Accountable Care Organizations and Transaction Cost Economics

Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information impactedness. Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development

Ambiguity in Speaking Chemistry and other STEM Content: Educational Implications

Ambiguity in speech is a possible barrier to the acquisition of knowledge for students who have print disabilities (such as blindness, visual impairments, and some specific learning disabilities) and rely on auditory input for learning. Chemistry appears to have considerable potential for being spoken ambiguously and may be a barrier to accessing knowledge and to learning. Educators in chemistry may be unaware of, or have limited awareness of, potential ambiguity in speaking chemistry and may speak chemistry ambiguously to their students. One purpose of this paper is to increase awareness of potential ambiguity in speaking chemistry and other STEM fields and the ramifications of ambiguity. Another purpose is to introduce rules (known as MathSpeak) for non-ambiguous speaking of mathematics that could be adapted for use in chemistry. Reducing ambiguity in speaking chemistry may enhance learning of chemistry and could encourage students who have blindness, visual impairments, and/or other print disabilities to pursue careers in STEM fields

Mechanisms for Outsourcing Computation via a Decentralized Market

As the number of personal computing and IoT devices grows rapidly, so does the amount of computational power that is available at the edge. Since many of these devices are often idle, there is a vast amount of computational power that is currently untapped, and which could be used for outsourcing computation. Existing solutions for harnessing this power, such as volunteer computing (e.g., BOINC), are centralized platforms in which a single organization or company can control participation and pricing. By contrast, an open market of computational resources, where resource owners and resource users trade directly with each other, could lead to greater participation and more competitive pricing. To provide an open market, we introduce MODiCuM, a decentralized system for outsourcing computation. MODiCuM deters participants from misbehaving-which is a key problem in decentralized systems-by resolving disputes via dedicated mediators and by imposing enforceable fines. However, unlike other decentralized outsourcing solutions, MODiCuM minimizes computational overhead since it does not require global trust in mediation results. We provide analytical results proving that MODiCuM can deter misbehavior, and we evaluate the overhead of MODiCuM using experimental results based on an implementation of our platform

Minority and Women Entrepreneurs Contracting with thw Federal Government

 This article uses learning network theory as a foundation upon which the assistance and barriers minority and women entrepreneurs face when attempting to contract with the federal government may be studied. The public policy programs analyzed for this study were the SBA's 8(a) program and the Department of Defense's Procurement Technical Assistance Program (PTAC). The methodology utilized was an in-depth analysis of government contracting experiences in two states, Missouri and Kansas, in the greater Kansas City area via formalized interviews and government data. Research results revealed strong responses to the 8(a) program and its overall effectiveness. Racial issues were of a particular concern, as well as the perceived lack of strength behind 8(a) contracting incentives. The PTAC program was revealed to be reaching a significantly increasing percentage of woman owned businesses, and to a lesser extent, minority-owned businesses while providing a more effective learning strategy for gaining government contracts.

Operator systems for tolerance relations on finite sets

We study the duals of a certain class of finite-dimensional operator systems, namely the class of operator systems associated to tolerance relations on finite sets or equivalently the class of operator systems that are associated with graphs. In the case where the graphs associated with these operator systems are chordal we are able to find concrete realizations of their duals as sitting inside of finite-dimensional $C^*$-algebras. We then use these concrete realizations to compute the $C^*$-envelopes, propagation numbers and extremal rays of these duals in the chordal case. Finally, we exemplify our results by applying them to operator systems of band matrices.Comment: 16 page

Clustered and Distinct: A Taxonomy of Local Multihospital Systems

Despite their prevalence and power in markets throughout the United States, local multihospital systems (LMSs)—also referred to as hospital-based “clusters”—remain an understudied organizational form, with studies instead primarily focusing either upon individual hospitals or viewing hospital systems collectively without distinguishing the local “sub-systems” that comprise larger regional or national hospital chains. To better understand these organizational forms, we develop a taxonomy specifically devoted to LMSs, applying taxonomic analysis methods to a sample of LMSs in six U.S. states while accounting for LMSs’ geographic arrangements and non-hospital-based service locations. Our analysis identifies five distinct LMS categories, with forms clearly distinguished according to their varying degrees of differentiation and integration. The study’s results accentuate the importance of accounting for hospital systems’ activities and arrangements in local markets—including their non-hospital-based sites—and highlight differences in systems’ achievement of integration and coordination across services and locations, providing considerations in light of U.S. health system reform as well as international patterns of regional system formation

Engaging in radical work: Students as partners in academic publishing

Students as partners is the radical antithesis of the consumerist mind-set in higher education. Yet students have traditionally been absent from one key arena of academia: publishing. The International Journal for Students as Partners seeks to address this absence through pairing academic and student co-editors for all its sections