Presence

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Impact 20 2023-Presence

Presence is a leading provider of teletherapy to K–12 schools in the U.S., with a focus on special education, behavioral health, and mental health needs. Post-pandemic, the company finds itself addressing a two-pronged challenge: a national shortage of school clinicians and increased student need. The National Center for Education Statistics reports that the percentage of special education students within the entire K–12 student population has nearly doubled in 45 years—from 8% in 1977 to 15% in 2022. In the past few years, more than two-thirds of public schools have reported large increases in students seeking mental health services. 
 
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Presence has curated the country’s largest network of school-based teletherapists. With the company’s technology, students can access over 2,000 clinicians—including speech-language pathologists, occupational therapists, school psychologists, social workers, and education diagnosticians—regardless of their physical location. 
 
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Since 2009, Presence has delivered over 6 million therapy sessions to students across 47 states. Of the 10,000 schools that partner with Presence, 3,300 are part of the Title I federal education program that supports low-income students.

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Eswar Prasad says the digital yuan will play “a marginal role” in increasing the renminbi’s global presence.

Eastworld Spotlight: China’s digital yuan is not going to displace the U.S. dollar

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Digital yuan is not going to displace the U.S. dollar

Mhm. Welcome to East world spotlight, where the editors of Fortune magazine speak with the world's leading thinkers about matters of trade, technology and finance in the fast growing economies of Asia Against This morning, is eswar Prasad, professor of economics at Cornell University, uh A senior fellow at the brookings Institution and a prolific author. His most recent book is called The Future of Money Dr Prasad, thank you for being with us. My pleasure, Doctor Prasad as I read your opening chapter, uh it's fairly clear to me that the overarching theme of your book is that we all need to get ready because cash is on its way out. Uh Tell us a little bit about that, How much longer does cash have? So the end of cash is certainly on the horizon. Digital payments of various sorts, either with a swipe of a card um or a phone is certainly becoming the norm in advanced economies as well as in many emerging market and even relatively less uh developed economies, including low income economies. And I think this is partly a reflection of the fact that we now have technologies that make it much easier for consumers as well as businesses to be able to conduct these transactions much more efficiently than cash could ever provide. Certainly caches. A lot of advantages. It is uh something that can be used by anybody. It is cost free. Um it provides some anonymous tea. But all of the disadvantages of being swept away by the share advantage of being able to have digital payments accessible at your fingertips are in the palm of your hand a little bit more about china if you can. I mean they're very advanced in terms of the central bank digital currency done multiple trials of that. We heard just in the last couple of days that they're thinking of really expanding some of those trials during the winter olympics next year will be which will be interesting to see. Um And yet the chinese seem to have a real aversion to cryptocurrencies. They've cracked down on crypto uh minors within china and they have expressed concern about having arrival to their own central bank currency. Why do you think that's so? And how do you see the future of cryptocurrencies inside china? So it's not just china but many other, most of the countries governments and regulators that are very concerned about crypto currencies and that's for a number of reasons. Um Of course a layer of something like Bitcoin was that it would provide um some degree of digital anonymity and transactions what is referred to a studio anonymity. In other words you would conduct transactions just revealing or digital rather than your actual identities. Um Plus it would provide a low cost and efficient payment system. But what turned out to be the case is that Bitcoin at least in the initial years was being used largely for illicit transactions because of this cloak of anonymity. And I think there were concerns that cryptocurrencies might end up um fueling illegal commerce various sorts both within and across national borders now, of course, um something interesting happened in the last three or four years. It turns out that Bitcoin has proven to be an object failure as a medium of exchange. It is very cumbersome to use. It is very slow in terms of having transactions validated and it's quite expensive to use. The average cost of one transaction using Bitcoin Um has averaged about $20 this year. So you can't go out and buy a cup of coffee really using Bitcoin unless it's a very expensive and fancy a cup of coffee. But instead, Bitcoin and other cryptocurrencies have become stores of value. And that creates its own concerns. If you have a lot of investors, especially retail investors putting their money into a purely digital asset that is not backed by anything that has no intrinsic use, then that bubble may one day burst and and could end up hurting retail investors and have at least marshall implications to financial stability. So I think these are the sorts of concerns that have central banks and regulators in china and elsewhere very worried about these decentralized crypto currencies. And is that something that the problem that's particular to Bitcoin? Or do you see those problems as being endemic to all the various types of cryptocurrencies now, interestingly, Bitcoin, which remains the granddaddy of all cryptocurrencies that accounts for over 40% of the market capitalization of all cryptocurrencies put together has a variety of flaws. As I mentioned, it's not working very well as a medium of exchange plus it is very volatile. So you can't exactly use the medium of exchange where you might go by one cup of coffee with Bitcoin one day, you can buy many cups of coffee these days, but in another day that same unit may be able to get you a fancy meal in a restaurant. So that's sort of volatility doesn't work well for the medium of exchange. So what has happened is that you now have a number of crypto currencies that have come up that try to remedy each of these deficiencies in Bitcoin but end up having their own deficiencies. It turns out that Bitcoin does not provide to anonymously, it's possible to unravel the actual identities of uses of Bitcoin. So now you have a new cryptocurrencies such as Manero and Z cash um that provide greater anonymity. You have uh ethereum which has a more efficient algorithm. Um And there is an upgrade that is expected to take place this year or next. That could make it even more efficient processing transactions uh in high volume and at very low cost. Um There are other cryptocurrencies that are called stable coins which have more stable values and the stability of those values, ironically enough, comes from the banking of those cryptocurrencies by stores of fiat currencies issued by central banks. Um And of course there is this new and potentially uh interesting but also dangerous development that large multinational corporations like facebook might start issuing their own stable coins or even cryptocurrencies. And that could certainly be a game changer because it could prove to be serious competition for central bank digital currencies. And especially for the currencies of small economies that don't have credible central banks or that have very weak currencies. I sense that you're perhaps more optimistic about the prospects for the stable coins as a means of transactions uh digitally than you are about uh other types of cryptocurrencies that that can fluctuate so much in value. That's right. If you think about what uh facebook's Cryptocurrency which is going to be called D. M. Is going to accomplish its actually fulfilling a real need. Um Even in a country like the US, let alone many developing economies, a lot of people don't have easy access to a digital payment systems because they can't afford to have a credit card or they don't have easy access to a bank account. International payments are still very slow, very expensive. Um and they're very difficult to track in addition to taking a long time. So if you think about workers faced some Mexico or India who are working in the US and want to send remittances back to their home country, those are very large volumes, But the transaction fees on those are quite large. So being able to conduct international payments more efficiently more cheaply and in a way that makes them easier to track would be very good for economic migrants sending remittances back to their home countries, but could also lubricate international trade and finance. Um, so the ability of stable coins to create more efficient domestic as well as cross ball repayment systems is certainly a huge potential benefit. The risk, of course, is that these could again become unregulated condo. It's not just for illicit, but also illicit, um, uh, forms of fund transfers, including terrorism, money laundering and so on. Terrorism financing and money laundering. Um, so there are those real concerns that while the objectives and potential of these payment channels um could be very positive, there are some negative implications as well that need to be kept in mind. People argue that the rise of chinese uh central bank digital currency is something that the U. S. Should be alarmed about. That. It could potentially displace the United States dollar as the world's reserve currency. Do you share that concern? Is that a real threat or not? Something we should worry about? I do not share the concern, the E. C. And Y certainly is going to um uh play a role, although only a marginal one in terms of the Renminbi's increasing prominence in international finance. If you think about cross border payments later for trade or finance, all of those are almost entirely digital already. Um And the People's Bank of china, the chinese central bank has made it very clear that at least in the short run, it does not see the Ec and y as being available for transactional use outside the country. But in combination with china's cross model interbank payment system, which is a payment system that can communicate with the payment systems of other countries. If the easy and might were more easily available outside the country, it would become possible for china to transact with other countries that it has a lot of trade with. Take Russia for instance. Um uh Russia exports a lot of oil to china and in turn buys a lot of goods and services in china. That trade would no longer have to be inter mediated through the dollar. Ultra dollar based financial institutions. You could have direct trade between china and Russia using their own currencies for payment and settlement. Yeah, so as a medium of exchange as an international payments currency, one could certainly see the dollar's role um uh eroding over time. Although my view is that it will still become remain dominant as the international payment currency. But what really matters for a store of value of the reserve currency is a country's economic size and the depth and liquidity of its financial markets. But in addition, the institutional framework that is necessary to have the confidence of foreign investors and the elements of their institutional framework include an independent central bank, the rule of law, as well as an institution life system of checks and balances among various arms of the government. Most of the existing reserve currency economies have those attributes china does not, ensuring no indications of moving in that direction. So I think the chinese Renminbi will become a somewhat more important reserve currency if the chinese government continues with financial reforms, continues with capital account opening. But it's hard for me to see the dollar being seriously challenged by the Renminbi, even if the Renminbi were to be available in digital form, both inside and outside the country. So you don't see then that the adoption, the greater adoption of a digital currency for china makes it more complicated and challenging for them to keep their capital accounts closed. That will become somewhat harder if the C. N. Y. Does become available outside the country. And I think that is likely to be the case a few years from now. And more importantly, as chinese firms and banks start operating more uh across borders. Um and as you have more digital currencies, both private and central banks being available around the world, the conduit for money to come into and out of china will certainly increase over time. The E. C. N. Y. May not play uh you know a dominant role in that change. But it will certainly add to these other influences that are leading to china's capital account becoming more open. But of course one should recognize that the People's Bank of china has already indicated. Um And it was shown through its words and actions that it is committed to more capital account, opening a more market determined exchange rate. So I think they will not resist that happening. But it is certainly true that if china were to try to clamp down on this capital account, it's going to become a lot harder over time. Doctor Prasad. Uh This is fascinating. I want to thank you for your time, your book. The future of money will be released shortly and it's uh it looks like a fascinating read. Thank you so much for joining us. It's been my pleasure. Thank you very much for having me and for this conversation.

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