The Mathematics and Physics within Organizational Landscapes and Finance

Posted on August 21, 2017
Nilza I. Cruz Ruiz

939-644-7683


"Physics cannot predict the madness of men..."
Albert Einstein

I began thinking about studying Pure Mathematics in college at about the age of fourteen (14). First, I was passionate about numbers and what was behind them. Second, for as long as I can remember, I've always been inquisitive not only about understanding what I was reading or studying, but about "seeing" and giving life to each subject. That is, making the transfer from pure abstraction to physical matter.

I would "draw" my interpretations on paper as I could picture them. 

Interpretations of different subjects, most math related. But the most fascinating parts were interconnecting subjects that logically, or not, led to the other. And the most exciting part was relating topics I suddenly noticed made sense, but they were not all  within the "mathematical world".  As a child,I would observe and stare at objects at school, at different houses, in the street, and  save a "picture" in my memory. After, for days and sometimes months, 

these observed "things" (even with motion!) would  arise in my imagination. There was a deep sense of understanding what numbers were, what was behind them,why they existed, and how can they help the world be better. Even going to the beach, playing with the sand, observing my hand through the water would ignite many questions! At a very young age, there was  very much disposition to openness; that is creativeness, if you will.

And what a fascinating base to begin with in College! Little did I know at that point in time what a spectacular journey it would turn out to be, especially when later combining the field of Pure Mathematics with Statistics, Insurance, Risk Management, Physics, Business Administration, Marketing, Finance and Complexity Science (Fractals, Agent Based Modeling, Chaos). Learning is a lifelong experience.

I. Context

I've read much and have been directly exposed in my different work and study experiences of how ideas and concepts arising from math and physics have been used to understand the financial markets, for example. As we discussed last week, from the perspective of organizational landscapes, models can be built using tools as Agent Based Modeling which heavily rely on mathematics and computer science to simulate the interrelations between its (the organizations) agents/stakeholders and their environments. This, in order to research the existing organizational behavior, and the emergence of defined phenomena; for example, economic behavior.

But science isn't a body of knowledge. It's a way of thinking and learning about the world.It's a continuous process of discovery, testing, and revision. Learning about the would is equivalent to learning about moving targets, so models or simulations we would use as tools need to incorporate ongoing dynamics.Models used to predict financial sustainability or asses existing organizational structures are just models! They depend on assumptions and we should never mistake a good model for the "truth" of what the "Real World" (e.g.; financial sustainability, organizational structure, etc.) really represents.

Ilustration of Agent Based Model created to Simulate Emergency Room Patient Flow

If we think about the 2008 fall in the US, the financial meltdown, previously, there had been many ideas from mathematics and physics that had been used to understand financial markets, and there was a strong connection between the fields. It seems that no matter the level of influences within the fields, it was impossible to do science on Wall Street. But this is nothing new! When we think about Puerto Rico' s Government Fiscal and Economic Standing and Politics, can the fiscal/economic measures that need to be enforced be deployed within a Political environment? 

II. The Mathematics and Physics within Organizational Landscapes

The problem in the financial markets, as we all know is predicting the unpredictable. It is easy to make money when markets are rising. But predicting the "unpredictable" has been an excellent business for some, precisely because a market crash is a dramatic profit opportunity, if and only if you see it coming.

Organizational landscapes are no different than financial markets. They are composed of stakeholders, rules and regulations, norms, internal politics, governance, and operational structures. But let's reiterate the fact that a great portion of the stakeholders represent human capital, which make organization's behave as Complex Adaptive Systems in which the sociological and psychological components are critical. The Organization is a "Living Bubble" which possesses an Internal Stability within its State, which may be exposed 

to a change in Stability (i.e.; Instability, caused by different factors)  making it (the organization) Susceptible  to explode. The organization's state need to be unstabilized in order for the external cause to hold. Hence, if the bubble the organization is within bursts, it is not directly associated with one or various causes. In order for the external causes to trigger, there needs to be a change in state or instability within the bubble.

The bursting of an organization is one of a variety of a phenomena known as ruptures.  When organizations are put under significant amount of stress, small fractures begin to appear. Sometimes these fractures grow and combine into larger fractures. These larger fractures may grow into still-larger fractures, and so on, until you may get a very large fracture. These fractures follow patterns that are known as fractals, where the tiniest fractures are self-similar to the larger ones; scales only varying. The difficulty is that tiny fractures may not affect the stability and state of the system, but large ones can be catastrophic.

Sometimes, the different components within the system (organization, in this case) begin to Conspire against one another. They display a king of herding effect. When this occurs, it's almost as if the components within the system have unionized. A kick in one part of the system can significantly make it's state unstable and sensitive to certain causes of disruption. This kind of Conspiracy is sometimes referred to as Self-Organization.

For example, this is how a small labor strike differs from a catastrophic one. All strikes are caused by the same categories of sparks: unfair termination, cut wages, etc. A large strike is like a small strike that, for whatever reason didn't stop! The difference is that the biggest strikes require something more than just a spark: they require labor movement with a high degree of structure and a capacity of coordinated action.

They require a mechanism of system-wide feedback and amplification, something to transform an otherwise small event into a large event. This said, if you want to predict a major strike, forget about the grievances. Look for the Unions, the patterns of organization! This is exactly what we're after, when conducting research and constructing models to predict catastrophic events as earthquakes and hurricanes.

III. Mathematics, Physics, and Economics

I really couldn't answer the question regarding changing the sociology of the math, physics or economics departments. But what I can say is that there should be more focus at the highest levels of the government, institutional and the private sector pertaining to major interdisciplinary research initiatives. Commitment at the highest levels could hold the community together and keep it on track.

One of the most prominent arguments against mathematical modeling in finance might be thought of as an argument from psychology and human behavior. The idea is that ideas from physics are doomed to fail in finance because they treat markets as pulleys. As Newton said, physics cannot predict the madness of men. But men are part of the system, and so this reason , they too should be part of the solution.

Modeling represents one component of the macro system, and as we mentioned before, they rely on assumptions which are correlated with dynamic occurrences. States of systems can be measured with numerical standards, but changes in state are caused by influx and outflux flows. Considering that the emerging phenomena related to complex systems need not only be evaluated by their states or changes in states, agent/environment interactions should be interrelated with changes of states under different conditions.

This kind of criticism draws on ideas from a field known as behavioral economics. But using math or physics

 as a springboard for new ideas in finance does not include describing people as theorems or pendulums.

Physicists like Mandelbrot and Osborne, made progress in understanding markets by drawing on their familiarity with statistics to identify new ways of thinking about market and risk. Others, like Farmer and Packard, used their expertise at extracting information to identify local patterns that could be useful for trading.

We need to be more open to creativity in a holistic way connecting the fields of mathematics, physics, economics, social sciences, psychology and anthropology. Among the major personality traits, it is openness that best predicts performance on divergent thinking tasks. Openness also predicts real world creative achievements, as well as engagement in everyday creative pursuits. The curiosity many of us always have to examine things from all angles may lead others in high openness to "see" more than the average person, or to discover "complex possibilities laying dominant in so called "familiar" environments".

Change of mind, openness, new thinking opportunities begin at our homes. How we teach our children. How we lead them to see. The environment we create for them to think creatively. Schools. their structures, And Universities, their holistic, or not, approaches. It's just the beginning....

Familiar?

Next week we'll continue our discussion on Science, Research, and Real World Experiences

Understanding the "Real World" before talking "Re-structuring" or "Re-engineering" within organizations

Posted August 14, 2017

Nilza I. Cruz Ruiz
939-644-7683


"It can scarcely be denied that the supreme goal of all theory is to make the irreducible basic elements as simple and as few as possible without having to surrender the adequate representation  of a single datum of experience"

- Albert Einstein - 1933

Part of Puerto Rico's Fiscal Plan relates to "right-sizing" as one of the measures for obtaining fiscal stability. But if we look closely, we have a plan referring to this tactic defined as "right-sizing" or "re-engineering" geared towards serving as a temporary fix in order to comply with a fiscal target of an $X dollar amount.

But what happens with the Real World in Puerto Rico? The Real World is the set of existing organizations (e.g.: agencies, corporations, etc.) within the government Macro - Structure that serve as base for emerging unsustainable output; in this case, data which leads us to define "Real World Financial Unsustainable Results". 

The Fiscal Plan is then proposing right-sizing efforts within the existing underlying structures which serve as base for producing adverse results in terms of services, operations, and financials. We may then conceptualize the Plan is proposing "right-sizing" components (which are not duly defined or communicated within the "plan") within an existing Real World that itself needs to be re-structured.  Right-sizing requires investment expecting greater returns after the corresponding plan is implemented as a function of time: T and of course, other factors or variables. But, realistic return projections would be accurate  if and only if the efforts are performed over a solid, re-conceptualized structural base. This is not the case for Puerto Rico.

Inspired by this dichotomy consisting of "investing" over the existing "Real World  deteriorating Structure"; and not focusing on tackling its structure changes, I decided this was today's topic! Again, this has been repeated  many times. For example, we need to begin to think differently and strategically about Complexity and it's application to the organizations we are within. This, in addition to our active roles as complexity thinkers!

I.Complex Systems, Emergence and Feedback

Before talking about the "Real World" within organizations, and need to take a small step back and briefly talk about Complex Systems, Emergence and Feedbacks.

Complex Systems are composed  of many interacting parts (hereinafter agents) in which the Emergent Outcome of the System = product of the interactions between the agents and the feedbacks between that emergent outcome and the individual decisions of the agents.

                                    

MODEL I : Complex Systems, Emergence and Feedback

Emergence is the idea that the action of the whole is more than the sum of the parts (John Holland, 2014). In other words, what emergence of a complex system does is not "linearly" sum the outputs of the individual agents; but represents a global pattern which evolves considering individual agent interactions within themselves and the environment. Agents follow sets of rules and/or policies under defined structures which include governance and internal politics as critical components embedded within the system.

Emergent Phenomena provides Feedback that then affects future decisions of other agents within the System.

An example is Market Share. My individual decision of buying brand A; [one of two similar products, ( one brand A and the other brand B )] is a decision on my own. It then contributes to the market share of product brand A vs the market share of product brand B. That market share then contributes to my decision or future decisions of other people as to whether buy the product of brand A or brand B. This is repeated for other brands and is repeated so forth.

II. The "Real World Assessment" within Organizations

So let's just take some time to think about defining the "Real World" in the organizational context. It may apply to organizations within the private or government sector.  For this presentation's purposes, It is the comprehensive assessment of the Existing - Actual representation of the organization which includes:

a. Agents 

b. Agent Properties

c. Agent Behaviors

d. Rules, Regulation and policies they (agents) follow

e Internal Politics

f. Existing Landscape - Structure 

g.Governance

h.Environment (Mission, Vision, Values, Strategic Objectives)

i. Type of Organization (for example : Path dependent)

j. Economic Resources - Operation Financing Model, State Funds? Federal Funds?

k Infrastructure Resources

l. Human Capital Resources and Skills

m. Information Technology Structure and Resources

n. Output - Fiscal Results, Intelligence Results (data mining and anaylsis) *

o. Macro Ecosystem rules and regulations

* It is critical to identify and obtain critical data for at least the past ten (10) years or 80% of the organizational lifespan (if not 100%) which serves as input within the organizations global and operational core business processes. This data should be validated and commensurate with our organization's output data (i.e., costs, financial, compliance, service levels, etc.). This critical data will represent the Macro Overall Operational and Financial results which will constitute the Real World Baseline Assessment Results.

In other words, if we were to "map" a representation of our organization's real world, what would it look like, who are the agents? and what are the results (output), based on what data (input), and macro conditions ?

Of course, this is not as simple as exposed. We would have to conduct a "Real World" Assessment, including the above referenced factors.  Assessment results would then serve as baseline and input  to define the pathways to design and construct one (1) or various Alternate Models that what comply with our "Re-structuring or Re-engineering" objectives.  This pathway is illustrated as follows: 

                                   MODEL II : The Roadmap to Organizational Re-Structuring or Engineering

Validation is the process of making sure the Alternate Implemented Model is commensurate with the Alternate Conceptual Modeling planning process and design.

Verification is the process of making sure the Alternate Conceptual Model matches the Alternate Implemented Model (i.e.; after the Alternate Conceptual Model is implemented, it will be our Real World).

These processes require extensive communication amongst the stakeholders which are part of the existing structure (Real World)  or will be impacted by the Alternate Model Implementation in some way.

During meeting or other encounters of agents within the Alternate Model Planning Phase, it is expected each stakeholder will think about their individual interests. This predicts fighting and non-conclusive meetings. But this should behavior occurs naturally because of the setting of having different thinkers with different interests in one same room (for example). It is highly predictable behavior given the conditions.

But as a general tactic, the 1st topic in this type of encounter should consist of presenting all stakeholders (by means of using a visual tool in which all audience is focused) the Real World and Alternate Model Story :  explaining a Visual Map of the Real World and its results. In addition, a second Visual Map and comparative explanation of the Alternate Model, its results,  and critical  projected changes in terms of services, operation efficiency, and economic sustainability.

Second, explain to all stakeholders that each of these Complex structures produce Emerging Results  which are a result of the interrelations of all the interests they represent.

III. Conclusion

Therefore, if the Emerging Results arise as a consequence of their (agent/stakeholder) interactions, then the solution for changing the existing emerging results would then require the interactions of the same subsets of agents/stakeholders : THEMSELVES. This includes internal politics and governance as factors underlying agent interactions; amongst other components. 

This strategy would then promote the awareness that emerging outcomes are the results of interactions or interrelations, promoting then continuous communication and feedback between critical agents/stakeholders. This directly addresses strategies and tactics to be used as part of changing the way we think, and obtain different (better) results by means of interrelations. An operational and functional representation of how systems produce emergent results as outcome! This is no different, but above all,  we need to be strategic.

 Next week we'll continue with Agent-Based-Modeling and a Real World Example

ACAA : What this Government Insurance Structure Represents for Puerto Rico's Medical Center, PR Fiscal Plan and Healthcare Economy

Posted August 7th, 2017

Nilza I. Cruz Ruiz

939-644-7683

"The intellect has little to do on the road to discovery. There comes a leap in consciousness, call it intuition or what you will, and the solution comes to you and you don't know how or why."

Albert Einstein

As a continuation of last week's blog, planned for this week was a discussion pertaining to building Complex System Model Simulations. But it was an interview I listened to last Wednesday in which Jay Fonseca interviewed the Executive Director of ACAA [(Administración de Compensaciones por Accidentes de Automóviles) (Administration for Compensation of Accidents of Automobile)];  which motivated me to alter my presentation for this week. 

The trigger? When the Executive Director stated the following as part of the interview:  "ACAA lo cubre todo" ("ACAA covers everything"). This, related to the topic of patients treated in the Puerto Rico Medical Center.

As part of my professional career, I've occupied two VP positions within multinational insurance companies. The first, managing a Life, Property & Casualty portfolios, and the other, Accident & Health lines of business. So, this part of the interview really did strike me! 

Naturally, everything depends on something and we need to present context in addition to the definition of the  perspective or angle in which the discussion will be framed:

I. Context

The Administration of Compensation for Accidents of Automobiles (ACAA) is a public corporation created by  law No. 138 of June 26, 1968, as amended, known as the law of Social protection by automobile accidents, which administers insurance health care and compensation to benefit the victims of motor vehicle accidents and their dependents.

The purpose of this Corporation is to reduce the tragic social and economic effects of road traffic on the family and other dependent victims. The ACAA provides services medical-hospital  and compensation to the victims and to the dependents of deceased victims to avoid  total economic distress.

The ACAA's corporate powers are executed by a Government Board responsible for the Administration and ensure that it enforces the provisions of the Act. The Board appoints the Executive Director responsible for complying with the provisions of the Act, as well as the rules and procedures referred to in this Board.

ACAA is an agile and dynamic institution with all its integrated operational systems, which facilitates efficient, quality services and in the shortest possible time. It has employees trained and committed to excellence in service, targeted to meet the needs of our members and to promote, through education, the prevention of traffic accidents. This is public information obtained from ACAA's website.

The words/phrases I have highlighted in the last paragraph represent the drivers for validation results to be presented and for you to evaluate. The universe of patients for this study consists of ACAA patients* treated at the ASEM Emergency Room and Trauma Hospital within the Puerto Rico Medical Center for the period of 2013-2016.

* ACAA patients are defined as patients for whom claims were submitted to ACAA as the primary insurance because of the nature of the accident (automobile related). It does not imply that the claims were paid by ACAA because coverage was denied as per exclusions stipulated in the ACAA/ASEM (Trauma Hospital is under ASEM governance) contract. In this case, ASEM, a government corporation is a provider of the ACAA Insurer network (another government corporation); i.e; this is a government-government relationship (begin to think about existing government structure and efficiency please!)

II. Key Findings

• Within the distribution of 100% of claims received in ACAA corresponding to medical-hospital services, at least 80% are from the ASEM Emergency Room/ Trauma Hospital Facilities. So, it seems the ACAA structure and operation is focused on it's main provider: The Puerto Rico Medical Center regarding medical-hospital coverage. (ACAA also provides other coverages as for example disability and dismemberment).
• Patients under the effects of drugs or alcohol are denied coverage and ASEM incurs in 100% of treatment costs for these patients.
• The ACAA billing operation is a manual process. Physical claims (in paper) are taken to ACAA Central Office premises and they need to be stamped as received "1 by 1" on the ACAA premises. So, there are ACAA designated employees for this "receive and stamping" function, while another ASEM resources delivers the boxes of claims and waits for them to be "received". Just imagine, one ACAA patient's length of stay in the Trauma Hospital can consist of 90 days before discharge. Services provided to this patient, and billed manually may be equivalent to more than 100 physical papers (which represent services billed).
• The ASEM Trauma Hospitals costs approximately $45 million by fiscal year. This may surpass 20% of ASEM's fiscal year budget.
• The ASEM Trauma Hospital is the only hospital in PR and the Caribbean specialized in Trauma. It serves as a resident facility for Medical Science Campus residents as well.
• While the annual frequency of Trauma patients is low, the severity in terms of costs is significantly high. This is because these patients are "poly traumatized"; implying their health conditions require more services which are highly specialized.
• An average of 1,900 patients by year have been treated at the Trauma Hospital for a nine (9) year period*.
• 22% of these patients have been covered by ACAA while 37% by the government health reform (i.e; government-government) relationships (average 9 years). 59% of Trauma patients rely on government related insurance.
• 22% of ACAA patients have represented an average cost of $23 mm while 37% of health reform patients an average of $26 mm for the same 9 year period). $49 mm in total costs incurred.
• The ratio of average [patient percentage vs costs incurred] = 22% / $23mm for ACAA Patients and 37% / $26mm for government Health Reform patients. There's a $3mm increase for a 68% patient count increase for non-ACAA government health reform patients. This obeys the fact that financial class ACAA patients may be lower in frequency, but with much higher severe health conditions with require more treatment times resulting in longer lengths of stay in the  hospital.

* FY's 2007/2008 - 2015/2016

III. ACAA as a government corporation adopting a Universal Third Party Payer System Model

The following Model presents the interrelationship between the three (3) critical Agents in this study:

ACAA-Insurer 

Patient ( future probable insured/claimant)

ASEM - contracted healthcare provider within ACAA'S provider net

What this Model clearly presents is :

• ACAA administration executes as per Law No 138
• ASEM contracts with ACAA in compliance with Law No 138 which at the same time drives contracted coverage and exclusions in ACAA/ASEM Contract
• Patients/Insureds/Claimants have to comply with Law 138 and ACAA/ASEM Contract. This implies these agents within the system follow two (2) sets of rules (one for each corporation), multiplied by the number of sub-rules that apply for each set. This is not a lean service for ACAA /ASEM patients or people (relatives, family, etc) representing them  in the  process of filing a claim! Especially with the patient (market)  we're servicing as a majority: polytraumatized patients...

In synthesis, when coverage is triggered (i.e; an insured /patient is converted to a claimant), the implementation of the operational process begins. Operational processes include :

• ACAA's cumbersome paper work completion and processing by patient's family, or relatives. This process is by hand, not electronic.
• ACAA issues ASEM a claim number once  paperwork is received by ACAA and ACAA determines if coverage will not be excluded. For example, if the patient is under the effects of drugs or alcohol, coverage will not be provided. In other words, the patient will be treated by the ASEM  emergency room and trauma hospital, but ASEM will not be compensated for incurred health treatment costs (not under the ACAA primary insurance).
• Covered claims will be submitted by ASEM to ACAA in paper! This, because ACAA lacks an electronic billing process (at least to December 2016) .
• Payments will be received by ASEM based on contracted rates, not costs of services. The following represent contracted rates by ASEM up to 2012 (contract was expired and rates had never been modified up to 2013) . Beginning in 2013,   a comprehensive cost analysis was completed by a designated cross-functional team  consisting of excellent existing personnel (doctors, finance, cost, accounting, medical record personnel) facilitated by myself:

                                                                                   ACAA Rate      ASEM per diem (cost study-2013)

"Unidad Aguda"                                                                             $600                       $1,293

"Unidad Aguda-Aislamiento"                                                           625                         1,347

"Telemetria"                                                                                     625                         1,347

"Intensivo Intermedio"                                                                     755                          1,627                                                         

"Intensivo Intermedio-Aislamiento"                                                 780                         1,681

"Intensivo- Critico"                                                                           915                          1,972

"Intensivo-Aislamiento"                                                                    940                          2,026

IV. ACAA DOES NOT COVER EVERTHING!

So, the statement that " ACAA covers everything" is not only misleading, but FALSE. Patients are under this belief until the time of the accident. While it is true that it is our responsibility to prevent drunk driving or under the influence of drugs; ACAA needs to be more aggressive in this matter. Treated patients not covered by ACAA because of drugs or alcohol cost the commonwealth millions. Yet, they are discharged from the Medical Center and their licenses are renewed!! I do hope ACAA Administration is on the road to legislation regarding actions taken amongst irresponsible drivers. It's not only their lives at stake, but other innocent people as well.
For example, gasoline stations are at their peak selling alcohol related products.

V. Actions Taken and Recommendations

In 2013, ACAA had a debt with ASEM regarding outstanding claims ascending to $6 million. In addition, ACAA would pay ASEM an aggregate of $500,000 by fiscal year. Effective 2014, a contract was negotiated (ACAA/ASEM) which included the payment of $6mm of the outstanding debt (which as paid off) and an the annual aggregate increased to $700,000 by fiscal year distributed by equivalent payments on a monthly basis. Fixed amounts were transferred electronically into ASEM's account before the 10th of each month.  This, to alleviate ASEM cash and liquidity constraints. 

An ASEM/ACAA committee was established and met on a monthly basis. This, to revise core standards pertaining to the operational processes that were developed. Action Plans with designated responsible personnel from both parties and deadlines were agreed and implemented. Corrective and preventive actions as well. Both parties had a better understanding of how each part operated. Why? Because patient service is the utmost common goal for each party. But the existing structure is indeed challenging and complex for patients, ACAA and ASEM personnel, in addition to related agents within the system.

Although the cost incurred by the Medical Center for ACAA patients (under the influence of alcohol or drugs) is still not covered, there was/is an acknowledgement by ACAA and ASEM top management and personnel that even though they are part of two different sub-systems represented by 2 separate corporations, both parts are really components of one (1) same system - the healthcare system. The problem is really structural. Existing separate structures do not promote lean patient service and the fiscal results for the ASEM Corporation, and the government as a macro, are unsustainable. In addition, legislation can be addressed for irresponsible drivers in order to prevent accidents. 

Let's not be blindsided by the fact that ACAA's financial statement may have positive outputs. It's the mere existence of it's actual medical-hospital structure; not the mission it represents, that should be carefully evaluated. This structure represents a $94mm budget within PR's existing financial crisis. It's almost the sole (more than 80% of it's claims are from the PR Medical Center) insurer (Automobile Accident related) for the Medical Center. So, I recommend the creation of a revised ACAA structure (not necessarily a corporation) be created  (including, a raise in the existing annual rate of $35 dollars); and have the Medical Center be auto insured for automobile related claims. (a transformation for the PR Medical Center Structure is recommended as well in a previous blog. it includes revision of relationships between ACAA/ASES/PR Medical Center).

The new ACAA structure could assign ASEM and the rest of the Medical Center components fixed monthly amounts according to cost structure and claims experience. Of course, within an audit structure for continuous revisions of services provided, costs incurred, and payments. ACAA, and the Government Health Reform existing structures, can follow similar landscapes regarding their government-government-government (ACAA-ASES-PR Medical Center) with the medical center. The government structure does not need to have 2 insurers representing $2.9 billion in it's budget. Especially if more than 70% of each of these programs insureds, are treated by the governments health facility structure: The Puerto Rico Medical Center. Patients will be better served.

The transformation of the Puerto Rico Medical Center , ACAA and ASES existing structures will represent the initial steps towards establishing new landscapes for identifying and eliminating the underlying factors causing existing and deteriorating financial constraints in the government healthcare component. Also, impacting the existing PR Fiscal Plan by depending less on the PR general fund and integrating alternate models preparing for the scenario of receiving less federal funds.

Next week we'll continue with Agent based Models and Complexity