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.