We present a mathematical modeling approach that determines the optimal allocation of care manager's time and quantifies the costs and benefits of Collaborative Care. In particular, we model Collaborative Care management at the clinic level as an infinite horizon Markov Dynamic Program. The objective is a weighted sum of total patient QALYs and the clinic profits. The model incorporates insurance payment, resource utilization costs, and disease progression of comorbid diabetes and depression. We derive structural properties of the optimal allocation of the care manager's time. Using these structural properties, we develop a practical and easy-to-implement solution approach that performs close to the optimal solution. We calibrate the model with data obtained from a large academic medical center and show that our solutions could potentially improve total QALYs and clinic profits when compared to current practices. We also perform sensitivity analysis to different payment models to derive insights relevant to healthcare policy.
Using a linked database of Paycheck Protection Program (PPP) loans and Yelp-listed restaurants, we document that businesses owned by minority racial groups are more likely to use fintech lenders than traditional lenders. We develop a simple two-sided matching model to show that this phenomenon can be potentially attributed to differences in performance among borrowers, racial disparities in lending relationships, and race-dependent values of borrower-lender matches. Empirically, we do not find consistent evidence that operational performance is an explanation. We find that minority-owned restaurants are less likely to have lending relationships and that restaurants without lending relationships are more likely to use fintech lenders. We also find a more negative minority-non-minority gap in operational performance for fintech lenders, suggesting minority-owned businesses have higher matching values with fintech lenders. We do not find a similar pattern for first-time bank participants, community development financial institutions, credit unions, or other non-federally insured lenders. Overall, our results suggest that there are racial barriers in traditional loan distribution channels and this can be at least partially addressed by fintech lenders.
Research and practice suggest that co-founded ventures outperform solo-founded ventures on average. Yet, little work has explored the conditions under which solo founding might be possible or even preferable to co-founding. Combining an inductive case-oriented analysis with a Qualitative Comparative Analysis of 70 new entrepreneurial ventures, we examine why and how solo founders can be as successful as their peers in co-founded ventures. We find that successful solo founders strategically use a set of co-creators rather than co-founders to overcome liabilities, retain control, and mobilize resources in unique and unexpected ways. A primary contribution of this paper is an emergent configurational theory of entrepreneurial organizing. Overall, we reveal the broader significance and theoretical importance of adopting a configurational lens for both practitioners and scholars of entrepreneurship.
Firms’ use of SPACs to go public has increased dramatically, leading to market and regulatory debate about their use of projections. Examining SPAC mergers from 2004 through 2021, we find that 80% of firms provide projections for four years ahead on average, with approximately one-quarter of recent projections extending more than five years. For the sample of SPAC mergers with observable post-merger revenue, we find that only 35% of firms meet or beat their projections. This proportion declines for forecasts that are longer horizon, and non-serial SPAC sponsors miss forecasts by greater percentages. When we compare SPAC projected revenue growth to benchmark samples of IPO firms and matched firms, the SPAC projections are approximately 3 times larger on average than benchmark firms’ actual revenue growth, with even greater differences for long-term projections. After the merger, firms reduce their use of projections, providing them at statistically similar rates as benchmark firms. Overall, the evidence supports concerns that the SPAC merger includes highly optimistic projections.
Our analysis reveals that banks could develop capital-constrained by holding nonperforming household debts supported by central bank liquidity. We demonstrate the sequential responses to nonperforming assets on retained earnings, capital reserve, and new equity issuance. With capital reserves, banks can keep adding risky assets when retained earnings lag. Running low, banks have to downsize and issue new equity. We document market predictions on firms’ exposure before a systemic event: large banks collectively reduced their debt supply in 2009. Practicing selectively and collectively downsizing, banks prioritize clients on historical revenue contribution. Borrowers with exclusive relationships report lower risk exposure.
Consultants and business leaders frequently declare that a strong business case exists for firms to increase the racial/ethnic diversity of their employees. Unfortunately, the reality is that in terms of robust empirical evidence, the jury is still out. Bear with us as we explain.
Stock prices reflect firm performance and aggregate investor information about investment opportunities. We show that these dual roles are in tension: when prices are more informative about future investment, they are less effective at incentivizing managerial effort. Overall firm value need not increase with price informativeness; both decreasing transparency and allowing for ex-post inefficient investment can increase firm value. We show that standard empirical measures of price efficiency are incomplete and derive testable predictions for the price-sensitivity and composition of managerial compensation.
Public calls for a national paid sick leave policy continue to grow in the United States. In the absence of a federal policy, many localities and states enacted their own paid sick leave mandates. We document an average increase of 1.9% in employment following the implementation of a paid sick leave policy. As predicted, workers with ex ante lower access to paid sick leave drive the employment effect, a result which holds with county-quarter fixed effects. Several non-mutually exclusive mechanisms can explain our findings. Following the implementation of a mandatory paid sick leave policy, we find a decline in labor turnover which has implications for labor productivity and, hence, labor demand. We also find results consistent with an increase in the labor supply. Finally, paid sick leave mandates are associated with an increase in household income, creating positive spillover effects on local markets and greater demand for local goods and services.
To characterize ambiguity we use machine learning to impose guidance and discipline on the formulation of expectations in a data-rich environment. In addition, we use the bootstrap to generate plausible synthetic samples of data not seen in historical real data to create statistics of interest pertaining to uncertainty. While our approach is generic we focus on robust portfolio allocation problems as an application and study the impact of risk versus uncertainty in a dynamic mean-variance setting. We show that a mean-variance optimizing investor achieves economically meaningful wealth gains (33%) across our sample from 1996-2019 by internalizing our uncertainty measure during portfolio formation.
Firms’ use of SPACs to go public has increased dramatically, leading to market and regulatory debate about their use of projections. Examining SPAC mergers from 2004 through 2021, we find that 80% of firms provide projections for four years ahead on average, with approximately one-quarter of recent projections extending more than five years. For the sample of SPAC mergers with observable post-merger revenue, we find that only 35% of firms meet or beat their projections. This proportion declines for forecasts that are longer horizon, and non-serial SPAC sponsors miss forecasts by greater percentages.
Employee spinouts, startups founded by prior employees of existing industry firms, play a critical role in firm creation and knowledge transfer within and across industries. Their superior performance often arises from resources and knowledge accrued during employment in parent firms. An understudied question relates to whether prior employment in parent firms impacts an employee spinout’s alliance formation, given that alliances are critical to the survival and commercial success of startups. This article examines when employee spinout’s alliance partners overlap with their parent’s partners. Drawing on alliance formation patterns of U.S. medical device spinouts founded between 1990 to 2013, we find that spinouts extending their parents’ technologies tend to have more alliance partner overlap with their parents, whereas product market overlap leads to fewer overlapping partners.
Newcomers from other states and abroad are principally responsible for North Carolina’s population boom--growth by 3.9 million-- since 1990. However, seven powerful demographic disruptors—analogous to gale force wind gusts in an adverse weather event—can potentially quell future growth and demand for residential and commercial real estate. Strategies to circumnavigate the adverse effects of the demographic gale force winds ahead are discussed.
Using a large database of U.S. equity position-level holdings for hedge funds, we measure the degree of securitylevel crowdedness. The crowdedness factor is related to downside “tail risk" as stocks with higher exposure to crowdedness experience relatively larger drawdowns during periods of market distress. This tail risk extends to hedge fund portfolio returns as the crowdedness factor explains why some funds experience relatively large drawdowns.
As of 2019, salary history bans have been enacted by 17 states and Puerto Rico with the stated purpose of reducing the gender pay gap. We argue that salary history bans may negatively affect wages as employers lose an informative signal of worker productivity. We empirically evaluate these laws using a large panel dataset of disaggregated wages covering all public sector employees in 36 states and find, on average, salary history bans lead to a 3% decrease in new hire wages. We find no decrease in the gender pay gap in the full sample and a modest 1.5% increase in the relative wages of women, as compared to men, among new hires most likely to have experienced gender discrimination historically.
Seven powerful demographic trends—analogous to gale force wind gusts in an adverse weather event—constitute potentially powerful disruptors of business and commerce in the years ahead. Four of the gale force demographic disruptors—slowing total and foreign-born population growth, white population loss, and declining fertility— have evolved over the past several decades.
For more than a year, researchers across the University of North Carolina at Chapel Hill’s (UNC) Kenan-Flagler Business School (KFBS) and School of Medicine (SOM) worked with Sharecare, Inc. (Sharecare) to establish a framework for measuring the true value of corporate well-being interventions and develop a measurement tool to quantify their impact over time. The goal of the research was to assess the value of implementing corporate well-being interventions to improve employee health and lower direct medical costs to employers.
Over the last two decades, executive compensation research has focused primarily on equity-based pay and incentives emanating from executives’ firm-specific equity portfolios, while generally ignoring cash-based bonus plans as a second order effect. Exploiting access to new data sources, there has been a revival of interest by accounting researchers in more deeply understanding the value adding roles played by bonus plans. Earlier research viewed accounting measures in bonus plans through the lens of effort incentives-risk premium trade-offs derived from classical principal-agent theory. In contrast, the recent literature emphasizes the idea that cash-based bonus plans play an important communication role in which a board’s performance measure choices reveal to outsiders the firm’s commitment to specific strategic objectives and facilitate the coordination of behavior across executives inside the firm. Public observability of bonus plans then provides a basis for investors and competitors to assess a firm’s strategic direction, and for investors to hold managers accountable for strategy execution. Building on my discussion of Bloomfield, Gipper, Kepler and Tsui (2021) in the 2020 Journal of Accounting and Economics Conference, my objective in this paper is to synthesize and critique key results from this recent literature and offer ideas for future research.
The North Carolina Community Action Association (NCCAA) commissioned a study to assess the impact of the COVID-19 pandemic on its efforts to combat poverty and facilitate self-sufficiency in low-income communities throughout the state. We conducted focus groups with individuals served by Community Action Agencies (CAAs) and conducted a corresponding set of key informant interviews with identified leaders in five communities across the state. The research focused on five themes. We generated eight key takeaways from our content analysis of the focus group transcripts and nine key takeaways from our content analysis of the transcripts emanating from our Zoom sessions with community key informants.
Firms devote significant resources to safety-training programs with the aim to mitigate financial loss due to safety incidents and create customer value. From both practical and theoretical perspectives, it is important to know (1) whether safety-training programs mitigate financial loss, so that senior management can maintain the support for them, and (2) whether safety-training programs contribute to firm sales so firms can use them as a critical marketing lever to communicate value to customers.
Theoretically, wealthier people should buy less insurance, and should self-insure through saving instead, as insurance entails monitoring costs. Here, we use administrative data for 63,000 individuals and, contrary to theory, and that the wealthier have better life and property insurance coverage. Wealth-related differences in background risk, legal risk, liquidity constraints, financial literacy, and pricing explain only a small
fraction of the positive wealth-insurance correlation.
Using U.S. tax-return data containing the universe of individual taxable stock sales from 2008 to 2009, we examine which individuals increased their sale of stocks following episodes of market tumult. We find that the increase was disproportionately concentrated among investors in the top 1 and top 0.1% of the overall income distribution, retired individuals, and individuals at the very top of the dividend income distribution. Our estimates suggest that, following the day when Lehman Brothers collapsed, taxpayers in the top 0.1% sold $1.7 billion more in stocks than individuals in the bottom 75%. This difference is equal to 89% of average daily sales by taxpayers in the top 0.1%.
Theoretically, wealthier people should buy less insurance, and should self-insure through saving instead, as insurance entails monitoring costs. Here, we use administrative data for 63,000 individuals and, contrary to theory, find that the wealthier have better life and property insurance coverage. Wealth-related differences in background risk, legal risk, liquidity constraints, financial literacy, and pricing explain only a small fraction of the positive wealth-insurance correlation. This puzzling correlation persists in individual fixed-effects models estimated using 2,500,000 person-month observations. The fact that the less wealthy have lower coverage, though intuitively they benefit more from insurance, might increase financial health disparities among households.
We measure and calibrate the racial/ethnic densities (RAEDs) of executives in US public companies. We show that the magnitudes of underrepresentation for Blacks and Hispanics and overrepresentation for Whites are 10+ times larger when executive RAEDS are calibrated against the US population than when calibrated against an economic benchmark that reflects the demand for and supply of proto-executive talent. We conclude that at least 90% of the underrepresentation of Black and Hispanic executives in US public companies comes from factors in effect before US public companies hire proto-executive talent rather than actions taken by companies after such talent is hired.
We keep hearing that the corporate tax code is riddled with “loopholes” and that large corporations are tax cheats for using them and not paying their “fair share.” Is it true? No, most large corporations pay the amount in taxes they do because Congress expressly wrote the tax code to allow them to pay that amount.
The more significant revenue loss, however, is from exceptions to the tax code. When it comes to lost corporate tax revenue, exceptions are the rule, and not following the rules is the exception.
The choice of location is a key facet of decision-making in operations. One such choice is whether to colocate activities, services, or personnel. Prior research, including in healthcare, has reported that colocation yields benefits. However, these benefits may need to be balanced with higher costs of colocation (e.g., due to operational constraints). Thus, it is critical to understand not only whether colocation makes a difference but also under what circumstances it is most beneficial, and the mechanisms through which those benefits are realized. We consider colocation in the context of healthcare services, and ask: Does colocation of mental and physical health resources improve patient outcomes? This colocation is important, as primary care serves as a gateway to address mental health concerns and referrals to specialists. We next study colocation's relationship with two important operational variables: continuity of care (CoC) with a provider, and patient severity. Finally, we examine the mediating role of patients' no-shows and medication adherence in the colocation-outcomes relationship. As America's largest integrated healthcare system, the Veterans Health Administration offers us an excellent setting to study these questions. We analyze over 300,000 patients – over an eleven-year period – who suffer from diabetes, a chronic condition, and show evidence of mental illness. We use an empirical approach to quantify the relationship between colocation and four key outcomes attributable to mental illness: hospitalizations, length of stay (LOS), 30-day readmissions, and suicidal behavior. We find that colocation is associated with improvement in outcomes. For example, a one standard deviation increase in the mean colocation measure is related to a 2.4% decrease in LOS – equivalent to an annual savings of approximately $1.5 million, on average, just for our cohort. In addition, we find that colocation and CoC are substitutes, in that colocation benefits patients whose care is fragmented. Further, we find that colocation offers greater benefits to patients whose mental health conditions are more severe. Finally, our analysis reveals that colocation improves outcomes (partially) through a reduction in the no-show rate and an increase in medication adherence. Our findings are validated by extensive robustness checks and sensitivity analyses. Our study has implications for both the theory and practice of healthcare operations. Theoretically, we advance the location literature, establish its connection with the continuity literature, and highlight key moderators and mediators in the colocation-outcomes relationship. Practically, our work offers insights into how to design an operationally efficient system and, in settings with limited resources, where to target colocation. Our study is particularly timely as it may help address the growing mental health crisis in America and around the world, further exacerbated during the COVID-19 pandemic.
In a series of influential studies, McKinsey (2015, 2018, 2020) report a statistically significant positive relation between the industry-adjusted EBIT margin of global samples of large public firms and the racial/ethnic diversity of their executives. However, when we revisit McKinsey’s tests using recent data for US S&P 500® firms, we find statistically insignificant relations between McKinsey’s inverse normalized Herfindahl-Hirschman measures of executive racial/ethnic diversity and not only industry-adjusted EBIT margin, but also industry-adjusted sales growth, gross margin, ROA, ROE, and TSR. Our results suggest that despite the imprimatur often given to McKinsey’s (2015, 2018, 2020) studies, caution is warranted in relying on their findings to support the view that US publicly traded firms can deliver improved financial performance if they increase the racial/ethnic diversity of their executives.
Corporations are able to deduct some strange things on their tax returns. But new tax proposals from President Joe Biden and Sen. Elizabeth Warren introduce a few doozies.
Sound crazy? We think it does. But because Biden and Warren want to place a tax on financial accounting income (the income that companies report to investors), everything that is allowed as an expense for financial accounting purposes would become a proper deduction under the new proposed taxes.And that includes a lot of things.
Question Is a crowdsourcing open call a feasible approach to engaging the university community in COVID-19 safety strategies?
Findings This qualitative study evaluated 82 submissions to a university open call for creative solutions from students, faculty, and staff to inform safety in the fall 2020 semester. Solutions were shared with university leadership, and several are being further developed.
Meaning The results of this study suggest that open calls are a promising approach to understanding university community members’ concerns and identifying stakeholder-driven, innovative solutions for safe university activity during the pandemic.
Are the agglomeration economies of technology hubs augmented by a localized market for start-ups – acquisitions, and IPOs? How does this affect the ability of places outside of those hubs to foster digital startups as a tool of local economic development? We study this with a particular focus on acquisitions by the seven largest American digital platforms – Amazon, Alphabet [Google], Apple, Microsoft, Facebook, Oracle and Adobe, which we call, collectively, Big Tech. We cover the years 2001-2020. We show that firms acquired by Big Tech are, disproportionately to the sectors in which they operate, concentrated in major tech clusters, and particularly in the Silicon Valley (San Francisco/San Jose). We argue that the acquisition market – and its effects on both the major tech hubs and the left behind rest – depends crucially on the proprietary control of access to various digital network products. Regulation of these markets, particularly in the form of common carrier status and open standards, could achieve a considerable re-balancing.
It is true that President Joe Biden has proposed increasing the capital gains tax, and it is very reasonable to think about how to respond to these potential rate increases. Indeed, in classes I teach to undergraduates and graduate students at the University of North Carolina Kenan-Flagler Business School, I mention that selling ahead of a capital gains tax rate increase might be a smart move. But when is it?
My testimony will focus on perceptions of fairness in the tax code and recent proposals to fix such perceived unfairness; specifically, a tax on book income and the wealth tax. My main message is that corporations and individuals remit the taxes they do, including in situations some perceive as unfair, frequently because of explicit allowances in the tax code. In other words, the largest holes in our national tax revenue bucket are ones Congress has, itself, poked, and not the product of elaborate tax planning schemes, as is a current misperception.
These five techniques for writing problem statements can improve results from crowdsourced challenges.
Economic theory holds that competition drives innovation, improves the quality of goods and services, and lowers prices for consumers. Health care delivery is no exception.
To what extent do consumers boycott in response to corporate tax planning? Anecdotes suggest consumer boycotts are a meaningful deterrent to tax planning, but empirical evidence on their frequency and impact is lacking. We undertake a comprehensive study to examine how consumers’ purchase behavior relates to corporate tax planning.
Recently proposed tax policies have financial accounting income (GAAP income, or book income) serve as part of the tax base. These proposals range from a flat tax on book income for corporations above a certain size, to using book income as part of a minimum tax for corporations above a certain size.
In short, including financial accounting income in the tax base will result in worse financial information for investors and less efficient tax collection, economically disadvantage companies based in the United States, politicize accounting standards, and require highly complex implementation, which may undermine the intention of current proposals. These arguments can be further understood below.
We examine how mission-oriented grand challenges—formed to address the public sector’s unmet needs through development of new technologies and products for high potential impact—originate and catalyze industry incubation. Our analysis of six prominent cases identifies the incubation process, consisting of: identification of unmet needs as a grand challenge, championing and articulation of a mission, leverage of private enterprise, and success or failure of the mission for subsequent industry emergence. The resulting conceptual model highlights key similarities and differences of industry incubation stemming from the public sector’s mission-oriented grand challenges relative to industries triggered by scientific discoveries or unmet user needs where the public sector is not as salient. The analysis reveals successful outcomes are associated with the public sector’s goal setting and carrying out “market functions” pertaining to selection, coordination, and knowledge sharing. We also provide cautions and caveats regarding fault lines that may arise in public-private partnerships.
We propose and test a framework of private information acquisition and decision timing for asset allocators hiring outside investment managers. Using unique data on due diligence interactions between an institutional allocator and 860 hedge fund managers, we find that the production of private information complements public information. The allocator strategically chooses how much proprietary information to collect, reducing due diligence time by 18 months and improving outcomes. Selected funds outperform unselected funds by 9% over 20 months. The outperformance relates to the allocator learning about fund return-to-scale constraints and manager skill before other investors.
The coronavirus disease 2019 pandemic has brought into focus the limits on flexibility and innovation associated with market consolidation in care delivery. While anecdotes about the ossification in care delivery predominate, broader economic indicators point to the negative outcomes of consolidation.
Despite advocacy from governmental officials and parents alike, we urge caution in the reopening of public schools before the coronavirus pandemic is fully under control. We are especially concerned about the premature re-opening of schools in impoverished and flood-prone urban and rural environments.
We axiomatize subjective probabilities on finite domains without requiring richness in the outcome space or restrictions on risk preference using Event Exchangeability (Chew and Sagi, 2006), which has been implicit in the prior literature (Savage, 1954; Machina and Schmeidler, 1992; Grant, 1995). In three successively stronger theorems, we characterize a probability representation of the exchangeability relation, followed by characterizing a unique subjective probability, and finally endowing this subjective probability with the property of reduction consistency—acts inducing the same lottery are indifferent.
People of color are overrepresented relative to their shares of the total population in coronavirus infections, hospitalizations, and deaths. The same is true for people living in over-crowded multigenerational households. Because people of color are more likely to live in multigenerational households than are Whites, the pandemic is having a double whammy effect in communities of color throughout the U.S.
There are bipartisan Medicare payment proposals that would reduce Medicare payments included in previous Obama and Trump budgets that could go a long way to filling the budget shortfall. While previous policy proposals either proposed new revenue sources or payment reductions, recent policies are pragmatic in nature and attempt to modify either beneficiary or provider behavior.
Considerable scholarly analysis and media attention has documented the racially disparate impact of coronavirus infections, hospitalizations, and deaths. Constituting 13 percent of the general population, Blacks reportedly account for 25 percent of those that have tested positive and 39 percent of the COVID-related deaths in the United States.
Background: Influenza imposes heavy societal costs through healthcare expenditures, missed days of work, and numerous hospitalizations each year. Considering these costs, the healthcare and behavioral science literature offers suggestions on increasing demand for flu vaccinations. And yet, the adult flu vaccination rate fluctuated between 37% and 46% between 2010 and 2019.
Aim: Although a demand-side approach represents one viable strategy, an operations management approach would also highlight the need to consider a supply-side approach. In this paper, we investigate how to improve clinic vaccination rates by altering provider behavior.
We study the impact of widespread adoption of work-at-home technology using an equilibrium model where people choose where to live, how to allocate their time between working at home and at the office, and how much space to use in production. A key parameter is the elasticity of substitution between working at home and in the office that we estimate using cross-sectional time-use data.
We specify and estimate a time-varying Markov model of COVID-19 cases for the US in 2020. We find that the estimated level of undetected infections spiked in March and remained elevated through May. However, since late April estimated undetected infections have generally declined though it was not until June or July that detected cases exceeded the estimated number of undetected cases.
We examine the impact of four classes of workplace interruptions on short-term (working hours) and long-term (across-shifts) worker performance in an agribusiness setting. The interruptions are organized in a two-by-two framework where they result (or do not result) in a physical task requirement and lead to a varying degree of attention shift from the primary task.
Since 2001, the number of financial statement line items forecasted by analysts and managers that I/B/E/S and FactSet capture in their data feeds has soared. Using this new data, we find that 13 item surprises—11 income statement and 2 cash flow statement analyst and management guidance surprises—reliably explain firms’ signed earnings announcement returns.
This paper evaluates the pros and cons of including private equity fund investments in defined contribution plans. Potential benefits include higher returns and improved diversification as well as a relatively safe method for accessing investments previously only available to institutions and the very wealthy. Despite these enticing benefits, they need to be weighed against potential challenges and costs that may arise from creating this broader access to private funds.
Mergers and acquisitions (M&As) are an important mechanism through which new technology is adopted by firms. We document patterns of labor reallocation and wage changes following M&As, consistent with the adoption of technology. Specifically, we show target establishments invest more in technology, become less routine task intensive, employ a greater share of high technology workers, and pay more unequal wages.
