The Role of Organizational Change in Health System and Payment Reform

The Maine Health Access Foundation (MeHAF) has awarded grants to 14 Maine health organizations to date to mitigate the increasing cost of health care in Maine through innovative delivery system and payment reform strategies that preserve access, improve quality, and offer better value. As part of the evaluation of this initiative, the University of Southern Maine Muskie School of Public Service (Muskie School) is producing a series of issue briefs that capture common themes and challenges across grantees in achieving payment reform and health system delivery change to assess lessons learned. This is the first issue brief which describes our evaluation approach and presents an analysis of the role of organizational change among grantees engaged in delivery system and payment reform

What Directions for Public Health Under the Affordable Care Act?

Outlines opportunities for public health efforts under the 2010 healthcare reform law, such as building prevention into insurance expansion and boosting innovation in population health, as well as challenges, such as budget constraints

Assessing the Impact of Integrated Personal Health and Care Services: the Need for Modelling

In Europe Public expenditure for healthcare and Long-Term Care (LTC) currently absorbs 6.8% of GDP and without innovative cost containment measures could almost double by 2050 and reach 12.8% of GDP due to several socio-economic and cultural trends. This challenge can be turned into an opportunity for inclusive innovation and growth if the potential of ICT would be fully exploited to deliver personal health and social care services to prevent and manage chronic diseases (i.e. remote monitoring and treatment) or to ensure a dignified and independent living at home for the elderly (i.e. Ambient Assisted Living, AAL). This potential is fully recognised in both the EU2020 Strategy and in the new Digital Agenda for Europe, and one of the first European Innovation Partnership in 2011 will focus on Health and Ageing and related services. This favourable context, however, suffers from a scientific gap with important strategic implications for policy making: there exists currently no micro or macro economic empirical or modelling analysis that would enable policy makers to either demonstrate ex post the impact of Health&Care services or to simulate ex ante their potential impacts. Lacking this support it is at times difficult to win traditional resistance to innovation and push full adoption of such services in Europe. This research explored the availability of tools and methods, both for macro- and micro- modelling tools and processes, assessed their implications, challenges and opportunities and reports on its findings. The paper concludes by laying the foundations for proposing a new research plan that would aim at filling the scientific and policy relevant gap by proposing a hands-on modelling exercise to study the impacts in one country for on chronic disease.JRC.DDG.J.4-Information Societ

Moving from a "human-as-problem" to a "human-as-solution" cybersecurity mindset

Cybersecurity has gained prominence, with a number of widely publicised security incidents, hacking attacks and data breaches reaching the news over the last few years. The escalation in the numbers of cyber incidents shows no sign of abating, and it seems appropriate to take a look at the way cybersecurity is conceptualised and to consider whether there is a need for a mindset change.To consider this question, we applied a "problematization" approach to assess current conceptualisations of the cybersecurity problem by government, industry and hackers. Our analysis revealed that individual human actors, in a variety of roles, are generally considered to be "a problem". We also discovered that deployed solutions primarily focus on preventing adverse events by building resistance: i.e. implementing new security layers and policies that control humans and constrain their problematic behaviours. In essence, this treats all humans in the system as if they might well be malicious actors, and the solutions are designed to prevent their ill-advised behaviours. Given the continuing incidences of data breaches and successful hacks, it seems wise to rethink the status quo approach, which we refer to as "Cybersecurity, Currently". In particular, we suggest that there is a need to reconsider the core assumptions and characterisations of the well-intentioned human's role in the cybersecurity socio-technical system. Treating everyone as a problem does not seem to work, given the current cyber security landscape.Benefiting from research in other fields, we propose a new mindset i.e. "Cybersecurity, Differently". This approach rests on recognition of the fact that the problem is actually the high complexity, interconnectedness and emergent qualities of socio-technical systems. The "differently" mindset acknowledges the well-intentioned human's ability to be an important contributor to organisational cybersecurity, as well as their potential to be "part of the solution" rather than "the problem". In essence, this new approach initially treats all humans in the system as if they are well-intentioned. The focus is on enhancing factors that contribute to positive outcomes and resilience. We conclude by proposing a set of key principles and, with the help of a prototypical fictional organisation, consider how this mindset could enhance and improve cybersecurity across the socio-technical system

Futures of a Complex World : Proceedings of the Conference “Futures of a Complex World”, 12–13 June 2017, Turku, Finland

”Futures of a Complex World” conference 2017 was a success by all standards. We got record amount of participants - 330 experts from 29 countries - with fascinating array of topics from future of agriculture to new modeling tools. This publication, based on papers presented in the conference, is a token of the fascinating variety of approaches we can adopt while penetrating the future with the tools of our research. As such, it also represents in a splendid way the complexity of our world, embedded with grand challenges as well as fascinating new developments. Complexity science itself proves us that we need particularly two capacities to thrive in the ever more complex world: on the one hand we need to build more resilience into our systems, on the other, we should create new capacities to transform, if necessary. Both aspects are well represented in the articles of this publications

HHS Action Plan to Reduce Racial and Ethnic Health Disparities

The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. With the HHS Disparities Action Plan, the Department commits to continuously assessing the impact of all policies and programs on racial and ethnic health disparities. It will promote integrated approaches, evidence-based programs and best practices to reduce these disparities. The HHS Action Plan builds on the strong foundation of the Affordable Care Act and is aligned with programs and initiatives such as Healthy People 2020, the First Lady's Let's Move initiative and the President's National HIV/AIDS Strategy.http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=28

Nudging lifestyles for better health outcomes: crowdsourced data and persuasive technologies for behavioural change

For at least three decades, a Tsunami of preventable poor health has continued to threaten the future prosperity of our nations. Despite its effective destructive power, our collective predictive and preventive capacity remains remarkably under-developed This Tsunami is almost entirely mediated through the passive and unintended consequences of modernisation. The malignant spread of obesity in genetically stable populations dictates that gene disposition is not a significant contributor as populations, crowds or cohorts are all incapable of experiencing a new shipment of genes in only 2-3 decades. The authors elaborate on why a supply-side approach: advancing health care delivery cannot be expected to impact health outcomes effectively. Better care sets the stage for more care yet remains largely impotent in returning individuals to disease-free states. The authors urge an expedited paradigmatic shift in policy selection criterion towards using data intensive crowd-based evidence integrating insights from system thinking, networks and nudging. Collectively these will support emerging potentialities of ICT used in proactive policy modelling. Against this background the authors proposes a solution that stated in a most compact form consists of: the provision of mundane yet high yield data through light instrumentation of crowds enabling participative sensing, real time living epidemiology separating the per unit co-occurrences which are health promoting from those which are not, nudging through persuasive technologies, serious gaming to sustain individual health behaviour change and intuitive visualisation with reliable simulation to evaluate and direct public health investments and policies in evidence-based waysJRC.DDG.J.4-Information Societ

Strategies for Improving Healthcare Efficiency While Reducing Costs

In comparison to the European healthcare system, the U.S. healthcare system has lower quality care, higher costs, and covers a smaller percentage of the population. Despite the high costs, the U.S. healthcare system remains dysfunctional. The purpose of this exploratory single case study was to identify the strategies that some healthcare managers in a hospital setting in the midwestern region of the United States use to improve efficiency while decreasing healthcare costs. Complex adaptive systems theory was used to frame this study that included face-to-face interviews with 6 highly experienced healthcare managers. Data were collected from audio recorded interviews and publicly available documents, and the audio recordings were transcribed and analyzed using deductive and open coding techniques to identify themes regarding strategies used by managers to find effective ways for improvement. Three strategies emerged as themes, including improving the accuracy of information and reports, implementing precise and accurate information, and improving quality. The findings of this study may directly benefit healthcare managers and compel positive social change by facilitating successful strategies to improve efficiency and reduce costs. The successful strategies identified in the study might provide a new direction to healthcare managers attempting to adopt new methods. The findings may also contribute to social change by providing solutions that may improve overall organizational performance in a hospital setting

Strategic evaluations and techno-economic networks. Vaccine innovation in the Cuban biotech sector: for public health – or for profits?

In this paper the Cuban biotech sector with its highly integrated vaccine industry is analyzed in the perspective of the techno-economic network model of Michel Callon. The paper discusses the strategic evaluations that have been performed in the sector. Given the emphasis on public health displayed by the Cuban government and the precarious condition of the Cuban economy (at least during the last 20 years), the strategic evaluations could be seen as an articulation of the (sometimes conflicting) interests of public health and commercialism. The main issue to be discussed in the present paper is how interests related to public health and economic considerations are articulated and balanced in the strategic evaluations that have been made in the Cuban biotech sector. There is a focus on the vaccine related activities of the sector, which will be loosely referred to as the Cuban vaccine industry. This is the first of two papers about the Cuban bitoech sector and vaccine industry.Innovation systems, techno-economic networks, Cuba, vaccines, biotechnology