TIME

Catching Criminals With the Cloud

Police database search illustration Harry Campbell Briefing Solutions
Harry Campbell For TIME

How better software can help the police

Scott Crouch doesn’t sugarcoat his feelings about the software that most of the country’s 700,000 or so cops use on a daily basis to log arrests, traffic stops and leads. “It looks like someone vomited a thousand bugs on a screen,” the 23-year-old says dismissively.

Crouch is the CEO of Mark43, a New York City–based startup that claims it has developed a better system for getting police records–currently a patchwork of isolated paper and digital files–into a single searchable body in the cloud. The software can display relevant information that’s as readable as the feeds on LinkedIn or Twitter. Crouch says this new way of visualizing suspects’ data–sketching out a web of phone calls or following a gang’s movements across a map, for example–could help investigators identify key players in a crime ring or exonerate the usual suspects much faster.

The deluge of so-called Big Data is overwhelming law enforcement as much as it is any company in the private sector. Detectives, for instance, often have access to more information than ever before, but pinpointing key facts, like a suspect’s activity in neighboring precincts, involves frustrating manual searches. In other words, connecting the dots is much harder than it looks on television.

Not that there’s a shortage of companies trying to change that. IBM’s Watson supercomputer, best known for its victory on Jeopardy! in 2011, is now fielding so-called natural-language questions in a trial run with police officers in Tucson, Ariz. Data-analytics giants SAS, Oracle and Microsoft provide software that can present existing law-enforcement reports in more easily readable formats. Nobody tracks exactly how much American police departments spend on such software, but overall IT spending in the criminal-justice system in the U.S. totaled $3.5 billion in 2014, according to researcher IDC Government Insights.

Mark43–the name is a nod to the Iron Man suit–began as a school project Crouch worked on as a Harvard junior. Shadowing Massachusetts state-police troopers to measure the effectiveness of police tactics, he found his attention repeatedly drawn to the way the police fumbled with their software. “You’d have to hit TAB five times, hit six buttons, open up three new boxes to actually search for a report, and even then it wouldn’t really work,” he recalls. By 2013, Crouch and two of his fellow engineering students had secured $2 million in a seed-funding round led by Spark Capital, an early investor in Twitter, Tumblr and Foursquare.

Since then, Mark43’s software has expanded to walk officers through the scut work of filing a police report. Regulations stipulate every question along the way. Recovering a weapon, for instance, triggers a cascade: Was the owner notified? Where notified? Date notified? Storage facility? Location of storage facility? Mark43 expands and contracts the decision tree, automatically filling in fields when possible. Police can search for a suspect by name, alias or keyword. Clicking on a suspect’s page pulls up a mug shot and, beneath it, mug shots of associates, much the way Facebook displays friends of friends. The page also loads live tweets pulled from the suspect’s Twitter feed, assuming he or she has one that’s public. (Crouch says a surprising number of suspects have active social-media accounts.)

This year, Mark43 secured a contract with one of the nation’s largest metropolitan police departments, which will replace its current record-keeping system with Mark43 software. Police chiefs will be watching closely. In recent years, massive new technology deployments haven’t always gone smoothly: New York’s $88 million 911 dispatch system has suffered a string of outages, and a glitch in Dallas’ $4 million record-keeping system resulted in the early release of 20 inmates. As Los Angeles’ former chief technology officer Randi Levin put it to trade publication Government Technology: “The criminal justice requirements were never written with cloud computing in mind.” Mark43 hopes to prove otherwise.


This appears in the May 25, 2015 issue of TIME.
TIME Transportation

How Smart Traffic Lights Could Transform Your Commute

Using data to make cities run smoother

The traffic signals along Factoria Boulevard in Bellevue, Wash., generally don’t flash the same stretch of green twice in a row, especially at rush hour. At 9:30 a.m., the full red/yellow/green signal cycle might be 140 seconds. By 9:33 a.m, a burst of additional traffic might push it to 145 seconds. Less traffic at 9:37 a.m. could push it down to 135. Just like the traffic itself, the timing of the signals fluctuates.

That’s by design. Bellevue, a fast-growing city of more than 130,000 just east of Seattle, utilizes a system that is gaining popularity around the U.S.: intersection signals that can adjust in real-time to traffic conditions. City officials say that these lights, known as adaptive signals, have led to significant declines in both the hassle and cost of commuting.

“Adaptive signals make sure that inefficiencies never happen,” says Alex Stevanovic, director of the Laboratory for Adaptive Traffic Operations & Management at Florida Atlantic University. “They can make sure that the traffic demand that is there is being addressed.”

As city leaders increasingly turn to data for insight into running their metros more efficiently, adaptive signals have emerged as a 21st century strategy to chip away at a longstanding scourge. According to the U.S. Census Bureau, almost 11 million Americans commute more than an hour each way to their job while 600,000 U.S. residents have one-way “megacommutes” of at least 90 minutes or 50 miles.

And all that time on the roads costs money. The Centre for Economics and Business Research estimates that U.S. commuters lost $124 billion in 2013 due to the cost of fuel, the value of time wasted in traffic, and the increased cost of doing business. CEBR predicts those costs will rise 50% by 2030.

Only 3% of the nation’s traffic signals are currently adaptive, but the number of smart signals in the U.S. has jumped from 4,500 in 2009 to 6,500 in 2014, according to Stevanovic, who tracks the signals’ installation around the U.S.

The largest concentration of adaptive signals is in Los Angeles, a city that has long struggled with congestion. Nearby Orange County, Calif. has the second largest, followed by Utah, where about 80% of the state’s traffic signals are adaptive. But the frontier of adaptive traffic management may be in Bellevue, according to transportation policy experts. The city’s overhaul began in 2010 when it began implementing a system called SCATS (Sydney Coordinative Adaptive Traffic System, which was first developed and used in Sydney, Australia). Currently, 174 of Bellevue’s intersections have been outfitted with the new technology with plans for all 197 intersections to use adaptive signals by the end of the year.

The system uses a series of wires embedded in city streets that tell the signals how much traffic is moving through the intersection. When traffic is heavier, the green lights stay on longer. Less traffic means shorter greens. During peak traffic periods, nearby intersections sync their lights to allow long stretches of green. When there are fewer cars on the road, those intersections revert to their own cycles. Mark Poch, the Bellevue Transportation Department’s traffic engineering manager, says uncoupled intersections work more efficiently when there are fewer cars on the road because they can better respond to specific situations at that cross street.

Along Factoria, one of Bellevue’s main downtown arteries, travel times have decreased by 36% during peak rush hour since adaptive lights were installed, according to city transportation officials. Along NE 8th Street, another heavily trafficked street, travel times are down 43% from 2 p.m. to 6 p.m. Those decreased delays appear to add up to real savings for drivers: Bellevue officials say the $5.5 million system saves drivers $9 million to $12 million annually (they estimate that a driver’s time is worth $15 an hour).

For all of Bellevue’s success, adaptive signals are not a panacea for clogged roadways. Kevin Balke, a research engineer at the Texas A&M University Transportation Institute, says that while smart lights can be particularly beneficial for some cities, others are so congested that only a drastic reduction in the number of cars on the road will make a meaningful difference. “It’s not going to fix everything, but adaptive has some benefits for a smaller city with a particular corridor on the verge of breaking down,” he says.

In Bellevue, the switch to adaptive has been a lesson in the value of embracing new approaches. In the past, Poch says, there was often a knee-jerk reaction to dealing with increased traffic: just widen the lanes. Now he hopes that other cities will consider making their streets run smarter instead of just making them bigger.

“It’s been a slow change,” Poch says. “It’s easy to think the way to get out of it is to widen the road. However, as we move toward being better stewards of our resources and more sensitive to environmental issues, let’s take what we have and operate it better. I think that’s a more prevailing thought now, and I think it makes sense.”

TIME

Road Service Gets an On-Demand Makeover

Getty Images

Tow trucks and phone apps are tapping data to give you a jump-start

The ice storm that hit Nashville this February was the worst in 20 years. Freezing rain glazed the roads, so when one of Michael Cunnyngham’s employees discovered he had a flat tire, there was already a long queue of auto-club members ahead of him who had put in calls for help. “They said they’d be there in an hour. Then it was two hours,” recalls Cunnyngham, who runs a tech company. “Then it was the end of the day. So I thought, There has to be some Uber for wreckers,” he says, referring to the popular ride-hailing app. His search results turned up Urgent.ly, a Virginia-based startup that indeed bills itself as the Uber of roadside assistance. He called the employee and told him to download the app. “I get a really happy message from him not more than a few minutes later saying somebody’s coming,” Cunnyngham says. Within 30 minutes, the tire was fixed. “You couldn’t ask for a better experience,” he says.

Roadside assistance is a $10 billion market in the U.S.–and now tech companies are revving to disrupt it, replacing call centers with dispatch algorithms designed to locate the best nearby vehicle that can help with a lockout or winch a car out of a ditch. Entrepreneurs like Urgent.ly CEO Chris Spanos believe that motorists need an on-demand alternative to paying for insurance plans they might not use or blindly calling tow companies in their time of need, with little way to tell if they’re being overcharged. “You should only pay for service when you need it,” he argues. But taking on an industry behemoth like AAA, which has 55 million members, is going to be a long haul–especially because AAA is mapping out innovations of its own.

Urgent.ly and its main competitor, the Santa Monica, Calif.–based Honk, both offer flat rates, promise quick response times and provide maps in their apps that show users where their rescuer is with real-time updates. These companies are positioning themselves as not just a snappy service for the smartphone crowd but also a new revenue stream for towing companies. While AAA, which is a not-for-profit corporation, says it does not release exact figures for how much its contractors get paid, tow-truck operators have said it’s in the neighborhood of $25 per call. Kwame Scott, owner of Scott’s Towing in Suitland, Md., says he makes about $75 if that same call comes through his Urgent.ly app. Like Uber, these startups are taking about a 25% cut and handing the rest over to the drivers. “If technology can get into towing, then, hey, swell. We’re in,” Scott says.

Honk CEO Corey Brundage says the company started getting a series of call-and-cancel orders last year that they traced to AAA employees. “We do mystery-shop to see how services compare,” says AAA spokesperson Yolanda Cade. She emphasizes that America’s famous motor club has been around for 100 years and responds to “more than 30″ million calls per year; members typically also receive travel discounts or other membership perks. AAA is a federation of 43 motor clubs around the country, which can customize what they offer. In late 2014, the Mid-Atlantic club started running RescueMeNow, a web-based on-demand service for nonmembers, which comes with a follow-up contact enticing users to join. The Southern California club has meanwhile been providing a “service tracker” that shows a real-time map in the AAA app. Some car manufacturers also offer roadside assistance as part of their warranties.

Silicon Valley investors and several national companies are betting on the new guard. Honk announced a $12 million fundraising round in March, soon after Urgent.ly announced that its app will be part of AT&T’s connected-car platform, AT&T Drive. Still, towing providers like Scott aren’t sure how revolutionary these apps will be. He says that while he might get $75 for a job placed through Urgent.ly, he’d get $100 if the customer called him directly. “It hasn’t become a major part of my business,” he says. “But it’s a nice addition.”


This appears in the May 11, 2015 issue of TIME.
TIME

See the Massive Monuments Silicon Valley Is Building

The tech world's crown jewels

On March 30, Facebook CEO Mark Zuckerberg announced that the Menlo Park, Calif.—based company had finally moved into its newest quarters, a 433,555-sq.-ft. box with a parklike roof created by architect Frank Gehry. “The building itself is pretty simple and isn’t fancy,” Zuckerberg wrote on his Facebook page. That may be, but it is also carefully designed open space. The company is building on decades of data—and its own experience–showing how free-form connections among employees are important in generating new ideas. Earlier this year, Google submitted a plan to redevelop part of its Mountain View, Calif., campus into four futuristic hubs under sweeping glass canopies. Instead of immovable concrete buildings, the company wants to construct lightweight structures that can be easily reconfigured as it explores new businesses (think self-driving cars or medical technology). Similar megaprojects under way at Apple and Amazon point to a wider break with the past. Technology’s most powerful (and wealthy) companies are grappling with how to be environmentally responsible while recruiting and retaining workers and continuing to foster innovation. “They’re betting that if you’re in the right space, you’re going to work hard; you’re going to be happier,” says Margaret O’Mara, an associate professor at the University of Washington who has studied the rise of Silicon Valley. “This signals a different phase in their history.”


This appears in the April 20, 2015 issue of TIME.
TIME Healthcare

Inside the Hospital Room of the Future

Go inside the hospital room of the future with Andrew Quirk, a senior vice president at Skanska, to find out what inpatient care might look like by the year 2020

TIME Solutions That Matter

The Rise of the Go Fetch Economy

Washington D.C. Bike Messengers
Willis Bretz—The Washington Post/Getty Images Postmates bike messenger Alex Caron-Schuler rides on Pennsylvania Avenue NW in front of the White House on Jan. 3, 2014.

Startups are trying to perfect same-day delivery using smartphones and GPS

Shamar Theus, a 25-year-old working for Postmates, sits in his Ford Focus in San Francisco for about a minute before the first order comes in on his iPhone. Someone not far away wants 18 lb. of crushed ice, and Postmates is offering Theus $4.80 to pick it up and then deliver it. When he accepts the job, his phone guides him to the grocery store and then to the drop-off. “Everyone’s superbusy, overtaxed. So you bring stuff to people’s offices at 8 o’clock at night,” says Theus, who is wearing a smart watch and long black dreadlocks. “People have just reached a point where they’re so busy that they need to outsource these tasks.”

Same-day delivery, an iconic failure of the dotcom boom, is back–and not just for giants Amazon and Google. Startups like Postmates are using data science to bypass the need for warehouses and delivery fleets in their quest to serve consumers who are willing to pay a little extra to get things right away. They’re also eschewing payrolls by tapping into the growing workforce of independent contractors who are willing to trade health insurance for jobs they can do whenever they want. “It’s not only the consumer who says, ‘I want it on demand.’ The supply is on demand,” says Yale management professor Ravi Dhar. The supply also has GPS-enabled smartphones. In the previous tech boom, doomed companies were talking to couriers with two-way radios.

The vast majority of deliveries made by Postmates, which plans to be in 50 U.S. markets by the end of 2015, are hot meals. The company crunches data like food-preparation times to get better at stacking—letting couriers drop off one order while their next pickup is already assigned and being prepared. “I’m not saying we’ve perfected it,” says co-founder Bastian Lehmann. “But we know better than Pizzeria Delfina how long it takes them to make two cheese pizzas on a Friday night at 5 p.m.”

Call up Pizzeria Delfina—a popular Bay Area joint—and they’ll tell you they don’t deliver but “we have services that deliver for us.” Which is another benefit of the new delivery craze: giving local brick-and-mortar businesses a way to boost revenue. “We’re bringing them online and using their unique advantage of having those stores in the city,” says Apoorva Mehta, the 28-year-old founder of Instacart, a company that organizes personal shoppers who buy and deliver groceries to users in as little as an hour. In February, the co-CEO of high-end grocery chain Whole Foods said Instacart was poised to drive it “more convenience business” than ever.

Sidecar, a lesser-known version of Uber and Lyft, is leveraging people who are already on the road. The app, which allows people to pay for rides in other people’s cars, requires all users to enter in a destination before they get a ride. In February, the company announced it was going to start using that data to combine ride sharing with delivery. “We’re predicting the likelihood of a package and a person going to the same place,” says co-founder Sunil Paul. “Riders shouldn’t even know there are packages in the trunk.” Doubling up means more money for Sidecar and the driver, the firm hopes.

The workforce that is key to this new model may also be its Achilles’ heel. Uber has been hit by lawsuits claiming that it misclassifies drivers as independent contractors to avoid covering costs it would pay for employees. This generation of couriers has more flexibility but more risk, forking up their own cash for gas and tolls. Theus says that after expenses and before taxes, he makes $20 to $30 an hour. “It takes a little more effort. You don’t have HR to tell you how the math all works out,” he says. “But there’s enough demand.” He estimates that the ice is his 1,151st delivery.

With a ping and a touch of a button, he’s off to the next one.

Read next: The Easiest Way to Deal With Annoying Online Shopping Returns

Listen to the most important stories of the day.


This appears in the March 16, 2015 issue of TIME.
TIME

Medicine Is About to Get Personal

Photographs by Gregg Segal for TIME Dr. Garrison Bliss is shaking up how primary-­care medicine works

How can Americans get better health care for less money? There's a quiet experiment going on among primary-care physicians, and the results are intriguing

Nowhere outside the pages of Dickens is there a more aptly named fellow than Garrison Bliss. A trim, gray man, he has twinkling eyes and a face lit by a smile of such authenticity that it makes you think of Shaker furniture. But he’s a doctor, not a mystic. And he’s smiling because he believes he and his cousin have found the answer to one of the toughest questions in health care.

The idea is deceptively simple: Pay frontline doctors a fixed monthly fee directly instead of through the byzantine insurance bureaucracy. Make the patient, rather than the paperwork, the focus of the doctor’s day. The result will be happier doctors, healthier patients and a striking reduction in wasted expense.

In one of the more intriguing experiments in the medical industry, Qliance Health, the company Bliss co-founded with his cousin Dr. Erika Bliss, 47, is applying this idea to managing the health of roughly 35,000 patients–about half of them on Medicaid. If it can work for them in Seattle, they say, maybe it could work for everyone.

How the Bliss cousins arrived at this notion is a more complicated story. But it’s one worth telling, because it says a lot about how the U.S.–normally adept at hooking up the buyers and sellers of goods and services–managed to make such a mess of its medical economy. The story starts with the fact that Garrison Bliss, 69, wasn’t always so happy.

He is a primary-care physician, and a career in primary care has become a recipe for misery in the U.S. Nearly a third of all frontline physicians ages 35 to 49 expect to quit within the next five years, according to a 2012 survey by the Urban Institute. Young healers who start with dreams of being Marcus Welby often sour when they meet the realities of the job–which can include seeing patients every 11 minutes and having their performance assessed by how many MRIs they order.

Like so many others in his field, Bliss came to feel that he wasn’t in the business of caring for patients at all. His job was to feed payment codes into the grinding machinery of the insurance companies, rushing from exam room to exam room, ordering tests, making referrals, scheduling follow-up visits in which the cycle would be repeated. He knew that a proper exam, with time for counseling and questions, can take 45 minutes or more. Yet even a 15-minute session became a luxury.

“There are no insurance codes for ‘cure,'” Bliss likes to say.

One day about 20 years ago, two of Bliss’s colleagues announced that they were stepping off the treadmill to create a new kind of practice. They invited a small number of their wealthiest patients to become members of a premium health care group. For a five-figure annual fee, those patients would have immediate access to the doctors. They would be able to schedule appointments on short notice and would never again languish in a waiting room. Should they need to see a specialist, their primary-care doctor would be happy to accompany them as an advocate and translator. This model, which was soon emulated by upscale doctors across the country, came to be called concierge medicine.

Coddling the rich was not Bliss’s bliss. Still, he was intrigued. Could the same idea work at a more affordable price? What if, instead of charging $1,000 per month for each membership, he charged $65? He didn’t have to decorate his clinic like a Canyon Ranch spa or set up shop on Seattle’s most expensive real estate. If he brought down the overhead, would ordinary people pay the equivalent of a monthly cable bill for the satisfaction of having a doctor who knew their histories and cheerfully answered their questions?

Bliss launched an affordable primary-care practice, called Seattle Medical Associates, in 1997–and soon had all the patients he could handle. At last, he was working for them. And he was happy.

Considering the health care model Americans are accustomed to, it can be hard to get your head around the approach Bliss had come to call direct primary care. But here’s how it works: for a flat fee every month, patients have unlimited access to their doctor–in person and by phone or email–for routine things like checkups, cuts and burns, infections, flu shots and skin exams, as well as chronic-condition maintenance like blood tests for diabetes or high cholesterol. Under the law, every American is required to have medical insurance–but direct-primary-care patients can seek less expensive policies, because they require coverage only for hospitalizations, surgeries and other specialized care.

It was working for Bliss, so when he heard that his cousin Erika was miserable after just three years in primary care (“burned out, cooked, feeling like a failure and thinking about getting out,” as she puts it), he shared some of his sunshine with her. “Every time I walk into the examination room, I feel like I’m going to a party!” he sang over the phone. “I think this model I’ve been doing has a lot of potential to change health care for the better. Come help me scale it up.”

Since then, they’ve signed up previously undreamed-of populations: big private employers like Expedia and Comcast, public and industry employee unions like the one for Seattle firefighters and–most radical of all–at least 15,000 Medicaid patients.

The private company’s results so far suggest that the model is scaling up nicely. Qliance now serves some 35,000 patients; the cost of about half of them is paid by the government through traditional and expanded Medicaid programs. Treating a wide variety of patients–young and old, healthy and chronically sick, well-off and poor–Qliance claims to be saving approximately 20% on the average cost of care compared with traditional fee-for-service providers. The company’s staff has tripled over the past year, and Qliance is looking to expand beyond Washington.

Unhappy primary-care docs from across the country are streaming to Seattle to find out if some version of Qliance could be their salvation. The American Academy of Family Physicians, which kept concierge medicine at arm’s length for years, is moving quickly to embrace the direct-care concept. And the promise of greater efficiency and better results has attracted the likes of Amazon’s Jeff Bezos and his fellow billionaire Michael Dell to invest in Qliance.

All of which makes Bliss smile.

A NEW MODEL

Concierge care was originally conceived before Obamacare, and it revved up in response to the Great Recession as an escape hatch for doctors fleeing the status quo. The existing fee-for-service system pays caregivers a certain amount for each test, diagnosis and procedure–which, according to critics, encourages overtreatment instead of preventive wellness care. Qliance, along with a growing number of similar operations, aims to be more than an escape. It seeks to be the answer to the quest of health care reformers: healthier patients at a lower cost. Fix the way primary-care doctors are paid, the Blisses argue, and we can cut unneeded tests, premature procedures and excessive ER visits.

The driving insight here is that primary care and specialized care have two very different missions. Americans need more of the first so they’ll need less of the second. And each requires a different business model. Primary care should be paid for directly, because that’s the easiest and most efficient way to purchase a service that everyone should be buying and using. By contrast, specialty care and hospitalizations–which would be covered by traditional insurance–are expenses we all prefer to avoid. Car insurance doesn’t cover oil changes, and homeowners’ insurance doesn’t cover house paint. So why should insurance pay for your annual checkup or your kid’s strep swab?

When people get good primary care, their maladies are diagnosed more quickly and can be managed before they grow into crises. Fewer patients wind up in expensive hospital beds. Emergency rooms treat genuine emergencies, not routine infections and minor injuries. Patients receive timely advice and encouragement from a trusted physician to shed those pounds, change that diet, drink a little less and exercise more. The fee-for-service insurance model discourages this approach. It pays mainly for treating disease, not preventing it. Worse, it makes the life of a primary caregiver so exhausting that students in medical schools and nursing schools are avoiding the field altogether. According to Colin West, a co-director of the Mayo Clinic’s program on physician well-being, the U.S. faces a shortage of tens of thousands of primary-care doctors–at a moment when we need them more than ever. In a definitive survey of third-year med students published in the Journal of the American Medical Association, he found that only about 20% were headed into primary care.

West was particularly dismayed by the number of students who started medical school with primary care as their ideal but gave up by year three. They had figured out, he explains, that the burdens of our health care system “roll downhill to the primary caregivers.” To make up for unpaid time spent filling out forms, docs must see more patients to generate more payment codes.

At the tangled heart of this dysfunction is Medicare, which by its sheer size sets the standards for insurance reimbursements. Specialists dominate the panel that sets its payment rates. Thus the system values surgeries, scans and other procedures more than it values checkups and management of existing conditions. West, a primary-care doc, explains it this way: “If I put in an hour with a patient, I will be reimbursed for one exam–the same payment I would get for seeing that patient for 11 minutes.

“Meanwhile, an ophthalmologist might perform three cataract surgeries in that same hour, and each surgery might be reimbursed at twice the rate of my exam. So that doctor is making six times as much money.”

And if the eye patient has questions after the surgery about her medicine or her recovery, the specialist’s office is likely to suggest that she consult with her primary caregiver. After all, neither doctor gets reimbursed for answering questions on the phone, so the chore is often traded like a hot potato. “We say primary care is critical to a healthier future,” West says, “but in every way we show value, it is at the lowest level.”

DIRECT ACTION, IN ACTION

On a rare crystal day in Seattle, I paid a visit to the headquarters of the online travel agent Expedia. For over a year, Expedia has paid Qliance a fixed per-patient fee to provide a direct-primary-care option for HQ workers. Specialists and hospitalization are covered by traditional insurance.

Expedia was motivated to try direct care for reasons that are familiar to business executives everywhere: health care bills were skyrocketing, but employees were not getting healthier. “We had a number of catastrophic illnesses in 2011 and a disturbing number of deaths–12,” vice president for human resources Connie Symes tells me. “We found Qliance and their model of spending quality time with patients addressed our need to get employees involved in their own care.”

Qliance opened a clinic in Expedia’s building. The clinic is staffed by three doctors and includes several exam rooms, a small lab to perform routine tests, an X-ray machine and a stock of commonly prescribed generic medicines. Expedia employees zip from their desks to the doctor’s office with little or no waiting time. New patients spend 45 minutes elaborating their medical histories; after that, most visits can be handled in 15 to 30 minutes. Patients can also reach their doctors by text and email.

At the end of last year, Expedia surveyed the staff, Symes says, and the response was emphatic. More than half the employees had tried Qliance, and of those, more than 95% said they were satisfied. “They love the doctors,” Symes says. “They love the personal relationships they’re forming.” And although Expedia still classifies Qliance as an experiment, Symes says direct primary care, with its emphasis on prevention, “is taking us in the right direction on lowering costs.”

Seems too good to be true, I tell Erika Bliss, Qliance’s CEO, and she replies that she hears that a lot–but that’s because we haven’t seen, from the inside, how much waste and inefficiency is larded into the existing system. With enough freedom, she says, a primary caregiver can easily find lots of ways to deliver superior health care at a lower price. Bliss suggests that proper primary care should cost an average of about $1,200 per patient per year and will save significantly more than that in emergency care, specialist visits and treatment of chronic diseases.

“The existing system is built around diagnosing and treating complex cases. It rewards expensive, invasive and complicated solutions. But patients don’t want to be complex cases,” Bliss says. She cites a famous study by the Institute of Medicine that estimated that 30% of each health care dollar is wasted in the U.S. While reformers struggle to “bend the curve” of rising costs by squeezing out the waste, “we just lop it off,” she says.

While the results at Expedia are intriguing, the real test of direct primary care began when Qliance became the first practice of its kind to join the Medicaid system. Medicaid patients can be a challenging population because many of them have untreated medical conditions after years of inadequate health care. Absorbing thousands into the Qliance practice–at a reported cost to the government of about $700 per person per year–had made for a roller-coaster year. Medicaid patients are promised the same care as other Qliance customers.

One of those new patients is Jim Papadem, an out-of-work printing-press operator in his mid-50s from Redmond, Wash., who had long ignored his deteriorating health out of fear that the cost of treatment would ruin him. “I was pretty sure I had diabetes, and it turns out I had atrial fibrillation too,” he says. At his first meeting with his new Qliance physician, Dr. Randy Leggett, Papadem detailed his many symptoms. Leggett dispatched him to an eye specialist for treatment of a diabetes-related condition. She also prescribed two generic drugs to manage his blood sugar. Next came a referral to a cardiologist to treat the heart malfunction, which Leggett now monitors routinely. “She calls me now and then to check up on me at the end of the day, and when I have questions, she is available to help me connect the dots,” Papadem said.

So where are the cost savings? For Papadem, proper primary care reduces the likelihood of blindness, stroke and heart failure. More immediately, the Qliance patients now have an alternative to getting their care at the local emergency room. According to a 2010 survey of ERs in Washington State, the vast majority of emergency-room complaints are not actual emergencies. Instead, they involve common maladies that are easily handled by primary caregivers. With the average cost of a child’s ER visit running almost $2,000–and the average adult ER visit more than $4,500–Qliance more than pays for itself every time it keeps a client out of the ER.

Qliance’s large, diverse patient group makes it the first direct-care firm in a position to compile compelling statistics on the promise of direct care. “What will tip the scales for us is when we can produce hard data on savings and outcomes,” Bliss says hopefully. That takes some time, but the numbers are firming up. “If we can show that we are getting 15% to 30% of the costs out by using a model that doctors like and patients want, the whole system is going to flip pretty quickly.”

Centene Corp. is a Fortune 500 company hired by Washington State to manage its Medicaid plans. Jay Fathi, CEO of Centene’s Washington affiliate, tells me that “we already have evidence to show us that they are doing a good job.” Confident that the direct-primary-care model has legs, Centene has joined the growing roster of Qliance investors.

SO WHAT’S THE CATCH?

Of course, there’s a catch–at least in the short term. Docs on the treadmill are often responsible for 2,000, 2,500 or even 3,000 patients each. Direct-primary-care doctors serve far fewer patients. In a nation where there is already a shortage of primary caregivers, this would seem to disqualify direct care as a mass solution.

“It’s a trend that will probably grow a bit, but I think there is probably some ceiling to it,” says Ceci Connolly, managing director of the Health Research Institute at consulting giant PwC. Connolly foresees direct care as one part of a wider mix of patient-directed primary-care options, from drugstore clinics and Weight Watchers outlets to wearable monitors and digital apps.

But leaders of the direct-care movement argue that in the longer term, their model can solve the shortage of frontline doctors. By giving primary caregivers a good living doing work they can love, direct care encourages young physicians to follow their heart.

On a recent visit to Wichita, Kans., I met a young doctor who is doing that. Josh Umbehr, 33, was an aspiring primary-care doctor at the University of Kansas when, like many others, he grew horrified by the fee-for-service system. “It was crazy,” he said. “Insurance paid more for a prostate exam if it was done on a separate visit from a checkup. So the patient would have to come in twice. Medicare would pay for cleaning out earwax–but only one ear per visit. You had to schedule a second appointment for the other ear.”

Then he discovered direct care. As the son of a garbage collector, he understood the idea of one price for unlimited service. With classmate Doug Nunamaker, 34, Umbehr launched a moderately priced clinic called Atlas MD. The idea caught on enough that they recently hired a third doctor. Now they care for about 1,800 patients at an average monthly price of about $50 each.

An entrepreneurial dynamo, Umbehr paints a sky’s-the-limit future in which primary care is transformed into medicine’s most valuable role. To hear him tell it, he’s already living that dream, seeing an average of five patients per day–with other interactions by phone, text and email–while earning $200,000 to $240,000 per year. (The national average for primary-care physicians is well below $200,000.)

His in-house pharmacy, run out of a closet, saves patients hundreds of dollars per year on meds–a major selling point for those who blanch at his monthly fee. Take the uninsured mother who could not imagine paying $120 each month to cover herself, her husband and their two kids. Umbehr asked if she was taking any medications, and she said that was the problem: her prescriptions cost $138 per month. Umbehr buys the generic version wholesale for $1.55. “I told her her membership would cover the drugs. We eat the buck and a half as a cost of doing business, and she gets primary care for her family. At the end of each month, she’s 18 bucks ahead.”

When people say this is going to worsen the physician shortage, Umbehr says, “No. The current system is worsening the physician shortage. The ship is already sinking. We probably talk to 10 doctors per week who are burned out, going bankrupt, ready to retire years before they ought to. And when they see they can take better care of their patients and never deal with insurance companies again, and earn $210,000, $220,000, $250,000 per year, you’re going to see physicians flocking.”

Wouldn’t that be something? After so many years of dire forecasts, of blue-ribbon panels and expert commissions, of alphabet agencies and battles on Capitol Hill–wouldn’t it be amazing if the health care revolution finally arrived in the form of simple family doctors offering better care in exchange for a happier life? It’s worth a try, because if it works, an awful lot of people will be wearing that blissful smile.

TO SEE MORE SOLUTIONS GO TO http://www.time.com/solutionsforamerica

Read next: Most Types of Cancer Just ‘Bad Luck,’ Researchers Say

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This appears in the December 29, 2014 issue of TIME.
TIME 9/11

Watch How One Company Is Keeping the 9/11 Survivor Tree Alive

It was found badly broken and burned among the rubble at Ground Zero

Perched at the tip of lower Manhattan, the 9/11 memorial is surrounded by skyscrapers, covered in concrete and has an elaborate system of subway tunnels running underneath. That’s not the most optimal conditions for nurturing the more than 400 trees that grace the site.

The trees are an integral part of the design of the memorial, symbolizing life and rebirth, and when fully grown will create a canopy of archways leading visitors around the area that memorializes the victims of the Sept. 11, 2001, attacks.

In 2007, team members from Peter Walker and Associates, the firm that designed the 9/11 memorial, contacted Baseline Inc. and asked them if their technology would be able to help monitor the trees at the site and keep them as healthy as possible.

Baseline Inc. put their moisture sensors in with the trees while they were growing at a nursery in New Jersey and have continued to monitor them since they were moved to their new homes near the Freedom Tower.

Of all the trees, the Survivor Tree stands out for something greater. It was found badly broken and burned among the rubble at Ground Zero, and then nursed back to health in Brooklyn and replanted at the site. The new life springing from its limbs is a living reminder of both the past and the present, symbolizing resilience and survival.

John Fordemwalt, President at CEO of Baseline Inc., tells TIME that he and his team are committed to making sure that none of the trees, including the Survivor Tree, will die, “as a testament to the lives that were lost and the heroism of that day.”

TIME Solutions for America

Disruptive Technology Is Changing How Kids Learn

Research show new tools can make kids more engaged and more creative

In a few weeks, the halls of a school in Nanuet, N.Y., will teem with mini race cars. The vehicles will sport custom-designed wheels, each set carefully tuned in diameter and thickness to achieve maximum speed.

But the cars’ makers aren’t college-level engineers; they’re middle-school students attempting to learn about physics and technology by using a device that combines both–the school’s 3-D printer. “It’s rewriting what’s possible” in education, says Vinny Garrison, the teacher who organizes the races.

It’s not the only innovation doing so. Nearly three-fourths of U.S. teachers use technology to motivate students to learn, according to a survey by PBS LearningMedia. And that tech is getting smarter: students can now virtually tour ancient worlds to learn history, take quizzes via smartphone and more.

Most of the changes are designed to better prepare U.S. students for careers in fast-growing fields like science and engineering. But they can come at a cost–and not just financially. A $500 million plan to supply Los Angeles students with iPads was recently suspended after students bypassed content filters and some parents complained that the initiative was pulling focus from much needed building repairs.

So far, however, research shows that using next-gen tech in the right ways can make students smarter, more engaged and more creative. Here is a look at six new technologies that are shaping the classrooms of the future.

TO SEE MORE SOLUTIONS, GO TO time.com/solutionsforamerica


This appears in the September 22, 2014 issue of TIME.

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