An ACO-Inspired, Probabilistic, Greedy Approach to the Drone Traveling Salesman Problem

In recent years, major companies have done research on using drones for parcel delivery. Research has shown that this can result in significant savings, which has led to the formulation of various truck and drone routing and scheduling optimization problems. This paper explains and analyzes a new approach to the Drone Traveling Salesman Problem (DTSP) based on ant colony optimization (ACO). The ACO-based approach has an acceptance policy that maximizes the usage of the drone. The results reveal that the pheromone causes the algorithm to converge quickly to the best solution. The algorithm performs comparably to the MIP model, CP model, and EA of Rich & Ham (2018), especially in instances with a larger number of stops

Barriers and Facilitators to Implementation of Value-Based Care Models in New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol

Introduction: Massachusetts established 17 new Medicaid accountable care organizations (ACOs) and 24 affiliated Community Partners (CPs) in 2018 as part of a large-scale healthcare reform effort to improve care value. The new ACOs will receive $1.8 billion dollars in state and federal funding over 5 years through the Delivery System Reform Incentive Program (DSRIP). The multi-faceted study described in this protocol aims to address gaps in knowledge about Medicaid ACOs\u27 impact on healthcare value by identifying barriers and facilitators to implementation and sustainment of the DSRIP-funded programs. Methods and analysis: The study\u27s four components are: (1) Document Review to characterize the ACOs and CPs; (2) Semi-structured Key Informant Interviews (KII) with ACO and CP leadership, state-level Medicaid administrators, and patients; (3) Site visits with selected ACOs and CPs; and (4) Surveys of ACO clinical teams and CP staff. The Consolidated Framework for Implementation Research\u27s (CFIR) serves as the study\u27s conceptual framework; its versatile menu of constructs, arranged across five domains (Intervention Characteristics, Inner Setting, Outer Setting, Characteristics of Individuals, and Processes) guides identification of barriers and facilitators across multiple organizational contexts. For example, KII interview guides focus on understanding how Inner and Outer Setting factors may impact implementation. Document Review analysis includes extraction and synthesis of ACO-specific DSRIP-funded programs (i.e., Intervention Characteristics); KIIs and site visit data will be qualitatively analyzed using thematic analytic techniques; surveys will be analyzed using descriptive statistics (e.g., counts, frequencies, means, and standard deviations). Discussion: Understanding barriers and facilitators to implementing and sustaining Medicaid ACOs with varied organizational structures will provide critical context for understanding the overall impact of the Medicaid ACO experiment in Massachusetts. It will also provide important insights for other states considering the ACO model for their Medicaid programs. Ethics and dissemination: IRB determinations were that the overall study did not constitute human subjects research and that each phase of primary data collection should be submitted for IRB review and approval. Study results will be disseminated through traditional channels such as peer reviewed journals, through publicly available reports on the mass.gov website; and directly to key stakeholders in ACO and CP leadership

Flip-OFDM for Optical Wireless Communications

We consider two uniploar OFDM techniques for optical wireless communications: asymmetric clipped optical OFDM (ACO-OFDM) and Flip-OFDM. Both techniques can be used to compensate multipath distortion effects in optical wireless channels. However, ACO-OFDM has been widely studied in the literature, while the performance of Flip-OFDM has never been investigated. In this paper, we conduct the performance analysis of Flip-OFDM and propose additional modification to the original scheme in order to compare the performance of both techniques. Finally, it is shown by simulation that both techniques have the same performance but different hardware complexities. In particular, for slow fading channels, Flip-OFDM offers 50% saving in hardware complexity over ACO-OFDM at the receiver.Comment: published in IEEE Information Theory Workshop, Paraty Brazil, Sept 201

Improving Care Coordination between Accountable Care Organizations and Community Partners: Early Findings from the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Program

Research Objective: The Massachusetts’ Medicaid and Children’s Health Insurance Program (MassHealth/MH) initiated the Delivery System Reform Incentive Payment (DSRIP) program in 2017, as part of its section 1115 Demonstration, to coordinate care for Medicaid members, reduce healthcare costs and improve patient outcomes. Central to this program was a requirement that Accountable Care Organizations (ACOs) develop relationships with all behavioral health and at least 2 long-term care service MH contracted Community Partner agencies (CPs) operating in their service areas to be responsible for coordinating care and developing care plans for members. This presentation will describe barriers and facilitators to developing ACO-CP relationships identified in the first 1.5 years of program implementation. Study Design: This paper focuses on ways in which ACOs and CPs are responding to new contracting requirements and programmatic expectations related to the MA 1115 DSRIP. Semi-structured interviews were conducted with individuals in leadership positions at all 17 ACOs and 27 CPs by pairs of trained interviewers, in person, or via video or teleconference. Interview data were analyzed qualitatively, using a framework approach informed by the literature, the program logic model, and the evaluation design. Population Studied: ACOs/CPs nominated 2 to 3 individuals best positioned to speak to implementation topics including governance and organizational structure, workforce development, ACO-CP relationships, provider engagement, care coordination, quality improvement, and environmental factors including the role of MassHealth. Ninety-four interviews were conducted with 99 interviewees across the 44 organizations. The majority of interviewees were female and typically held managerial roles, ranging from program managers to executives. A majority were with their organizations prior to or at the time of DSRIP inception. Principal Findings: Communication and information sharing were identified as key ingredients to coordinating member health care between ACOs and CPs; the absence of effective means to communicate and share information were identified as major barriers. Strategies for enhancing communication included scheduling regular meetings to discuss shared patients (i.e., within and between organizations), designating points of contact (e.g., staff liaisons), and clarifying roles regarding member-facing activities. Information sharing was found to be most effective when organizations agreed on processes, particularly around the use of electronic medical records or other information exchange technologies. ACO and CP interviewees indicated that successful communication and information sharing led to the development of stronger and more positive partner relationships (e.g., between an ACO and the CPs with which they share information and coordinate care well). Participants also described ways in which MassHealth has actively responded to challenges within the original design of the ACO-CP relationship to improve coordination and member experience. Conclusions: Designated points of contact, well-conceived and executed communication strategies, and effective information exchange are essential for developing relationships and coordinating care between ACOs and community-based organizations. Implications for Policy or Practice: States need to consider the complexity of coordinating care with multiple community-based agencies and the importance of standardized processes for effective information sharing when promoting care coordination between health care and human service entities. States should also incorporate means of ongoing technical support and rapid cycle feedback to allow for continuous policy improvement in Medicaid delivery systems

Optimal sub-arraying of compromise planar arrays through an innovative ACO-weighted procedure

In this paper, the synthesis of sub-arrayed monopulse planar arrays providing an optimal sum pattern and best compromise difference patterns is addressed by means of an innovative clustering approach based on the Ant Colony Optimizer. Exploiting the similarity properties of optimal and independent sum and difference excitation sets, the problem is reformulated into a combinatorial one where the definition of the sub-array configuration is obtained through the search of a path within a weighted graph. Such a weighting strategy allows one to effectively sample the solution space avoiding bias towards sub-optimal solutions. The sub-array weight coefficients are then determined in an optimal way by exploiting the convexity of the problem at hand by means of a convex programming procedure. Representative results are reported to assess the effectiveness of the weighted global optimization and its advantages over previous implementations. (c) The Electromagnetics Academy - The final version of this article is available at the url of the journal PIER (Progress In Electromagnetics Research): http://www.jpier.org/PIER/pier.php?paper=1009200