This has been a productive year for the Laura and John Arnold Foundation
(LJAF) and our team. We significantly expanded our work on evidence-
based policy, extended our efforts in criminal justice, made highly
strategic investments in education, and advanced important initiatives in various
other areas, including healthcare and research integrity.
From LJAF’s inception, we have adhered to a single process for achieving
transformative change, regardless of issue area: We study problems in great
detail by surveying existing data and research, seek advice from leading experts,
develop proposed solutions, rigorously test programs and interventions, and
scale those that are proven to be effective.
As a young foundation, we are still at the early stages of this trajectory, but we have made great headway
in 2015. Our Research Integrity team helped lead the effort to develop new guidelines for research
transparency that have been endorsed by more than 500 scientific journals and organizations. Our
Sustainable Public Finance team supported initiatives to improve retirement security for workers
in several states. In education, we worked to advance the portfolio model of school governance, as
more cities embrace this structure to address systemic inequities and improve student achievement. In
criminal justice, we have increased the presence and impact of our Public Safety Assessment (PSA) tool
while continuing to evaluate its efficacy. And in healthcare, we invested in efforts that are making it
easier for doctors, insurance companies, and individuals to obtain objective information about how well
pharmaceutical drugs work and for which patients.
In the coming year, we will continue to pursue our methodical approach to problem solving so that
innovative ideas can be tested, proven, and widely adopted. In some areas, leaders have already expressed
interest in interventions such as our PSA tool and the Pay for Success financing model. Our challenge is
to promote the adoption of these tools while, at the same time, maintaining fealty to the very important
concepts of rigor and evidence. Other areas will require investments in the development of an evidence
base. Such is the case with our work in research integrity, where we fund replication studies to ensure
that foundational knowledge is accurate and reliable, and in evidence-based policy, where we evaluate
promising social programs to identify those that deliver significant results.
In addition, we will explore new areas where we see opportunities to apply our strategy for improving
social good. This includes our recent investments to increase transparency and fight government
We plan to build on our commitment to furthering evidence-based practices across multiple disciplines in
2016, with the ultimate goal of fixing broken systems and producing measurable, lasting improvements
in people’s lives.
Laura and John Arnold
Evidence-Based Decision Making02
The Laura and John Arnold Foundation (LJAF) works to solve some of society’s most pressing and persistent problems.
Our team is
focused on fixing the nation’s education and criminal justice systems,
increasing government performance and accountability, improving the
quality of scientific research, and addressing a range of other critical
issues. At the heart of all of our work is a deep commitment to developing
and identifying solutions that are grounded in reliable research and
information. If we are to truly achieve transformational change in any
aspect of society, we must have a clear understanding of the evidence.
In 2015, LJAF dramatically expanded efforts to advance evidence-
based decision making in the public sector by launching a new
initiative area specifically focused on evidence-based policy and
With team members based in our new office in Washington, D.C., as well as
in Houston, this group supports initiatives that encourage governments
and nonprofit organizations to help build the evidence base for social
interventions and to consider reliable evidence as one of the primary factors in
We believe that governments and nonprofits should continually analyze and
evaluate the impact of their programs and try new approaches. Efforts that are
found to be successful should be replicated and scaled, while those that are
ineffective should be modified or eliminated.
All too often, public funds are allocated to projects and programs that do not
deliver the intended results. When evaluated in scientifically rigorous studies,
many programs are found to have little to no positive impact. In order to make
significant progress in any area, we must accelerate the pace at which we learn
what works and insist on services that produce measurable results.
Rigorous Evaluations to Identify Promising Social Interventions
A major portion of our work in evidence-based policy and innovation is focused on identifying the
social interventions that produce the greatest benefit. One of the primary ways that we do this is by
systematically monitoring all of the rigorous program evaluations that are conducted in every area
of social policy. We then highlight the programs that meet, or nearly meet, a “top-tier” standard of
evidence. These are interventions that have been shown in well-conducted randomized controlled
trials (RCTs) to produce sizable, sustained benefits to the program participants or society as a whole.
Examples of highly effective interventions identified through our expert review process include
an early childhood home visitation program for first-time mothers shown to reduce child abuse
and neglect by up to 50 percent and to significantly improve other outcomes; and a low-cost,
personalized job placement program that helps individuals receiving unemployment insurance
return to the workforce and increase their earnings by 18 percent over two years.
We maintain a comprehensive, user-friendly database of these and other highly effective interventions
spanning the full spectrum of social policy. The collection is one of the most frequently cited
resources of its kind and is used by policymakers at all levels of government to inform more effective
decision making. This review effort was initially launched in 2008 by the Coalition for Evidence-
Based Policy, an organization that was integrated into LJAF this spring.
Another important way that we work to identify proven interventions is by directly funding
low- or modest-cost evaluations, including well-conducted RCTs, that measure the effectiveness
of programs and practices. RCTs, which are widely recognized as the gold standard in scientific
research, make it possible to isolate the effect of a program apart from complicating factors. When
programs are shown to have a significant impact, we fund more extensive evaluations to ensure that
those impacts can be successfully reproduced and sustained over time and to identify the conditions
under which the programs are most effective.
Key LJAF-funded RCTs include an evaluation of a diabetes prevention and management program
that is administered by food pantries instead of doctors’ offices; a housing authority initiative
intended to provide better support for tenants by restructuring rent rules to include financial
incentives for steady employment; and an effort aimed at improving outcomes for college students
by changing the way financial aid is distributed so that students are more likely to make wise
financial management decisions and complete their studies.
Effective and Efficient Government03
Across the nation, many state and local governments have expressed interest in using data and research to ensure that public services are delivered in an efficient and impactful way.
Despite this strong desire to adopt an evidence-
based approach to decision making, jurisdictions often do not have the resources to
translate data and research into sound public policy. Governments frequently lack
the funding and expertise to rigorously evaluate the programs they provide. As a
result, new programs may be implemented without a solid understanding of whether
they will work as promised, and existing programs may remain in place without
evidence to show that they are achieving their intended outcomes.
In 2015, we seeded policy labs to help governments conduct and
use high-quality research to improve operations and the delivery of
The Government Performance Lab at Harvard University’s John F. Kennedy School of
Government is developing direct partnerships with a select number of state and local
governments to help them carry out and evaluate a variety of projects. Key initiatives
include establishing performance-based payments for social service providers,
gauging the impact of current interventions, and implementing dashboards to track
the efforts of government workers and improve the delivery of public programs. The
lab also aims to create a network of innovative government leaders that is focused on
using data to improve government performance across a broad range of areas.
A second project is the creation of the Rhode Island Innovative Policy Lab (RIIPL), a
first-of-its-kind partnership between the state of Rhode Island and Brown University.
RIIPL is helping state leaders craft policies based on data and scientific studies in
an effort to strengthen the state’s economy and provide meaningful improvements
for Rhode Island families. Areas of interest include streamlining social services,
improving public safety, and strengthening job training programs.
Pay for Success Financing to Improve Lives and Save Tax Dollars
LJAF is working to advance Pay for Success (PFS), an innovative funding model that allows state
and local governments to drive resources toward better, more effective programs.
Under the model, the government identifies a problem and specific target outcomes such as
decreasing the number of days children spend in foster care or reducing the number of individuals
who return to prison. Private investors cover the up-front costs of a program designed to meet
those outcomes, and the government agrees to “pay for success.” The government should only repay
the investors if an independent entity concludes that the program has achieved its predetermined
goals. LJAF believes that rigorous, third-party evaluations are an essential component of all sound
This unique approach to government contracting is helping to reorient public spending around
outcomes and innovation by allowing governments to make low-risk investments in promising
programs. There are roughly 30 PFS projects in various stages of development in the United States.
In order to support this demand, LJAF funds a number of groups that are providing direct technical
assistance to help governments develop and execute PFS projects.
Our largest grant in this area supports the Urban Institute’s Pay for Success Initiative. The
organization is creating resources to help governments determine whether a PFS project is the
most effective and cost-efficient way to address a particular issue, as well as tools to structure deals,
establish benchmarks for success, and identify a method to evaluate whether a project is successful.
In addition to funding technical assistance, LJAF supports the pilot and evaluation components of
specific PFS projects and is a direct investor in two initiatives.
Sustainable Public Finance04
One of the most pressing issues threatening the fiscal health of cities and states is the unsustainable state of their public pension systems.
systems, which are supposed to protect workers’ long-term financial
interests, are now putting their retirement security at risk. In fact, conservative
estimates indicate that cities and states currently owe workers more than a trillion
dollars for retirement benefits they have already earned.
Many governments have been shortchanging workers for far too long. Political
leaders have failed to make adequate payments into the pension systems and have
relied on improbable investment return assumptions to make up the difference. This
chronic underfunding has serious implications for both workers and taxpayers. The
growing pension debt is forcing many localities to direct money away from critical
public services such as schools and policing.
LJAF helps cities and states analyze the true magnitude of
their pension problems and create systems that are affordable,
sustainable, and fair.
We believe that responsible pension reform should include a plan for cities and states
to pay down the pension debt in 20 years or less, and a requirement that governments
pay their pension bill in full every year.
In addition to our work in public pension reform, we seek to improve retirement
security for private-sector workers. Approximately 35 percent of private sector
employees do not have access to a retirement savings plan through their employer.
One promising solution is a state-sponsored Secure Choice savings program that
provides a low-risk, low-cost way for individuals to voluntarily save for retirement
through automatic payroll deductions and to retain those savings even if they change
jobs. LJAF supports Secure Choice plans in California and Connecticut by funding
the research and analysis used by each state to develop a plan design that benefits
Minimum Wage Research
In an effort to improve the well-being of low-income workers and families, a number of cities have
recently approved minimum wage increases of up to $5 an hour. Yet not much is known about the
impact of such sizable increases. The existing research does not provide a comprehensive picture of how
the effects will be spread across individuals and households, and how they will vary across industries,
neighborhoods, and geographic areas. LJAF is funding several research projects that will study whether
a higher minimum wage can promote economic opportunity and contribute to the long-term financial
sustainability of workers and families. In particular, researchers will assess whether a higher minimum
wage produces significant benefits for workers in areas such as health, food security, and overall earnings.
The researchers will also examine businesses to analyze changes in employment levels and operations,
as well as low-income neighborhoods to determine the effects of residents’ increased spending power.
As part of our effort to promote fiscal sustainability and the effective oversight of public funds, LJAF
supports initiatives to help governments evaluate the impact of tax policies. Well-designed tax policies
not only raise revenue to finance government programs and operations, they also play an important
role in expanding opportunities, reducing income inequality, and supporting the nation’s long-term
economic growth. However, poorly designed policies can have the opposite effect. In 2015, we funded
research to assess the impact of minimum wage increases, the Earned Income Tax Credit, and how
geographic location affects individuals’ ability to recover from economic downturns.
LJAF also supports The Pew Charitable Trusts’ Economic Development Tax Incentives project. In the
past year, each of the six states participating in the project—Indiana, Maryland, Michigan, Oklahoma,
Tennessee, and Virginia—has made progress toward implementing scalable solutions that would
improve the way they evaluate the impact of economic development incentives, articulate policy goals,
or use data in their incentive programs. In addition, Oklahoma and Tennessee approved laws requiring
that tax incentives be regularly evaluated. The legislation will serve as an example for other states.
To help ensure that government funds are spent wisely, LJAF supports initiatives to deter, identify,
and combat corruption. We are funding the expansion of a research hub at Columbia Law School
that is bringing investigators, prosecutors, oversight authorities, and ethics officials together to develop
the alliances, tools, and insights needed to tackle corruption at all levels of government. Currently,
investigators often rely on random audits and tips from whistleblowers to identify instances of
manipulation of public data, bid-rigging, money laundering, and other abuses of public authority for
private gain. A major portion of the center’s work is focused on building a data-driven framework that
will allow investigators to proactively identify areas where problems are most likely to occur and to
intervene before they become widespread.
We are also funding efforts to fight corruption in government contracting on a global scale. It is estimated
that up to a quarter of procurement budgets worldwide may be influenced by corruption and fraud.
In addition to the obvious economic losses, there are significant human costs, such as when poorly
constructed schools in earthquake zones have collapsed on students or when counterfeit medicines
have resulted in patient deaths. The Open Contracting Partnership is working to improve transparency
in public contracting, and we support its work to push for the standardized disclosure of data and
information about the planning, procurement, and management of public contracts.
Well-informed citizens play a central role in a healthy democracy.
When individuals are armed with reliable information, they are able
to vigorously debate important issues, evaluate the effectiveness
of public and private institutions, demand accountability, expose injustice,
and drive positive change. LJAF supports the development of technology and
resources to make public information more readily available.
One such example is our funding for Digital Democracy, a web-based platform created by Cal Poly,
San Luis Obispo that allows citizens to virtually access any state legislative hearing in California.
Individuals can enter a search term and find relevant video clips and contextual information about
political issues and debates.
Users are able to watch videos and read scrolling transcripts that identify the speakers and link
to profiles for the legislators and lobbyists who are participating in the discussion. In addition,
individuals can access information about specific pieces of legislation, including summaries, the full
text of the bill, and committee analyses.
Digital Democracy has been recognized by journalists, state officials, and political activists as a
potential game-changer for improving government transparency and state political coverage.
Since the launch of the platform in May, its automated transcription service has transcribed more
than 700 hours of testimony from lawmakers, lobbyists, and members of the public. The Digital
Democracy team has also developed a database of lobbyists and the clients they represent, and has
created profiles for more than 8,600 people who spoke during public hearings in 2015.
In addition, LJAF supports the Internet Archive, the world’s largest public digital library, to ensure
that there is a comprehensive, open record of the internet that is accessible to all. Studies show that,
on average, a webpage is altered or deleted after only 100 days of being online. When pages are
erased, edited, or abruptly moved, there can be wide-ranging consequences. For example, public
figures can retract or modify statements after issuing them and annotations in scientific studies can
The Internet Archive has worked to address this issue by preserving more than 439 billion Web
captures—including webpages, video, and images—through data donations, automated archiving
of millions of websites, and collaboration with a thousand scholars and librarians. We are funding the
development of an enhanced search engine that will enable users to perform more robust searches by
entering a topic or keyword. This functionality will allow individuals to find an extensive selection
of content tailored to their search criteria and will create unparalleled access to our digital history.
LJAF recognizes the importance of high-quality journalism and the need for more thorough reporting
on critical issues. In today’s competitive, fast-paced, digital world, many news organizations have
shifted away from investigative reporting since these stories often require an extensive amount of
time, significant resources, and in-depth analysis to produce.
We provide general operating support for organizations that create accurate, objective reports,
including ProPublica, a nonprofit organization dedicated to investigative journalism in the public
interest. ProPublica adheres to the strictest standards of journalistic impartiality and covers stories
related to government, business, institutions, and other areas where the team’s reporting can make
a major impact. Our funding also supports The Marshall Project, a nonprofit, online organization
focused on issues related to criminal justice in the United States. The Marshall Project is committed
to accuracy, fairness, and impartiality. It develops deep investigative projects, narratives, and profiles
that put a human face on criminal justice, and produces explanatory and contextual pieces.
In addition, we fund the Center for Public Integrity’s (CPI) ongoing coverage of the flow of money
in state politics in order to increase transparency in state-level government decision making. CPI
tracked political contributions and advertising in all state races and ballot initiatives in the 2014
election cycle. It is now monitoring elected officials during at least the first two years of their terms.
Journalists are producing reports about officials’ voting records, analyzing policies that may have
been influenced by donors, and creating profiles of national groups that are active in state politics.
The reporting, profiles, and other information are hosted on a Web platform that serves as a hub for
the public and other news media.
Criminal Justice Reform06
In 2015, LJAF conducted the widespread rollout of the Public Safety Assessment (PSA).
Considered one of the most important criminal justice
reform initiatives in the United States, the PSA helps judges determine
which defendants should be detained prior to trial and which can be safely
released. A number of jurisdictions have adopted the pretrial risk assessment
tool, and initial results indicate that it is helping to increase public safety,
reduce jail populations, and free up millions of tax dollars for other government
LJAF developed the PSA after research showed that many defendants who we as a society would
expect to be detained while awaiting trial—the individuals who pose the greatest threat to public
safety—are released. Meanwhile, low-risk, nonviolent defendants regularly spend extended periods
behind bars before trial. This occurs because judges often do not have access to relevant information,
such as a defendant’s criminal history, while making pretrial release and detention decisions, and
frequently must rely on inflexible, charge-based rules, like bail schedules.
The PSA is helping to improve the way the system operates by providing judges with objective,
reliable information about the likelihood that a defendant will engage in violence, commit a new
crime, or fail to return to court if released before trial. Judges can then use that information—in
concert with their professional discretion—to make more effective, evidence-based decisions.
Developed using the largest, most diverse set of pretrial records ever assembled—1.5 million cases
from approximately 300 jurisdictions across the country—the PSA is based on factors that are race-
and gender-neutral. These include a defendant’s criminal history, age, and current charge. The tool
is easy to administer and will be adopted by other jurisdictions in the years to come.
Having now implemented the PSA in numerous jurisdictions of varying characteristics, we have
engaged third-party researchers to conduct rigorous evaluations of the PSA. These evaluations
include RCTs as well as qualitative evaluations, both of which will inform the scope and future use
of the tool.
In response to recent incidents in Ferguson, Missouri, and other communities, LJAF is working to
advance evidence-based policing practices. Initiatives in this area demonstrate our commitment to
conducting rigorous empirical research and then translating it into actionable policy and practices.
One key initiative is focused on assessing the impact that police body-worn cameras have on
public safety, policing strategies, and community perceptions of law enforcement. Currently, there
is limited research about how the cameras can be most effective. We are funding a number of
foundational research studies to address this and other critical questions.
This year, LJAF funded a series of research studies on the common practice of imposing monetary
sanctions on individuals involved in the criminal justice system. Beyond anecdote and a handful
of case studies, very little national research exists on important questions regarding the application
of fines and fees, including their impact on public safety. To fill the gaps, we funded researchers to
study the effects of court-imposed monetary sanctions and to assess the field of alternatives to fines.
LJAF supports a number of initiatives focused on preventing crime. One promising approach is the
use of Cognitive Behavioral Therapy (CBT), which targets the dysfunctional thought and decision-
making patterns that contribute to negative behavior. We are funding Roca, a nonprofit dedicated
to disrupting the cycle of incarceration, and its partnership with Massachusetts General Hospital
to create and evaluate a specialized CBT program for 17- to 24-year-old men, the population that
is most likely to engage in criminal activity. To date, there has been no CBT program specifically
designed for this cohort. If successful, the program will be scaled to serve as a national model.
LJAF is working closely with the forensic science community to ensure the reliability and integrity
of evidence used in law enforcement investigations and criminal prosecutions. One of our major
areas of interest is improving crime lab operations. In recent years, serious problems with oversight,
policies, and procedures at a number of labs across the country have come to light. In 2015, we
assembled a panel of experts to review and evaluate dozens of strategies to address these issues. We
plan to develop the most promising concepts into specific projects.
Data Collection and Distribution
Our Criminal Justice team is laying the foundation for best practices in data collection and
distribution so that leaders can make decisions based on an objective understanding of the tactics
and interventions that have the greatest impact on safety, efficiency, and fairness. This year, we
funded The Governance Lab to develop ways to make it easier for criminal justice agencies to share
data within and across jurisdictions. The initiative will place a fellow at the White House who will
lead the effort to organize stakeholders in support of data-driven criminal justice innovation. It will
also document the baseline of current data-sharing practices and communicate the benefits of more
openly accessible data.
Innovation in Education07
Over the past ten years, students, teachers, administrators, and civic leaders in New Orleans have done what few thought was possible: They have transformed one of the lowest-performing school districts in the nation.
Student performance in New Orleans is improving faster than it
has in any other district in history. The numbers speak for themselves: 62 percent of students are performing at grade level,
compared to just 31 percent in 2004; the proportion of students attending low-performing
schools has decreased by 47 percentage points; 73 percent of students are graduating on time,
compared to 54 percent in 2004, and nearly two-thirds of these students are enrolling in college.
Scalable breakthroughs in education have been few and far
between, but the New Orleans model is proving that opportunity and
achievement can be dramatically increased across entire cities.
The model is built around a portfolio concept of school governance, where educators are empowered
to make decisions at the campus level, families are no longer limited to their neighborhood school,
and an independent entity evaluates student performance and works to promote equity throughout
LJAF has invested heavily in New Orleans. We support efforts to create excellent schools, develop
talented teachers, and build community engagement. We are proud to partner with all those who
are committed to ensuring that every child is able to attend a high-quality school.
Inspired by the progress in New Orleans, we are also pursuing opportunities to help other cities, such
as Memphis, Tennessee, and Camden, New Jersey, transform their school systems using elements of
the portfolio model. We fund initiatives that promote a decentralized administration, more school
choice, and greater flexibility and accountability for school leaders and educators.
In addition to this work, LJAF supports a number of education research programs and partnerships.
The Education Research Alliance for New Orleans at Tulane University is studying how the New
Orleans reforms have influenced teaching and learning in the city’s schools and what those findings
might mean for other communities. We also seeded the Houston Education Research Consortium
at Rice University and the Dallas Education Research Consortium at University of Texas at Dallas.
Through these partnerships, researchers work with local school leaders in Houston and Dallas,
respectively, to design and conduct studies that evaluate the impact of district policies and programs.
The long-term alliances are aimed at closing student achievement gaps by providing the evidence
needed to support more effective decision making in K-12 education.
Cutting-edge Technology to Improve Student Achievement
LJAF believes that technology can play an important role in helping to ensure that every child, no
matter where he or she lives or attends school, can obtain a high-quality education. We are funding
a digital personalized learning assistant (PLA) that has the potential to transform the educational
experience for today’s students.
Developed by a team of scientists, engineers, and human learning experts at Rice University, the
PLA combines the principles of cognitive science—what research has taught us about the way
the brain works and how people learn—with the power of machine learning. It uses data-driven
algorithms that adapt and react to an individual student’s needs.
The technology, which can be accessed for free from any device, assesses what a student understands
and how he or she learns best. It then caters to that child’s learning style by delivering customized,
interactive lessons. Teachers, parents, and administrators are able to track a student’s progress in real
time. They can see which concepts the child comprehends as well as those that he or she finds more
challenging. These unprecedented insights allow teachers to intervene at the first sign of trouble to
support every child in mastering the subject material.
The PLA is currently being piloted for Advanced Placement physics and high school biology courses,
and the Rice team will rigorously evaluate the PLA’s impact on student learning. If it is shown to be
successful, the group will produce a replicable system that can be applied across subjects and grade
levels in school districts throughout the United States.
In addition to funding efforts that promote high-quality educational opportunities at the K-12
level, we are supporting initiatives that leverage technology to make a college education more
affordable. We fund edX, an interactive online platform that provides free, Massive Open Online
Courses (MOOCs) from some of the world’s top universities. A 2015 grant will allow edX to
expand its partnerships with colleges and universities. These partnerships will make it possible for
more students to take classes on the edX platform and earn college credit for those courses at a
fraction of the normal cost of tuition. Credits earned through the MOOCs are indistinguishable
from those earned by students who take the classes on campus.
Personalized Learning Assistant
Adapts to individual learning preferences
Delivers customized, interactive lessons
Pinpoints areas where students need more help
Reacts by delivering content to reinforce concepts
LJAF has created a comprehensive plan to increase value in our nation’s healthcare system.
We began by conducting a detailed analysis of every
layer of the system, including the care provided by doctors and health
systems; the coverage plans offered by employers and insurance companies;
the quality and cost of medicines and treatments; and the decisions made by
patients themselves. This extensive review allowed us to identify a number of
high-leverage opportunities that we believe will help to improve the quality of
care and reduce costs.
The healthcare payment system is currently designed as a fee-for-service model, where physicians
and hospitals are incentivized to deliver services regardless of whether they are actually needed or
will have the greatest impact on patient health. This structure does not support the best interests of
individual patients and carries significant costs for the health of our nation and the economy. Our
grantees are exploring ways to realign the payment system so that it is driven by the ultimate goals
of keeping people healthy and providing patients with high-quality care at a sensible price.
As the single largest payer, Medicare exerts tremendous influence over healthcare pricing. It recently
began experimenting with ways to transition away from the fee-for-service model to payment
structures that emphasize lower spending and higher quality through models such as Accountable
Care Organizations (ACOs). LJAF is funding an evaluation of ACOs conducted by the Harvard
HealthCare Markets and Regulation Lab. We believe that this study will yield valuable information
that decision makers can use to better understand and improve healthcare payment systems.
Employers can also play a central role in changing the system since they collectively purchase health
insurance plans that serve 160 million Americans. Yet, to date, only a few of the nation’s largest
employers have actively negotiated with insurance companies to make changes to the healthcare
payment structure. We support Pacific Business Group on Health and its efforts to create a broad
network of employer purchasers of healthcare that will evaluate new employer-led payment changes.
Those that are shown to have the greatest impact will be implemented and scaled throughout the
network with the aim of reducing costs and improving patient health.
Patient Decision Making
The decisions that we make when choosing a doctor, hospital, or treatment plan are some of the
most important considerations of our lives. Yet, we often have very little reliable information to
help guide these decisions. It is nearly impossible for patients to effectively compare and evaluate
the quality and cost of the care provided by doctors and medical centers. This has significant
implications for people’s health and personal finances, and it plays a major role in the unsustainable
cost of the healthcare system. LJAF is supporting a number of efforts that will empower patients to
make informed decisions about their health.
We seeded the Center for Healthcare Transparency (CHT), which is developing solutions that
will make it easier for individuals to compare healthcare options. CHT is establishing common
protocols that will help regional data centers integrate various types of healthcare data—such as
medical claims, clinical data, and patient surveys—that are extremely difficult to combine today.
They will then communicate that information in ways that benefit patients, employers, and public
In addition, we are funding a Harvard HealthCare Markets and Regulation Lab study to determine
whether providing cancer patients with transparent information about the cost of care influences
their treatment decisions. People with cancer must often choose between treatment pathways
when there is no definitive clinical recommendation for care. As a result, the “right” choice for a
patient depends heavily on that individual’s preferences. Given that cancer care can be cripplingly
expensive for patients and families, it may be critically important for patients to understand up
front the likely health effects that the treatment will have as well as how much it will cost. Currently,
most doctors are not able to provide patients with estimated out-of-pocket costs when discussing
treatment options. Ensuring that individuals have financial information at the outset may help
them to better assess the value of various treatment options relative to clinical benefits and to choose
a plan that best meets their health and financial needs.
Hospital and Physician Best Practices
The way care is delivered to patients varies widely from hospital to hospital and even from physician
to physician. This means some patients may receive treatment for a common condition such
as diabetes or congestive heart failure that is less effective or more costly than other treatment
approaches. While experts have demonstrated ways to improve value in certain settings, the lack
of coordination across health systems and the absence of a framework for large-scale changes
among different types of providers can lead to a significant gap between the time that breakthrough
treatments or practices are identified and the point at which they are widely adopted. It is therefore
essential to improve communication channels in order to help save lives and conserve resources.
Our grant to the High Value Healthcare Collaborative (HVHC) is funding the creation of a first-of-
its-kind learning network for disseminating best practices across HVHC’s member health systems,
which serve 20 percent of the U.S. population. The network will provide clinicians with access to
the information, training, and resources needed to implement evidence-based treatment strategies
that have been shown to make a difference in other hospitals.
Pharmaceutical Drug Pricing
The skyrocketing price of pharmaceutical drugs poses a serious threat to the sustainability of the
healthcare system. Drug prices have soared to new highs amid questions about their true value
to patients. In an effort to address this urgent concern, LJAF is funding a program through the
Institute for Clinical and Economic Review (ICER) that is designed to transform the way drugs
are evaluated and priced. ICER is producing public reports on new drugs that have the potential
to significantly impact patient care and health system budgets. Each report includes a thorough
analysis of how well the drug works and for which patients, and how it compares to other similar
drugs on the market. In addition, ICER uses transparent methods to calculate a price benchmark for
each drug that is directly tied to the benefits it delivers to patients. The reports will help healthcare
providers negotiate prices that reflect a treatment’s value to individuals and the healthcare system
as a whole. This will support the design of new insurance benefit programs that more effectively
manage patients’ health outcomes and the cost of treatment.
Obesity and obesity-related diseases are costing the U.S. healthcare system more than a billion dollars each day, and the problem is only getting worse.
In the almost four decades since the government first started
providing dietary advice, the percentage of Americans who are obese has more
than doubled, and the number of people with diabetes, according to the Centers
for Disease Control, has quadrupled. With such alarming increases, we can no
longer pretend to know what constitutes a healthy diet.
LJAF has developed a three-pronged strategy to address this public health crisis.
First, we are funding rigorous nutrition research to help establish clear evidence
about what is causing the obesity epidemic. Second, we are promoting the use of
the limited high-quality information that does exist to inform nutrition policy in
the near term. And finally, we are supporting efforts to develop a process that will
help to ensure that, over the long term, all nutrition policies are crafted using high-
Rigorous Nutrition Research
The vast majority of nutrition research that has been conducted to date is deeply flawed. It is difficult
to discern any credible guidance from existing studies, which often rely on small sample sizes or
demonstrate only correlation, not causation. Many studies also base their findings on unreliable
observational research, such as the results of a survey in which people were asked to remember what
they ate and write it down.
These and other substandard research methods and findings do not allow us to
determine what is causing the obesity epidemic. Conclusive scientific evidence
is needed, and LJAF is funding well-designed, highly controlled studies to help answer several
Are all calories the same, or do calories from fat and carbohydrates have differing effects on weight gain?
What is the most effective way to maintain a healthy weight: consume fewer calories, or change the amount of fat and carbohydrates in your diet?
Can a sugar-free diet reverse the effects of Non-alcoholic fatty liver disease, the country’s most prevalent obesity-related disease?
These studies will be more reliable than those conducted previously and will help to establish what
we should and should not eat in order to be healthy.
Near-Term Policy Solutions
While more research is urgently needed, there is a growing body of scientific evidence that indicates
that consuming too much sugar is harmful to one’s health and can lead to chronic diseases such
as heart disease, liver disease, diabetes, and other conditions. We are sponsoring research to assess
the impact that various policies can have on reducing sugar consumption and improving public
health. These possible policy solutions include a tax on soda and sports drinks; a warning label
on sugary products similar to the label that appears on cigarettes and other tobacco products; a
limit on the amount of sugar included in food served in schools, daycare centers, and nursery
schools; a restriction on the purchase of sugary drinks and incentives to purchase healthy food
under the Supplemental Nutrition Assistance Program (SNAP); and the elimination of sugary food
and drinks from kids’ menus in restaurants.
Long-Term Policy Solutions
Over the long term, we must develop a process that helps to ensure that nutrition policy is grounded
in high-quality evidence. Earlier this year, the Dietary Guidelines Advisory Committee (DGAC)
produced a report detailing recommendations for the government’s official dietary guidelines. The
guidelines are used to influence a number of key government programs including SNAP and the
National School Lunch Program. LJAF funded an analysis of the science that served as the basis
for the DGAC’s report, and the independent review revealed numerous problems. In addition to
undeclared conflicts of interest, much of the DGAC’s report is based on observational epidemiology
that cannot show what sort of diet actually causes better health. The analysis indicated that the
recommendations were developed after a select review of evidence that did not include highly
relevant but contradictory studies. The committee failed to follow rigorous standards for reviewing
evidence. A higher standard of rigor and transparency is needed in the scientific review process, and
LJAF is continuing to pursue initiatives that will support the creation of policies that are based on
reliable scientific evidence.
LJAF’s Research Integrity initiative is working to improve the reliability and validity of scientific research.
As a society, we depend on research to
produce scientific advancements, support the discovery of new medical
treatments, inform sound public policy, and guide our personal decisions on
everything from nutrition to parenting. Unfortunately, a substantial portion
of research, including many studies published in academic journals, does not
adhere to rigorous standards of quality.
In 2015, there were a number of major developments in our efforts to increase transparency and
reproducibility in scientific research, including the release of the findings of an unprecedented
replication initiative; the development of new publication standards for scientific journals; an
expansion of our work to improve reporting and transparency in clinical trials; and the launch of a
new center focused on improving the reliability of neuroscience research.
In August, our flagship Research Integrity grantee, the Center for Open Science, released the
findings of the Reproducibility Project, the largest-ever replication effort in any scientific discipline.
The ongoing replication of important research is an essential component of scientific progress.
However, after attempting to reproduce the findings of 100 published studies in psychology, the
Reproducibility Project found that less than half of the original results could be replicated by an
independent lab. As The New York Times put it, the Reproducibility Project “confirmed the worst
fears of scientists who have long worried that the field needed a strong correction.” The results of
this initiative demonstrate the importance of rigorous standards in scientific research as well as the
need for more replication studies to strengthen the body of scientific knowledge.
While the Reproducibility Project was focused on the field of psychology, we are funding a similar
effort aimed at validating dozens of landmark cancer cell biology studies. Systematic validation of
these studies could be crucial to developing future cancer drugs.
The researchers involved in the Reproducibility Project cited misaligned incentives as a problem
that is undermining the credibility of science. Journals and funders frequently show a strong bias
for provocative findings and statistically significant results. Researchers, who have a better chance
of securing future funding when their previous studies have been featured in prominent journals,
are incentivized to alter their research, manipulate results, and publish only their successes. By de-
emphasizing the importance of null, negative, or inconclusive findings, the research community is
compromising the pursuit of scientific truth, which can only be achieved by considering all of the
One way that we are working to address this issue is by supporting efforts to improve publication
standards for scientific studies. We sponsored the Transparency Openness and Promotion (TOP)
Committee’s work to develop the TOP Guidelines. The guidelines call for scientists to preregister
their studies by submitting a description of the project before the analyses are performed, so as to
make it possible for others to assess whether the study’s findings truly confirm the stated hypothesis.
The guidelines also call on scientists to share their data and code and make their results publicly
available. In July, the leading journal Science dedicated an entire issue to the topic of “self-correction
in science.” It included the release of the TOP Guidelines, a related editorial from our Vice President
of Research Integrity Stuart Buck, and a piece that Dr. Buck co-authored on “promoting an open
research culture.” Since then, more than 500 journals and 49 organizations have pledged support
for reproducibility and transparency by endorsing the TOP Guidelines.
Clinical Trial Transparency
Another major focus of our work in research integrity is improving reporting and transparency in
clinical trials. A 2015 investigation published in The New England Journal of Medicine showed that
most clinical trial results are hidden from public scrutiny. In fact, only 38 percent of trials complied
with the federal law requiring the public disclosure of their results. Furthermore, the results of trials
funded by the federal government were reported less frequently than the results of those funded by
the pharmaceutical industry. This lack of transparency means that we do not have a true picture of
the effectiveness of many drugs and medical treatments, which poses a significant threat to patient
In order to solve this problem, we support the AllTrials initiative and its campaign to require that
all clinical trials—past and present—be registered with full disclosure of study methods and results.
In a related effort, we are funding the creation of Open Trials, an open, online database that will
aggregate all data and documents on clinical trials throughout the world. Led by Ben Goldacre
at Oxford’s Centre for Evidence-Based Medicine and Open Knowledge in the United Kingdom,
Open Trials will help to automatically determine which clinical trial results have not been disclosed,
making it possible to investigate their sponsors and researchers. For those clinical trials with
published results, the Open Trials database will make it easier to double-check the findings by
providing access to more detailed information than usually appears in the published literature.
LJAF has seeded several entities that are doing groundbreaking work to improve the quality of
research in specific fields. In 2015, we provided seed funding for a new group that is focused
on increasing transparency and improving reliability in neuroscience research. The Center for
Reproducible Neuroscience (CRN) at Stanford University will create a free, online platform that
will use supercomputers to provide scientists with cutting-edge tools that can help them better
understand the root causes of serious mental illnesses such as Alzheimer’s disease, bipolar disorder,
addiction, and depression. Many labs currently lack these computing capabilities because of
financial or technical limitations. CRN will now make it possible for researchers across the country
to perform in-depth analyses of large neuroimaging datasets as part of their efforts to study and help
doctors diagnose brain disorders.
Science and Technology
Recognizing that advances in science and technology are essential to solving many of the world’s
biggest problems, LJAF launched a new division in 2015 that is specifically focused on driving
innovation in these areas. Based in Washington, D.C., our new Science and Technology division is
working to accelerate progress across the sciences by investing in high-risk, high-reward research;
developing a network of objective entities that analyzes science policies and promotes those that
are effective; and supporting the creation of technological infrastructure that has the potential to
produce significant breakthroughs.
Occasionally, a tool, technique, or instrument is created that revolutionizes the way research is
conducted. LJAF is currently exploring promising opportunities to help stimulate these important
We are driven by new ideas and are encouraging bold thinkers to take on major challenges. In
the coming year, our Science and Technology division intends to pursue a number of strategies to
catalyze and promote new scientific advancements.