Corporate Behemoths in Healthcare: Will the Patient Win? | healthcare

The past several weeks have been abuzz with the mergers and acquisitions in the healthcare arena. CVS has purchased Aetna for a cool 69 billion dollars and went through the regulatory process with flying colors. Amazon (on their quest for world domination) has teamed up with Warren Buffett, CEO of Berkshire Hathaway and financial powerhouse J.P. Morgan to use their resources, influence and power to, according to Buffett, “tackle healthcare costs in our nation.” Buffet also said that because the U.S., at 18% of our gross domestic product, the U.S. is at a competitive disadvantage, at 3.3 trillion dollars annually. He believes the private sector can handle healthcare better than the government.Albertson’s, a grocery company, is ready to acquire retail pharmacy giant Rite Aid. And now, Cigna, the insurance behemoth, is buying Express Scripts in a deal for upwards of 50 billion. Software giant Apple is dipping their toe into employee health, while things are starting to rumble at Wal-Mart, the retail monster.After all of that information, you need a breather. But will a disruption by these companies be the thing that makes healthcare better in the U.S.?Yet, as a patient advocate and caregiver supporter, my main concern is this: Will all of this be a win for patients, caregivers and families? You know – the healthcare customers?While the shake-up in healthcare is oh-so-long overdue, is the combination of behemoths the right way?First, this healthcare shake-up won’t be the last of the behemoths to combine. I would be willing to bet on that. We have yet to hear from the likes of Microsoft, Walgreens, Google or any of the Generals (Electric, Motors, Mills). What about other insurers? Where is Humana or United Healthcare in this game?Many companies will follow suit. It’s just a matter of time. I liken it to the most popular girl in high school getting into a relationship with the most popular boy and becoming a force to be reckoned with. Everyone will see the trend, its benefits and potential, and jump into it. Sorry for the high school analogy.The point is everyone sees that it is time for change in healthcare.So what’s in it for patients/customers?Something we must question is this: Are these corporations in it for the billions of dollars that healthcare is worth or do they really want better conditions, cost and efficiency for patients? Will the combination of all these behemoths reach past their employees and meet the needs of all patients in our nation? What are their motives?My mission is to empower patients and caregivers to navigate healthcare confidently and correctly, to save them and all parties involved time, money and frustration. I show them that they have rights and responsibilities in their Healthcare journey and must take a strong and active role in their care. Patients are the lifeblood of the healthcare system.None of these behemoth combinations will be successful without patient/customer buy-in. They’d better put all of their goals into a nice and helpful package for patients so they feel supported and empowered. If these corporations can show how the patient will be helped and how their alliances can save money for all parties involved, they should have no trouble in the regulatory processes they face.But I implore all of you behemoths… DO SOMETHING.Do something for the 64% of Americans who avoid getting care because they are afraid of the costs.Do something for the working poor who make too much for Medicaid and not enough to afford skyrocketing healthcare premiums.Do something that shows how healthcare can actually be affordable and where service prices do not have to be excessive.Do something to empower patients and establish real healthcare cost transparency.Do something about actual care and system processes to show that it doesn’t have to be as difficult or time-consuming as it is currently.You behemoths have the power to change healthcare for the better for the foreseeable future and possibly, forever. Please don’t look down from your Ivory Towers upon us mere mortals and pity us or hope for the best. Do something.Make it a win for patients, and we all will win.

Making Money Via an Online Business | online business

The internet (Web) has revolutionized the way we live. The web caters to different online businesses and drastically altered the way corporations and private parties do business. A lot of people are looking for various ways to find a balance for work, leisure and making money nearly simultaneously. Different types of online businesses present themselves as each gives opportunities for people to earn money. A person can either have a passive or active income. From the way it’s described, passive income can be generated from actions a person sets up that earn a recurring income without other functions done to them while an active income needs work to be done continuously.In making money online, one should consider several factors before deciding which business is right. Here is a 3 step guideline to consider before a person embarks on their online business.1. Plan – The amount of experience and knowledge you will need for an online business is important. You can do the learning yourself or have a mentor guide you in the business. Think of the time you need for learning the business and the time allotted for it to grow and make money. Also plan for expenses that a person has to allot for the business. This includes the website, computer tools, training, virtual assistants, web developers and other factors. Making money online needs a lot of planning which will definitely help you in the long run.2. Decide – After research, decide on the type of online business that you will venture into. Research in the beginning is very important. One should know their way around the internet as the business revolves on it. Decide on a name for the business as it should be unique to catch search engine visitors attention.3. Market -To be making money online it is important for you to effectively market your website business. You should decide wisely on the structure and design of your website. Think of ways to attract an audience, then market your website according to that plan. Internet marketing involves different techniques to earn a higher page rank on the search engines. Moving your page rank higher attracts a larger audience for you to build a customer or subscriber list. Techniques include article marketing, search engine optimization, social media marketing, blog marketing, backlinking, Google AdSense ads and other techniques. You can either do affiliate marketing or direct online selling. Affiliate marketing is putting unique links on your website where you can earn a commission from a sale. Direct online Selling involves the selling of products and services through the internet. from a website business.There are many misconceptions in making money with an online business. Some say it is fast and easy, but the truth is that it is not that easy. A person needs to dedicate time to learn about it first to achieve the goal, which is to earn a profit of course. If any online business offer claims a person can make money easily and without much effort, it would be more logical to doubt it. It is important to reexamine the online business website, verify the testimonials and look for second opinions. If they are offering products for affiliate marketing, reexamine if it is legitimate. To improve the odds to earn an income for an online business, one needs to perform considerable research before making any decision. This will serve as the all important foundation for anyone making money with an online business.

Open Source Software in Higher Education | Education

The higher education sector is quite unlike other industries. It has its own processes and a different set of demands. Most commercial proprietary application vendors develop their applications focused on a wider domain spread across industries. This, academics complain, creates a distinct disconnect between software vendors and the end-users in academia.To overcome these shortcomings, the education industry started looking to “open source” as an alternate model. Around a decade back, institutions started debating total cost of ownership in adopting an open source based community approach vis-à-vis proprietary applications, viability of open source based business models, sustainability and security issues.The success of community developed open source software is quite well established. Linux and Apache are ample proof of its success. A similar trend, though not that widespread in its reach, can be traced to the development of community projects in education like the Moodle and Sakai.Through the course of its formative years, the open source community based approach in education has developed several alternative models. Some of these models and schools of thought have thrived and been implemented successfully across a significant spectrum of the industry. Progress and success in open source projects like the Sakai, Moodle, Kuali, uPortal, Shibboleth, and many more are being closely watched by the industry.Community Source ModelOne school of thought believes that open source sharing is more a philosophical approach than a viable alternative. The adoption of open source in higher education seems to suggest otherwise. FLOSS (Free/Libre and Open Source Software) communities are thriving well in learning environments too.The FLOSS model has been extensively used in initiatives like the MIT OpenCourseWare and Open Source Biology. Project Gutenberg, the Wikipedia, The Open Dictionary project are prime examples of how open source has been successfully adapted to education initiatives.In a community source project, multiple institutions come together to partner in the project. All partners contribute financially as well as in employing human resources for the effort. In the early stages, the partnering institutions provide all design and development efforts and only in subsequent stages is the project opened to the broader community. This way, the initial support is secured and the institutions have a substantial influence in deciding how the application is modeled and designed.The initial focus of community source projects is on collaboration between institutions. The focus in the crucial first stages is therefore to form a common economic outlook and an appropriate administrative framework rather than forming a community around a shared code. Most community based open source projects slowly migrate to open source in the later stages.The Sakai project, for example, started as a joint effort between four institutions (Michigan, Indiana, MIT and Stanford). The initial agenda was to set up a framework of common goals that would produce appropriate software based on an agreed list of objectives. The scope for participation was later increased by forming the Sakai Educational Partners Program (SEPP), whereby other institutions can join and participate in the community for a small fee.The Current LandscapeAn education enterprise like any organization has its own needs ranging from resource planning to budgeting. Additionally, they have typical requirements like the need to integrate with financial aid programs of the government, multiple payroll cycles, and student information systems (SIS) that handle admissions, grades, transcripts, student records as well as billing. All these call for robust ERP systems. Until recently, colleges and universities mostly rely on either custom-developed systems that are more than 15 years old, or have transitioned to commercial products from vendors like Oracle, SAP, PeopleSoft or vendors like SunGard that are geared towards the higher education market.Kuali Financials was borne due to the lack of open source solutions Enterprise applications in the higher education sector are comprised of a mix of some proprietary application vendors and some key open source community initiatives. PeopleSoft, Oracle, SunGard and Datatel are some key vendors that offer tightly integrated ERP packages for the education sector.Recent consolidation in the industry, like the acquisition of PeopleSoft by Oracle and of WebCT, Angel, etc by Blackboard, has caused considerable unease in the education fraternity. The concern stems from the fear that the trend of consolidation would lead to the monopoly of a few key vendors. The plans of these vendors to offer tightly integrated systems heightens the fear that this will provide an unfair leverage to these vendors as it would extend the community’s dependence on them.One area of concern about proprietary applications is a seeming disconnect between the industry and software application developers. Institutions also have strong reservations about the currently available administrative software and course management systems. The feeling is that applications provided by vendors such as SAP and PeopleSoft are adapted from other industries and does not work well for educational enterprises. Moreover, the proprietary nature of the applications implies that the source code is not available and customization efforts involve substantial costs.In the context of such a wide breadth of requirements, open source can prove to be a viable alternative. In fact, these constraints provided the impetus for open source initiatives in higher education. Some of the success has helped provide a strong foundation to building an alternative support model for the education industry.In the Sakai project, the participating institutions decided to integrate and synchronize their educational software into a pre-integrated collection of open source tools termed Collaborative Learning Environment (CLE). Sakai has active implementations running at multiple institutes including the University of Michigan and Indiana University.In parallel, Sakai also established a set of activity based communities that have spawned an active cooperation between the industry and application vendors. The Sakai Educational Partners Program allows educational institutions to participate in the program for a small fee. Besides, there are the Sakai Commercial Affiliates, who offer fee-based services for installation, integration and support..Kuali, on the other hand, mainly addresses aspects of educational administration. The Kuali Financial System (KFS) is the most prominent application. It handles administrative and operational tasks like general accounting, purchasing, salary and benefits, budgeting, asset management and grants. The system is designed around modules that enable it to be tweaked to work with existing commercial applications. For example, at Indiana University, Kuali applications work together with PeopleSoft’s HR and student system. The Kuali Foundation is a non-profit consortium of multiple universities and some hardware and software companies. The Kuali Commercial Affiliate program operates on similar lines like its Sakai counterpart. The community has been growing and now includes the University of California, Cornell, Michigan State University, San Joaquin Delta College (Calif.), and The University of Arizona.Significantly, according to the 2008 Campus Computing Survey, around 13.8 percent of the survey participants have already identified an Open Source LMS – either Moodle or Sakai – as the campus standard LMS.Besides these, several other projects offer SIS functionality. For example, openSIS manages student demographics, scheduling, attendance, grades, transcripts, and health records, and its parent company makes add-on modules to support additional features like disciplinary tracking, billing, food service, and bulk email/SMS messaging for emergency contact.Other Key intiaitives areJaSig community developing uPortal, and CAS (Central Authentication Services) two components serving as input to Kuali Rice.Internet2 – A consortium led by universities working in partnership with industry and government to develop and deploy advanced network applications and technologies including products such as Shibboleth and GrouperOpen Source CurriculaAs with any “open source” activity, open source curricula by its very definition is one that can be freely used, distributed and modified. A model like this would seemingly be antithetic to the concept of higher education as it strikes at the credibility of the education environment. Campus education is designed to operate as a structured learning methodology. The concept of community collaboration involving academics and students on the same platform brings a lot of unpredictability into the scenarioHowever, FLOSS communities (Free/Libre and Open Source Software) in education have proved to be quite successful. A key principle of this learning approach is its root in adapting it to the context of ones’ experience. With its stress on learners and their preferences, this learning approach focuses more on learning by collaboration, communication and sharing.Significant initiatives include the Connexions Project at Rice University, the OpenCourseWare project at MIT and the social learning medium of Wikipedia.The FLOSS approach in higher education has been operating in combination with traditional teacher centered approaches. The objectives of the FLOSS approach are not to replace traditional methods but to achieve synergies in combination and offer the learner an enhanced learning environment.The ‘FLOSS-like education transfer report’ published in September 2008, as part of the FLOSSCOM project, notes that FLOSS communities can create effective learning environments. The study has also come up with three different approaches that could be combined effectively with traditional teaching approaches.Economic Models of Open SourceOne aspect that clearly marks the adoption of open source as a winner is the fact that in this scenario, the developers are most often also the users of the software. This removes the perceived disconnect between the developer community and the end-users unlike in the case of proprietary applications. However, this is less evident in the case of administrative applications like payroll or HR. In such cases, adoption of open source has to be a directed process.Initiatives like the Kuali project have proved that open source can also build up sustainable models that provide adequate support mechanisms. In such models, there is active collaboration between the community that comprises not only developers and end-users, but also an extended support group comprising commercial vendors. These support groups are available to offer timely support to mission critical applications. The community approach also ensures that the code is not closed and that an active community of interest ensures that enhancements keep happening as necessitated.Projects like uPortal have been developed with minimal resources but are deployed across hundreds of institutions. The community approach has proved sustainable as in the case of the Sakai project. In terms of funding, the Sakai project garnered an investment of $6.8 million over two years.The viability of the open source, community based model stems not from the monetary or cost aspects but principally the adaptability that it offers. The debate over cost of ownership between commercially available proprietary software and open source applications is yet to be proved empirically. However, the fact that the code is open means it can be easily adapted to suit new requirements and does not involve significant investments in terms of customization or enhancements. This does make significant economic sense in the longer term.The case for open source in higher education is nicely documented in a study by the Alliance for Higher Education Competitiveness. In a 2005 study report titled, ‘Will Open Source Software Become an Important Institutional Strategy in Higher Education?’ Rob Abel notes how open source is a “great fit for higher education”. The study, based on an analysis of open source projects in education, opines that the community-based approach is an interesting model that also helps reduce the inherent risks in adopting an open source approach.As for the cost model, the study notes that while open source has helped generate cost savings in the range of 20 to 30 percent for the commercial sector, the same may not be entirely true in education. The community-based approach, the writer notes, with its associated participation fees, may prove only marginally beneficial in terms of costs. Institutions that have their own infrastructure and resources may however, benefit from substantially reduced costs from their open source initiatives.The FutureOpen source has proved to be adaptable and a reliable platform for collaboration and learning. In their quest for ideal application software to handle administrative, operational and education platforms, most CIOs are looking at interoperability, reliability and scalability of applications. Applications like the Sakai and Kuali have proved beyond doubt that open source applications offer great configurability.Development communities and the support of commercial vendors, as in the case of Kuali and Sakai, fuel a greater rate of innovation. Moreover, the advantage that is offered by collaboration also provides an impetus to continued improvement of the system. Support systems and enhancements for future requirements are ensured.On the question of how to approach or adopt open source as a model, the answer would depend on the needs, the infrastructure and the means available to an institution. The community development model has shown that costs can be broadly distributed amongst participants. Experience shows that universities and colleges can collaborate to produce open source software that caters to their needs in a way that is superior to some commercial products. The collaborative model enables educational institutions to pool their financial and technical resources. Moreover, a larger community ensures that the applications are tested in a variety of testing environments, thus aiding in building robust solutions.In term of core academics, learning systems will evolve to accommodate formative assessments and evaluation outside the classroom. Many higher education institutions have taken the lead of MIT and are offering online course materials that are accessible by anyone, free of cost. It has been adopted at Yale, Notre Dame, Tufts and Stanford School of Engineering, to name a few. The United Nations has launched an initiative that would leverage social media technologies and ideas to offer higher education opportunities to people who would otherwise not be able to afford the costs.Commercially, open source projects have taken their first steps in the marketplace. The model is evolving aided by some significant commercial vendor backing. For the community-based open source approach to prosper, substantial financial backing is an absolute necessity to prevent it from faltering and to avoid the pitfalls that arise form source code being easily modifiable and rebranded by a different vendor. From the commercial perspective, projects like Sakai and the Kuali Foundation are likely to thrive as they have substantial stakeholders from both the academic and the corporate world.What could derail further adoption? There are several potential risk areas:
Lack of understanding of entry points for adoption
Lack of support to adopt the applications
Minimal staff to support the applications
Lack of training / documentation to train staff
A “runaway” project that consumes much press and develops a negative bias toward the project
Many of these risks may be mitigated though co-operative initiatives between the foundations developing the open source solutions and commercial affiliates looking to support the solutions – and develop complementation solutions. Some examples:
Further publicity through conventional, non-education related channels such as Google and industry-based sites such as edu1world
Furrther innovation and cooperation – whether through ‘summer of code’ collaborations; or community collaborations that will transform the current listservs to more accessible forums
Commercial affiliates offering training and webinars
Commercial affiliates offering ease of use entry points, such as pre-installed servers or virtual images that can be downloaded and used out of the box
In conclusion, open source initiatives in higher education have a long way to go before they enter the commercial mainstream in a significant fashion. However, with industry and academic collaboration, it has a great potential to change the higher education landscape in the longer term.