Telemedicine Saves Almost $4K Per Diabetic Annually

People are always looking for these fast facts. This is a good one. Broadband World News reports…

Telehealth can save rural diabetes patients almost $4,000 per year, according to a pilot program sponsored by broadband infrastructure finance firm CoBank.

The Federal Communications Commission’s proposal to cap Universal Service Funds (USF) prompted a flurry of comments from organizations ranging from operators to libraries, schools to healthcare providers. It also generated input from CoBank, which works with a number of smaller and regional operators looking to finance infrastructure deployments.

Here are some of the specifics…

“The first pilot concludes that rural patients with Type 2 diabetes can reduce federal healthcare costs by up to $3,855 per patient, per year using telehealth,” Tyree said in the letter.

Impact of competition on broadband speeds may come down to type of provider

Roberto Gallardo and Brain Whitacre have a new report out – A Look at Broadband Access, Providers and Technology. They used FCC Form 477 to figure out who are the biggest providers in the country, the state of competition and access to speeds of 25/3 (FCC definition of broadband) in rural vs urban areas and more.

Here are the six largest providers in the US:

I was surprised to see Charter with 22 percent rural housing units since I think of Charter as cable and I don’t think of cable as a primary rural provider. But that wasn’t what I found most interesting in the report.

I was a little surprised to see the discrepancy between urban and rural household access to 25/3:

I don’t know why I was surprised but the stark difference between 1 percent and 26 is jarring. But even that isn’t what really caught my eye. What caught my eye was the map of broadband providers by group:

Here’s an explanation of the key:

Figure 5 shows four layers: the orange layer indicates where top 6 and non-top 6 providers overlap; the blue layer indicates where Top 6 providers were the only providers (darker blue indicates a higher number of top 6 only providers); the green layer indicates where other (nontop 6) were the only providers (darker green indicates a higher number of other providers only).

Remember “top 6” are the providers shown above.

What struck me was the blueness of East Central Minnesota – trailing up north.

Roberto was kind enough to below of the Minnesota portion of the map for me. I’d like to compare it to two other maps. In each map you can see the color pattern in East Central MN – just north of the Twin Cities.e

  • The first map blue indicates only one of the “Top 6” providers serves that area.
  • The second map shows access to 25/3 broadband; orange means 50-60% have access, beige is 60-70% and light blue is 70-80%
  • The third maps shows access to 100/20; it is more diverse but yellow indicates less than 50 percent have access.
  • The first maps also shows where there is only one “other provider” which may be a cooperative, an independent or really anyone outside of the top 6.

I think it’s a powerful image of the impact of limited competition – and impact of the type of provider. Comparing East Central MN to West Central – each has areas served by one provider but the type of provider seems to make a difference in the speed of connection.

Roberto was also kind enough to send a spreadsheet with provider numbers and types by county – but with the county-level into we lose the granularity of the map. There are areas where the county may have numerous providers but a section of that county has just one – that is better demonstrated by map.

[Updated Sep 8: I’m delighted to share a new map from Roberto that includes county boundaries and provider number/types.]

Who is taking advantage of online sharing economy? And how?

The NTIA recently released info from a recent survey on who is participating in the sharing economy…

In our most recent Internet Use Survey, conducted in 2017, NTIA included questions about participation in the sharing economy for the first time. The results show that a third of Internet users in the U.S. reported selling goods or requesting or offering services from others through online platforms. This compares with the significant majority of Internet users – 69 percent – who reported using the Internet for more traditional e-commerce activities such as online shopping or travel reservations.

Sharing economy participants tend to be younger, have higher incomes and education levels, and live in metropolitan areas, our data reveal.

It turns out the biggest gap in use was between rural and urban users…

The difference between rural and urban participation was most pronounced in how consumers use peer-to-peer services. People living in rural areas are more like to sell goods online than request services. The data show there is a 64 percent difference between metropolitan and non-metropolitan Internet users when it comes to requesting services, while only a 15 percent difference for selling goods online.

If I had to guess, I’d say the absence of Uber/Lyft type services in many rural areas might explain some of that difference.

State of Broadband: better but not good enough

Craig Settles has released a new report (Revving the Community Broadband Economic Engine) on the state of broadband from the perspective of a community. He surveyed members of the International Economic Development Council  (IEDC), and looks at:

  1. the state of broadband
  2. broadband’s impact on local economies
  3. broadband-driven education and healthcare
  4. community broadband money matters

Hard to summarize such an expansive report – but I think the key is asking community members about broadband not the providers. As I found when we looked at community return on public investment in broadband – it doesn’t always coincide with profitability for a provider; just because a home or business is better off economically with broadband, that doesn’t mean they want to send a bigger check to their provider. But what providers with local roots have seen is that the investment is creating greater need (new startup businesses) and stability (greater stability for local residents, means less chance of someone leaving).

Here are some points I found interesting:

Reliability is an issue

It seems that when many communities talk about broadband quality in their area, they often are referring to network speed. But in reality, communities need to focus on reliability as much or more than speed. If kids are relying on the network to take their finals, or parents are relying on telehealth to keep them alive, being 99.99 certain that their network won’t go south tomorrow matters. A lot!

Affordability is an issue

In this year’s IEDC survey, 28% of respondents felt their constituents got great value for the money they spent for broadband. However, 27% say constituents pay too much for too little. Another 27% feel broadband in their area, if they can get it, is so expensive many cannot even afford to subscribe. 17% are happy they can get broadband but feel they should be able to get faster speeds and better service

Supply and Demand creates a vicious cycle in rural areas

On the business side of the equation, the three top barriers to broadband for businesses are codependent on each other. Rural population density, or the lack thereof, is the crux of the problem because without density it’s hard to make the financial case that draws ISPs to the table.

Without core broadband technology, it is hard to attract and retain talented people in the community. And the lack of innovative broadband enhancements after/if a community gets an initial network (because of a weak business case) just starts the circle again.

Broadband is key in economic development strategy

The percentage of respondents who are not sold on community broadband as an economic engine decreased significantly from 29% in 2014 to 13%. However, 38% say broadband is a big part of their current plan, and another 24% are incorporating broadband into their upcoming plans. 25% of respondents report that they do not have plans for using community broadband in their activities, so this stat has changed little in five years.

How does MN rank in prosperity? Pretty well

The Legatum Institute is…

a London-based think-tank with a global vision: to see all people lifted out of poverty. Our mission is to create the pathways from poverty to prosperity, by fostering Open Economies, Inclusive Societies and Empowered People.

They have created a tool that tracks how a state (or country) is doing in a number of categories:

  • Business Environment
  • Market Access & Infrastructure
  • Economic Quality
  • Safety & Security
  • Personal Freedom
  • Governance
  • Social Capital
  • Living Conditions
  • Education
  • Health
  • Natural Environment

Here’s what they say about the US…

United States is 17th in the overall Prosperity Index rankings. Since the Prosperity Index began in 2007, United States has remained at the same position.


In the Prosperity Pillar rankings, United States performs best on Business Environment and Social Capital and scores lowest on the Safety & Security pillar. The biggest positive change, compared to last year, came in Personal Freedom increasing by 5 places, whereas they dropped 4 places on Natural Environment.

Visit our Rankings table to see how United States compares to other countries.

The also have a Minnesota report. Spoiler alert: Minnesota comes in third for overall prosperity! So that’s good. And our score has increased from 62.4 to 64.3 in the last 10 years. It’s a 14-page report and it’s very interesting. I strongly suggest you check it out it’s so broad in topic. Looking at the details with a broad brush, I’d say its Minnesota’s quality healthcare and social capital that buoy our scores. Personal freedom is an area where we could use some improvement. Unfortunately our market access and infrastructure are not boosting us either.

Pew Trust new tool tracks broadband by state and compares

Pew are created a cool tool that compiles and organizes broadband policy by state. They look at

  • Broadband Programs (such as is there a Office of Broadband Development)
  • Competition and regulation (are there policies that support/hinder municipal broadband)
  • Definitions (speeds)
  • Funding and financing
  • Infrastructure access
  • Other (Such as legislative intent)

As you peruse the tool you can see how many states have legislation or other things to support broadband. For example, Minnesota is only one of 12 states to have a state broadband goal. They list 21 features or characteristics for Minnesota. Too much to copy it all here but I check out just a few things. Like state goals they list two:

It is a goal of the state that by 2022 and thereafter, the state be in: (1) the top five states of the United States for broadband speed universally accessible to residents and businesses; (2) the top five states for broadband access; and (3) the top 15 when compared to countries globally for broadband penetration.


It is a state goal that: (1) no later than 2022, all Minnesota businesses and homes have access to high-speed broadband that provides minimum download Speed of at least 25 megabits per second and minimum upload Speed of at least three megabits per second; and (2) no later than 2026, all Minnesota businesses and homes have access to at least one provider of broadband with download Speed of at least 100 megabits per second and upload Speed of at least 20 megabits per second.

Each taken from the legislation. It seems like a slick tool – especially helpful for practitioners or anyone having to understand practitioner.


FCC Should Assess Making Off-School-Premises Access Eligible for Additional Federal Support

Federal funding is the reason than so many schools and libraries have adequate access. It’s a boon to those communities. But there’s still a huge gap between students with access as home and students without it.

I have three kids. I work full time. I have lots of volunteer gigs. If I had to take them to the library to get homework done we would all be less productive citizens. So I was pleased to see the US Government Accountability Office ask the FCC to look at federal support for home broadband access for students.

Here’s their recommendation…

Recommendation: The Chairman of the Federal Communications Commission should determine and execute a methodology for collecting and analyzing data—such as conducting a new pilot program regarding off-premises wireless access or analyzing other data—to assess the potential benefits, costs, and challenges of making off-premises wireless access eligible for E-rate program support, and publish the results of this analysis. (Recommendation 1)

More recommendations are promised once the that step is completed. They also post an easy chart that outlines the downsides of having to leave home for access.