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Rising Costs: The Greatest Threat to Health Reform

By Mark A. Kelley, MD |9/21/17
Founder, HealthWeb Navigator

The main character in the popular film Groundhog Day is caught in a time loop where he must repeat the same day over and over again.

The U.S. Senate is now having its own “Groundhog Day” moment as it debates (yet again) a law to replace the Affordable Care Act. To add to the drama, Senator Bernie Sanders (I-Vt.) is promoting his single payer alternative popularly branded as “Medicare for All.” In a recent TV interview he raises many of the same points I raised in my previous post.

Meanwhile, the average person watches their health care costs spiral out of sight, something our elected officials seldom discuss. How did that happen? Who is to blame?

The answer is no one…and everyone. Human history is full of examples when humans exhausted their resources. This is believed to be the reason why Easter Island’s inhabitants disappeared, eradicated by their own unchecked “ecocide.”

In North America, humans wiped out 50% of the large animal population in the geologic blink of an eye. Of course no one planned these extinctions. But we humans seem to have trouble learning that excessive demand eventually devours resources.

We have the same problem when it comes to health care. Over the last 40 years, health care has become one of the most innovative and profitable sectors of our economy. However, its costs are now taking big bites from the budgets of government, industry, and private citizens.

Until recently, this toxic effect was hidden behind spectacular successes in medicine: new technologies and cures, improved public health, better quality of care, etc.

For businesses, the success has been equally impressive. Health care has been profitable for insurance companies, hospitals, device manufacturers, and the pharmaceutical industry. These sectors thrived because the government and employers could afford to pay the costs, very little of which was passed on to patients.

But those “good times” ended a decade ago when health costs pushed the U.S. auto industry into bankruptcy. After the
Great Recession of 2008, most companies faced the same challenge and were forced to cut their health benefits to stay afloat.

As a result, employees now pay more for health care out of pocket, while the average worker’s income has flatlined. You don’t have to be a math major to figure out that health care will soon be too expensive for most people. Meanwhile, the big business of health care has shown few signs of slowing down. Nearly all companies remain profitable.

However, there are some cracks in the armor. The profits of some hospitals and systems have dropped off, and several have closed as a result. Physician incomes are stable, but the pressures of practice are becoming intolerable. Many physicians are suffering from burnout, causing them to leave practice.

Health care is a major sector of the economy, accounting for 17% of the GDP. It is a field with many powerful constituents who support—and wield substantial influence over—members of Congress. That fact alone makes legislative reform difficult.

How will change occur? Possibly, though not ideally, from America’s most common instrument of change—a national crisis.

Despite what many experts believe, health care is not “too big to fail.” It has few price controls and bears no resemblance to a free market. The industry cannot survive without employer and government subsidies. As a nation, we have become gluttons for health care that is inefficient and becoming prohibitively expensive. There is no clearer path toward extinction.

Left unchecked, healthcare prices will continue to rise. Unless those costs are subsidized or controlled, more consumers will choose to be uninsured and seek care in hospital emergency rooms, leaving other patients to foot the bill.

If employers retreat from health insurance, the consequences will be catastrophic. The uninsured will flood the country’s delivery system of doctors and hospitals. Without federal bailouts, the system will bleed itself dry and suffer a full-blown meltdown.

That may happen no matter what Congress decides in the coming months. If Congress reduces current federal subsidies, more Americans will find themselves instantly uninsured, triggering a political and financial crisis. But even if the subsidies survive, costs will continue to rise, eventually resulting in catastrophe for all.

Unwittingly, with health care we have created a game that the public simply cannot win. The time has come to change the rules in our favor.

The Affordable Care Act: Moving the Public Closer to “Medicare for All”?

By Mark A. Kelley, MD |8/30/17
Founder, HealthWeb Navigator

The Affordable Care Act (ACA) debate resumes when Congress returns from its summer recess on September 4th. In the meantime, the debate has already had major effects on public opinion.

A recent report describes how Americans currently view the ACA. According to national polls, over 90% of Americans would change the current law. Most Democrats would expand ACA coverage while most Republicans would reduce ACA benefits or rewrite the law completely. Only 8% of those polled would repeal the ACA without a replacement.

The most surprising result is the public’s response to the following statement: “It is the responsibility of the federal government to ensure that all Americans have health coverage.”

Last year, 51% of Americans agreed with that statement. In 2017, the approval rate jumped to 60%. It appears that a government health insurance option is gaining popularity.

Meanwhile, contrary to some reports, the ACA program is stable. Most regions of the country still have private insurance plans available through the ACA. Many insurers increased premiums to cover losses, but that one-time intervention seems to have stabilized the markets.

The reality of health insurance is that it must be profitable to cover unexpected losses. The insurance company has several tools to ensure a profit: charge high premiums, select consumers with low risk, or limit the services and/or payments of coverage.

The ACA eliminated most of these options. High-risk consumers could not be denied coverage or be overcharged. Further, every health plan was required to pay for a standard portfolio of services.

To offset losses, the federal government has provided supplements to cover costs on a year-to-year basis. The ACA has proven even more expensive than anticipated because the uninsured have been much sicker. The ACA had plans to offset these costs but they have had no major effect to date.

To force Congress to pass a new law to replace the ACA, President Trump has threatened to stop its federal supplements. That threat has already caused some insurance companies to leave the ACA. Congress, however, does not favor this action since it would leave millions of Americans without health insurance.

This situation has exposed the major weakness of the ACA — its financial fragility.

• The ACA required all Americans to purchase health insurance to create a new funding source. That plan failed because the law was poorly enforced. Now the ACA has no consistent source of revenue to offset costs.

• On the costs, the ACA is also vulnerable. The ACA insurance plans are managed by the private insurance industry. As long as insurance companies can rely on federal subsidies, they have little incentive to reduce costs.

• The bottom line is that the federal government must continue to subsidize the ACA.

This challenge is not new. With Medicare for the elderly, the federal government has a long experience with publicly supported health insurance. Medicare is a popular plan that is predictable, understandable, and accepted across the nation. Because it controls national pricing, Medicare has kept inflation low compared to private insurance.

“Medicare for All” was popular with some voters during the 2016 presidential campaign. Many now wonder why they cannot have the same federal insurance plan as their parents and grandparents.

That is a timely question. For most Americans, employee health insurance has become too expensive and unwieldy. Our U.S economy rewards workers who have geographic mobility and job flexibility. For such employees, finding health insurance in differing local markets can be a nightmare. A national health plan, like Medicare, solves that problem.

Companies see the rising cost of employee health insurance as a threat to the bottom line. Many businesses pass these costs to their employees through higher deductibles, co-pays, and co-insurance. That maneuver may reduce company costs, but it puts economic stress on employees and does little to curb medical inflation.

Americans are beginning to understand these issues and envision a future where the federal government ensures access to health care for everyone. During the ACA debate, voters sent several strong signals to Congress:

• Do not repeal the ACA without a replacement plan in place.

• Do not reduce current benefits.

• Do not interrupt or threaten any current insurance.

The message seems clear: most Americans want Congress to improve the ACA and move forward—not backwards. The only institution with the experience, power, and resources to lead the way is the federal government. If that happens, the country will be on the path to a “public option” like Medicare where the federal government is the insurer.

That option was proposed for the ACA in 2010 but was withdrawn due to political pressure from the insurance industry. Reviving the public option will likely provoke the same industry reaction. However, if voter support continues to grow, the public option could prevail. That will be a game-changer.

Planning for the End of Life: What Baby Charlie Can Teach Us

By Mark A. Kelley, MD |8/7/17
Founder, HealthWeb Navigator

Charlie Gard was a one-year-old boy who had a rare genetic disease leaving him blind, comatose, and unable to breathe on his own. This metabolic disorder can be fatal and has no known cure.

Charlie’s parents wanted him treated with experimental drugs in the hope that a miracle would happen. As reported in the press, the British medical and legal community considered this care futile and blocked it.

This sad story created a flurry of public discussion about ethics, end of life care, and patient and parent autonomy. Experts debated the wisdom of the parents’ decision. The discussion centered on whether the experimental therapy would help Charlie or make him suffer more.

These “end of life” issues have evolved during medicine’s successes over the last 50 years. Thanks to life-saving advances, premature infants have been saved. Organ transplants have given new life to patients with failing lungs, heart, kidneys, and livers. Many cancers are now curable.

However, there are limits to what medicine can do. Full recovery is rare among patients who have multiple-organ failure or advanced chronic disease. This raises the important issue of length of life versus quality of life.

As an intensive care physician, I have treated many patients facing this challenge. These situations are exceedingly difficult for everyone: patients, their families, and their medical teams. Emotions are magnified even more when the patient is young and/or cannot speak their wishes.

The major question for a critically ill patient is, “What happens next?” Sometimes, nature sends clear signals: the patient does not respond to maximum therapy, or there is no sign of brain activity. But more often the situation is uncertain. The patient may enter the twilight zone of the “chronically critically ill.” Such patients, who are often comatose, can be kept alive by machines that inflate the lungs, pump the heart, and dialyze the blood—all in the hope of a major recovery.

Research has shown that patients who need such advanced life support for many days have a grave prognosis. Those few who survive and leave the hospital usually die within one year and most never achieve full function. Physicians and families find it hard to know how aggressively to treat such patients without understanding their wishes.

This situation is preventable. While 90% of patients feel that they should discuss end-of-life plans with their family, only 27% actually do so. Knowing such plans in advance is invaluable for developing a treatment plan that respects the patient’s wishes. However, unless patients tell their families beforehand, how can anyone know?

Fortunately, progress is being made, thanks to public support and resources such as The Conversation Project. This advocacy program encourages everyone to “have the conversation“ with family when there is no pressure to make a hasty decision. The group’s website has helpful information and tools to guide the discussion. As some experts have written, we make plans for our estates—why not include our end-of-life wishes?

Charlie Gard’s parents were in a very difficult situation. They had to make a decision about his care and initially defied the medical/legal community by choosing aggressive therapy. Many supporters, including Pope Francis and President Trump, rallied to endorse the parents’ position.

That was before the medical facts became clear. According to published reports, experts agreed that Charlie’s disease had permanently damaged his brain and that he would never awaken or breathe on his own. The experimental therapy would not reverse his current state of suffering but could possibly make it worse.

Once they understood these facts, Mr. and Mrs. Gard chose to remove their young son from life support, and he died peacefully. We can sympathize with their painful and loving effort.

The Gard story has a message for us all. As a comatose child, Charlie could not speak about end-of-life decisions—but, as adults, we can. It is important to remember that the end of life is inevitable and that we will all experience it some day.

Having “the conversation” can relieve our loved ones from a responsibility that rightfully belongs to us. It may be the most important gift we can give them.

How to Effectively Manage Appointments with Your Doctor

By Mark A. Kelley, MD |7/12/17

Everyone in health care is busy these days. Most doctors have full schedules and patients often can’t afford to take time off from work.

Neither patients nor doctors are satisfied with this situation. However, once you and your doctor get together, there are ways you can make the visit more valuable.

Doctor appointments fall into two different categories:

• Urgent visits: For true emergencies, you should seek immediate medical attention. For a problem that is not an emergency but worries you,  the best approach is to contact your doctor’s office. Your doctor may be able to solve the problem by phone or work you quickly into the office schedule.

• Routine planned visits: These visits are usually for a new consultation or a follow-up for a known condition. You can get more from these scheduled visits if you do some preparation.

The New Consultation

You can take a few steps to ensure a new consultation goes as smoothly as possible.

Educate yourself beforehand: Understand the reason for the consultation from your referring doctor. Have you read up on your particular problem? Have you checked the credentials and experience of the new doctor? Is this new doctor affiliated with a hospital that you like? Does the doctor accept your insurance?

Bring your medical records, drug list, and results of any lab/radiology studies: This step can make a major difference in your first visit. Medical records provide a clear picture of your health history. The doctor can read faster than you can talk, and this written information frees up time for the doctor to have a better conversation with you. The information may also reduce the need for more tests, allowing the doctor to focus on a diagnosis and treatment plan.

Prepare a list of questions in advance: Make a list that you can share with the doctor. This conversation will help you to understand the medical issues involved, as well as help the doctor understand your concerns.

Ask a close relative or friend to accompany you on the visit: This has several advantages. Your relative may remember something about your medical history that you forgot to mention. They may also be helpful in remembering specific details that the doctor mentions. Additionally, it is always comforting to have a close companion with you to provide support.

Ask the doctor to summarize their findings and recommendations for you: Then, in your own words, repeat the summary back to the doctor. This will help you remember details and ensure that you and your doctor are on the same page regarding your problem and action plan. Don’t be shy about asking questions. Doctors want their patients to be well informed.

Understand the plan and goals before the next visit: These may include any new medications, tests, procedures, or therapies. For each one, consider asking the following questions: How does this test or therapy work? Why do I need it? How long will I need it? What are its benefits? What are its risks? For a new medication, what side effects should I look for? Will it interfere with my current medication? If I have a problem, who should I contact?

Ask for a printout: Request hardcopies of any diagnosis, medications (especially new ones), or tests before you leave the office. You can also ask the doctor to send you a written summary of the visit for your records. By law, you are entitled to this information, and physicians are usually glad to provide it.

Learn more about your condition: Although you may have read about the subject beforehand, your doctor may direct you to other helpful resources. The information may come in the form of written materials or online resources. HealthWeb Navigator can direct you to the most trustworthy, independently reviewed health websites online today.

The Follow-Up

Follow-up visits are scheduled so that the doctor and patient can monitor progress together. You should expect to discuss the following issues with your doctor:

• Are you feeling better or worse?

• Are there any problems to report? If so, let the doctor know early in the visit. They can evaluate whether this issue is serious and/or related to other conditions.

• Are you taking your medicines as prescribed?

• Have you had any new tests or other doctor visits recently? The doctor may not have the results but should be able to get them quickly.

• Do you have any questions about your condition?

• Do you understand the treatment plan? Before you leave the appointment, be sure you receive written summaries and instructions.

Based on my decades of practice, this preparation makes the office visit more productive for doctor and patient alike.

Final Tip

Sometimes routine follow-up visits become “too routine.” Physicians know that patients spend a lot of time and money on medications and doctor visits. If you are doing well and everything has been under control, you may want to pose the following questions to your doctor:

• Can I cut back on any of my medicines (or even stop them)?

• Can I reduce the number of routine follow-up visits?

• Can some of these follow-ups be done by phone or email?

Physicians are modernizing their practices to suit your needs. I suspect that most are more than willing to discuss these requests.

Firearm Fatalities – What Are the Issues?

By Mark A. Kelley, MD |6/22/17

The recent shooting at a Congressional baseball practice is another example of firearm violence. When such crimes grab headlines, it is helpful to review the national statistics concerning guns and safety.

According the Centers for Disease Control, 33,000 Americans die from gun injuries annually. About 65% of these deaths are from suicides. Easy access to firearms, especially in the home, is associated with higher rates of suicide.

Because self-inflicted gun injuries are highly lethal, most suicide attempts by this method are successful. However, patients with unsuccessful suicide attempts rarely succumb to suicide later. Therefore, keeping these patients away from guns is life-saving.

The second major cause of firearm death is homicides (33%). Nearly all of these deaths are in the home or among people who know one another. Random shooting fatalities are rare.

The final cause of firearm deaths is accidental shootings, usually in the home, and often involving children. These deaths account for 2% of firearm fatalities.

Mass shootings, such as at the Sandy Hook Elementary School in 2012, are heart-breaking tragedies. From 2007-2016, the national fatalities per year from mass shootings ranged from eight to 67 victims. Over that decade, the nation averaged 38 deaths per year, or 0.3% of the total gun-related homicides.

Firearm mortality statistics can be summarized as follows:

• The majority of Americans who die from gunshot wounds are the victims of suicide.

• Most other fatalities are due to domestic violence or among people who know one another.

• Mass shootings, while dramatic, are a very small part of this problem.

In all these scenarios, easy access to firearms increases the likelihood of a fatal outcome.

Mass shootings are a relatively new phenomenon in our country. Many hypotheses have been raised to explain this change. Among them are the expansion of social and news media, the availability of automatic weapons, and weak gun control laws.

These who commit these crimes share some common characteristics. In many cases, they do not know their victims. Most of the perpetrators act alone, have no plans for escape, and die violently, often by their own hand. Many obtain firearms legally.

Why motivates such people? Psychologists have suggested that this violence stems from rage at society because of some grievance. The result of this anger is mass casualties and usually the shooter’s own death by gunfire, often self-inflicted.

This raises several issues. Are mass shootings a form of public suicide? If so, will they occur more often? While no one has the answers, one fact is clear. The behavior behind these shootings is highly abnormal and suggests serious mental health problems as the root cause of the violence.

Our society has two problems that are closely linked—lethal weapons and mental health. Those with mental health issues and violent intent are more likely to harm themselves or others if they have access to guns. However, gun control is only a partial solution.

The major challenge is early recognition and treatment of mental illness. We need to help mentally ill patients well before their depression or rage reaches the breaking point.

Our elected officials are now considering cuts to healthcare benefits, particularly in mental health. Such cuts would be a major public policy mistake. In this era of gun violence, public safety requires that we make mental health one of our top priorities.

What Can We Expect From the Proposed American Health Care Act?

By Mark A. Kelley, MD |6/1/17

Our last blog focused on the political movement to replace Obamacare. Since then, the U.S. Senate has been busy revising a new healthcare bill passed by the House of Representatives called The American Health Care Act (AHCA). Some of the specifics of the bill have been clarified.

The Facts to Date

If the AHCA replaces Obamacare, the Congressional Budget Office (CBO) predicts the following outcomes:

• 14 million Americans would lose their coverage within the next two years. Most of them have little or no income and have serious healthcare challenges.

By 2026, over 51 million Americans would be uninsured compared to 28 million if Obamacare remained in place.

By 2020, insurance companies would be able to exclude those with pre-existing conditions. As a result, millions of sick Americans could lose their current health insurance.

The AHCA also cuts taxes for the rich, and reduces federal revenue by $700 billion over ten years. The impression is that health care is being sacrificed to help the top 1% of wage earners in the nation.

The Key Issues – Insurance Availability and Cost

Most Americans are focused on two health insurance issues: availability and affordability. There are reasons to worry on both counts.

Insurance Availability: The AHCA cuts Medicaid and threatens other forms of insurance coverage. Obamacare defined the benefits for all health insurance, including no penalty for pre-existing conditions. The AHCA offers “waivers” for insurance companies to “customize” these features to reduce cost. These waivers could include denying coverage for pre-existing conditions or any future expensive illness. In a worst-case scenario, pre-existing conditions might include common problems like hypertension, asthma, and obesity that affect many Americans.

Insurance Affordability: The AHCA may lower premiums by limiting benefits or covering only low risk patients. However, this would deny health insurance from those who need it most.

Even more worrisome is a long-standing problem of national healthcare costs. The reality is that cost inflation continues to drive higher premiums and threatens the national economy. There has been little attention paid to that major challenge.

Can we afford to cover more people when health care cost inflation continues to rise? The answer is “No”…unless we change the current status quo.

Health Care Cost Inflation – A National Problem

The cost problem can only be solved through a national system that has a budget, reliable revenue, and the tools to control costs.. The best example is Medicare, which covers the elderly. With the advantages of national price and policy controls, Medicare has begun to curb the rate of medical cost inflation.

Why is this example important? Medicare is a federal insurance plan that sets prices, controls costs, and covers its beneficiaries through taxes. Private health insurance is different. It is an industry that operates as a free market, like any other type of insurance. No country has successfully used the free market to provide health care for its citizens. The reason is that many people cannot afford to buy private health insurance. Only a government program can help them.

Obamacare was a major step forward. The law standardized benefits and offered subsidies to help cover the cost of private insurance. The result was that over 14 million Americans were newly insured.

But that plan will fail without a system that has enough predictable revenue to cover everyone and has the power to control costs. That is a task that only the federal government can manage.

We have already started down that pathway. The federal government manages, directly or indirectly, more that half of all U.S. health care expenditures: Medicare, Medicaid, the Veterans Administration, and the Armed Forces. In effect, we have a large national health portfolio supported by taxes.

Voters are becoming weary of the politics of health care. Soon they will wonder why they cannot enjoy the same benefits as their parents on Medicare. If that bandwagon gains momentum, politicians will scramble aboard.

The process may take time but as Winston Churchill quipped, “You can count on Americans to do the right thing…after they have tried everything else.”

The Affordable Care Act – Scrap or Save?

By Mark A. Kelley, MD |5/16/17

You may have noticed that we have been busy “tuning up” HealthWeb Navigator over the past few months. Based on your feedback we are expanding the number of our reviewed websites. We have also improved our review process. The details can be found in the section “Our Process” on our homepage.

Our blog will also be posted more frequently so we can update you on the current advances in medical science and healthcare policy. We encourage you to share your thoughts.

This week’s post will focus on the fate of the Affordable Care Act under the Trump administration.

The Affordable Care – What’s Behind the Politics?

The politics of federal health policy have dominated the headlines for weeks.

The House of Representatives narrowly passed a bill called the American Health Care Act (AHCA) to replace the Affordable Care Act (ACA, also known as Obamacare). The AHCA has now been sent to the Senate.

The ACA has expanded healthcare insurance to 20 million uninsured Americans. It also mandated basic benefits for all insurance plans. Among them is a law that prohibits financial penalties for patients with pre-existing conditions. The result is that many more Americans can protect their health and avoid bankruptcy from medical payments.

Critics claim that the ACA has failed. They describe higher premiums, insurers leaving the program, and excessive costs. These are real problems—but not failures. The AHCA will make them worse by reducing coverage with no significant cost savings.

The U.S. has not caught up with most other developed countries that have government-supported universal health care. These programs are funded by taxes on everyone. That policy distributes the financial risk across the population and gives everyone the same health insurance benefits.

That approach could work in the U.S. At least 50% of Americans are very healthy and have little or no health care costs. If these healthy consumers would buy health insurance (or pay taxes), we could cover the 20% of our population who consume 80% of health care costs.

But the U.S. has never viewed health care that way. There is no tax for health care (except Medicare for the elderly).

The ACA tried to fix that by requiring healthy, uninsured Americans to buy health insurance to support sicker patients. That law, called the “individual mandate,” has not worked because the government has not enforced it.

That worries insurers, who have enrolled many sick people but few healthy ones. Now some insurers are facing losses. By law, the insurers cannot charge sick people more. The ACA gave insurers temporary guarantees against losses but that guarantee period is ending.

The responses are predictable. Insurers are increasing their premiums to cover any losses. Some have left unprofitable marketplaces or exited the ACA altogether. Lacking any enforcement, millions of uninsured healthy Americans still pay nothing into the pool. Meanwhile, millions more Americans have new health insurance that they want to keep.

For universal coverage, all Americans must contribute to the costs of health care. Our taxes pay for defense, education, highways – why not health? In fact the Supreme Court ruled that the ACA is legal because the individual mandate is basically a tax that the government has the right to impose.

We already have experience with such a plan. For decades, taxes have supported Medicare for our elderly population. Medicare took years to evolve but is highly successful and popular with patients. It has survived many challenges. Elected officials have found that “messing with Medicare” can be politically dangerous.

The American public has been strongly in favor of universal health coverage, which exists in every other developed country. The ACA has been a major step in that direction. Many more citizens now have the opportunity for a healthy life and freedom from medical bankruptcy. They will not easily surrender these benefits.

The AHCA is a setback for universal coverage. The proposed law will reduce insurance for millions of Americans, and use those savings to cover a tax cut for the wealthy.

It is time for our elected officials to get down to business and fix the ACA without threatening patients with the loss of their health insurance.

The only political “win” is assuring that all Americans have affordable health care long into the future.

Tips for Reviewing a Website’s Usability

By Nathan Blake |2/15/17

Following up on our previous blog post, this week we will explore how usability reviewers analyze health websites while also providing some tips for becoming a more informed web user.

HealthWeb Navigator’s content reviews and usability reviews are distinct but complementary. Whereas a content review analyzes what information is provided (its accuracy, completeness, currency, depth, etc.), user-experience reviews are focused on how information is provided; that is, whether or not the presentation and organization of material, in your opinion, is easy to use and navigate, visually appealing, readable, widely understandable, speedy, and geared toward its audience appropriately.

Reviewers should always include direct evidence from the website to support any judgment made about a website’s usability.

Below you will find some specific tips for using your web experience as you review a health website’s usability. Due to time and space constraints, you won’t be able to touch on each one of these aspects in your review, but we hope that they can guide you to think more critically about a website so as to be a stronger resource for consumers.

Evaluating a Website’s Usability

A usability expert for HealthWeb Navigator should be prepared to:

Scan the pageReviews of usability should take visual appeal into account. Design is often unconsciously linked to credibility, and though a website’s credibility doesn’t necessarily hinge on its appearance, it does play a part. Let your eyes wander around the page; where’s the first place you look? What does your instinct prompt you to click on first? Do advertisement obstruct navigation, or is the focus directed toward content? Is the content well-organized? Do the colors or font make it difficult to read the type? How about pop-ups? Answering these questions will train your eye to slow down and analyze what it’s seeing. They will also help you determine whether or not the website is effectively designed, allowing you to articulate what could be done to create a more pleasant user-experience.

TIPPut down in writing or speak aloud your initial impressions about the layout of the page and what you think of the colors, graphics, photos, etc. Is it on par with other websites, or is it better or worse than you expected? What can the website do to catch the reader’s eye, and where does it excel at grabbing your attention?

Take the wheel. Think of each website as a vehicle for disseminating information. Each has a different design, yet there are widely shared features such as navigational schemes, search options, editorial disclaimers, etc. Some websites have site-wide search bars, while others only allow users to click links when searching for material. Usability reviewers should try to understand how the site functions and whether or not it’s easy to “drive,” testing out its various components before casting judgment. Is the website easy to use, and can you find what you are looking for? What’s the loading speed of individual pages? Are there any dead links? Can you get around the website intuitively, or does it have you spinning in circles?

TIP: An easy way to focus on a website’s functionality is to disregard the actual content on the page. Play with the website and test out as many of its features as you can, which often helps reviewers discover user-experience issues. It can also be helpful to search for a specific topic that falls under the website’s scope, testing out the various organizational schemes to determine if the site is user-friendly.

Identify the audience(s) and purpose. All texts presume an audience and a purpose, and it is the job of the reviewer to understand those potential audiences and purposes implied by a given web resource. Start with the idea that all writers, consciously or unconsciously, have an ideal audience in mind when they write, and with that knowledge they determine the shape, form, and scope of the ensuing content. The important concept to understand is that readers and listeners will vary in how much they know about the health information being offered, and websites will vary in what they want to accomplish. Some websites listed on HealthWeb Navigator have very little interest in providing medical content. Some are strictly focused on providing social media capabilities, others act as advocates on behalf of patients, and others simply list resources. Identifying these varying purposes can help you understand if the website successfully meets its goals or not.

TIP: Approach each website as an educator: If you had to give the website a grade, from A to F, what grade would you give it and why? What audiences does the website exclude and how? Is material offered in multiple languages, and it is accessible for people with disabilities? What’s the site’s purpose; is it to inform or persuade, describe or convince, define or influence, review or argue, notify or recommend, instruct or change, advise or advocate, illustrate or support?

Paraphrase information. A paraphrase is a restatement of an idea into your own words. Part of a usability reviewer’s duties involves assessing a site’s understandability, how easy it is to read and follow. One quick way to determine whether or not a website is easy to read is to try and summarize material after reading. Imagine teaching the content to someone else. Can you articulate the material’s substance, or are you floundering for meaning? If you find it easy to paraphrase a website’s content, especially as a layperson, then chances are the site is written clearly. If not, try to hone in on what makes the website difficult to understand and mention that in your review.

TIP: Think about how to articulate information in your own words. Of course some of the more clinical concepts will be difficult to summarize without using the resource’s exact language, but you should at least understand the gist of what is being said. Read over a page, look away from the website, and then write down or speak aloud the essential meaning. If you find this difficult, then the website may have a readability issue.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our usability review process. Check back to our previous blog post that focuses on how our volunteers conduct content reviews.

Finally, if you are a web user and are interested in a becoming a usability reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Usability Reviewer.

Tips for Reviewing a Health Website’s Content

By Nathan Blake |2/1/17

It is estimated that 40% of the global population uses the internet every day, including over 88% of the U.S. population. As healthcare costs continue to rise, more and more patients turn to the web for health information to learn about diseases and conditions, insurance costs, patient advocacy, and more.

But how can you be sure that the information you find online is credible, up-to-date, and easy to understand?

HealthWeb Navigator is a free online service that helps consumers make sense of the internet’s rapidly expanding collection of health-related websites. Our team continuously publishes reviews of online health resources. The idea is that these reviews will allow consumers to take control over their own health care by guiding them toward only those websites that are accurate, clear, and user-friendly.

Our credibility rests on the expertise of our volunteers, whom we group into two categories: content reviewers and usability reviewers. Medical authorities are tasked with evaluating a health website’s content, while our usability reviewers come from all walks of life and are responsible for reviewing a website’s user experience.

Whereas a usability review analyzes how information is provided (its organization, visual design, user-friendliness, speed, etc.), reviews of content are focused on what information is provided and whether or not that information can be trusted to be accurate, complete, up-to-date, and sufficiently explored.

Below you will find some tips that our health authorities keep in mind when judging a website. We hope that consumers can incorporate these tips into their web-browsing routine, helping them distinguish a reliable web resource from a misleading one.

Evaluating a Website’s Content

A content expert for HealthWeb Navigator should be prepared to:

Look for gaps. If you’re a mental health professional reviewing a website focused on teen mental health, and you notice that the website does not include information about self-harm, then clearly there is a gap in the site’s scope. Consulting a website’s site-map can give you an aerial view of what can or can’t be found on the site. Use your review to make note of any noticeable gaps you find. This is equally true for websites that feature a doctor/provider-finder tool; if, when searching a familiar ZIP code, you see that a specific doctor/provider is missing, then that too is appropriate to mention in your review in regards to completeness.

TIP: Gaps in content are often found simply by browsing a website, keeping an eye out for information that could be present but is in fact missing. You might also consult a site-map when available, allowing you to get a quick idea of those topics the website covers without having to browse every single page. A litmus test for a site’s content might be: On content alone, would you recommend this website to a patient? If “yes,” give examples of what you liked. If “no,” explain what is missing and why it concerns you.

Test the depths. Some websites cover the breadth of a particular subject, including numerous topics and subtopics for consumers to explore. But how useful is the breadth of a site’s material if individual articles are too shallow to gain anything substantive? Use your knowledge to determine if a website’s materials are sufficiently examined in enough depth to provide consumers with quality information. Some websites sacrifice depth for breadth, others go very deep into a limited amount of subjects, while still others manage to strike a balance between the two.

TIP: The key to fairly judging a site’s depth is using your medical expertise to determine whether or not the page with less detail offers enough information to be of use to the public. It may be shallow, but sometimes shallow is all that is necessary, depending on the topic. Consequently, too much depth can overwhelm some readers, especially if the tone is clinical in nature.

Verify the research. Suppose the website you’re reviewing makes a variety of claims but does not provide research or evidence to support those claims—would you trust that website more so than an organization that includes direct links to outside sources? Or what if the site in question relies on misleading or downright false information to prove its points? In both cases, it is the job of the content reviewer to look for and judge the research (or lack thereof) being used by a website to determine whether or not it is credible and accurate. Follow up on any research you see linked on a page, and make note if you see either a lack of verifiable research or an abundance of biased materials.

TIP: Always look for evidence. Remember that good science relies on data and statistics, although even the most objective data can be influenced by bias. Keep the phrase “prove it” in mind, then assess the quality of that proof. Websites that lack research or only reference internal research should be analyzed with caution.

Check the dates. Imagine how you would go about reviewing a website on heart surgery that cited research from 1983. Would you trust that the research holds up after all these years? Or what if a website publishes material on a rapidly-evolving subject like the Affordable Care Act, yet the material has not been reviewed or updated since 2012? Look for dates of both publication and revision to determine if the website is maintaining its currency; the same goes with any outside research or support a site relies upon.

TIP: When you’re looking for evidence, take publication and revision dates of individual articles into account. Usually these dates are found at the top or bottom of web pages. Using your expertise, you can determine whether or not the website maintains currency in a rapidly changing medical landscape.

Know Who’s Who. Everyone approaches the world with particular biases, and it’s important to recognize that occasionally these viewpoints are not necessarily rooted in observable fact. When it comes to website content, always look for names to which information can be attributed including parent and affiliate organizations, leadership, sponsors, advisors, editorial boards, writers, etc. Approach it from the angle of expertise: Would you be more willing to accept an article’s claims if they were written by a layperson or a trained medical authority? If information is generated by laypeople, then there should be some form of expert oversight to maintain quality.

TIP: If individual authors cannot be attributed, do some digging on the website to find out who is responsible for writing and editing content. If you can’t find this information, then that is an appropriate issue to raise in your review.

Follow the Money. Have you heard the phrase “follow the money”? A good tool for assessing the influence of bias and allegiance starts with recognizing the power of financial transaction—determining who’s being paid and who’s providing the money. Look for any products being sold and ask yourself if the website is unduly advertising those products over established medical knowledge (that is, a “cure all”). What organization or sponsors support the website? Who is responsible for generating content, and can you see any financial incentive for what content is generated and what stance the content promotes? You can learn more about how to find out who sponsors a website HERE.

TIP: If you don’t recognize the organization providing the information, some cursory digging can reveal who finances the operation. Most websites you encounter through HealthWeb Navigator will provide this information in an “About Us” or related section. You can also dig deeper into a charity or nonprofit by looking up their listing on Charity Navigator.

We hope that these tips and reminders will help you better assess a website’s value and give you a peek behind the scenes of our content review process. Stay tuned for our next blog post, which will focus on how our volunteers conduct usability reviews.

Finally, if you have medical training of any kind and are interested in a becoming a content reviewer for HealthWeb Navigator, please visit the following link to sign up as a volunteer: Becoming a Medical Reviewer.

When Your Doctor Doesn’t Accept Your New Health Insurance Plan

By Nathan Blake |1/17/17

An estimated 20 million Americans have been insured under the Affordable Care Act. Though the Senate recently voted to begin the process of repealing President Obama’s health law, the effects of that decision won’t take place for some time. Meanwhile, consumers can still enroll in a Marketplace plan as usual, with the 2017 open enrollment period for Obamacare ending on January 31st.

If you recently changed health plans, or are planning to do so, there is a chance that your provider no longer accepts your new insurance. Some common reasons are that you may have chosen a less expensive insurance which the doctor doesn’t accept, or perhaps the doctor recently decided not to work with your new insurance plan. 

Losing access to a trusted doctor can not only be distressing, but also time-consuming, since finding a doctor you like requires considerable planning and a bit of trial-and-error. The effort, thankfully, pays off in the long run. Research shows that patient satisfaction is directly correlated to treatment outcomes; that is, the more satisfied a patient is with their care provider, the greater the odds that they will experience a successful treatment.

In short, it’s worth investing time and energy into finding a quality doctor who you enjoy consulting again and again.

But what happens when a good doctor-patient relationship is jeopardized because of health insurance issues? Before answering that question, it might help to understand the basic workings of health insurance, specifically how insurance plans pay doctors for their services.

Health Insurance in a Nutshell

Health insurance policies are contractual agreements between consumers and insurers—called “policies”—that stipulate how much money the insurer will pay for health expenses such as hospital visits, medical tests, surgeries, immunizations, etc. The amount that the insurer pays, or “coverage,” will vary among insurance companies as well as their individual policies. Ultimately, it is the insurance company that sets the rate of pay, not the doctor.

There are two scenarios:

The doctor is contracted with the insurer: The doctor can only charge what that insurer allows.

The doctor is not contracted with the insurer: The doctor can charge their “list price” for services, which is usually higher. The insurer may reimburse you for the amount they would usually allow, but you have to make up the difference.

Let’s say Doctor X charges $100 for a routine physical exam, but Insurance Company Y believes such an exam is worth only $40. Doctor X can either accept the price difference or attempt to negotiate a higher payment. If the two parties are unable to resolve the discrepancy, Doctor X can refuse to work with Insurance Company Y altogether, leaving consumers insured through Insurance Company Y to pay Doctor X’s charge out of their own pocket.

Insurance Company Z, on the other hand, may provide a higher payment for Doctor X’s services (for example, $80 for a routine physical). If Doctor X finds that payment attractive, they could begin accepting patients insured through Insurance Company Z.

This negotiation process, believe it or not, occurs every year for each medical service provided at all insurance-accepting medical practices across the nation. As you might imagine, it is quite normal for doctors to change which insurances they choose to accept over the course of time.

When You Just Can’t Stand to See Your Doctor Go

So you’ve discovered your doctor of choice no longer accepts your new health insurance, but you do not want to see another provider.

Your first step is to ask your doctor what insurance carriers they do accept. The easiest solution would be to then switch to a policy included among that list of accepted insurances.

Keep in mind that Marketplace plans can only be changed during certain times of the year or for specific “special enrollment” scenarios like having a baby, getting married, losing a job, etc. Check online to determine whether or not you qualify before you make a switch.

There are other options for working with your preferred provider. You can:

See if your plan will work with out-of-network coverageConsider asking your insurer to include specialists that are technically out-of-network. Call the insurer directly to see if they would consider adding your doctor to their network of providers; if they refuse, always ask for specific reasons. Conversely, you may want to contact the doctor with reasons as to why they should join a particular network. Sometimes a vocal patient is enough to do the trick.

Pay out of pocket: If you have the finances to do so, you may choose to pay for services out of pocket and then submit insurance forms for reimbursement. It is important to note, however, that insurers often apply reimbursements to your deductible rather than give you the money outright, and there is a good chance that you will be reimbursed for only a portion of the original cost. Keep in touch with your insurer during this process to make sure your voice is heard.

Negotiate a price directly with your provider: As more doctors choose to not take contracts with insurance companies, patients insured with incompatible plans are forced to pay the market price for medical services and then submit a reimbursement form to defray medical costs. Some doctors are willing to negotiate prices with patients on an individual basis, especially if there is already a long-standing relationship at play. The key to navigating these negotiations is to know what the fair price would be for a given expense.

Use a flexible spending account: A flexible spending account allows consumers to pay for medical costs using personal savings or money provided by an employer (usually capped at a certain amount per year without annual rollover). Consult with your employer to see if they offer employee FSAs; if so, you can pay for medical costs using these tax-free dollars.

When You Have No Choice But to Move On

If you’re not particularly attached to your doctor, then it might be easier to simply move on and find another doctor who accepts your new insurance plan. Consult our previous blog post, “Choosing Your Primary Care Physician,” for tips on how to secure the services of a doctor who works best for you. Being informed and prepared is your best bet to making a smooth transition between providers.

Health Web Navigator