Local governments increasingly use strategic planning as a tool to anticipate and address the complex challenges they face. Strategic planning is the process of setting long-term goals, prioritizing ...actions to achieve the goals, and mobilizing human and financial resources to execute the actions. Although there has been considerable debate about the appropriate scope, content, and procedures for strategic planning in local government, less attention has been paid to the quality of municipal strategic plans, meaning the presence or absence of key characteristics that analysts typically associate with good plans. This article explores the content and quality of municipal strategic plans in Canada. It presents results of a comparative plan quality evaluation, which assessed the official strategic plans of the 66 most populous Canadian municipalities using a comprehensive set of criteria derived from existing scholarship on plan quality and strategic planning. The findings indicate that there is considerable room to improve municipal strategic plans, which lack many of the features commonly associated with good quality plans. Municipal strategic plans should contain a comprehensive fact base to prioritize and rationalize the goals within the plan, and there should be appropriate provisions for implementing, monitoring, and evaluating plan progress and outcomes.
•Study evaluated municipal strategic plan quality using 30 indicators.•Strategic plans lacked many characteristics associated with high-quality plans.•Coordination, mission statements, and goals were the strongest plan elements.
Surgeons are critical for the success of any health care enterprise. However, few studies have examined the potential impact of value-based care on surgeon compensation.
This review presents ...value-based financial incentive models that will shape the future of surgeon compensation. The following incentivization models will be discussed: pay-for-reporting, pay-for-performance, pay-for-patient-safety, bundled payments, and pay-for-academic-productivity. Moreover, the authors suggest the application of the congruence model-a model developed to help business leaders understand the interplay of forces that shape the performance of their organizations-to determine surgeon compensation methods applicable in value-based care-centric environments.
The application of research in organizational behavior can assist health care leaders in developing surgeon compensation models optimized for value-based care. Health care leaders can utilize the congruence model to determine total surgeon compensation, proportion of compensation that is short term versus long term, proportion of compensation that is fixed versus variable, and proportion of compensation based on seniority versus performance.
This review provides a framework extensively studied by researchers in organizational behavior that can be utilized when designing surgeon financial compensation plans for any health care entity shifting toward value-based care.
Many countries are facing a retirement savings crisis. In the United States, for example, the fraction of workers at risk of having inadequate funds to maintain their lifestyle through retirement is ...estimated to have increased from 31% to 53% from 1983 to 2010 (1). Roughly half of U.S. employees (78 million) have no access to retirement plans at their workplace (2). Fortunately, there are solutions to these problems. We simply have to change the choice architecture of retirement plans by utilizing the findings of behavioral economics research (3) and make such plans available to all workers. We describe a large-scale field demonstration of the potential impact of such research-based changes in how we save.
Spending and quality under global budgets remain unknown beyond 2 years. We evaluated spending and quality measures during the first 4 years of the Blue Cross Blue Shield of Massachusetts Alternative ...Quality Contract (AQC).
We compared spending and quality among enrollees whose physician organizations entered the AQC from 2009 through 2012 with those among persons in control states. We studied spending changes according to year, category of service, site of care, experience managing risk contracts, and price versus utilization. We evaluated process and outcome quality.
In the 2009 AQC cohort, medical spending on claims grew an average of $62.21 per enrollee per quarter less than it did in the control cohort over the 4-year period (P<0.001). This amount is equivalent to a 6.8% savings when calculated as a proportion of the average post-AQC spending level in the 2009 AQC cohort. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (P<0.001), 9.1% (P<0.001), and 5.8% (P=0.04), respectively, by the end of 2012. Claims savings were concentrated in the outpatient-facility setting and in procedures, imaging, and tests, explained by both reduced prices and reduced utilization. Claims savings were exceeded by incentive payments to providers during the period from 2009 through 2011 but exceeded incentive payments in 2012, generating net savings. Improvements in quality among AQC cohorts generally exceeded those seen elsewhere in New England and nationally.
As compared with similar populations in other states, Massachusetts AQC enrollees had lower spending growth and generally greater quality improvements after 4 years. Although other factors in Massachusetts may have contributed, particularly in the later part of the study period, global budget contracts with quality incentives may encourage changes in practice patterns that help reduce spending and improve quality. (Funded by the Commonwealth Fund and others.).
As firms switch from defined‐benefit plans to defined‐contribution plans, employees bear more responsibility for making decisions about how much to save. The employees who fail to join the plan or ...who participate at a very low level appear to be saving at less than the predicted life cycle savings rates. Behavioral explanations for this behavior stress bounded rationality and self‐control and suggest that at least some of the low‐saving households are making a mistake and would welcome aid in making decisions about their saving. In this paper, we propose such a prescriptive savings program, called Save More Tomorrow™ (hereafter, the SMarT program). The essence of the program is straightforward: people commit in advance to allocating a portion of their future salary increases toward retirement savings. We report evidence on the first three implementations of the SMarT program. Our key findings, from the first implementation, which has been in place for four annual raises, are as follows: (1) a high proportion (78 percent) of those offered the plan joined, (2) the vast majority of those enrolled in the SMarT plan (80 percent) remained in it through the fourth pay raise, and (3) the average saving rates for SMarT program participants increased from 3.5 percent to 13.6 percent over the course of 40 months. The results suggest that behavioral economics can be used to design effective prescriptive programs for important economic decisions.
Climate change poses serious risks to rural communities which rely heavily on climate-sensitive resources. Rural communities are also significant contributors to GHG emissions given the prevalence of ...agriculture and related activities and are therefore expected to develop courses of action that tackle climate change. This includes either formulating a standalone plan that outlines mitigation and adaptation strategies or integrating these priorities into existing plans. The extent to which municipalities fulfill these planning functions, and how well, has been found to vary considerably from one community to another. In this study, we sought to contribute to knowledge about how well rural municipalities are planning for climate change risks. To this end, we systematically evaluated the contents and quality of rural climate change plans in Ontario (Canada). Using a well-established plan quality evaluation framework, we found that rural plans generally contained strong mechanisms for coordination between departments, and most had outlined specific goals concerning climate change action. By contrast, few plans provided a meaningful fact base to support their goals, many lacked specific policies to guide decision-makers in achieving climate goals, and most contained weak provisions for monitoring and evaluation. After drawing out some key themes from the plan quality analysis, the article concludes by pointing to areas of rural climate change planning that require further attention, and by outlining some areas for further study.
•Rural municipal climate change planning is in its infancy in Ontario, Canada.•There is an emphasis on climate mitigation over adaptation.•There is a lack of meaningful fact base to support climate change goals.•Plans lacked specific policies to guide decision-makers in achieving climate goals.
This study provides evidence that, when “hard” freezing their defined benefit pension plans, employers select downward biased accounting assumptions to exaggerate the economic burden of their benefit ...plans. Downward biased expected rates of return and discount rates allow managers to increase reported pension expenses and, for discount rates, allow managers to increase reported pension liabilities. We find that prior to the Sarbanes-Oxley Act, both rates are downward biased when firms freeze their plans, whereas after SOX the bias is lower. This finding is consistent with managers opportunistically biasing pension estimates to obtain labor concessions during periods of reduced regulatory scrutiny.
In this paper we investigate an optimal investment strategy for a defined-contribution (DC) pension plan member who is loss averse, pays close attention to inflation and longevity risks and requires ...a minimum performance at retirement. The member aims to maximize the expected S-shaped utility from the terminal wealth exceeding the minimum performance by investing her wealth in a financial market consisting of an indexed bond, a stock and a risk-free asset. We derive the optimal investment strategy in closed-form using the martingale approach. Our theoretical and numerical results reveal that the wealth proportion invested in each risky asset has a V-shaped pattern in the reference point level, while it always increases in the rising lifespan; with a positive correlation between salary and inflation risks, the presence of salary decreases the member’s investment in risky assets; the minimum performance helps to hedge the longevity risk by increasing her investment in risky assets.
•A portfolio optimization problem for a loss-averse DC pension plan member is studied.•Inflation risk, salary risk and longevity risk are considered.•A realistic way to define minimum performance constraint is proposed.•S-shaped utility function is adopted and explicit investment strategy is derived.•Some sensitivity analyses, numerical examples and economic implications are stated.
The focus of plan quality is on evaluating plans-as-objects against normative characteristics researchers and planning practitioners believe contribute to a high quality plan. This study builds on ...the established plan quality literature and methods to assess the quality of official (comprehensive) plans from sixty-three of the most populous municipalities in the Ontario-Greater Golden Horseshoe region (Canada). Three key themes emerged from this analysis. First, the provincial government plays a role in municipal official plan quality. Second, monitoring and evaluation is underutilized in many plans. Third, the communication of plan contents could be improved to enhance its use and readability.
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