Integrated Delivery Networks: In Search of Benefits and Market Effects

Integrated Delivery Networks (IDNs) have very different stated purposes than mere collections of hospitals: to coordinate care across the continuum of health services and to manage population health. IDN advocates claim that these complex enterprises yield both societal benefits and performance advantages over less integrated competitors. The purpose of this analysis is to evaluate the evidence to support these claims.For the study, researchers performed a review of the academic literature on IDN performance, as well as an analysis of publicly available quality and financial data from 15 of the biggest not-for-profit IDNs in the U.S., including Sutter Health in Northern California. The authors compared the publicly available performance information on the IDNs' flagship hospital in its principal regional market with that flagship's most significant in-market competitor. The study found that it is possible for integrated delivery networks to offer meaningful benefits, but there is little evidence they have reduced costs or improved the quality of care. Findings include:Hospital-physician integration has raised physician costs, hospital prices and per capita medical care spending;Hospital integration into health plan operations and capitated contracting was not associated either with clinical efficiency or financial efficiencyProviders are likely to see a decrease in operating margins and return on capital as they invest in IDN developmen

Strategic Positioning Under Agricultural Structural Change: A Critique of Long Jump Co-operative Ventures

Industrial Organization, Agribusiness,

Strategic Positioning Under Agricultural Structural Change: A Critique of Long Jump Co-operative Ventures

This study utilizes strategic management theory to analyze the recent proliferation in non-commodity vertical integration producer-owned businesses in the US. The paper introduces the notion of the Value Creation Triad where ownership, competency, and control need to be aligned for success. Very related to the Triad concept is the differentiation in strategy between long and short jumping. The paper presents an empirical case of successful vertical integration by a New Zealand lamb cooperative.Strategic management theory, Value added agriculture, Vertical integration, Producer-owned enterprise, Core competencies, Tacit knowledge, Productivity gap, Opportunity gap, Agribusiness,

STRATEGIC POSITIONING UNDER AGRICULTURAL STRUCTURAL CHANGE: A CRITIQUE OF LONG JUMP CO-OPERATIVE VENTURES

Structural change in US agriculture has disrupted the traditional organization of the supply chain. Not only does the scale increase of firms common during the industrial period (1970-1995) continue, but also with the rise of a knowledge-based economy, new organizational forms and supply chain linkages are proliferating. Examples are the radical transformation of the relationship between input suppliers and producers in the biotech arena, the dominance of the swine industry by the integrated model, the rise of marketing and production contracting, and the arrival of multi-member closed producer organizations such as the new generation cooperatives and limited liability companies. The focus of this research is these new integrated producer organizations. Much of the activity and subsequent analysis of new producer organizations has focused on value-added opportunities through integration (i.e., Merrett et al, 1999). There are numerous examples from pasta plants and egg breaking, to cattle feeding, hog slaughter, and alcohol production. These value-added opportunities we define as long jump ventures. That is, they lie outside the core competencies of the principles in the firm, the producers. Strategic management theory (Prahalad, 1986,1990,1993; Quinn, 1977,1990; Mintzberg, 1987,1994,1996,1998,2000) suggests that there may be other opportunities available to producer organizations that better leverage their core competencies, short jump ventures. Short jump ventures are value-creating opportunities that involve a minimum R&D, less capital, less risk, and less direct specialized knowledge. While the economy at large is producing vast quantifies of long jump innovations in the fields of biotechnology and information, there is another revolution occurring in business involving short jump innovation in the area of service. This new field, known as; one-to-one marketing (Pepper, 1993, 1999), relationship management (Hansen, 1983), relationship marketing (Curry, 2000), and strategic partnering (Rackam, 1996), focuses on the supplier-client interface. Value is created by significant coordination between supplier and client. The boundary between firms is blurred, knowledge is actively shared, and partners are dedicated to mutual profitability. By understanding the needs of the client, the supplying firm is able to adapt its products and more importantly services. This creates a unique and more valuable business for the supplier insulating it from competitive forces and allowing greater value capture. This not only creates greater supply chain efficiency, but intra-firm and inter-firm product innovation result as well. The objective of this paper is to study strategic options for production agriculture dealing with the failure of the commodity business model. From this analysis of strategic positioning the paper introduces relationship management as a viable strategic alternative for commodity producers. Finally, a case study of the Wairarapa Lamb Cooperative, a New Zealand based firm doing business in the United States, is introduced. The case serves not only as an example of relationship management in agriculture but also demonstrates how producers can work within their own core competencies, leverage knowledge assets, and avoid highly specific fixed assets. The methodology will be: 1) Review the literature as to the types of activities in which integrated producer organizations are engaged. 2) Present a theoretical model of strategy analyzing short jump versus long jump ventures. 3) Introduce Relationship Management. 4) Employ a case study example of the theory in practice. This paper theoretically analyzes producers' vertical integration through "brick and mortar" investments, such as hog slaughter and ethanol production. A theoretical model using strategic management theory and a case study are used to critique the long jump strategy and suggest relationship management as a more viable alternative.Agribusiness,

Astrobiological Effects of F, G, K and M Main-Sequence Stars

We focus on the astrobiological effects of photospheric radiation produced by main-sequence stars of spectral types F, G, K, and M. The photospheric radiation is represented by using realistic spectra, taking into account millions or hundred of millions of lines for atoms and molecules. DNA is taken as a proxy for carbon-based macromolecules, assumed to be the chemical centerpiece of extraterrestrial life forms. Emphasis is placed on the investigation of the radiative environment in conservative as well as generalized habitable zones.Comment: 3 pages, 3 figures; submitted to: Exoplanets: Detection, Formation and Dynamics, IAU Symposium 249, eds. Y.S. Sun and S. Ferraz-Mello (San Francisco: Astr. Soc. Pac.

FIRMS, INCENTIVES, AND THE SUPPLY OF FOOD SAFETY: A FORMAL MODEL OF GOVERNMENT ENFORCEMENT

Recent instances of significant food safety breeches in both meat and biotechnology challenge traditional safety efforts. A formal model utilizing agency theory is used to explore the power relationships between the regulator and the firm. Fundamental issues effecting firms' supply of safety are demonstrated and alternative corrective mechanisms are discussed.Food Consumption/Nutrition/Food Safety,

DNA-decorated graphene chemical sensors

Graphene is a true two dimensional material with exceptional electronic properties and enormous potential for practical applications. Graphene's promise as a chemical sensor material has been noted but there has been relatively little work on practical chemical sensing using graphene, and in particular how chemical functionalization may be used to sensitize graphene to chemical vapors. Here we show one route towards improving the ability of graphene to work as a chemical sensor by using single stranded DNA as a sensitizing agent. The resulting broad response devices show fast response times, complete and rapid recovery to baseline at room temperature, and discrimination between several similar vapor analytes.Comment: 7 pages, To appear in Applied Physics Letter