Big Ideas for Arkansas 

Suggestions from readers and a variety of experts on how to make Arkansas a better place to live.

In what's become an annual tradition, the Arkansas Times recently solicited suggestions from readers and a variety of experts on how to make Arkansas a better place to live. We present their ideas here and hope you find them as inspirational as we do. If any especially strike a chord with you, help make them happen. Unlike years past, when some of the big ideas we featured were more provocative than feasible (such as re-routing the Arkansas River to bring Little Rock and North Little Rock together with a shared park), all of this year's Big Ideas could be achieved. Many are works in progress; those that aren't only lack the right mix of advocates to be realized.

Give art jobs to teen-agers
By Leslie Newell Peacock

John Gaudin has so many ideas for North Little Rock it's a wonder his head isn't the circumference of Verizon Arena. The man who has spearheaded numerous arts-related developments in Argenta has embarked on yet another: The Art Connection, his plan "to get kids off the streets and into art and art jobs."

So far, it's working. The 20 high school students selected for the inaugural program are working three nights a week at an enviable job: They're painting, with instruction from North Little Rock artist Angela Green and under the direction of Pammi Fabert, whose vision and energy is ideally suited to Gaudin's. Fabert has used the typical teen-age job of flipping hamburgers as a metaphor, telling the students "these paintings are your hamburgers." Students have to arrive at their classes, on Tuesday, Wednesday and Thursday nights, on time; they'll get docked if they're late and if they don't take their job seriously, they'll lose it.

If that sounds less like work and more like fun, consider this: These students had huge success at their first exhibit at November's Argenta ArtWalk, all selling something and some selling all their work. That means they have to keep producing.

The program is about more than money, of course: It's about putting at-risk kids in a situation in which they can see the results of work, take pride in it and learn to be self-sufficient so they can succeed in the adult world. Fabert has seen one of her shyest artists blossom, acting as host to the hordes who attended their opening.

Gaudin's inspiration came from another big idea: the Artists for Humanity paid apprenticeship program in Boston founded two decades ago. The more than 200 teen-aged participants in that program earned nearly $800,000 last year, according to its website. "It's an incredible model," Gaudin said. After seeing how the Boston program worked, Gaudin said he and fellow philanthropist Harold Tenenbaum "were determined to launch the program" in North Little Rock. They got financial commitments both public and private, renovated space at 204 E. Fourth St., hired Fabert and went to North Little Rock's high schools to find interested students. Sixty-seven students interviewed, but so far the program only has funds for 20. Gaudin said the program sought a diverse demographic from all over the city.

Next summer, Art Connection students will have summer jobs in art-related fields, Gaudin said, such as mural-painting. With a year's example to show, director Fabert will seek out new investors to grow the program, which she would like to see statewide.

Start a Maker Faire
By Leslie Newell Peacock

John Gaudin has another idea up his sleeve: He wants to bring the maker movement to North Little Rock. The Argenta Innovation Center, in the same building that Art Connection occupies, would serve as a collaborative space for young entrepreneurs who would be focused on making their ideas tangible. Gaudin has applied for a Maker Faire license so that someday he can host such a fair, where creative types display their inventions, in North Little Rock. Think 3D printers, robots, life-sized Mousetrap games, colored fire, a Gaudi structure recreated in toothpicks, a subwoofer powered by a bicycle (the "stompodium") — all featured in a recent Maker Faire in San Mateo, Calif. Gaudin anticipates that Art Connection artists and the makers next door will bounce ideas off one another, a ping-pong game of creativity and another score for Argenta.

Grants for backyard chickens
By Jayce Hafner

Arkansas is at the top of the pecking order when it comes to chicken. Tyson Foods, a major supplier of both broilers and eggs, is based in Arkansas. But chickens remain far from people, far from nature, kept in the dark recesses of an industrial hen house.

It doesn't have to be this way. Perhaps the most compelling virtue of the chicken is that it's a microcosm of sustainability. You can feed your table scraps to the chickens, and the chickens will fertilize your grass, produce fresh, delicious eggs, and weed your garden, ultimately helping you to get food back on the table. It's a closed-loop production cycle, and a symbiotic relationship. Chickens lay so much that you often have more eggs than you need, and you can sell the surplus to the neighbors, or donate them to your food bank, contributing to a local, more self-sufficient economy (and in this time of financial uncertainty, self-sufficiency can't be underestimated). These birds have a way of bringing neighbors and friends together around a common agricultural project, strengthening communities, and nurturing social sustainability.

We see the power of the backyard chicken taking off across the nation. Zoning laws are adapting to support backyard chicken projects in suburbia; inner-city 8th graders are raising chickens in their school yard to supplement their biology curriculum, and higher education institutions (including Hendrix College) are implementing student-run chicken-raising clubs. These birds are contagious, and it's time to capitalize on the momentum of our time.

I propose a statewide grant program to promote and support backyard chicken-raising in Arkansas. The fund would allocate small grants to churches, secondary schools, university student groups and community centers (who are most likely to enjoy both a vibrant social network and the property necessary to comply with zoning laws) with a demonstrated commitment to sustainable development. Recipients of each grant would receive funds sufficient to build a small, portable chicken coop for rotational grazing for 4 to 12 hens, to purchase and vaccinate the chicks and to buy standard equipment (feeder, heat lamp, and water trough). After the chickens mature and begin to lay, they will begin to pay for themselves. "Chicken tenders" can assure their neighbors of noise control by avoiding rooster-raising all together.

Perhaps most importantly, this backyard chicken grant program will foster a relationship between consumer sand their food source. Rather than objects, these birds can be valued and appreciated personalities.

Jayce Hafner initiated the successful moveable chicken coop program in 2010 at Hendrix College, where she majored in International Relations and won a Fulbright Scholarship.

Video record judicial trials
By Mara Leveritt

In response to the tragedy of the West Memphis case, the Arkansas Supreme Court should require courts to video-record, stream and archive all trials — with only a few, carefully considered exceptions — to improve access to court proceedings, heighten understanding of judicial processes and promote accountability.

Exonerate the West memphis three

If state officials believe the West Memphis Three are guilty of murdering three children, why did they free one from death row and two from life in prison? If the men are innocent, as most believe, the state should own up to the train-wreck of errors that kept them in prison for nearly 18 years. The official "guilty-but-free" stance is a cynical farce, a mockery of justice; contemptuous and contemptible. Exonerate the West Memphis Three. Investigate those murders for real.

Mara Leveritt is a contributing editor to the Arkansas Times and the author of the books "The Boys on the Tracks" and "Devil's Knot."

Allow voting by mail
By Karama Neal

Allow Arkansans to vote by mail like they do in Oregon. Pair that with the automatic registration at 18, and we could make some real progress in civic participation.

Karama Neal is director of Southern Bancorp Community Partners.

Help Delta students attend college
By Gabriel Fotsing

During my first year of teaching at Lee High School, I had multiple seniors coming to me during their spring semester. They wanted help with their college applications, and I gladly accepted. Unfortunately, for most of them there was nothing I could do. Some had never taken the ACT or the SAT, which meant that they could not apply. Others, who had taken the test, had not scored high enough to gain admission. Furthermore, so many had not filled out their FAFSA and therefore did not qualify for financial aid. Frustrated, I decided to shake things up a bit. We started offering college prep workshops dealing with every aspect of the college application process, from picking a college, to prepping for the ACT, to filling out the FAFSA. We've had some success; a student of ours is at Washington University in St. Louis on full scholarship, another was the first at our school to receive the Gates Millennium Scholarship, and the class of 2012 beat all school records in terms of scholarship money. We want to duplicate this at other schools throughout the Delta.

With these in mind I decided to start the College Initiative, a nonprofit agency that will provide motivated, college-capable low-income students with both the tools and the mentorship necessary to enter into and complete a four-year college degree program. My experience in the Delta has taught me one thing: no kid grows up wanting to be mediocre or average, let alone below average. All students want better lives for themselves and their families, and they understand the crucial advantage they would gain from a college education. However, they cannot do this alone. It takes a village to raise a child.

Gabriel Fotsing is a native of Cameroon and a Harvard graduate who first came to Arkansas in 2010 through Teach for America.

Build the Rose Creek Trail
By Mason Ellis

For many years now, residents of Stifft Station and Capitol View have steadily pushed for the Rose Creek Trail to connect their neighborhoods directly to the River Trail. For the most part, the river trail is nearly inaccessible by bike for all but the extremely fit cyclists who can power up Overlook Drive at the west end or brave heavy street traffic to access the trail downtown on the east end. However, along the Union Pacific rail line, a trail could be built from the riverfront all the way to Fourche Creek and Interstate Park on the south end of Little Rock. Much of the trail between the State Capitol and Central High could follow an abandoned right of way alongside the current track line that is already level and even includes a bridge across Seventh Street that is currently without track and is not being used. This trail could also connect to many existing east/west bike corridors like the new 12th Street bike lanes, the Third Street route that is heavily trafficked by bikes and is to be painted with bike-share markers (known as sharrows) soon, or Seventh Street, which is a popular bike connection between UAMS and downtown. Important points along the route include the River Trail connection, Union Station, Capitol View, Stifft Station, the Stephens and Central High neighborhoods, the Central High National Historic Site, Barton Coliseum and the Fairgrounds, South End Neighborhood, Interstate Park and Fourche Creek.

Let's build this vital bike and pedestrian path to connect the river trail and downtown, to connect visitors to the Central High National Historic site as well as students to their homes, and reconnect Little Rock neighborhoods to each other that have been divided physically and economically by I-630. Such a crucial connection has great potential to build strong and active communities and revitalize and energize a significant portion of Little Rock.

Mason Ellis is an intern architect at Witsell Evans Rasco Architects and Planners.

Enact campaign finance reform
By Eric Francis

We should amend the state Constitution so that you can only make campaign contributions (for, against, or independent of) to candidates or ballot issues if you meet these three requirements: 1) You must be an individual person and United States citizen; 2) You must be legally eligible to register to vote; and 3) You may only make such a contribution if you are eligible to vote on the issue in question.

That's it. No corporations, no unions, no PACs, no special interests. Only individuals get to spend their hard-earned money deciding who or what gets the nod (or the boot) in an election, and only in the elections they actually have a constitutionally mandated voice in.

That is how you return the power in politics to the people.

Eric Francis is a freelance writer and the former editor of The North Little Rock Times.

Turn an Arkansas prison into a college
By Vic Snyder

The Arkansas Prison system has really done a remarkable job getting inmates to take GED classes and pass them. They have so many graduates. What do you have when you have that many people together pursuing an education? A college. We should convert one of the state's prison units into a full-time, five-day-a-week college. Most inmates in Arkansas prisons will be released one day. Continuing to expand efforts to educate them can only improve the chances they'll successfully reintegrate into society once they're released.

Vic Snyder is corporate medical director for external affairs at Arkansas Blue Cross and Blue Shield. He represented Arkansas's 2nd Congressional District from 1997 to 2011.

Add a community service component to lottery scholarship
By Robert Lowry

The generation in and just out of high school values community and volunteerism more than most in recent memory. The Arkansas Lottery scholarship should encourage that spirit by adding a volunteerism component.

I propose that every graduate who qualifies under the current rules should get 100 percent of the lottery scholarship award for their freshman year. This will allow students to make the transition and get their feet firmly planted in college life. In subsequent years, qualifying students should receive only 50 percent of the award unless they fulfill some sort of community service. For fulfilling the community service obligation, students would receive the full award. Continuation of the full scholarship beyond the freshman year would depend on both academic performance and service to the campus and community.

The intent of the lottery scholarship is to elevate the number of our high school graduates who can afford college. That is a worthy goal and should be continued. But success in college is about more than just grades. It is about growing into thoughtful, productive and good citizens. A service component underscores the notion that this scholarship is about not only the lives of individual students, but the life we share in this great state.

The Reverend Dr. Robert Lowry is a transitional teaching elder at First and Harmony Presbyterian Churches in Clarksville.

Visit a detained immigrant
By Sara Mullally

Everyone should take the time to visit an immigrant in jail, prison or a detention center. It is an eye-opening experience that will redefine the comfortable line you've drawn between yourself and those inside. I participate in a program through Arkansas Interfaith Conference, where the only goal is to provide a friendly visit to an immigrant in jail. Immigrant detainees often have no visitors for one or many reasons. Their families fear having to present an ID or may have no way to get to the jail, and some detainees simply have no family for miles. Immigrants can be taken into custody over something as petty as a traffic violation. Once they are in the immigration system, they may be transferred multiple times while awaiting trial or deportation. While detainees are shipped to what can be deplorable, dehumanizing facilities, their families are left in the dark, wondering where their loved ones will end up. The detainees say that even visits from perfect strangers help them cope. It helps them feel human again, rather than being relegated to some Alien Identification Number. As visitors, we gain so much. Through connecting with these forgotten people, our views on immigration and criminal justice are influenced by what happens to the real people we have come to know. Afterwards, we can't look at our society with the same naive eyes. It's transformative to see how our government policies affect children, friends, families, and communities. The policies championed at the Capitol take on a different hue when viewed from the perspective of a beleaguered stranger, shielded from the public's view.

Sara Mullally is co-founder of El Zocalo Immigrant Resource Center. She teaches Spanish in the North Little Rock School District.

Promote social entrepreneurship
By Jamie Fugitt

Blake Mycoskie launched Tom's Shoes in 2006 after he befriended shoeless children in Argentina. Instead of launching a non-profit, he created a company that gave a pair of new shoes to a child in need every time it sold a pair of shoes at retail. Within the first year Blake delivered 10,000 pairs of shoes to the source of his inspiration — children in Argentina. By the close of 2011, his company had given over 2 million pairs of shoes to children in need all over the world.

Tom's Shoes is a cool idea and a great company. Mycoskie, like other social entrepreneurs, targeted a problem and built a world-class solution that also makes money. Under this model, Mycoskie has made a greater impact in a far shorter amount of time than he likely ever could have under a traditional public service model.

Mycoskie is one of the more prominent examples of a social entrepreneur. These innovators understand that the next leaders in public service must be as skilled in business as they are in program planning. They think of success in terms of a triple bottom line — people, planet and profit.

Little Rock should be the hub of social innovation. Social-focused startups, like any emerging industry, need three primary building blocks — talent, community and money.

We have the talent. Each year nearly a hundred students attend the Clinton School of Public Service in Little Rock, coming from across the globe and from a variety of backgrounds. They are the best and brightest of the world's service-focused professionals and are naturally inclined to tackle big social problems.

While they are here the Clinton School educates and inspires them with a "hands-on," world-class program. They learn to identify complex problems, plan innovative solutions and execute their plan to create tangible social good.

However, after their time with the Clinton School many leave. Admittedly those who leave blaze trails of good across the world. But I (selfishly) wish more of them would stay.

We should put more emphasis on social innovation in the Clinton School curriculum. We should encourage these students to launch and seed their passion, whatever it is, right here in Little Rock. We should give them the tools to do so in the hands-on, real-world way the Clinton School teaches. Their reach can still be global, but their headquarters can be local.

We have the community. A growing number of entrepreneurs, mentors, technology whizzes, designers, government programs and service professionals have built a community in Arkansas and are laying the foundation for the next generation of innovators. We should encourage the Clinton School students to tap into this resource. The reach and power of the Clinton School network itself would also be unmatched in public-good circles.

We have the money. A growing number of funding sources, both private and government, are investing and helping emerging companies grow in this state. We should connect the Clinton School students to this potential and let them know that the funding they need is in their backyard.

Little Rock could be the center for social innovation in this country. We have the building blocks. Let's put them together and then build on top.

Jamie K. Fugitt is an attorney with Williams & Anderson, a mentor for the ARK Challenge, the Arkansas Director of Cleantech open and a board member of the Arkansas Motion Picture Institute.

Create a homeless shelter for LGBT young adults
By Penelope Poppers

All of the cards are stacked against lesbian, gay, bisexual transgender homeless individuals, specifically young adults. While LGBT people make up a very small portion of the general population (5 to 10 percent), LGBT people make up a large portion of the homeless population (20 to 40 percent). Yet, several shelters and services in the area are not able to properly handle or address the specific that LGBT individuals face, especially transgender folks. In our area shelters, residents are gendered according to what their ID says, not necessarily by how they actually live, identify or present themselves. In a perfect world, clients would be able to self-designate their gender, regardless of whether or not they've had gender reassignment surgery. When you begin this conversation, inevitably someone will say, "What if men pretend to be women, simply to get inside women's shelters to rape and abuse residents?" But in California, many shelters have allowed transgender people to self-designate for years and, according to a Human Rights Commission investigator, this situation has never come up. But if you force a trans woman to stay in a men's dorm, there are plenty of opportunities for harassment and rape, and historically, that is happening.

I recently formed an organization called Lucie's Place in Little Rock to work with LGBT homeless individuals, specifically young adults. In early 2013 we hope to begin two programs: emergency short-term housing and free counseling services, both specifically available to LGBT young adults who are currently homeless or at risk of becoming homeless. In 2014, Lucie's Place hopes to open a long-term home specifically for LGBT identified homeless young adults — the first of it's kind in the state. Lucie's Place Transitional Living Program (TLP) will be a place where young, homeless, LGBT adults will be able to openly live as themselves, while developing the skills necessary for their future independence. For several of our residents, this home will be the first place they have ever lived where they can be open about who they truly are, without the fear of repercussions from parents.

Penelope Poppers is the organizer of Food not Bombs and a co-founder of Lucie's Place.

Offer late-night bus routes
By James Szenher

The Central Arkansas Transit Authority should offer limited late-night bus routes. The end times of current service hours — 8:15 p.m. on weekdays, 6:20 p.m. on Saturday and 4:15 p.m. on Sunday — effectively strand those without transportation at night and encourage drunk driving. CAT could start with four routes that run from 6 p.m. to 2 a.m. on weeknights and Sunday and 6 p.m. to 6 a.m. on Friday and Saturday: Markham/Chenal from the River Market to the Promenade; Kavanaugh/University/Chicot from Markham to Mabelvale Cut-Off; Roosevelt/Asher/Col. Glenn from airport to Barrow and Arch/Broadway/NLR Main/JFK from Interstate Park to McCain. This is a proposed sketch; research would help determine ideal routes, stops and times. The program could be funded through a contribution from Little Rock and North Little Rock (as the routes would promote economic consumption and keep drunk drivers off the road), federal grants, rider fees and advertising (nightlife businesses might buy targeted advertising). Outfit the buses with a nightlife theme, and promote the new service with a marketing campaign aimed at the nightlife crowd. The night service would likely diversify the base of regular bus riders, which could increase ridership during the daytime and eventually lead to demand for more routes, more frequent stops and improved service for all riders.

James Szenher is information and communications coordinator at the Arkansas Public Policy Panel and a bassist and vocalist in the band Tsar Bomba.

Create a state Division of Food Security to provide local organic food to the neediest
By Brian C. Campbell

The contemporary U.S. food system is unsustainable and precarious. In addition to the distance our food travels, we have an over-reliance on non-renewable fossil fuels, an over-use of irrigation water, an over-application of biocides that poison drinking water and destroy the natural fertility of agricultural lands, and a dependence on a monoculture production of few crop varieties.

If the industrial food system falters, people in Arkansas and beyond will be without food. U.S. Department of Agriculture statistics show that Arkansas currently has the lowest food security in the country, and the highest rate of childhood hunger in the nation, with nearly 25 percent of Arkansas kids going hungry. Our rates of obesity and diabetes also rank among the highest in the nation. While Arkansas engages significantly in U.S. industrial agriculture, we fail to address the most basic needs of our citizens. We have a volunteer food bank system working tirelessly, but it primarily distributes food donated by corporations, which tend to be unhealthy and contribute to our obesity and diabetes epidemics.

I propose that the Arkansas Agriculture Department should create a Division of Food Security, with leadership trained in agroecology and the social sciences of poverty, that prioritizes the production of local organic food (not commodities) and works collaboratively with the existing food security structure (food banks, hunger relief agencies, etc.) to ensure that the impoverished have access to healthy food. This division would re-allocate corporate donations in strategic ways to ensure that local, organic, healthy foods receive the subsidies that industrial commodity production currently enjoys. (In 2010, Walmart pledged a $2 billion commitment to fight domestic hunger and the USDA paid $443,214,770 in agricultural subsidies to Arkansas's industrial farms).

In this Food Security Division, each county would designate some public lands (perhaps adjacent to a public library) as food security farms, where farmers trained in organic agricultural production would grow locally adapted foods to be donated to food pantries for redistribution to the needy. These food security farms would house seed banks and serve as demonstration sites for testing out and saving seeds from locally adapted crop varieties, to ensure that the state has the genetics necessary to produce food sustainably in the coming years of global warming, and to host public workshops on how to build and manage backyard organic gardens.

This food security division would also subsidize local organic produce in the private sector to level the playing field with large-scale industrial agriculture, so that Arkansas consumers can choose healthier options in the grocery store and we can rejuvenate local economies through the development of new family farms.

Much of this is happening already, despite federal and state policy that makes it difficult. A range of dedicated, hard-working organic farmers, non-profits and activist-entrepreneurs have overcome myriad obstacles to address Arkansas's agriculture dilemma in an ad hoc fashion, attempting local food security on less than a shoestring budget. Still, the problem of accessibility for the general public remains. Imagine if the creativity and practical knowledge of these low-budget operations had some government support. Inaccessibility remains the biggest knock against local organic food. An Arkansas Division of Food Security could bridge this gap, simultaneously making healthy food available to all levels of wage earners, ensuring local food availability in case of emergencies, strengthening our local economies, and reducing preventable diseases.

Brian Campbell is associate professor of anthropology at the University of Central Arkansas and director of CAAH! Conserving Arkansas's Agricultural Heritage and Ozarkadia Films.

A purse museum for SOMA
By Leslie Newell Peacock

Anita Davis, creator of the Bernice Sculpture Garden (a public park on private land at 1401 S. Main St.), restorer of buildings just south of the garden and mastermind of the cornbread man mural that increases the joy factor in The Root restaurant parking lot at 1500 S. Main, can be credited with much of the new life along Main Street south of Interstate 630. It's been a boon to the Southside Main Street (SOMA) goals, with the sculpture garden providing a stage for Arkansas artists, a home for the new Cornbread Festival and a farmer's market in summer and the renovations attracting the Green Corner Store, StudioMain and Boulevard Bread Co. to the block.

Next year, Davis will add to the mix a museum that should attract everyone who loves a handbag and history, an exhibit that reveals female identity in the 20th century — as Tim O'Brien's "The Things They Carried" illustrated the life of a soldier, so will Davis' purses illustrate women's history.

Davis' purse collection — which now totals around 2,000 — has been on display at the Historic Arkansas Museum and Smith Kramer has toured an exhibition of the collection for five years all over the country, from Sacramento to Columbia, S.C. While they were on the road, Davis turned her energies to SOMA. "I thought I was over purses," she laughed. "This [SOMA] was so much more."

"Then these huge crates of purses came back," after the tour, Davis said. They were curated, ready for display. The one-story building occupied by Stageworks, next door to The Root (nee the Sweden Creme drive-in), became available when the business moved to North Little Rock and Davis bought it, a museum in mind. The first change to the building: the cornbread man mural, by Steven Otis and Shannon Wallace, went up on its north wall, facing The Root; "I wanted to honor the cornbread festival," Davis said, "and thought how fun it would be to have this silly thing up on the wall," especially for children.

Second: a renovation of the building as a museum, with the help of architect Kwendeche, artist Otis and historian Sara Drew. Davis is working on the collection to freshen it up, and hopes to have the museum open in late spring 2013. The collection will be one any woman can relate to, Davis said; rather than an exhibit of Gucci bags through the ages, "mine is more what people would remember as what their mothers or grandmothers would carry," along with contents that will remind viewers how women's lives have changed, from calling cards and cigarette holders to condoms.

SOMA's generous idea person says her work on Main has been "the best thing I could have ever done for myself." You can be sure culture seekers and downtown Little Rock will find it a good thing, too.

Use distance learning to raise the ceiling for high school achievers
By Calvin Smith

In the last decade, Arkansas has made significant strides in giving more high school students the opportunity to pursue higher education. Adequacy funding and the implementation of Common Core standards have helped ensure that all school districts, regardless of demographic make-up, provide students with a foundation of education necessary for them to pursue higher education. But that doesn't mean all Arkansas high school graduates are equally prepared for college. What about students with abilities beyond what their schools offer? Every school, regardless of demographics, has students who are achieving to the highest reaches of their schooling. The problem is that achievement tops out too early for many kids. It's not logistically possibly for some lower-achieving schools to offer the variety of AP and college-level courses that higher-performing ones do.

The state Department of Education should embrace distance learning to reach high school students who are reaching their ceiling too early. Imagine, for instance, a physics professor at the University of Arkansas delivering a lecture through streaming video online or through the same Interactive Video Network Units UAMS uses between its Little Rock and Fayetteville campuses to schools across the state. One professor could reach scores of students scattered across the state.

The high-speed fiber optic Arkansas Research and Education Optical Network already connects most of the state's public universities and extends to all four corners of the state. We should expand it into high schools. Meanwhile, much distance learning technology only requires a basic Internet connection, and the University of Arkansas System is on its way to becoming a leader in distance learning technology. Why not piggyback on its efforts?

Calvin Smith is director of business development at UAMS Northwest campus.

Shift pet population control tactics
By Jennifer Carman

It is time for the city of Little Rock to get serious about reducing our pet population crisis. Cities around the nation have demonstrated that this is indeed possible, largely through policies that shift funds away from impounding and euthanasia and, instead, direct them toward free spay and neuter programs. The cost of sterilization is utterly nominal compared to the cost of impounding, sheltering and euthanizing the many unwanted pets that strays produce over their lifetime. Taxpayers foot the bill for this either way, so it only makes sense to exercise both moral and fiscal responsibility. We could liaise with officials in other cities where such programs have been successful. One such program operates in the city of Pittsburgh. That program (run by the city's Animal Care and Control Bureau) currently provides free spaying or neutering for up to five animals per household, the maximum number that city residents are allowed to own. Furthermore, the program enables residents to bring feral cats found in their neighborhood for sterilization procedures as well. Though the city experimented briefly with low-cost and discounted sterilization options, they ultimately discontinued these methods in favor of a universal free option. Ultimately, a mobile spay-neuter clinic or vehicle would be ideal, and there are excellent mobile programs (like one in Kansas City) from which we could draw inspiration. For the safety of animals, drivers and pedestrians alike, a program such as this could truly revolutionize one of Little Rock's most heartbreaking problems.

Create a tool-lending library

The city of Little Rock should create a tool-lending library of sorts, with a city-owned repository of basic tools and yard equipment that residents could borrow, much like a library book. Many families have sheds full of such equipment that is utilized only once or twice a month, or perhaps even once annually. In these difficult economic times a program such as this might provide just the boost and inspiration needed for individuals who may not otherwise be able to access such commodities. Wouldn't it be terrific to have a resource where you could borrow a ladder, lawn mower, tile saw, drill, floor nailer, rake, etc.? Items could be secured with a cash deposit or credit card, and residents could check items out for a specified period of time.

Maybe patrons could also borrow "how-to" DIY instruction manuals, and such a library could organize periodic training days to encourage and empower residents of the city to tackle home and community improvement projects. A handful of these programs exist around the country in cities such as Columbus, Berkeley, Atlanta and Seattle. Little Rock is a city in which the historic preservation opportunities are abundant, and programs such as this could be a vital component in the revitalization of homes and communities throughout our city. A Seattle-based non-profit group called Share Starter now offers a free "Tool Library Starter Kit" to any community interested in starting its own lending library.

Jennifer Carman is the president of J. CARMAN Inc., a fine-art advisory and appraisal firm based in Little Rock.

Cut health-care costs, improve care
By David Ramsey

In October, the Arkansas Department of Human Services began the Payment Improvement Initiative, a program to lower Medicaid costs and improve the quality of care via a partnership with the state's biggest private insurance companies, which will create incentives for providers who meet those goals. If the initiative works, the state will save millions of dollars, and health-care officials across the country will look to Arkansas as they scramble for ideas to "bend the cost curve." Already, the Kaiser Foundation has lauded the initiative as a "bold effort to cut Medicaid costs [and] add transparency" and the National Association of Medicaid Directors has suggested that Arkansas's plan could be a model for other states. 

"The health-care system, including Medicaid in Arkansas, for years has been growing in costs much faster than the economy has been growing, which increasingly puts pressure on all of us to manage cost in some way, while keeping quality high or even improving quality," DHS director John Selig says.

Gov. Mike Beebe and DHS both became convinced, Selig says, that "the core of the problem was our fee-for-service payment system where, really, we pay for volume. The more tests you do, the more you get paid for. The more times somebody comes in to see you, the more times you get paid. As long as we were paying for volume and not paying for quality and coordinated care and outcomes, we were going to continue to have this problem."

Some states have tried to get out of this trap by turning to managed care; others, like Massachusetts, have created their own integrated health-care systems that can essentially act like managed-care companies.

"Arkansas [like many] rural states is not in either of those boats," Selig says. "We really have no managed care to speak of and most people don't want managed care here. Our belief is that we'd rather run the Medicaid program ourselves and not pay a large fee to somebody. We also don't have a large integrated system. In general around the state, you've got relatively small hospitals and a lot of independent doctors."

The fresh approach pioneered by Arkansas is to establish a statewide program of incentives and accountability within the existing system of payers and providers, a reform effort that has never been attempted on this scale.

One of the initiative's key innovations is a move toward evaluating quality and costs via "episodes of care." Rather than looking at providers and procedures in isolation, DHS and their private partners evaluate costs and quality over the entire course of treatment of a condition, from office visits to hospitalizations to prescribed medications, and so on.

"Let's take a knee replacement," Selig says. "We look at that entire episode. Who are all the providers involved in that episode of care, from the hospital to the radiologist to the surgeon, and others. We're going to look at that [entire] period and figure out what it costs to do all that care that's involved. We're going to say to the provider, 'we are going to incentivize you to make sure the care is coordinated and the best practices are used.' "

The other innovation in the initiative is the public-private partnership. Arkansas Blue Cross Blue Shield and QualChoice, the two largest private insurance companies in the state, have worked alongside Medicaid on establishing the episodes of care and the standards used to evaluate them. For many providers, Medicaid patients represent less than 20 percent of their practice, so the only way to get buy-in on the initiative was to include other payers.

"We work on this project very closely with the private payers," Selig says. "We want to be giving the same kind of signals and incentives. We don't want Blue Cross saying something completely different than we do."

Selig is quick to clarify that they are not colluding — private insurance companies will still set their own prices. But they will use the same standards to incentivize providers that Medicaid uses. This kind of coordination between multiple payers is unprecedented on this scale and the federal government is watching closely — Medicare may eventually join the initiative.

So far, the Payment Improvement Initiative is focused on five episodes: ADHD, perinatal care, congestive heart failure, joint replacement and upper respiratory infections. Each of these episodes has quality and cost standards developed by meeting with local doctors, as well as employing local and national historical billing data, claims data and evidence-based quality standards.

For each episode, the payer (either Medicaid or a private insurance company) will identify a primary doctor, known as the principal account provider (PAP), or as Selig puts it, "the quarterback" (for example, for perinatal care, the PAP would typically by the ob-gyn). The initiative features three broad categories for evaluating the PAP's episode-of-care costs — if rated "commendable," the PAP will be rewarded by receiving a bonus payment; if rated "acceptable" they will be paid as normal, and if rated "exceeding the acceptable threshold," they will be penalized by having part of their reimbursement withheld.

By giving one key provider skin in the game, the initiative should produce more motivation to keep costs reasonable, and will also put someone in charge of coordinating the care — not some bureaucrat, but the primary doctor. Coordination not only improves the care the patient receives, it drives down costs, for example, by avoiding multiple duplicative tests ordered by doctors unaware of what other doctors have ordered.

Providers must meet quality standards as well as hitting cost targets so that the level of care does not decline even as doctors practice in a more cost-conscious way. (In many cases, DHS hopes improved quality will reduce costs by avoiding problems that require more care down the road.)

"Part of what you're trying to do is get the unnecessary variation out of there," Selig says. "You might see a lot of providers able to do a knee replacement for $10,000 and others up in the $25,000 range."

Selig says that simply providing clearer information about actual costs has been a revelation to some doctors.

"We've had surgeons say to us, 'I never knew that that's what that costs — that test or that implant, I just ordered it. I liked it as well as any other. Nobody told me that that cost 20 percent more.' "

According to Selig, the program still gives doctors flexibility and will not produce one-size-fits-all medicine. Tracking is done over an entire year, so doctors are being evaluated with a large sample, not on any individual patient. And exceptions and risk adjustments will be applied to certain types of patients that might drive up costs beyond the provider's control.

"You always are going to have docs who, given the individual patient, are going to treat them differently," he says. "We are not wanting a cookie-cutter approach. We still want every doc to do what's best for that specific patient. We're just saying over the course of a year, if your costs are a lot higher than the other guys, or if they're a lot better, we want to incentivize you on that."

Additional episodes of care will be added to the initiative in the coming years and DHS is hoping to completely move to the new payment system over the next three to five years.

"At a minimum, we think we can probably save 2 percent of what we would otherwise have spent," Selig says. "That turns in to millions of dollars over the next few years and compounds from year to year." DHS projects that the initiative will save the state Medicaid program, currently facing a budget shortfall, $15 million in fiscal year 2014 and $65 million in 2015.

Selig acknowledges that some providers may be nervous about the changes, but says that most are "cautiously optimistic."

"Good physicians will tell you, 'we work to coordinate the care, and you don't pay us a dime,' " he says. "We're trying to incentivize what good docs already do."

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