National / International News
Ben Hewitt's sons do not follow standardized curriculum; there are no tests or grades. He is a member of the "unschooling" movement.
Venture capitalists are getting into the new health care game — a game in which the more money you save, the more money you make.
Enter Aledade, one of the first companies with VC backing. It's teaming up with small, independent primary care docs.
Why do investors think they can strike gold in these health care outposts?
It’s because of physicians like Dr. Rebecca Jaffe, who has spent the last 30 years running a family medicine practice in Wilmington, Delaware.
“We serve newborns and their parents, and their parents, and their parents, up to four generations of a family. We call it womb to tomb,” says Jaffe.
To Jaffe, “womb to tomb” is a pledge she makes to her patients. That type of attention often leads to meaningful patient-doctor relationships. To Aledade CEO Dr. Farzad Mostashari, those relationships represent a business opportunity.
“When a health plan sends a video out, a video about nutrition for people with diabetes, 4 percent of people open that link. When their primary care doctor sends it, 95 percent of the time we know that they click and open that video,” he says.
Today, the health care industry spends billions trying to buy the kind of persuasive power a physician like Jaffe wields.
If you can control — or at least influence — patient decisions, you can limit health care spending, which has become a high-stakes business. Mostashari says to imagine the case of a 30-something recreational runner who comes in complaining of knee pain and wants an MRI. The patient would think, “If they are not recommending an MRI for me, it’s because I don’t need one. And I trust my primary care physician,” says Mostashari.
Aledade is betting the relationships you find in these independent mom-and-pop practices will help control health care costs more than almost anything else. Already, the company is working with 100 doctors to form what are called Accountable Care Organizations, or ACOs.
That’s a jargon-y way of saying that the less spending overall, the more money doctors can earn while ensuring quality care.
To date, Aledade has helped the doctors create three ACOs under the federal government’s Medicare Shared Savings program. Mostashari says Aledade will be a savvy partner with cash.
“I’m going to give them what they need,” he says. “Whether that’s data, whether it’s capital, whether it’s tools, whether it’s technology.”
In exchange, Aledade keeps 40 percent of any savings.
Venrock’s Bryan Roberts sees that kind of possibility for Aledade, too.
Even though the practices are small independents, 100 doctors like Jaffe call the shots on nearly $1 billion of referrals, tests and hospitalizations every year. The trouble, says Roberts, is many don’t realize it.
“Today those primary care physicians have no control over and no incentive for control over those downstream dollars. And so to me that’s the place where magic can happen,” he says.
That magic will often mean offering same-day appointments, checking on patients just discharged from the hospital or extending hours to help avoid trips to the ER.
Similar programs in Massachusetts and Florida suggest this is a winning formula.
Under its Alternative Quality Contract, Dr. Dana Safran of Blue Cross Blue Shield of Massachusetts says not only do doctors make more money, but patients experience a new level of attention.
“Like never before, they have their doctor’s office calling them, just to check back in. So, they are finding, they are a patient the practice is thinking about all the time."
The Urban Institute’s Dr. Robert Berenson says he’s preached this kind of approach for more than two decades.
But as hospitals have gobbled up physician practices, there are a shrinking number of doctor partners. Berenson sees no reason to think that trend will change anytime soon.
“Independent, small practices are likely going to die out simply because recent graduates of medical school don’t want to live that kind of life,” he says.
Venrock’s Roberts concedes the current crop of docs are more interested in shift work than paying bills and managing staff — the kind of responsibility that comes with running your own business. But he likes to think Aledade could reverse the trend.
“We show these primary care docs can have a real effect on their microcosm in the system. Having that effect will make them more money. That may in fact change the desires of doctors to be independent,” he says.
Dr. Jaffe certainly hopes signing on with Aledade makes life better for her and her patients.
She says she’s sick of hitting health care walls, like a recent case in which no repair company would fix a 101-year-old patient’s wheelchair.
“I have known this woman for more than 35 years. And I want what’s best for her — and what was best for her was for us to do our utmost at getting that seat fixed. I went so far as to ask my husband if he would consider doing it,” she says.
Jaffe worried the woman would get hurt trying to learn some new doodad of a device, but ultimately, that was the only choice.
“In less than two days, she fell, broke her leg and is now sitting in a nursing home,” she says.
It all goes back to Jaffe’s womb-to-tomb pledge. Even if Aledade makes bundles, but she does most of the work, Jaffe wants these sorts of health care pileups to go away. Something she knows she can’t do on her own.
The judge said that the states had given the court "no reasonable basis" for forbidding same-sex marriage.
A statement from the Department of Health and Human Services said a hacker uploaded malware onto the website's test servers. No data was taken.
Making movies isn't for the faint of heart.
Filmmakers have to raise huge amounts of money and yet maintain creative control – all the while negotiating the twists and turns of a byzantine industry.
Not to mention that he acts a bit too. He plays football player Pete in FXX's "The League", which debuted its sixth season Wednesday, and he co-stars with Mad Men's Elisabeth Moss in the film "The One I Love".
How does he do it? We've paraphrased some of his advice - and you can listen to all of it in the audio player above.
A short guide to getting your film financed, via Mark Duplass:
Step 1 - Find yourself a star.
Decide to make a $5 million movie. Go to a movie star like Elisabeth Moss and offer "Schedule F," or $65,000.
Step 2 - Begin budget cuts.
When the $5 million budget gets cut down to $3.5 million, go back to the hopefully-still-interested Elisabeth Moss, and offer "scale," or about $3,000 a week. Then, throw in "a point," or back-end profits.
Don't dwell on the fact that with creative accounting at these companies, you'll never see that money.
Thus, Elisabeth Moss is now working on this $5 million movie for four weeks and making making $12,000.
Step 3 - The twist.
Return to the agent and offer the minimum pay, with something extra added on. Everybody — Elisabeth Moss, a PA or Ted Danson — is going to make $100 per day, but they also get big points on the back end. And because they've made it so cheaply, profits will roll in sooner.
The agents will say, "How do I know I'll see the points?"
Show them the documents from your other films. If you're Mark Duplass, that's: "Safety Not Guaranteed", "Your Sister's Sister" and so on, including what everyone made. It dwarfs the Schedule F pay they were going to make in the first place.
Step 4 - Repeat.
Keep playing the game; keep producing.
Over the next six months, about 20,000 people will get Ebola. Half will likely die. To stop the virus, the World Health Organization says it needs thousands of health care workers and $600 million.
If you have gone on a trip and stayed in a nice hotel lately, you might have shelled out more than expected. You are not alone. Hotels are increasingly boosting the bill with add-ons: fees for their gym, Wi-Fi, the “free” newspaper. God forbid you actually open the mini-fridge.
Fees have become a big part of the hotel business model. A study by Bjorn Hanson of New York University shows that the industry is going to rake in $2.25 billion this year from all those little additional charges. That is 6 percent more than in 2013, and a new all-time record.
These are not your garden-variety charges, says Colin Johnson, the chair of hospitality management at San Francisco State University. He says customers used to balk at bills for long-distance telephone calls. Now the list of fees scrolls on and on: charges for early check-in, using the gym, late checkout, baggage holding, even putting your own stuff in the minibar. Now that, Johnson says, is really creative.
Hotels have had some rough years: first the recession, and now rental websites like Airbnb. Fees offer some extra profit. So why not raise them? Airlines do it, and passengers make do with a pack of peanuts.
“Some of the businesses, honestly, just don't care,” says Carl Winston, who directs the Payne School of Hospitality and Tourism Management at San Diego State University. Nor do those business have to, he says.
Winston says these fees are not due to bad times. They are the product of big data. Hotels now know better what we will and won’t pay for. “They are really able to predict consumer behavior in a way that they had no possibility of doing in the past,” he says.
Lots of little fees give hotels more information to profile us, to squeeze out every dollar. Plus, they create ammunition to build customer loyalty. And if you’re angry, maybe you’ll get the “free newspaper” for free.
Stripping out all the perks allows hotels to keep the initial room price low. If they bring you in the door with that, Winston says, they won’t waste what is called “perishable inventory.”
“An airline or hotel can only sell its seat or its bed today,” Winston says. “If they don't sell it, it's gone.”
So, gripe all you want about the fees. As long as you keep coming back for the cheap rooms, they won’t be going anywhere.
A federal court of appeals in San Francisco has ruled that Yelp can, if it so chooses, raise or lower the rating of a business on the site depending on whether or not that business advertises with them.
Such a move would not be classified as extortion, which is what the lawsuit at issue had claimed.
Yelp is happy with the results, but claims it doesn't do such things, anyways. The company said in a blog post:
"We are obviously happy that the court reached the right result, and saw through these thin attempts by a few businesses and their lawyers to disparage Yelp and draw attention away from their own occasional negative review."
This is not your father’s productivity rate.
Back before the recession, the Labor Department reported worker productivity increases of 2 to 3 percent a year. We’ve been stuck at around 1 percent for the past few years.
“One percent today is not the 1 percent of 2006 before we went into the recession,” says Christopher Rupkey, chief economist of MUFG Union Bank.
Rupkey says, before the recession, a 1 percent productivity-rate increase would have been awful, because we were in that crazy housing bubble. It skewed productivity up. After the bubble burst, productivity skewed down.
So, if you think about it, 1 percent isn’t so bad, says James Craft, a business administration professor at the University of Pittsburgh.
“Given what we’ve experienced in terms of some of the problems in the economy and its recovery and so forth, I think that is reasonable at this point in time,” he says.
And here’s another thing to think about: It’s harder to measure productivity now. It was easier when technologies like Microsoft Word first came along, and the cause-and-effect was clearer.
“The big benefit was, of course, secretaries don’t have to retype memos here after taking advantage of word processing,” says Doug Handler, chief U.S. economist at IHS Global Insight.
Now, Handler says, we have so many new technologies it's hard to tell what's responsible for productivity improvements. The cloud? That new app on your phone? Both?
Still, Handler says, some things haven’t changed. Companies need to hire good people and spring for the latest technology, even if they’re not sure how it will affect productivity.
While CBS airs football games on Thursday nights, ABC is hoping all the not-so-sports-inclined spouses settle in for a night of Shonda Rhimes.
Don’t know the name? Rhimes created "Grey’s Anatomy" and "Scandal." The two TV shows have been bright spots for a network that’s had a rough couple of years when it comes to prime time, says Horizon Media analyst Brad Adgate.
“Last year, they were last in adults 18–49. But when it came to women 18–49, they were second,” Adgate says.
Shonda Rhimes is credited, in large part, for that success. She's a creator and showrunner who champions strong female leads and a diverse cast. Adgate says that formula appeals to women, who now make up about 65 percent of the network’s audience. With network ratings sliding, he says, it’s not surprising that ABC would double down on its niche success.
So the network is promoting Rhimes to its audience. An advertisement for the Thursday night lineup edits together dialogue from each show to make the characters say "I love Shonda Rhimes."
Cynthia Littleton, TV editor at Variety, says while there have been powerful showrunners in the past, this may be the first time a network promoted one as a star.
“This branding and the three shows stacked on one night,” Littleton says. “That is absolutely a function of social media and how it has turned Shonda Rhimes literally into a marketable star for the network.”
Littleton says Rhimes was also masterful in using Twitter to promote shows and make herself a star with viewers.
— shonda rhimes (@shondarhimes) July 24, 2014
But will this branding work?
“Network TV these days is a game of trying to do better than you did last year, which is hard to do,” says Joe Adalian, an editor with Vulture.
Adalian said by that measure, ABC’s Thursday strategy will work. The night is already filled with two hit shows, and with Rhimes' star status, the third has a good chance of becoming one, too.
Shonda Rhimes didn't initially set out to be a television writer, much less one of the industry's most powerful showrunners. According to a New York Times profile from last year, Rhimes decided to apply to USC's film school after graduating from Dartmouth because she read that it was more competitive than Harvard Law.
Rhimes got in, graduated, and initially broke through as a writer for HBO's Dorothy Dandridge biopic, starring Halle Berry. She went on to write Britney Spears' acting debut, "Crossroads," which was critically panned but a box office hit. She scored her first Disney credit with "The Princess Diaries 2" and sold "Grey's Anatomy" to the Disney-owned ABC around the same time.
"Grey's" was a midseason replacement but an instant hit, prompting a Rhimes-lead spinoff in 2007 that lasted six seasons. Broadcast TV is crowded with medical shows, but Rhimes' series distinguished themselves and became a cultural touchstone. Just ask the many, many people who tossed around nicknames like "McDreamy," "McSteamy," etc. in the late 2000s.
In 2013, Rhimes' shows were pulling in $300 million in advertising each season, Forbes reported, or about 5 percent of ABC's revenue. Since "Grey's" premiered, she has adopted two children, who, the Times wrote, regularly come to work with her.
After cementing her place at ABC with two hits, Rhimes created "Scandal," which she told the Times is her most unfiltered project, uninhibited by network notes, and appropriately insane and melodramatic.
"What were they going to do, fire me? I wasn't worried about what anybody else thought," she told the Times. "This one was for me."
Rhimes has said she doesn't want to be pigeonholed into a certain type of show. So, she's branching into another crowded space — the legal drama — with "How to Get Away With Murder," starring Viola Davis as a law professor who becomes embroiled in a homicide with four of her students. The show will follow "Scandal" to round out ABC's three-hour Rhimes block.
Whipping out the big guns, monetarily speaking.
Europe’s Central Bank announced today it was stepping on the economic gas, giving the eurozone a shot, or whatever your choice of analogy.
More specifically: It lowered its deposit rate for banks to negative-0.2 percent from negative-0.1 percent.
“Nobody except the ECB has flirted with negative interest rates. Even Japan. This is unprecedented,” says Marc Chandler, Global Head of Currency Strategy at Brown Brothers Harriman.
A positive interest rate means banks earn money on what they hold on reserve with a central bank — whereas a negative interest rate means banks have to pay to park their money there. The idea is that this will push money out into the financial system and promote lending.
Secondly, the ECB said it would start purchasing asset-backed securities, much like the United States Federal Reserve and the Bank of England has done (the quantitative easing strategy) to promote lending and inject money into the stock market and economy.
Second-quarter GDP growth flat-lined in Europe.
“The eurozone economy is failing to recover in the way that the U.S. or U.K. economy has been recovering,” says Andrew Lilico, head of Europe Economics. “You have countries with 25 percent and up unemployment that are still very much trapped. While it just got out of recession, the economy has gone from contraction to stagnation.”
One symptom of this, says Chandler, has been that “lending has collapsed in the euro area as banks try to rebuild balance sheets and deleverage.”
The European Central Bank is preparing to take on new regulatory authorities. As banks brace for future stress tests, they have cut back on lending. At the same time, says Chandler, consumers and small businesses aren’t inclined to borrow.
Plus, the inflation rate has inched down over the past few months, reaching precariously close to zero.
“We had the inflation rate of eurozone countries running at 0.5 percent in June, 0.4 percent in July, 0.3 percent in August. It has been gradually declining,” says Abdur Chowdhury of Marquette University and chief economist at Capital Market Consultants.
Chowdhury predicted the ECB’s move, contrary to many analysts who assumed the bank would wait until later this year to act. “The major concern that people have is they don’t want deflation, because that would create a vicious cycle” of economic contraction.
Early ECB assessments have pointed out that drops in inflation were occurring for “good” reasons — fuel costs were falling, for example. But Chowdhury says even if that’s true, the fact that the GDP isn’t benefiting from those good reasons makes the threshold of 0 percent inflation and the risk of crossing over into deflation territory dangerous, because deflation is a difficult problem to solve once it starts.
Why not sooner?
Hindsight is 20-20, but many economists argue some things are just plain easy to see coming. “They should’ve done it four or five years ago,” says Lilico, a sentiment Chowdhury echoes.
“The governing council that makes the decision has one member for each of the eurozone countries,” says Chowdhury. “These member look at national interest first and the interests of the eurozone second, to be honest.” Still, he says, “better late than never.”
Will it work?
Chandler, who also anticipated the ECB’s move, says “probably on the margins.” He expects inflation to bottom out in the next few months, but not cross over into deflation territory, and he says the stimulus, rate adjustment and resulting slide in the euro may all contribute to this.
As for what this means for the U.S., Chandler says, “It makes us look like a high yielder; it makes the U.S. look more attractive."
European investors may opt to put money into U.S. bonds and securities at the same time the Federal Reserve stops doing so. This could keep yields on bonds from falling precipitously as the Fed exits its stimulus.
As rates fall and yields in Europe shrink, the euro will become a less attractive currency to hold and will fall in value against the dollar (1 percent shortly after the ECB’s news was announced). This means European goods will be cheaper for Americans to buy, but it also means Europe will become less hungry for American exports as they become more expensive in Europe.