Must the creation of excellent data visualizations be solely relegated to UI and graphic designers?


Posted by Paloma Medina

Just when I thought my obsession with data visualizations was over, I come across a new gem.  Up until this point, my fan-dom had been focused on admiring finished products, like Hans Rosling’s Gapminder or GE’s Healthymagination Stats of the Union. However, what next interested me was how to bring this tool to the masses. My question was, “Must the creation of excellent data visualizations be solely relegated to UI and graphic designers?” As it turns out, no, it does not. There is a tool that democratizes the creation of data visualization:

Many Eyes: An experiment based on IBM research.

Many Eyes is an online tool that democratizes data visualization by allowing anyone, regardless of design or coding background, to turn data into visual information that is so much more than bar graphs and pie charts.  In addition, the site includes a browsing function and discussion forum that fosters collaborative learning.

Created in 2007, the site features pre-loaded data sets as well as the ability to upload your own set. Once you’ve selected what data you want to work with, you have more than a dozen options for how to organize your data. This is where it gets interesting. The beauty of the site isn’t just that you can create these amazing visual representations, it’s that you can play around and see how the same data translates depending on which type of visualizing model you choose. This means that non-designers can learn by doing what makes some data visualizations work and others not, depending on the data you’re working with.

The exciting thing about all of this is that tools such as Many Eyes will allow us to move towards a day when data visualization can benefit from crowd sourcing the way other fields have. What if Many Eyes was to health data what Flickr is to photographs?

Explore the site, let me know what you think and what potential you think it could have in your own health work.

Paloma Medina is an MPA HPAM 2012 candidate with a specialization in organizational coaching and development. Her background is in homeless health care, community development and design.


The Power and Shortcomings of Healthcare Interventions


Posted by Katie Magoon

I was living in rural Kenya the first time I really began to think critically about the power and shortcomings of healthcare interventions.  I stumbled upon this totally accidentally as I was studying the economic empowerment of females in the “informal sector” of Kenya’s rural economy.   Specifically, I was exploring the ways in which women create and distribute their wealth, and the how these decisions impact the communities in which they live.  As I looked more intimately into the lives of these women, I realized that one could not truly understand the role of a female in an economy without understanding a variety of aspects related to her health.

In talking with many women, it became clear that some of their economic concerns were in large part related to the number of children their husbands/communities expected them to have.  Some women secretly obtained birth control in order to shelter their families from the economic hardships that they would face with having more and more children.  In some cases, their husbands would begin to suspect this and abuse them or use it as an excuse to have extra-marital affairs with other women (often bringing home sexually transmitted infections or HIV).  In many settings, women bear the brunt of raising families.  As a result their individual health is extraordinarily important to the health of an individual female’s family as well as community.  Issues such as lack of access to birth control, “back-alley” abortions, the dangers of childbirth, lack of empowerment for sexual decision-making and boundary setting, and even post partum depression can have a tremendous impact on the economic health of a community.  Such issues were so pervasive in the lives of the women with whom I spoke that it quickly became clear that these women could not achieve economic security without accessible and effective healthcare that is responsive to their specific needs.

Many believe that these are problems that do not apply to women in the United States.  I have found this belief to be grossly inaccurate.  In my work as a nurse practitioner, I encounter young women every single day who are forced to have sex, pressured to leave school and have children, and struggle with depression and other mental health problems that can make employment and/or caring for children very difficult.  Often these women put faith in their “boyfriend” who quickly moves on when their belly starts to grow or times get tough.  A young woman may be left to support a family with very limited resources.  Further, she has already stopped school to have and begin to raise the child, leaving her even more vulnerable to economic hardship.  This has obvious implications for her family and community.

Health interventions can address a small portion of this problem by offering family planning to women.  Women that do not want or are not ready to have more children can use birth control.  If need be, they can do this without the knowledge of their partner.  However, a woman is more likely to be successful with the use of her birth control if her partner is supportive.  In my mind, this simultaneously points to a success and shortcoming of the health system.  In this example, birth control is simply addressing a symptom of a larger problem in society—gender inequality.  Birth control could be considered a single disparity-decreasing intervention that can help women, and in turn their communities.  However, in a world that often does not value women as it values men, I cannot help but to ask: Is birth control enough?  Internationally and domestically, when will women finally be empowered to make their own decisions about what happens to their bodies, and offered support for those decisions?

Katie Magoon is a North Canton, Ohio native who currently works as a nurse practitioner at an adolescent community center in Manhattan.  She is an HPAM student, specializing in policy.

 


A Design Oriented Approach to Presentations


Posted by Paloma Medina

In our last voyage into data visualization and design, I posed that incorporating these tools into the health sector could vastly improve how we share information with providers and front-line staff. In this last entry I want to focus on how these tools can make an impact for health administrators and policy folks.  To be specific, I want to explore the role of a design-oriented approach in presentations and trainings that we create.

To start us off, let’s explore the work of Hans Rosling. A statistician, award-winning global health researcher and all-around genius, Rosling also has an appreciation for good design. Rosling has infused the health field with inspiring presentations that rely on impressive data visualizations to show health data in a brand new way.

His talk, “Let my dataset change your mindset” on Ted.com is one of my favorite examples of the impact created from the marriage of design and data. Rosling’s lectures showcase his award-winning Trendalyzer software, which transforms an intense amount of complicated data with multiple data points into an engaging, beautifully interactive narrative that walks the audience through a new perspective on global longevity — all in under 20 minutes!

It is the ability to turn data into a story that makes Rosling’s Trendalyzer software (available for public use at gapminder.com) effective. The human brain processes information easier and faster when it’s able to see it as part of a story. Both data comprehension and data retention increase dramatically when new information is presented as a narrative. This is why it’s quite difficult for some of us to remember all 8 of these random words:

DONKEY  GIRL  GREEN REINDEER POLISH SHED APPLE PETS
But why almost anyone can remember them when we present them as a story:

The girl will polish the green apple laying by the shed after she pets the donkey and reindeer.

It’s a silly but important example – as administrators, policy makers and analysts, turning our data into a story can make the difference between a snoring and an inspired audience. Effective visual design takes this concept a step forward and transforms that story into an visual narrative — a series of images that communicate data faster than the brain can read text.

Your question now may be: That’s all well and good for people like Rosling, with his fancy software, but how does this relate to the rest of us who don’t have these resources?

I’ll answer that with a personal example:
Four years ago I attended a federal training on new cervical health reporting guidelines for Federally Qualified Health Centers. The presentation was a series of 25 PowerPoint slides overflowing with text and tiny work flow charts outlining confusing and frustrating new guidelines that doubled our reporting work load. We left angry at the government and dragged our feet on complying, in large part because we were not sure how to — even after a three hour training.

A year later, I attended a refresher training on the same topic, this time there were a similar number of slides but all with large images, hardly any text on them, and a worksheet that was well-designed and listed the requirements on the left and an area for audience members to write down their own notes and ideas for how to operationalize each guideline. The series of images told a story, narrated by the presenter, of a woman with many years of untracked pap smear results and how she was able to catch cervical cancer in the early stages thanks to her clinic’s new ability to track and report on her results. It was the story of what our clinic could do if we implemented the new guidelines. The presentation ended with a beautiful infographic of how tracking, reporting and better health outcomes all fit together. We left feeling energized and armed with information we could easily pass on to our staff members.  The interactivity, story, captivating images and infographic punchline all contributed to the success of the training. It mirrored Rosling’s lectures even without fancy software.

I personally would love to see the Trendalyzer in more global health presentations I attend, or the elements that make it a successful tool incorporated into the next training I’m required to go to. Do you have examples of a great presentation that used design to engage a health care audience? I’d love to learn of others – email them to me and I’ll post them in future posts.

Paloma Medina is an MPA HPAM 2012 candidate with a specialization in organizational coaching and development. Her background is in homeless health care, community development and design.


The Business of Nonprofits


Posted by Debbie Koh

The Wall Street Journal recently ran a special section on philanthropy and charitable giving. I recommend reading the entire report (available here), but the article that first caught my eye was Should Philanthropies Operate Like a Business?

The “yes” side argues that nonprofits should adopt more business practices in order to create social returns on one’s philanthropic investment. More specifically, the authors argue that data collection and measurement are necessary for nonprofits to generate impact. The argument against this kind of business approach hinges more on a market-gap argument; that nonprofits serve a population that government and business don’t. The author of this “no” side worries that a dramatic shift toward a businesslike mentality will end up leaving the underserved, well, underserved.

I’m inclined to fall somewhere in the middle. It is critical, though inherently difficult, to find ways to measure and evaluate impacts in health, welfare and other social issues. Such efforts must be undertaken with great care. Ill-defined criteria may be useless at best or end up subverting the intended effects at worst.

Achieving specific indicators, like serving x many people food, doesn’t address what might be a systemic problem that requires policy change achieved by sustained advocacy efforts. A hyper-focus on hitting specific benchmarks, like enrolling y number of children participating in an after school program, can be detrimental to the quality of service provision if resources are spent on recruitment efforts rather than curriculum development.

But, I don’t think the debate here is really about the application of “business thinking” to the social sector. The authors are essentially arguing about the role of the philanthropist: how much say should an individual or institution get when it comes to how their money is spent? I think this concern reflects an often-voiced uneasiness or ambiguity the larger public holds about nonprofits and social service organizations: they recognize the importance of the work but struggle to see how their donation really leads to change. They’re trying to figure out how exactly you hold the whole nonprofit, social impact sector accountable for the money they receive.

This issue can be frustrating even to me, a practitioner in this field. (I think this is why featuring child sponsorships or individual loan needs have become such a popular fundraising strategy. That individual connection, the feeling that one’s money will meet a person’s specific need, is powerful.) Like measurement, instituting such accountability can be a double-edged sword. Meeting current donor requirements, whether government or private, is already an arduous task for many organizations. Additional requirements may push some organizations beyond their current capacity or simply take away resources from achieving those desired returns. More money might be needed to hire extra staff or to create an IT system to track all those new indicators, for instance.

There are no clear answers here but these are issues that we should continue to grapple with, whether we are on the giving or receiving end. Overall, I’m happy that this kind of discussion is moving beyond the classroom and into a larger forum. Please feel free to share your thoughts.

Debbie graduated from Wagner in 2010 with her MPA in Healh Policy and Management, International Health She returned to her native California in 2011 and
currently works for Venture Strategies Innovations (www.vsinnovations.org), a US-based nonprofit organization committed to improving women’s health in developing countries.  All views expressed  in this post are her own.


On Ineffective Governance


Posted by Tony Kovner

I recently finished teaching my seven-week MPA course in non-profit governance and came up with three recommendations as to “the main thing” in improving health care organization governance:

- Get the board to admit “we have a governance problem.”

- Appoint a team to investigate this leadership challenge and make recommendations for improving the governance process.

- Get a commitment in advance from the full board to implement the team’s recommendations

Also, the board chair and the CEO should agree that one of the areas the CEO should be accountable for is “empowering the board.”

Suggested reading: Chait, Ryan and Taylor, “Governance as Leadership” Wiley, 2005.


What is my company worth? Part 2


Posted by Joel Wittman, MS, MBA

Last month’s blog contained information about valuation and value drivers for health care companies.  In this posting, the strategies that can be used to enhance the value of an M&A transaction is discussed.

After a decision has been made to sell the business, owners ask what strategies they can implement to enhance the value of the transaction in addition to those indicated above.  Some of those include:

- defining your business, personal, and financial goals – This drives the comprehensive     divestiture strategy.  The seller has to consider what he or she can realistically expect in the future. What does the seller want to do post transaction? What are the seller’s financial requirements?  Am I suffering burnout?  A clear understanding of these goals is the foundation for a successful transaction.

-exerting control and influence over the content and flow and information.  It is imperative to present the company in its best possible light to qualified buyers and to control the timing of the release of information.

-identifying the correct sources of value – While revenues and profits are the drivers of fair market value, buyers are looking for strategic opportunities.  This is the basis of investment value and translates into a higher purchase price.  The goal here is to distinguish between fair market value and investment value.

-managing weaknesses in your business – No company does things perfectly.  Buyers are aware of this and expect to see some “warts” on the face of the business.  A seller should identify the weaknesses, develop a course of correction, and reveal these to the buyer.  This strategy reduces the uncertainty a buyer may have that there are other problems in the company and also compartmentalizes the weaknesses from other aspects of the business’s operations. The effect: the perceived risk in acquiring the company is reduced to the buyer which results in increased value and pricing.

-creating a critical mass of buyers – The larger the pool of qualified buyers, the more likely that there will be more than one offer received for the company.  This creates a competition between buyers that result in a higher purchase price.

-orchestrating simultaneous presentations – Maintaining control over the timing and distribution of information is critical to managing the mergers and acquisition process.  Strategic dissemination of materials can create a competitive bidding situation that will likely result in increased value.

-know the buyer – Play to the strategic interests of the qualified buyers that have been identified as potential acquirers of the company.  This tends to improve your negotiating position – you are meeting a need of the buyer – and creates higher investment value for the company (N.B. investment value always exceeds fair market value).

-setting expectations high – The higher you aim, the better the result.  Know your sources of power – the strengths, performance, and reputation of the company; the competition in the market place; your ability to exhibit time and patience – and utilize them to achieve higher value.

-paying attention to the deal structure – What exactly is the buyer buying? Is it a stock or asset deal?  What are the components of the purchase price?  Remember to discount non-cash remuneration and carefully evaluate “earnouts” or payments contingent upon achieving certain parameters.

-working the letter of intent to closing –  Prepare well for due diligence – make it easy for the buyer to buy.  Be wary of “nibbling” to the “corners” of the purchase price.  Carefully scrutinize any post transaction adjustments that can result in a change to the price. Employ counsel wisely including your M&A advisor, attorney, and CPA; when was the last time you sold a business?  And, finally, assume the deal won’t close – manage your company like you are not selling because you never know what can happen that can cause a transaction not to close.

You may be wondering how the answer to such a simple question such as “what is my company worth?” is so complex.  Selling or acquiring a business is a complex process that combines the aspects of valuation, finance, legal, and emotional matters.  If you decide to embark on the M&A process it is wise to engage an experienced professional who can help you achieve your goals and objectives.  It would also help if this advisor has the attributes of a good mental health therapist.  It can be a grueling ride.

Joel Wittman is an Adjunct Associate Professor at the Wagner School of Public service of New York University.  He is the proprietor of both Health Care Mergers and Acquisitions and The Wittman Group, two organizations that provide management advisory services to companies in the post-acute health care industry. He can be reached at joel.wittman@verizon.net.


The Curious Case of Kansas


Posted by Errol Pierre

On April 28, 2009, Kathleen Sebelius joined the Obama Administration as the Secretary of the Department of Health and Human Services (HHS). It was one month and five days after the President signed his landmark healthcare legislation into law. Sebelius’ primary task would be to lead the massive implementation effort of a very complex bill with multiple phased in milestones that run through 2018. Throughout her first two and half years she has been vocal about her commitment to transparency and affordability for the American healthcare consumer. She is no stranger to the underlying issues in our system. In fact her dealings with healthcare started in America’s heartland way before this cabinet appointment. It started in Kansas; the Sunshine state. Ironically, the same state where President Obama’s mother grew up.

There’s No Place like Home

After receiving a Masters in Public Administration from the University of Kansas, Sebelius moved to Kansas and pursued politics. This led her to an eight year stint as the state’s Insurance Commission from 1995 to 2003. It was historic for Kansas. Sebelius was the first woman to ever hold the post. She was later profiled as a public official of the year in 2001 noted for her balance between tough regulations and her promotion of business. In full manifestation of her principles, she publically battled healthcare giant, BlueCross BlueShield of Kansas. She successfully blocked the sale of the company to an even larger out of state insurance conglomerate noting her determination to keep healthcare costs low for Kansans. The move was unprecedented and proved to be very timely. It happened one year before the Kansas gubernatorial election of 2002. Sebelius would win that election handedly with 53% of the vote.
Despite her victory, she was a Democrat governing in a bright red Republican state. Nonetheless she reached across the aisle and signed several bipartisan healthcare reform bills in her first two terms. Her work increased the number of health professionals in underserved areas, expanded health coverage for children, and relaxed Medicaid eligibility rules covering more Kansan families. She also established the Kansas Business Health Policy Committee which found ways to the lower the number of the uninsured and increase the number of businesses that offered health benefits to their employees. The committee’s most important work however was the creation of a program that provided health premium assistance to low and modest waged employees ensuring affordability.

We’re not in Kansas Anymore

The Governor’s work on healthcare quickly caught national attention. She also publically supported Obama’s healthcare legislation prior to her cabinet post noting benefits the bill would have on her state. 13% of Kansas lacked health coverage but she believed those 360,000 Kansans could be covered through Obama’s bill. So it made perfect sense for Obama to have Sebelius continue her work on healthcare but on a much larger stage. Rather than worrying about the coverage of 2.8 million Kansans, as head of HHS, she now worried about 49 of the 308 million Americans that lacked insurance and the 40 or so insurance companies across the country she now had the power to regulate.
Sebelius brought along her expertise. Kansas had the prelude to health exchanges – the staple of the healthcare reform legislation. Health exchanges create a marketplace where individuals and small businesses can shop for coverage similar to the way they purchase airplane tickets from online websites. Subsides are also made available through these exchanges to anyone who cannot afford coverage. Exchanges must be in place by 2014 and will be equipped with navigators and a toll-free support line to assist with enrollment questions. HHS recently launched a 50 state version of such a website on November 21st (www.HealthCare.gov). As a former Governor, Sebelius realized that execution of exchanges would be a huge undertaking for the states though. So to nudge tem along, her office provided grants to states that act early. More than $241 million was awarded to seven states that were called early innovators. Secretary Sebelius’ own home state of Kansas was one such recipient; winning a $31.5 million grant

Ding-Dong Reform is Dead

After Sebelius’ departure from Kansas though, things quickly began to change. Her successor, Mark Parkinson, indicated he would not run in 2010. Sam Brownback, a Kansas household name, won the election convincingly with 63% of the vote. As a Republican Senator for Kansas prior to winning, Brownback was one of the strongest challengers to federal healthcare reform not only voting against the bill but calling for its repeal.  One of his first acts as Governor was a very public and symbolic gesture. He returned the $31.5 million grant Kansas received from Sebelius’ office prior to his election.  It was a politicized move that reiterated his firm belief that healthcare reform placed a heavy financial burden on states just like Kansas. The reasons are surprising.

Mandates Are Costly - Kansas already requires thirty seven different health benefits be added to every health plan sold in the state regardless if the consumer wants it or will use it. Mandates like the coverage for Alzheimer’s disease regardless of a person’s age, or the coverage of child annual check up’s for policy holders without children, increase the cost of healthcare for everyone. Additionally, in 2014 when exchanges are implemented; Kansas will not receive federal funds for any mandated benefits that exceed the federal ones. This could potentially be a budget crisis for Kansas if not managed properly. Brownback would prefer to have consumers build their own health plans allowing the free market to dictate what sells and what does not.

Subsidies Shift Costs to the States – Brownback also fears that exchange subsidies will spur employer ‘dumping’. There are about 70,000 businesses in Kansas but the healthcare reform law only requires that roughly 7,800 of them offer health coverage because they are considered large employer. The remaining smaller employers representing close to half a million Kansas workers will not have to offer coverage even though their employees will face financial penalties if they are uninsured. Since these employees will receive lower prices through exchanges, the incentive for small employers to offer insurance in the state will naturally decline, a worry for the Governor. Kansas already has one of the lowest unemployment rates in the nation at 6.2%. Yet the uninsured rate in the state is more than double that.  Kansans are already working for employers that do not offer insurance and exchanges have the potential to widen that gap.

As a result of these issues, Brownback has yet to introduce a health exchange bill for his state; but he’s not alone. Only 14 states currently have legislation passed. However inaction by a state could prove to be costly. Kansas runs the risk of defaulting to federally facilitated exchange which would essentially give power to Sebelius to create an exchange in his state. Brownback acknowledges this ironic twist of events in a letter sent to Sebelius’ office with signatures from 19 other governors stating that unless he receives complete flexibility in handling healthcare reform, he vows to not to act at all.
Brownback has even questioned whether the healthcare bill infringes on the rights of the people of Kansas. In another letter signed by 27 other governors, Brownback strongly requested President Obama to speed up the ruling from the Supreme Court on the constitutionality of the healthcare reform law. The court is due to make its ruling by next summer, but in the meantime the Governor has has taken matters into his own hands. On May 26, 2011, he signed bill HB 2182 into law. The bill created the Kansas Health Care Freedom Act which sets out to protect the rights of Kansas citizens to either participate (or not participate) in any healthcare system freely. It is clearly a preemptive move attempting to block the portion of the healthcare reform law that would require citizens of his state to purchase health coverage from a private insurance company.  Despite all these actions, Kansas has made some progress with regard to healthcare reform. A sanctioned work group of leaders from government and the private sector discuss the implementation of several provisions of the reform bill monthly.  Their work thus far can be view at http://www.ksinsurance.org/consumers/healthreform/hcr.htm.

Errol Pierre works at a large insurance company focused on business development, sales, and strategy for employee benefits. He is currently pursuing a degree in Health Policy and Management with a specializing in health finance. He can be reached at errol.pierre@nyu.edu


My Time at Wagner


Posted by Debbie Koh

Though it’s hard to tell with near 80° weather here in Southern California, fall is well underway – which means application season is in full swing. I’ve been talking to several prospectiveHealth Policy and Management students over the past few weeks, and they typically want to know the same things about my time at Wagner: my favorite or most valuable experiences, and some of the challenges I faced.

I’ll detail what I usually tell people below, but I’d love for readers to add anything you think prospective students should know in the comments section, especially insights from current students or recent graduates.

1)     Favorite or most valuable experience:

Of course this is a difficult question to answer, but my capstone project is probably the highlight of my Wagner experience. I was an International specialization and enrolled in a summer capstone session, so my group of four and I traveled to India to document best practices of a school lunch program for our client, the Global Alliance for Improved Nutrition (our final product is available here).

This was an invaluable opportunity for me because I hadhad limited work and international field experience prior to graduate school. My capstone brought together what I learned in the classroom, from project management skills to international development theory to successful group work. I often cited examples from the project during job interviews, including my current employer.

2)     Challenges:

Being an International specialization in the HPAM program was sometimes an identity crisis for me. I knew I had an interest in global health specifically, so I applied to HPAM instead of the Public and Non-Profit Management program. Few of my January 2008 “spring start” cohort were also International specializations and I sometimes felt like my lack of desire to work in hospital administration or my limited passion for domestic health policy created a barrier between me and others in the program.

Eventually, I embraced being an HPAM-International student and sought to better represent this portion of the student body through my involvement with the Wagner Health Network (WHN). Though starting in the spring presented its own challenges, my extra semester allowed me to serve as both International Events Chair and Co-President of WHN. During my tenure I tried to plan events that bridged the International with the Policy, Management, and Finance specializations and to strengthen ties with other student organizations focused on international issues.

It’s been less than two years since I graduated, but I know things can change quickly. If you have an experience to share that might illustrate another aspect of Wagner that prospective students should know about or any additional words to share, please leave a comment and I would be happy to pass them along.