Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

The natural history, sensory ecology and biogeography of the seed dispersal of large fruits in Fynbos

Seed dispersal is a crucial life-history stage for the regeneration of all reseeding plants. In the Fynbos Biome of the Greater Cape Floristic Region (GCFR) of South Africa, at least 100 plant species have seed traits that suggest they are scatterhoarded by small mammals. The aims of this thesis were to investigate the dispersal biology of large-fruited Fynbos plants by: 1) determining the spatial and taxonomic extent of scatter-hoarding through seed trials, investigating both dry, nut-like and semi-fleshy fruits; 2) trait-based analyses investigating selective drivers of seed colour polymorphisms in flat-winged, serotinous Leucadendron and 3) modeling the relative influence of environmental, biological and disturbance drivers in predicting the distributions of serotinous and scatterhoarded Leucadendron. Seed predation and scatter-hoarding by small mammals was widespread, yet locally patchy. Four new fynbos species with large, nut-like fruits were confirmed to be scatter-hoarded, by either Acomys subspinosus or Gerbilliscus paeba. Many species with small, nut-like fruits, with no clear dispersal or defense strategies, suffered intense seed predation by the nonhoarding small mammals, Rhabdomys pumilio and Micaelamys namaquensis. The large, dry, nut-like fruits of Ceratocaryum argenteum have a globally unique, alternative strategy for effective dispersal. The nuts emit a strong scent that mimics the scent of herbivore dung and exploits the olfactory sensory perception of dung beetles, which rolled and buried the seeds. The semi-fleshy fruits of the rock-restricted Heeria argentea were dispersed by the mutualistic M. namaquensis, which consumed only the pericarp, allowing for germination, as well as moving fruits to fire-protected, rocky outcrops. Many flat-winged Leucadendron seeds, with polymorphic brown or black seed coats, displayed background matching with post-fire soils. This plant defense likely reduces predation by visually cued avian granivores. Finally, modeling results suggest that the distributions of both serotinous and scatter-hoarded plants are strongly negatively and positively influenced by more intense seasonal drought and longer fire return interval in the GCFR, respectively. Overall, this thesis advances our understanding of large-fruited Fynbos plants, providing unique insights into their natural history, ecology, evolution, conservation and biogeography

Assessing Social-Emotional Abilities of Preschool-Aged Children Within a Social-Emotional Learning Framework

During the past decade, there has been an increasing amount of research demonstrating a positive relationship between early childhood social-emotional abilities and later life outcomes. As such, practitioners who work with preschool-aged children are called to understand the social-emotional abilities that constitute healthy development. Doing so provides practitioners with a social-emotional framework from which to work so that they may efficiently assess and intervene in these abilities. This manuscript grounds social-emotional abilities within the Collaborative for Academic, Social, and Emotional Learning’s (CASEL) Framework for Social-Emotional Learning (SEL). We describe the need for a multi-method, multi-sourced, multi-setting comprehensive social-emotional assessment of preschool-aged children and describe a rating scale that can be used as a part of the assessment process. The manuscript concludes with a discussion regarding the importance of intervening early to prepare preschool-aged children for future academic and life success

3-PG Productivity Modeling of Regenerating Amazon Forests: Climate Sensitivity and Comparison with MODIS-Derived NPP

Potential forest growth predicted by the Physiological Principles in Predicting Growth (3-PG) model was compared for forest and deforested areas in the Legal Amazon to assess potential differing regeneration associated with climate. Historical deforestation and regeneration have occurred in environmentally marginal areas that influence regional carbon sequestration estimates. Effects of El Niño–induced drought further reduce simulated production by decreasing soil water availability in areas with shallow soils and high transpiration potential. The model was calibrated through comparison of literature biomass and with satellite-based estimates. Net primary productivity (NPP) for mature Amazonian forests from the 3-PG model was positively correlated (r 2 = 0.77) with a Moderate Resolution Imaging Spectroradiometer (MODIS)-derived algorithm, though with some bias. Annual total NPP for the study area using a 1961–90 average climatology was 4.6 Pg C yr−1, which decreased to 4.2 Pg C yr−1 when simulated with climate from the severe 1997/98 El Niño event. From a regional analysis, results showed that biomass accumulation is almost entirely controlled by the availability of soil water. Also, areas currently forested in the eastern Amazon are more sensitive to extreme El Niño–induced drought than southern areas with the greatest deforestation extent

From Local Velocities to Microwave Background

The mass density field as extracted from peculiar velocities in our cosmological neighborhood is mapped back in time to the CMB in two ways. First, the density power spectrum ($P_k$) is translated into a temperature angular power spectrum of sub-degree resolution ($C_l$) and compared to observations. Second, the local density field is translated into a temperature map in a patch on the last-scattering surface of a distant observer. A likelihood analysis of the Mark III peculiar velocity data have constrained the range of parameters for $P_k$ within the family of COBE-normalized CDM models (Zaroubi et al 1996), favoring a slight tilt in the initial spectrum, $n<1$. The corresponding range of $C_l$'s is plotted against current observations, indicating that the CMB data can tighten the constraints further: only models with ``small'' tilt ($n\sim 0.9$) and ``high'' baryonic content ($\Omega_b \sim 0.1$) could survive the two data sets simultaneously. The local mass density field that has been recovered from the velocities via a Wiener method is convolved with a Boltzmann calculation to recover $10'$ resolution temperature maps as viewed from different directions. The extent of the CMB patch and the amplitude of fluctuations depend on the choice of cosmological parameters, e.g., the local 100\hmpc sphere corresponds to $90'$ to $30'$ at the CMB for $\Omega$ between 1 and 0 respectively. The phases of the temperature map are correlated with those of the density field, contrary to the contribution of the Sachs-Wolfe effect alone. This correlation suggests the possibility of an inverse reconstruction of the underlying density field from CMB data with interesting theoretical implications.Comment: 16 pages, 6 figures. Submitted to Ap.

Black Holes in Galaxy Mergers: Evolution of Quasars

Based on numerical simulations of gas-rich galaxy mergers, we discuss a model in which quasar activity is tied to the self-regulated growth of supermassive black holes in galaxies. Nuclear inflow of gas attending a galaxy collision triggers a starburst and feeds black hole growth, but for most of the duration of the starburst, the black hole is heavily obscured by surrounding gas and dust which limits the visibility of the quasar, especially at optical and UV wavelengths. Eventually, feedback energy from accretion heats the gas and expels it in a powerful wind, leaving a 'dead quasar'. Between buried and dead phases there is a window during which the galaxy would be seen as a luminous quasar. Because the black hole mass, radiative output, and distribution of obscuring gas and dust all evolve strongly with time, the duration of this phase of observable quasar activity depends on both the waveband and imposed luminosity threshold. We determine the observed and intrinsic lifetimes as a function of luminosity and frequency, and calculate observable lifetimes ~10 Myr for bright quasars in the optical B-band, in good agreement with empirical estimates and much smaller than the black hole growth timescales ~100 Myr, naturally producing a substantial population of 'buried' quasars. However, observed and intrinsic energy outputs converge in the IR and hard X-ray bands as attenuation becomes weaker and chances of observation greatly increase. We obtain the distribution of column densities along sightlines in which the quasar is seen above a given luminosity, and find that our result agrees remarkably well with observed estimates of the column density distribution from the SDSS for appropriate luminosity thresholds. (Abridged)Comment: 12 pages, 7 figures. Accepted for publication in ApJ (September 2005). Replacement with minor revisions from referee repor