Summary

Prevention plays a crucial and underappreciated role in our health system. To improve health outcomes and bring down costs, it will be important to establish a better balance between preventive measures and drug treatments. The next administration should provide incentives to healthcare providers that scale up—and reduce costs of delivering—preventive interventions with demonstrated efficacy. Currently, the U.S. Department of Health and Human Services (HHS) sets broad standards regarding managed care contracts. But states have considerable latitude. States can set income eligibility criteria, define services, and set alternative payment methods with Managed Care Organizations (MCOs). And in just the last few decades, Medicaid programs have been almost fully privatized: MCOs now cover over 85% of the Medicaid population. Because of the existing patchwork of insurance programs and state rules, it is important that regulations set minimum national standards to ensure that health care is accessible and affordable for those who need it the most. Particularly important to this effort are non- distortionary prices and reimbursement policies.

For a few decades, policymakers have, with bi-partisan consensus, moved away from a fee-for-service (FFS) system whereby providers are paid for service delivery and toward capitation and pay for performance (p4p) models. While these models offer significant improvements over FFS models, each involves risks of incentivizing non-optimal care and expenditures if they are not structured carefully. When paying capitation rates, bonuses adjusting for population risk alone should be avoided as this incentivizes an increase in diagnoses without necessarily improving care. Either all health care payments should be p4p, or a p4p component should be added to the capitation base. Pharmacological interventions should also be included in the overall provider reimbursement structure to align reimbursement incentives with health outcomes. Healthcare providers will then determine the right mix of services. Furthermore, while p4p is generally a good idea (i.e., hospitals and MCOs are rewarded for decreasing the number of avoidable hospital readmissions), if this metric is not applied homogeneously across all services, this payment structure significantly hampers the provision of preventive services.

Summary

Everyone hates cookie notifications, click-thrus, and pop-ups. While cookies give the web more functionality, their excessive use and attendant consent system can interfere with user experience and raises serious privacy concerns. The next administration should commit to finally resolving these and related issues by creating a digital privacy task force within the White House Office of Science and Technology Policy (OSTP). The task force would coordinate relevant agencies—including the Federal Trade Commission, Federal Communications Commission, and Department of Commerce—in working with Congress, state actors, and European Union partners to develop meaningful data-privacy protections.

Summary

Artificial intelligence (AI) is transforming our everyday reality, and it has the potential to save or to cost lives. Innovation is advancing at a breakneck pace, with technology developers engaging in de facto policy-setting through their decisions about the use of data and the embedded bias in their algorithms. Policymakers must keep up. Otherwise, by ceding decision-making authority to technology companies, we face the rising threat of becoming a technocracy. Given the potential benefits and threats of AI to US national security, economy, health, and beyond, a comprehensive and independent agency is needed to lead research, anticipate challenges posed by AI, and make policy recommendations in response. The Biden-Harris Administration should create the Fair Artificial Intelligence Research & Regulation (FAIRR) Bureau, which will bring together experts in technology, human behavior, and public policy from all sectors – public, private, nonprofit, and academic – to research and develop policies that enable the United States to leverage AI as a positive force for national security, economic growth, and equity. The FAIRR Bureau will adopt the interdisciplinary, evidence-based approach to AI regulation and policy needed to address this unprecedented challenge.

Summary

From HIPAA to doctor-patient confidentiality, the U.S. healthcare system is replete with provisions designed to ensure patient privacy. Most people are surprised, then, to hear that patients in the United States do not legally own nearly any of their health data: data as diverse as health and medical records, labs, x-rays, genetic information, and even physical specimens such as tissue and blood removed during a procedure.

Providing patients with agency over their health data is necessary for elevating patients as partners in their own health management—as individuals capable of making genuinely informed and even lifesaving decisions regarding treatment options.

The next administration should pursue a two-pronged approach to help do just that. First, the administration should launch a coordinated and comprehensive patient-education and public- awareness campaign. This campaign should designate patient data and tissue rights as a national public-health priority. Second, the administration should expand provisions in the Cures 2.0 Act to ensure that healthcare providers are equally invested in and educated about these critical patient issues. These steps will accelerate a needed shift within the U.S. healthcare system towards a culture that embraces patients as active participants in their own care, improve health- data literacy across diverse patient populations, and build momentum for broader legislative change and around complex and challenging issues of health information and privacy.

Summary

The next administration should launch national Place-Based Public-Private Partnerships for Innovation (P4I) to supercharge American innovation by leveraging the power of proximity and partnerships, and in so doing, lay the foundation for a new and more inclusive era of American prosperity.

The P4I initiative will catalyze the formation and growth of vibrant Innovation Zones (IZs), creating powerful points of convergence that weave together place-based investments with educational, research, entrepreneurship, and economic supports to advance inclusive economic development from the American heartland to the coasts. IZs will catalyze the public-private development of mixed-use innovation hubs that house and support: training programs to prepare diverse and resilient labor forces; advanced research and development (R&D) activities undertaken by partnerships between universities and industry; and, incubators, accelerators, and investor groups to incubate, grow, and retain high-tech businesses.

P4I should be implemented by an interagency committee convened by the White House Office of Science and Technology Policy (OSTP) under the auspices of the President’s Council of Advisors on Science and Technology (PCAST). An interagency initiative will be critical for success, mobilizing federal agencies that share responsibility for all aspects of innovation and economic development policy, including STEM R&D, formation and growth of U.S. innovation industries (small to large), and innovation-based economic and workforce development.

Summary

While the Veterans Health Administration (VHA) provides telehealth services across the country, current services neglect to respond to the access challenges that constrain veterans, particularly in rural areas. Of the nearly 5 million veterans who live in rural areas, 45% lack access to reliable broadband internet and smart technology. In the absence of available or reliable internet, veterans are often forced to access telehealth services in person at VA Clinical Resource Hubs (CRHs). However, these facilities are limited in number and are typically located far from rural communities. To address digital inequities and constraints posed by infrastructure and geography, the VHA needs to create more ways for veterans to access and fully utilize telehealth. We propose that the VHA partner with federal agencies like the United States Postal Service (USPS) or United States Department of Agriculture (USDA), leveraging their infrastructure to develop telehealth hubs. We further suggest that the VHA develop and lead a federal taskforce to build critical technology infrastructure that will facilitate expansion and use of telehealth for veterans. These interventions will be vital for ensuring that veterans in rural communities have greater access to care and can not only survive but thrive.

Summary

While the United States is a global leader in Artificial Intelligence (AI) research and development (R&D), there has been growing concern that this may not last in the coming decade. China’s massive, state-based tech-investment schemes have catapulted the country to the status of a true competitor over the development and export of AI technologies. In response, there have been repeated calls as well as actions by the Federal Government to step up its funding of fundamental and defense AI research. Yet, maintaining our status as a global leader in AI will require not only a focus on fundamental and defense research. As a matter of domestic policy, we must also attend to the growing chasm that increasingly separates advances in state-of-the-art AI techniques from effective and responsible adoption of AI across American society and economy.

To address this chasm, the Biden-Harris Administration should establish an applied AI research program within the National Institute of Standards and Technology (NIST) to help community-serving organizations tackle the technological and ethical challenges involved in developing AI systems. This new NIST program would fill a key domestic policy gap in our nation’s AI R&D strategy by addressing the growing obstacles and uncertainty confronting AI integration, while broadening the reach of AI as a tool for economic and social betterment nationwide. Program funding would be devoted to research projects co-led by AI researchers and community-based practitioners who would ultimately oversee and operate the AI technology. Research teams would be tasked with co-designing and evaluating an AI system in light of the specific challenges faced by community institutions. Specific areas poised to benefit from this unique multi-stakeholder and cross-sectoral approach development include healthcare, municipal government, and social services.

Summary

To clear a path for the innovations that will fuel our nation’s economic recovery, the Biden-Harris Administration should streamline the patent application process by improving the correspondence between patent claims and the specification, supporting search clarity, and ensuring concise specifications. Not only would this reduce the time lost to bureaucratic paperwork, but these efforts would also give innovators a more efficient road to acquire patents. In turn, applicants, examiners, and the public at large would benefit from the new industries and innovations to come.

Summary

The COVID-19 pandemic has had devastating impacts on communities across the country. Tens of millions of people lost jobs and millions of school children have fallen behind. To help people recover from the effects of the pandemic, the next administration should invest in proven solutions by working with Congress to embed evaluation and evidence-building into economic stimulus legislation, strengthening the foundation for an equitable and efficient recovery.

The new administration and Congress should ensure that any forthcoming economic stimulus legislation include provisions requiring commitments to build new evidence and utilize existing evidence. Specifically, the administration should establish a task force coordinated by the National Economic Council to:

1. Work with agencies and Congress to set aside a portion of recovery resources (up to 1%) for evaluation and evidence-building, based in part on agency learning agendas created in response to the Evidence Act.
2. Create a National Economic Mobility Innovation Fund at the U.S. Department of the Treasury.
3. Empower the Office of Evaluation Services (OES) within the General Services Administration (GSA) to help agencies develop evaluation and evidence-building capacity.
4. Create Excellence in What Works in Economic Mobility Awards.

These strategies, which we are collectively calling a “Stimulus Evaluation Act,” should be integrated into current and future economic recovery efforts.

Summary

Optimizing the dosing of many expensive drugs can drastically reduce both costs and toxicities. The Federal Government, state governments, employers, and individual patients could collectively save tens of billions of dollars each year by simply optimizing the dosing of the most expensive prescription drugs on the market, particularly in oncology. Optimized dosing can also improve health outcomes. The next administration should, therefore, launch an effort to control the cost of prescription drugs through an evidence-based approach to optimizing drug dosing and improving outcomes. The requisite trials pay for themselves in immediate cost savings.

Summary

The Biden-Harris Administration should launch a national initiative to bring together academic and industry researchers and practitioners in a public-private partnership (PPP) to advance, at scale, the research foundations of artificial intelligence (AI) and its application in areas of economic advantage and national need. The National Public-Private Partnership in AI (NPPP-AI) Initiative would initially create 10 coordinated national AI R&D Institutes, each with 10-year lifetimes and jointly funded by industry partners and the U.S. government through its research agencies at $10M/year each (10x10x10).

NPPP-AI would accelerate future breakthroughs in AI foundations, enable a virtuous cycle between foundational and use-inspired research that would rapidly transition into practice innovations that contribute to U.S. economic and national security, as well as grow education and workforce capacity by linking university faculty and students with industry professionals, settings, and jobs.

Summary

As the United States continues to grapple with unprecedented economic, health, and social justice crises that have had a devastating and disproportionate effect on the very communities that have long struggled most, the next administration must act quickly to ensure equitable recovery. Improving economic mobility and increasing equity in communities furthest from opportunity is more urgent than ever.

The next administration must work with Congress to quickly enact a new round of recovery or stimulus legislation. State and local governments, school systems, and small businesses continue to struggle to respond to COVID-19 and the economic and learning losses that have accompanied the resulting closures. But federal resources are not unlimited and there is little time to spare – communities need positive results quickly. It is imperative, furthermore that the administration ensures that the dollars it distributes are used effectively and equitably. The best way to do so is to use existing evidence and data — about what works, for whom. and under what circumstances — to drive recovery investments.

Fortunately, the federal government has access to unprecedented evidence and data tools that can increase the speed and effectiveness of these urgent recovery and equity-building efforts. And where evidence or data do not exist, this unique moment affords an opportunity to build evidence about what does work to help communities recover and rebuild.

Thus, one of the first priorities of the next administration’s Office of Management and Budget (OMB) should be helping agencies develop their capacity to use existing evidence and data and to build evidence where it is lacking in order to advance economic mobility across the country. OMB should also support federal agency efforts to assist state and local governments to build and use local evidence that can accelerate economic growth and help communities recover from the current crises.

Specifically, OMB should issue guidance directing federal agencies to: 1) define and prioritize evidence of effectiveness in their grant programs to help identify what works, for whom, and under what circumstances to advance economic mobility post-COVID; 2) set aside 1% of discretionary funding for evidence building, including evaluations, technical assistance and capacity building; 3) support state and local governments in using recovery funding to build their own data, evidence-building and evaluation capacity to help their communities rebuild; and 4) require that findings from 2021 evidence-building activities be incorporated into strategic plans due in 2022.