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Wednesday, October 22, 2014

A reply to Education Secretary Arne Duncan

While there is a great deal of fine-sounding window-dressing in US Secretary of Education Arne Duncan's recent op-ed ("cut back testing that doesn’t meet that bar or is redundant"), the heart of his philosophy for public education is covered in a single paragraph (especially the last sentence):
Parents have a right to know how much their children are learning; teachers, schools and districts need to know how students are progressing; and policymakers must know where students are excelling, improving and struggling. A focus on measuring student learning has had real benefits, especially for our most vulnerable students, ensuring that they are being held to the same rigorous standards as their well-off peers and shining a light on achievement gaps.
Because this is all couched in very high-minded rhetoric, that last sentence has to be very carefully unpacked to understand the baseline assumptions at its foundations.

Please note the three phrases in red; let's look at them one at a time:

Thursday, October 16, 2014

Did Highmark have a role in demise of Aetna's DE Physicians' Care?

No competition? Higher rates?
Sweetheart deals?  What's not to
love for an insurance monopoly
in Delaware?
Aetna, which has provided the only token competition to Highmark in the Delaware private insurance market, has announced that it is shutting down its Medicaid group plan--Delaware Physicians' Care--at the end of this year:
Aetna Medicaid President and CEO Pamela Sedmak said the company is “reluctantly” taking the action after several months of extended negotiations with the state failed to result in a rate agreement that would cover the costs of operating the plan. 
“We regret having to make this very difficult decision,” said Sedmak. “Delaware Physicians Care is an integral part of the fabric of the community.… Unfortunately, recent changes to the Medicaid landscape in Delaware are requiring the plan to absorb significantly higher levels of costs. Without payment rates that support our ability to continue to provide high-quality service to members, we cannot keep this great health plan open.”
This is a very interesting development in the State's health insurance and health care landscape for a variety of reasons.

First, there's the absence of coverage of this story (at least so far) in Delaware media.  You have to ask yourself why Aetna choosing to shut down the largest (137,000 customers), most popular, and easily most effective Medicaid group plan in our State would not be news.  But apparently it isn't.  Maybe tomorrow somebody in the News Journal's "Newsroom of the Future" will read the Philadelphia Business Journal and discover what's happening in our own back yard.

Second, there's the fact that the reason cited for the closure--failure to achieve "a rate agreement that would cover the costs of operating the plan"--is really suspicious.  Here you need to know that Delaware is one of only a handful of states wherein the physicians reimbursement rates are virtually the same for both Medicare and Medicaid--in 42 of 50 states Medicaid reimbursements have always been significantly lower than those of Medicaid.  One of the reasons that most physicians in Delaware will accept Medicaid patients is that they don't get short-changed on the reimbursements.  On the other hand, in a state that did not make adequate financial provisions for the recent Medicaid expansion (potentially 30,000 new patients), you can see how the government might be trying to reduce those costs.

Moreover, Aetna is NOT notorious (at least in Delaware) for gratuitously charging higher rates.  Two months ago, when Highmark was proposing rate increases for some plans in the 5-15% range, Aetna was reducing rates on some plans and only filing for about a 2.5% increase on others:
Aetna ... filed requests for several plans, some of which would reduce rates by an average of 2.5 percent for those holding similar 2014 plans under its Coventry brand. 
The cost of some small-group plans would rise by an average of 1.9 to 3.1 percent, Aetna's filing said. Aetna acquired Coventry last year, but will offer all 2015 plans under its own brand.
So the idea that Aetna is somehow price-gouging and therefore could not come to an agreement with state negotiators does not initially pass the smell test.

Third, you have to consider the torturous (one might say, "fratricidal") relationship between Highmark and Aetna.  In Delaware we like to ignore the fact that our state is too small to be the driver in major economic issues--we are more usually the piece of paper whirling around in the larger hurricane.  In this case the larger hurricane is what's going on in Pennsylvania, which is home territory to Highmark of Delaware's parent company, and the Mecca to which Highmark Senior VP Paul Kaplan is often summoned to kneel for his marching orders.

Most of the coverage of what's happening in the Keystone State has centered on Highmark's well-publicized feud with the University of Pittsburgh Medical Centers, but there has been plenty of friction between Highmark and Aetna as well.  Here's just one item to give you the flavor of it:
When Westinghouse Electric Co., the Cranberry-based nuclear engineering giant, announced this autumn that it was jilting Highmark Inc. and handing its health insurance business to Aetna in 2014, Highmark responded with radio and TV ads implying that Aetna is an out-of-state carpetbagger, stealing business and jobs from Pennsylvanians.
Highmark attempted to appear philosophic about the whole affair:
"Westinghouse is considered a national account," Highmark spokesman Aaron Billger said. "The national account space is extremely competitive. We win some accounts and lose some accounts." Westinghouse is a "name-recognizable loss, but we have a tremendous book of business with national accounts." 
The reality is, however, that Highmark is facing a real challenge to its dominance in western PA, a challenge it cannot afford on its corporate doorstep:
Now the Pittsburgh health care landscape looks very different. "It went from one of the least competitive environments that you can imagine — a dominant insurer and a dominant health system joined at the hips with a long term contract," says Romoff, "To one without a long-term contract with, now, five choices." 
In addition to the two new competitors, UPMC invited three large insurance companies into the Pittsburgh market: Cigna, Aetna and United Healthcare. "Competition is good," says Romoff, "It keeps us all on top of our game. It gives us incentive to not be fat and sloppy."
Hopefully you caught that "competition is good" meme--don't believe it for a second, because monopolies are never interested in competition.  They are interested in profits, and profits are generally higher when there is no competition to keep prices down.

So where is the connection to Delaware?  Here I've only got patterns and logic so far, but as Sherlock Holmes famously suggested, it is important to note that the dog did not bark.

We know (patterns) that Highmark's feuds with other insurance companies and health providers has repeatedly spilled over Pennsylvania's borders--that's how we ended up abruptly having multiple MedExpress locations dropped in Delaware about two years ago.  Highmark's preferred strategy is to move out of the purely insurance arena and into the provider area (hence the acquisition of hospitals in PA and the cobbling together of the nation's second-largest retail optometry chain).

We also know (or at least infer) that Aetna's footprint in Delaware is currently slender enough (and our market is small enough) that it wouldn't take much to cause that other insurance giant to pull out of the state completely.  Aetna's Delaware Physicians' Care contract is a lot more significant than its small (well under 10%) share of the private insurance market.  So is it merely an interesting coincidence (remember what Ian Fleming and James Bond said about "coincidence") that talks with State officials break down right after Aetna embarrasses Highmark with far lower rate increase requests?

Why (or how) would State officials be responsive to the Highmark-Aetna conflict of interest?  First, you have to know that this Insurance Commissioner has been completely onboard with whatever Highmark wanted since she actively recruited the Pennsylvania insurance giant to buy out Delaware Blue Cross Blue Shield with a $175 million sweetener.  Then you have to realize just how quickly and thoroughly Highmark has penetrated even physician circles in Delaware over the past two years, a tangled web involving the Medical Society of Delaware and its subsidiary Mednets and four Provider Organizations.  That's a story that can only be pieced together from fragments, but as you get the puzzle pieces one at a time it amounts to the de facto elevation of Highmark from an insurance company to a provisional element of the State government.

Ask yourself, especially if you have taken the time to check the links I have provided, why you've heard no hint of any of this in the mainstream media?  If you google for critical work on Highmark in Delaware, guess what?  Almost all you will find is my own work.

I wish I could let you read my mail.  Not a week goes by that a physician or medical service provider does not contact me to say (paraphrasing):  "Why isn't anybody else covering this?  Highmark is taking over everything.  Here are the documents, but you can't print them because I'll lose everything if you do."

There is one other voice in our state discussing this issue, Delaware Business Daily:
Delaware has made the  American Medical Association’s  annual list of 10 states with the least competitive commercial health insurance markets. 
The lack of competition means consumers and employers in Delaware have fewer choices among commercial health insurers than consumers and employers in almost all other states, the association stated.
By the way, according to this survey we are the 4th least competitive insurance market in the USA.

In the end, one of the reasons I decided to run for 22nd State Rep is that SOMEBODY has to tell the story of what Highmark is doing to Delaware health insurance and health care.  Maybe we're past the tipping point (and this Aetna story suggests that to me), but people have the RIGHT to know what's happening here, and apparently no platform short of the General Assembly will allow me to tell that story.

Wednesday, October 15, 2014

Can we make it happen?

Good ideas are wonderful, but you've got to be able to deliver.  That means experience, credentials, and the proven ability to get people working together.

Here's what I bring to the table:

20 years of military service--US Army/VaRNG Master Sergeant (Ret.)--field medic; infantry brigade evacuation NCOIC; State Medical Training Detachment NCOIC; military hospital administrator.

24 years (and counting) as Professor of History & Political Science at Delaware State University--Director of Social Studies Education; Director, Global Societies pilot program; member, President's Blue Ribbon Task Force; member, DSU Wilmington Task Force.

6 years at union president--DSU Chapter, American Association of University Professors; experience in grievances, personnel issues, collective bargaining, general labor law.

Parent Advocate for Special Needs Children in Delaware and Arizona, Maryland, New Jersey, New York, Oklahoma, and Pennsylvania.  I understand both the Americans for Disabilities Act [ADA] and the Individuals with Disabilities in Education Act [IDEA], and I've spent years in the trenches helping parents of special needs kids get the education they deserve.

Member, DE Division of Public Health Task Force on Non-Nurse Midwives--fighting for broader birth choices for Delaware women.  We almost got a bill re-legalizing Certified Professional Midwives through the last General Assembly; I'd love to be there to vote "YES" for it next time.

Co-Chair, DE Social Studies Curriculum Frameworks Commission--primary editor and co-author of the DE Social Studies Curriculum Standards, adopted in 1995 and not yet watered down by Common Core.

Parent Representative, Interagency Committee on Adoption--conducted Delaware's first survey of mental health resources available to adopted children and their families.

Consultant, US Office for Domestic Preparedness--in the aftermath of 9/11, I created and piloted the original course, "Introduction to Terrorism," taught to State Readiness Officers across the nation at the Center for Domestic Preparedness in Anniston AL.

Activist for Marriage Equality--before the Democrats were even willing to touch the issue, I led the Libertarian Party of Delaware to start collecting hundreds of signatures for Delaware Right to Marry.

Volunteer activities supporting Resurrection Parish, Western Family YMCA, Hockessin Soccer, Charter School of Wilmington sports.

Politics is the art of the possible; you've got to be able to convince people to sit down at the table and work with you.  I've done that, and with your help (first your vote, then your active support), I'll take those skills to Dover on your behalf.

Sunday, October 12, 2014

DOE: micro-managing district bus routes


Today's WNJ points out that DOE is overruling Cape Henlopen on where to place bus stops by withholding funds for additional buses:
In the past, when the district requested additional buses for its fleet, the state denied those requests because Cape had not followed the code for development stops or enforced walk zones. 
At the Oct. 9 Board of Education meeting, board members, such as Jennifer Burton, were caught between state mandates and local safety concerns. 
"Obviously we have our hands tied with the Department of Education and Transportation Department," Burton said. "In a lot of these instances the state has no idea of what is going on down here. They don't come and look and they're not really mindful of what is happening."
This, of course, is spun by the State as saving money, like it did when it cut the reimbursements to local districts for transporting homeless children to school.

The reality is that if the State actually cared about saving money it could do so by extending allowable school bus life to 20 years, saving 63% per year on bus replacement costs.

Friday, October 10, 2014

A Roadmap for fixing the Common Core mess ...

Look, academic standards are important.  I know--I led the Commission that from 1992-1995 developed the Social Studies Standards that Delaware still uses today.

Overzealous linkage of standards to high-stakes testing is dangerous, and we are experiencing its aftermath today (as the explosion continues to go off).

Meanwhile the Federal government is mandating draconian "scorched earth" financial action against States that abandon the Common Core, which makes political and educational leaders leery of the risks of dumping Common Core.

But there is an answer, as respected educational blogger/reporter Valerie Strauss suggests in the Washington Post:  adopt the husk of Common Core [mostly the name] and then exercise State authority to review and modify the standards.

Strauss suggests three "modest" starting points:
Step 1: Insist that the State Education Department translate each standard into clear language that the public can understandIf the standard can’t be written so that the average parent can understand it, throw it out.
For this purpose, DOE and the districts could create a Curriculum Review Commission similar to the Content Standards Commissions of the early 1990s, tasked with cleaning up the excess and overly technical jargon existing in the Common Core State Standards.  That Commission should be co-chaired by a teacher and a representative of higher education in Delaware, NOT by a DOE bureaucrat or politicians.  The commission should be mandated to have open meetings and take public testimony before taking on the task of rewriting the standards, and then those revised standards should be taken to an up or down vote by the State Board of Education.

Back to Strauss:
Step 2: Ask experts on childhood development to review the Pre-K to 3rd grade standards. Standards should be rewritten based on their consensus.
This step needs to be entrusted to a sub-committee of the CRC (above) composed entirely of Pre-K-3 teachers and childhood development experts from UD and DSU.  Their recommendations should again be folded into a final report that cannot be nitpicked, but must receive an up or down vote.

And again:
Step 3: Reduce the emphasis on informational text, close reading and Lexile levels.
This one may take some explanation (pay particular attention to the very first words):
There is no evidence that reading informational text in the early grades will improve reading. Informational text in primary school should be read as a one means of delivering content or included based on student interest. Ratios of 50/50 (informational text/literature) in elementary schools and 70/30 in high school are based on nothing more than breakdowns of text type on National Assessment of Educational Progress tests, not on reading research. The force-feeding of informational texts in the primary years is resulting in the decline of hands on learning in science and projects in social studies, as my teacher’s email attests.   At the high school level, literature is being pushed out of English Language Arts to make room for informational text. For example, take a look at the readings of Common Core Engage NY curriculum modules for 9th grade. Literature is minimal, replaced by texts such as “Wizard of Lies,” a biography of Bernie Madoff, and articles that include “Sugar Changed the World,” “Animals in Translation” and “Bangladesh Factory Collapse.”

Another subcommittee of the CRC for ELA teachers and academic content experts.
 Strauss does not directly address CC Math, but the same process applies.

Of important note:  while DOE should be able to supply ex officio members, under no circumstances should they (or elected politicians or union leaders as such) receive a vote on the commission.  In my opinion, the best mix would be to create a commission that included about 45 people (enough for working subcommittees) with 20 of the spaces reserved for teachers, 5 for district content specialists, 5 for higher education experts, 5 for community partners, and 10 for parents.  At least 2 of the teachers should be special education teachers, and at least one of the parents should have a special needs child.

Look:  we can rail about CCSS and exchange memes on the internet for as long as we want, and that will gin up reservoirs of impotent outrage useful only to defeat some politicians who lack the ability to make that many changes in the first place.

But if we really want to get serious about giving a professional voice to Delaware teachers and higher education content experts, we need to be incredibly subversive and create the CCSS(D):  Common Core State Standards (adapted to Delaware) and take that process outside the normal process.

Then we let the Feds threaten us, and we laugh and tell our Attorney General to do his (or her) damn job and defend us.



 

Wednesday, October 8, 2014

DOE: Don't hold us to the same standards we hold the schools

As Lt. Gov. Matt Denn's IEP Task Force continues to wade through the morass that is Special Education in Delaware, lost in the shuffle is a particularly blatant and telling piece of DOE sidestepping on so-called "Standards-based" IEPs.

In 2012 DOE applied for a grant to improve Special Education outcomes in Delaware.

What DOE told the Feds was that not enough kids on IEPs were passing DCAS or graduating:

Goal 1: To increase the academic achievement of students with disabilities, through the implementation of sustainable, evidence-based instructional strategies to impact students with the greatest academic needs. 
Goal 2: To increase the graduation rates and academic achievement of students most at risk of dropping out of school, through the use of sustainable, evidence-based social and behavioral practices, as well as enhanced professional development to educators and related staff. 
"Academic Achievement" is clearly and unambiguously defined in the grant proposal as scoring a passing grade on state assessments (then DCAS).

What DOE proposed to do (not surprisingly) was double-down on Common Core and High-stakes testing, and require--beginning in pilot districts then later extending to the whole state--that ALL IEPs be directly linked to Common Core standards.

Red Clay was selected as one of these pilot districts, and the special needs teachers there have been literally inundated with "training" in developing and implementing those new IEPs.

I'm going to leave aside for the moment the very real question of whether or not this is a good strategy for improving the education of these kids (it isn't).  Let's just assume that, for sake of argument, Standards-Based IEPS are actually going to work as advertised.

That's what DOE believes, right?  Or else they wouldn't be putting themselves on the line here to raise test scores for special needs kids, would they?

Well, it turns out that DOE is NOT putting itself on the line, and is in fact holding itself to a FAR LOWER standard than it does, say, the six "Priority" schools, Moyer, or Reach.

You see, DOE has identified the Problem (low Spec Ed test scores) and then identified a strategy to improve those scores (Standards-based IEPS), and that only leaves the ASSESSMENT of how effective the strategy has been, once it has been implemented.

That assessment would logically involve looking to see if test scores actually went up for the students in question, right?

Wrong.

Here's what DOE is assessing itself on:  Fidelity of Implementation
The project evaluator, working closely with the DE SPDG Management Team, will develop training, coaching, and intervention fidelity instruments during the first two quarters of Year 1. Each intervention fidelity instrument (IEP development, SIM, and communication interventions) will be developed in accordance with the evidence-base it is derived from. IEP training and coaching fidelity protocols will be developed in alignment with the research presented in the Holbrook/Courtade and Browder publications, and reviewed by the authors. SIM fidelity instruments are provided by the University of Kansas. Fidelity protocols established by researchers at U.K. will be used to assess the implementation of communication strategies. Pre/post training assessments will also be developed during this time. 
The DE SPDG Management Team will be responsible for overseeing fidelity measurement and reporting. Project evaluators will train and coach the state and LEA coaches on the use of implementation (training and coaching) and intervention (i.e., IEP development, SIM, and communication) fidelity instruments. An easy to use, web-based data management system (using tools such as SurveyMonkey and Microsoft Access) will be developed. 

"Fidelity of Implementation" means whether or not DOE trains teachers as it said it would do, and whether or not the teacher actually employ the new strategies like they are supposed to do.  In other words, DOE is evaluating its success in this grant NOT on whether student test scores actually go up, but just on whether or not they tried real hard according to the model they thought up.

Now you will have to read the entire 103-page grant to assure yourself that what I'm saying next is correct, and encourage you to do so:  DOE never uses data about improvements in student test scores on state testing to determine whether they have done their job.

Do you understand what this means?

To Red Clay, Christina, and the rest of the schools in the State, DOE has repeatedly said that all that matters in determining your effectiveness as educators is how well students do on the State assessments.  If a school does not do well on those assessments, it is failing, plain and simple.

Yet when DOE implements a plan to raise the test scores of a target group of students (in this case special education students), it does not evaluate its own success based on test scores.

Wow.  Just wow.

So while DOE is passing out MOUs on "failing" schools (based entirely on test scores) that empower the State to fire entire faculties and convert public schools involuntarily into charters--again, based entirely on test scores--DOE does not feel it is appropriate to measure the success of its own programs based on test scores.

Here's a serious suggestion to Red Clay and Christina:  how about when you finally develop those Priority Schools plans, you base success or failure on "fidelity of implementation," not test scores, and cite as your rationale that this is the standard that DOE applies to its own initiatives?

Here's the link to the grant application.  Check it out for yourself.

Saturday, October 4, 2014

Populism in Delaware Frightens our Elites


Over the past 2-3 years something very new, and, for our political elites, very frightening has been happening in the Delaware:  the rise of actual populist (or popular) politics on both the right and left.

Consider:

Marriage equality advocates gathered signatures and lobbied for years before even the Democrats would touch their cause publicly.

The Occupy Wilmington movement held out for months in the face of every official pressure that could be brought against a handful of committed activists.

The Campaign for Liberty used grassroots organizing defeat gun-control measure HB 88 in 2012 when the supposedly essential NRA had given up.

On the other side of the spectrum, Residents Against the Power Plant turned back the University of Delaware and assorted political elites (corporate and union combined) in the fight over the so-called "data center."

Organizers for women's right to have home births attended by Certified Professional Midwives came within a hair of passing new legislation during the last General Assembly session, and will be back, stronger than ever, this year.

Parents and teachers in the Red Clay Consolidated School District organized themselves to engage their school board on a special education inclusion plan, and changed the district's choice.

A handful of activists, employing the Freedom of Information Act, got a Governor's working group on charter school reform declared to have met illegally (even though the Attorney General then declined to act).

Parental critics of Common Core and high-stakes testing have become so vocal and so numerous that even the usually-very-pro-"reform" Delaware PTA found itself forced to take a survey on parental opt-outs.

When Governor Markell and Secretary Murphy announced their "Priority" schools initiative, both the RCCSD and CSD boards, supported by massive outcry from parents and teachers alike, refused to sign DOE's "take it or leave it by September 30" MOU.

And it's starting to show in the polls:  even the University of Delaware has had to admit that, on the left, Green Party candidate Bernie August is polling four times as strongly as he did two years ago, and on the right, Libertarian Party candidate Scott Gesty is polling seven times stronger than in 2012.

But, of course, neither August nor Gesty nor Andy Groff (Green; polling at 6% for US Senate) will be invited by UD to its major televised debate.

From the Tea Party to the Green Party, the Libertarians to the Progressives, what's happening in Delaware is a sea change in the political landscape.  It's called "populism," the radical notion that citizens themselves can organize, protest, campaign, and effect direct political change without having to defer to the existing political elites.

It's unlovely, raucous, and quite scary for the people who insist that everything has to be filtered through the appropriately sanctioned organizations, to find out that rest of us are no longer willing to accept their decisions about who gets to be at the table.

For a long time the small size of Delaware contributed to the illusion that we could all have a voice in what goes on, but lately our political leaders have become so smugly satisfied that they dropped all pretense at subtlety, and that gave away the game.

Consider:  when the new IEP Task Force was formed, the "parent representative" from New Castle County was the wife of a State Senator, and one of the House appointees was the spouse of a State Board of Education member, while the other was an incumbent campaigning for his political life against (you guessed it) a special needs parent.  Several individuals with considerable experience were turned down as "parent advocate representatives" because that slot was reserved for somebody from the Federally funded Parent Information Center.  I like Matt Denn, and he works hard for special needs children, but the political debts being paid here by somebody were pretty obvious.

Or consider that when the Wilmington City Council meets this week to discuss Secretary Murphy's "Priority" schools plan, no public comment will be allowed.  Unrestricted time for the appointed bureaucrats of the entrenched politicians--no time for response or rebuttal from parents, teachers, or district officials.

They're scared that we're coming, and they're falling back on what has always worked for them before:  plowing millions into political campaigns to keep you voting for more of the same.

But if we don't lose our determination, and if populists on the right and populists on the left learn how to work together on some issues and always advocate for broader inclusion (even of their opponents), then guess what?  We'll make inroads.  We'll get there.  Maybe not this year, and maybe not in 2016.  But they are learning that it is not safe to ignore us.

(The next thing they'll try is to buy us off.  Be careful.)

Be the change  you want to see.