiple for the average home mover went up to 3.39 from 3.37.

Buy to let activity was driven by remortgage lending which accounted for over two thirds of total lending. Buy to let house purchase and remortgage activity in June remained consistent with monthly levels seen since the change on stamp duty on second properties introduced in April last year.

Jeremy Duncombe, director of the Legal & General Mortgage Club, pointed out that the figures show that a year on from the European Union referendum, the mortgage market has remained stable in the face of ongoing political uncertainty.

‘As these figures show, lending remains buoyant and buyers are mostly undeterred. For borrowers who are unsure about the market, professional advice has been crucial in helping to make the right choices and find the best mortgage deal amidst the political upheaval,’ he said.

‘Long term affordability issues continue to have an impact though. Although house price inflation is at its lowest level in four years and beginning to align with inflation, lack of supply and the barrier of stamp duty is still leaving many hopeful first-time buyers facing a mountain to climb. Increasing housing supply and addressing the possibility of a stamp duty exemption for first and last time buyers must remain at the top of the Government’s housing agenda,’ he added.

Output: The UK mortgage market has remained stable despite the upheaval and uncertainty since the Brexit vote, according to Jeremy Duncombe, the director of the Legal & General Mortgage Club. His comments followed figures from banking representatives group UK Finance, which demonstrated the first-time buyer sector had grown by 26% to 36,000 loans in June compared with the previous month, while mortgage lending in Q2 reached £34.4bn ($44.2bn), a rise of 18% on the previous quarter and 24% up on the same period in 2016. Buy to let borrowing reached £8.4bn, down 6% compared with Q1 but up 5% on the second quarter of 2016.


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Input:
Shell's plan to decommission Brent oil field angers Greenpeace
 The Brent oil field in the North Sea neatly bookends the history of oil and gas production in the UK.

Brought online in 1976 during an energy crisis, Brent at its peak produced half a million barrels a day. Four decades on, with production on the UK Continental Shelf (UKCS) in terminal decline, this iconic field – which lends its name to the international crude price benchmark – is being decommissioned.

Operated by Shell, Brent is situated midway between the Shetland Islands and Norway, and is served by four huge platforms − Alpha, Bravo, Charlie and Delta. Of the four, only Charlie still produces oil.

The platform topsides housing the accommodation block and drilling structures are anchored to the sea bed by much taller ‘legs’, which stand in 140m of water. The proposal by Shell to leave these 300,000t concrete bases from Brent Delta has prompted furious reaction from environmentalists.

"Shell is asking the UK Government for permission to leave behind the rig's huge concrete legs, and the oil residues they contain, to cut costs,” stated Greenpeace UK's chief scientist Dr Doug Parr.

“Under the OSPAR regulations, oil firms can only dump this infrastructure if they can prove that's more environmentally sound than attempting to remove it. Shell hasn't produced any useful evidence to this effect and seems instead anxious to wriggle out of the proper process.

“The government should not bend the rules for the sake of Shell's profits but uphold hard-won international laws. Shell and other oil firms have squeezed billions out of their platforms, driving climate change in the process. The least they can do is to take full responsibility for the clean-up."

Concrete evidence: the environmental challenges of decommissioning

Environmental concerns centre upon residual or ‘attic’ oil entombed in huge concrete storage cells within Brent Delta’s legs as well as hydrocarbons that accumulated during the production phase.

“Shell is developing technology to remove any hydro-dynamically trapped oil that is a threat to the marine environment,” explains Duncan Manning, Shell’s business opportunity manager for Brent.

“The second type of oil is sediment at the bottom of the cells composed of roughly 25% sand, 25% oil, and 50% water. We took samples to understand the composition and engaged with multiple stakeholders including Greenpeace to develop options.

"The four Shell platforms have paid over £20bn in today’s money in tax during their lifetime."

“These cells are made of reinforced concrete 60m high, 20m wide and 1m thick, and will last more than 700 years. Extract sediment to the surface, shipping it to shore, recycling and removing a proportion to landfill for treatment would be an incredibly time consuming and technically challenging process. The safety of personnel in undertaking this work is also a key factor.

“We concluded that leaving the oil in place was the right thing to do. Shell’s Independent Review Group concurred, agreeing that the effect on the environment of the recovery, transport, treatment and disposal of the oil would be far greater than the minimal impact of leaving it in place.”

Lessons from Brent Spar: stakeholder engagement and OSPAR exemption

Two decades on from the Brent Spar debacle, when Shell’s plan to sink an oil storage buoy sparked protests by Greenpeace and petrol boycotts in Germany, the company says it has learned its lesson.

“Shell’s stakeholder engagement began in 2007,” says Manning. “For the past ten years we have engaged with more than 180 organisations and 300 individuals including fishermen, academics, community groups and environmental NGOs. Since the mid-1990s operators are required to make decommissioning and removal instrumental in the design of oil and gas platforms. So, there are definitely lessons that we have taken on board.”

The OSPAR regulations protecting the marine environment in the North Atlantic forbid the dumping of legacy installations or leaving them wholly or partly in place. Shell is applying for an exemption.

“OSPAR acknowledges that there are significant difficulties with the removal of certain infrastructure including gravity-based structures and jackets over 10,000t,” explains Manning. “As long you can make a case and justify the rationale you can seek a derigation from these clean sea bed regulations.

“The Department for Business, Energy and Industrial Strategy breaks that down into five categories; impact on sea users, technical feasibility, safety, environmental impact and cost. Taking the factors into consideration, Shell concluded that leaving the legs in place makes sense. We’ve even broken down the five categories into 12 sub-divisions to better explain our case to stakeholders.”

The Guardian reports that just five exemptions have been issued by OSPAR for 124 installations decommissioned since the rules came into force in 1998. Is Manning confident Shell will prevail?

“The application is very much ongoing,” he explains. “We have finished the public consultation and now Shell will respond to each of the many comments, make any changes to our decommissioning programme and then go back to the UK Government, which will engage with OSPAR on our behalf. We also received a 20-page letter from eight NGOs, which we also need to respond to, but we require further clarity from them on what they propose. Once we have that, we’ll move forward.”

Taxing times: the tax relief debate and Pioneering Spirit

Dismantling Shell’s Brent infrastructure will take ten years and cost billions. Oil companies are given between 40% and 75% tax relief on clean-up costs, a policy that has angered campaigners, who argue it amounts to yet another fossil fuels subsidy. Manning is quick to spring to Shell’s defence.

“Oil and gas operators are expected to pay tax on the total income of any field minus full lifecycle costs, which include setting up, operating and decommissioning the infrastructure,” he argues. “We get decommissioning tax relief based on the tax regime during the production phase. Brent Delta is positioned in a high tax regime, so we receive around 70% relief on decommissioning.

"Oil companies are given 40% and 75% tax relief on clean-up costs, a policy that has angered campaigners."

“However, a third of that that goes back to the Treasury in the form of corporation and income tax. The four Shell platforms have paid over £20bn in today’s money in tax during their lifetime, so while we do attract tax relief it is a tiny percentage of the money that’s already been paid to the Treasury.”

In May, the world’s largest floating vessel, Pioneering Spirit, lifted the 24,200t topside of the Brent Delta platform – a new world record – and carried it to a recycling centre 700km away in Hartlepool.

Over the next ten years £17.6bn will be spent to completely or partially remove more than 100 rigs on the UK and Norwegian continental shelves. More than 1,800 wells are scheduled to be plugged and abandoned and 7,500km of pipeline decommissioned. For Shell, it represents a mammoth task.

“Brent decommissioning is large and complex because there are four platforms with three different designs – three gravity-based and one steel jacket,” explains Manning. “Delta was the first where we’ve completed the entire process and we are learning and improving from platform to platform.

“The topside of Brent Delta is being recycled and we are switching focus to Brent Bravo. We have plugged the wells, isolated the reservoir from the surface and are preparing the platform for lifting. With Alpha, we are nearly halfway through plugging the wells, after which will prepare it for lifting. Brent Charlie is still producing but we will soon start the reservoir isolation phase on the final rig.”

And with that Shell’s presence in the Brent field will end, 40 years after the oil first started flowing.

Output: Shell has submitted plans to the UK government to decommission its Brent oil field in the North Sea. The field, which has been in operation since 1976, now produces oil from only one of its four platforms. Shell wants to leave the 300,000-tonne concrete bases that support the platforms behind, angering Greenpeace campaigners that warned the oil residues they contain could be harmful. Shell said it is developing a technique for removing the residual “attic” oil, but maintains that leaving it would be safe for marine life. Shell will have to win an exemption from regulations before the bases are allowed to stay.


Instruction: create a high quality summary of the given input

Input:
Streaming platform Britbox now available on US Amazon Prime
 BritBox, a collaborative subscription streaming platform backed by BBC Worldwide and ITV, is now available to US Amazon Prime members who can sign-up for $6.99 a month and a seven-day free trial.

In return for parting with their dollars anglophile customers will be granted access to thousands of hours of British TV

In return for parting with their dollars anglophile customers will be granted access to thousands of hours of British TV shows such as Dr Who, Poirot and Upstairs Downstairs, as well as movies like Pride and Prejudice.

Output: US Amazon Prime members can now access BritBox, a subscription streaming platform supported by BBC Worldwide and ITV, for $6.99 per month. The service is offering a seven-day free trial, allowing users to watch popular British TV shows. The platform also hosts newly commissioned shows and offers instant access to recently broadcast episodes of soap operas. The platform can be accessed through the Prime Video app.


Instruction: create a high quality summary of the given input

Input:
Infiniti Prototype 9 has a Nissan Leaf motor in a racing body
 Infiniti is far from the first luxury automotive brand to show off an electric car concept in the wake of fending off Tesla and other startups, but Nissan’s upscale division has taken the 2018 Leaf’s heart and run in a very different direction.

This is the Infiniti Prototype 9, a design concept due to be shown this week at the 2017 Pebble Beach Concours d’Elegance near Monterey, California. But under the vintage-looking clothes of the Prototype 9, lies the powertrain from the 2018 Nissan Leaf.

Spend all your charge on a racetrack and Infiniti says the Prototype 9 should last up to 20 minutes

A 148-horsepower electric motor, with 236 pound-feet of torque, and a 30kWh battery, powers the rear wheels through a single-speed transmission, according to Infiniti. Interestingly enough, that sounds a lot like the electric motor that’s set to power the front wheels of the new Leaf, based on vehicle specifications that were leaked last week. Therefore in this Infiniti design project, it’s billed as a “next-generation EV powertrain.”

Still, its performance may bode well for the upcoming Nissan Leaf. Infiniti says the Prototype 9 has a top speed of 106 mph, with a 0–62 time of 5.5 seconds. Spend all your charge on a racetrack and Infiniti says the Prototype 9 should last up to 20 minutes (without actually giving a number of miles it might last).

The Infiniti Prototype 9 is packing Nissan’s newest EV technology under a striking body, mixing old and new. But why does it look like a 1940s racecar? After all, Infiniti doesn’t have a mid-20th century racing history because it was a brand created in 1989.

The technology underneath is destined for a Nissan dealership very soon

Alfonso Albaisa, Infiniti’s senior vice president of global design, says the Prototype 9’s look was inspired by the fantasy of “‘chancing' upon an unrecognized race car, hidden away for decades in a barn, deep in the Japanese countryside.” Therefore, it bears a heavy resemblance to the German and Italian racecars from the 1930s and ‘40s, even if Infiniti’s designers in Japan tried to infuse cues from the brand’s production cars in the front and sides.

Output: The Infiniti Prototype 9 from Nissan’s luxury automotive subsidiary has used the 2018 Nissan Leaf electric motor under a high-end racing car exterior. The 148 hp vehicle is powered by a 30 kWh battery and has a top speed of 106 mph and a 0-60 mph time of 5.5 seconds. The vehicle’s style is distinctly 1930s-1940s in a bid to evoke the look of historical racing cars. The Infiniti Prototype 9 does not yet have a release date.


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Google secures search engine status on iOS for $3bn
 Everyone and their grandmother, who might have just received an iPhone and is still getting used to it, probably hate one iOS quirk that Apple …

Output: Google has paid Apple $3bn for the right to remain the default search engine for Apple's products. Apple's standard search engine, Safari, is owned by Google, despite the rivalry between Android and iPhone. Google's search engine is widely considered the best, so the deal benefits both parties, with Apple providing the best possible user experience and Google receiving the most available exposure.


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Fibre optic cable designed for mining keeps dust and water out
 Digital applications are becoming more important to the mining sector, and as Conventional optical interfaces are sensitive to contamination, HARTING has developed a solution.

The industry requires high bandwidths to cover long distances, making the use of fibre optic cable essential, but since conventional optical interfaces are very sensitive to contamination, a hardy and reliable solution has had to be developed.

HARTING’s solution for data transportation under these extreme conditions is the Expanded Beam Cable Assembly. The assembly’s high bandwidth allows the high-definition video signals used to control the boring machines and associated equipment to be safely and securely transmitted. The fibre is contained in a connector housing that cannot be penetrated by dust, water or other environmental factors.

The hermaphroditic mating design of the expanded beam connectors ensures that regular disconnection and re-connection of the cabling in these environments is simpler than standard fibre optic cabling. The length of the optical connection is as simple as connecting an additional cable, with no need to spend time organising the laying direction or adding additional adaptors. As a result, the new assembly saves time and money by eliminating the need to match different mating faces in the field.

Apart from application in the mining sector, HARTING's Expanded Beam Cable Assembly can also be used to link networks in other harsh and intensive environments, including outside broadcast events, concert and music festival stage installations and container ports.

Output: Harting’s Expanded Beam Cable Assembly enables high-definition video signals that are used to control boring machines and associated equipment to be transmitted in harsh environmental conditions where standard fibre optic cabling may fail.


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LNG/diesel fuelling truck developed by US partnership
 Chart has announced that it has joined forces with Ground Force Worldwide (GFW) to launch the first dual LNG/diesel fuelling truck.

The vehicle was designed and constructed specifically for a large rock quarry customer in Florida, US. The customer is reportedly using the vehicle to fuel its recently converted fleet of haul trucks, which were retrofitted with LNG conversions.

Chart claims that the truck is based on a Kenworth T800 and Chart’s Orca unit. Originally developed as an efficient way to deliver packaged atmospheric gases, the latest incarnation of this unit bears testament to its longevity and durability.

Neither company has worked together before, and this project was GFW’s first venture into LNG and cryogenics. Chart claims that – with the mining sector increasingly interested in LNG, and the major truck original equipment manufacturers (OEMs) developing LNG and LNG/diesel hybrid haulers – there is the potential for this partnership to grow.

Output: Mining equipment manufacturer Ground Force Worldwide has partnered with international LNG services provider Chart Industries to launch the first dual LNG/diesel fuelling truck. The vehicle is based on a Kenworth T800 truck and Chart’s Orca unit, and will go into service at a rock quarry in Florida. Chart claimed that with major industries such as mining becoming more interested in LNG as a fuel source, there is significant potential for the partnership to grow.


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RWE to cofire biomass at two Dutch coal-fired power plants
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On Aug. 14, Germany-based RWE AG released second quarter financial results. A quarterly financial report released by the company briefly discusses plans to cofire biomass at two coal-fired power plants.

Within its quarterly presentation, RWE said its executive board decided earlier this year to retrofit its two Dutch hard coal-fired power plants Amer 9 and Eemshaven to cofire biomass. According to the company, the Dutch state approved subsidies of up to €2.6 billion ($3.5 billion) for the two plants. Along with the retrofitting, the company said subsidies will also finance the additional expenses for procuring fuel. RWE said the funds will be received over an eight year period.

According to RWE, the subsidies are allocated so that Amer 9 can achieve a biomass ratio of 80 percent, rather than the previous 35 percent, with Eemshaven able to achieve a ratio of approximately 15 percent.

The 643 MW Amer 9 power station has been in operation since 1993. The twin unit at Eemshaven has a capacity of 1,554 MW and has been generating power since 2014.

In its report, RWE said it plans to use a total of 2.5 million metric tons annually at the two facilities, which will lower carbon dioxide emissions by approximately 4 million metric tons. Biomass will be sourced from Europe and North America and will satisfy the requirements of Dutch sustainability protocol.

Output: German energy company RWE said it plans to retrofit its Amer 9 and Eemshaven coal-fired power stations in the Netherlands to increase the amount of biomass they can burn. The 642 MW Amer 9 will raise its biomass ratio to 80% from 35%, while the 1,554 MW Eemshaven will achieve 15%. The Dutch government has approved subsidies of up to $3.5bn.


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Lithium iodide doesn't solve lithium-air charge cycle issues: MIT
 Battery researchers agree that one of the most promising possibilities for future battery technology is the lithium-air (or lithium-oxygen) battery, which could provide three times as much power for a given weight as today’s leading technology, lithium-ion batteries. But tests of various approaches to creating such batteries have produced conflicting and confusing results, as well as controversies over how to explain them.

Now, a team at MIT has carried out detailed tests that seem to resolve the questions surrounding one promising material for such batteries: a compound called lithium iodide (LiI). The compound was seen as a possible solution to some of the lithium-air battery’s problems, including an inability to sustain many charging-discharging cycles, but conflicting findings had raised questions about the material’s usefulness for this task. The new study explains these discrepancies, and although it suggests that the material might not be suitable after all, the work provides guidance for efforts to overcome LiI’s drawbacks or find alternative materials.

The new results appear in the journal Energy and Environmental Science, in a paper by Yang Shao-Horn, MIT’s W.M. Keck Professor of Energy; Paula Hammond, the David H. Koch Professor in Engineering and head of the Department of Chemical Engineering; Michal Tulodziecki, a recent MIT postdoc at the Research Laboratory of Electronics; Graham Leverick, an MIT graduate student; Yu Katayama, a visiting student; and three others.

The promise of the lithium-air battery comes from the fact one of the two electrodes, which are usually made of metal or metal oxides, is replaced with air that flows in and out of the battery; a weightless substance is thus substituted for one of the heavy components. The other electrode in such batteries would be pure metallic lithium, a lightweight element.

But that theoretical promise has been limited in practice because of three issues: the need for high voltages for charging, a low efficiency with regard to getting back the amount of energy put in, and low cycle lifetimes, which result from instability in the battery’s oxygen electrode. Researchers have proposed adding lithium iodide in the electrolyte as a way of addressing these problems. But published results have been contradictory, with some studies finding the LiI does improve the cycling life, “while others show that the presence of LiI leads to irreversible reactions and poor battery cycling,” Shao-Horn says.

Previously, “most of the research was focused on organics” to make lithium-air batteries feasible, says Michal Tulodziecki, the paper’s lead author. But most of these organic compounds are not stable, he says, “and that’s why there’s been a great focus on lithium iodide [an inorganic material], which some papers said helps the batteries achieve thousands of cycles. But others say no, it will damage the battery.” In this new study, he says, “we explored in detail how lithium iodide affects the process, with and without water,” a comparison which turned out to be significant.

The team looked at the role of LiI on lithium-air battery discharge, using a different approach from most other studies. One set of studies was conducted with the components outside of the battery, which allowed the researchers to zero in on one part of the reaction, while the other study was done in the battery, to help explain the overall process.

They then used ultraviolet and visible-light spectroscopy and other techniques to study the reactions that took place. Both of these processes foster the production of different lithium compound such as LiOH (lithium hydroxide) in the presence of both LiI and water, instead of Li2O 2 (lithium peroxide). LiI can enhance water’s reactivity and make it lose protons more easily, which promotes the formation of LiOH in these batteries and interferes with the charging process. These observations show that finding ways to suppress these reactions could make compounds such as LiI work better.

This study could point the way toward selecting a different compound instead of LiI to perform its intended function of suppressing unwanted chemical reactions at the electrode surface, Leverick says, adding that this work demonstrates the importance of “looking at the detailed mechanism carefully.”

Shao-Horn says that the new findings “help get to the bottom of this existing controversy on the role of LiI on discharge. We believe this clarifies and brings together all these different points of view.”

But this work is just one step in a long process of trying to make lithium-air technology practical, the researchers say. “There’s so much to understand,” says Leverick, “so there’s not one paper that’s going to solve it. But we will make consistent progress.”

“Lithium-oxygen batteries that run on oxygen and lithium ions are of great interest because they could enable electric vehicles of much greater range. However, one of the problems is that they are not very efficient yet," says Larry Curtiss, a distinguished fellow at Argonne National Laboratory, who was not involved in this work. In this study, he says, "it is shown how adding a simple salt, lithium iodide, can potentially be used to make these batteries run much more efficiently. They have provided new insight into how the lithium iodide acts to help break up the solid discharge product, which will help to enable the development of these advanced battery systems.”

Curtiss adds that “there are still significant barriers remaining to be overcome before these batteries become a reality, such as getting long enough cycle life, but this is an important contribution to the field.”

The team also included recent MIT graduates Chibueze Amanchukwu PhD ’17 and David Kwabi PhD ’16, and Fanny Bardé of Toyota Motor Europe. The work was supported by Toyota Motor Europe and the Skoltech Center for Electrochemical Energy Storage, and used facilities supported by the National Science Foundation.

Output: MIT researchers have found that lithium iodide, a compound in lithium air batteries, may not be suitable for use. In previous tests, researchers introduced lithium iodide to address lithium air batteries' need for high voltages to charge, low efficiency, and poor cycle lifetimes. Lithium-air batteries provide up to three times the power-to-weight ratio of lithium-ion batteries. However, the addition of lithium iodide was unable to prevent limited charging-discharging cycles and irreversible reactions, the MIT researchers found.


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Aberdeen stocks to be removed from LSE in final stage of merger
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The £11 billion merger between two of standard-bearers of the Scots financial sector Standard Life and Aberdeen Asset Management (AAM) has cleared its final regulatory hurdle after the deal was rubber stamped at Edinburgh's Court of Session.

The completed formality means that shares in AAM will be suspended from trading at the close of business today before they are cancelled from the London Stock Exchange on Tuesday morning.

To complete the deal and create the merged entity Standard Life Aberdeen, a copy of the court order must be delivered to the Registrar of Companies in Scotland, which is expected to happen on Monday.

At which point the tie-up will become effective.

Announced in March after a run of outflows from AAM, the merger aims to achieve savings of £200 million a year, with about 800 jobs expected to be lost over a three-year period from a global workforce of 9,000.

The deal creates a global fund management giant with some £670bn of assets. Under the merger, each AAM share held by investors will be exchange for 0.757 shares in Standard Life, which were valued at 426.8p a piece at the close of trading yesterday.

Figures earlier this week from Standard Life, led by chief executive Keith Skeoch, revealed a 6 per cent rise in operating profits to £362m for the six months to the end of June, while assets under management edged up 1 per cent to £362bn.

Standard Life's last results as an independent company before its merger with AAM were overshadowed by outflows of £5.6bn from its flagship Global Absolute Returns Strategies (Gars) fund in the first six months of the year.

Standard Life Aberdeen will be jointly headed by Skeoch and his counterpart at AAM, Martin Gilbert.

The group will be chaired by Standard Life chairman and city grandee Sir Gerry Grimstone, with AAM’s chairman Simon Troughton serving as deputy.

Output: Shares of of Aberdeen Asset Management have been suspended and will be cancelled from the London Stock Exchange on Tuesday, in the final stage of the asset management giant's merger with Standard Life. The deal cleared its last legal obstacle last week when a court in Scotland gave its approval for the company being combined with Standard Life to form Standard Life Aberdeen. The £11bn merger creates an entity with about £670bn in assets, though 800 jobs are expected to disappear.


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End-of-week tiredness causes crashes on UK roads
 Friday is the most common day of the week for car crashes, new figures show.

Evidence shows there are more road accidents on a Friday than on any other day of the week.

Analysis of more than 700,000 traffic accidents in Britain by Direct Line Car Insurance found that drivers have a 14% higher chance of being involved in a collision on Fridays than the average day.

The riskiest hour on the roads is 5-6pm, with 9% of all incidents occurring in that period, according to the study.

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Motorists are least likely to be involved in an accident on Sundays when there are 24% fewer crashes than average as there are fewer vehicles on the road.

The research revealed that the total number of crashes fell by 8% between 2011 and 2015.

Gus Park, a managing director at Direct Line Car Insurance, said: "Towards the end of the week we are often tired, rushing to get home or away for the weekend, and this can lead to people not paying as much attention to the road conditions and their surroundings.

"It is important people remain vigilant every time they get behind the wheel - for their own safety and that of other road users."

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Office for National Statistics figures for personal injury accidents reported to police between 2011 and 2015 were analysed for the research.

Here are the average daily number of road accidents in Britain, according to the study:

* Monday: 397.1

* Tuesday: 419.8

* Wednesday: 419.1

* Thursday: 424.0

* Friday: 453.2

* Saturday: 363.3

Output: British drivers are more likely to suffer a crash on a Friday, when they are more tired and less attentive to road conditions, according to a study by Direct Line car insurance. It found that there was a 14% greater than average risk of crashing at the end of the week, with 5pm-6pm being the most dangerous time of the day. The safest day of the week is Sunday, according to the study, when motorists are 24% less likely than to be involved in a collision because there are fewer vehicles on the road.