HealthCare.Gov: The New Guide to Marketplace Health Insurance

This week the federal government launched a new consumer-focused website and 24 hour call center to provide information on the coming Healthcare Insurance Marketplace, which will help people buy private insurance or locate free or low cost government options under the Affordable Care Act (or, Obamacare).

Healthcaregov

Right now HealthCare.Gov has fairly general information, but is a good start for consumers who want to learn more about the Health Insurance Marketplace before the open enrollment coverage period begins in the fall. Website functionality will continue to expand through the summer, and 24 hour help is also available through a variety of mediums. You can chat online with a representative, or you can use the 24 hour call center at:

  • 1-800-318-2596
  • Or 1-855-889-4325 for hearing impaired users with TTY/TDD technology

Important Dates:

  • October 1, 2013: Open enrollment begins
  • January 1, 2014: Coverage begins
  • March 31, 2014: Open enrollment ends

You can keep up with the conversation by following @HealthCareGov. The New York Times also has coverage on the new HealthCare.gov and its interaction with the Affordable Care Act.

Nationwide Hospital Charges

On the heels of yesterday’s post on U-M’s analysis of its visualization activities, today’s post also touches on the impacts of visualization, although on a much broader scale. The New York Times recently released an interactive data visualization map that tells you how much hospitals charge per procedure. You can search by location (state & zip code) and see how the charges compare to national averages. Visualization is based on 2011 data collected from 3,300 hospitals and includes the top 100 common procedures (including hip replacement, heart operations, and gallbladder removal).  Naturally, there is an accompanying article.
The pricepoints that the NYT used to build its interactive map comes from the Centers for Medicare & Medicaid Services, and the full (warning: massive) dataset can be found here.
UMHS reported costs slightly above the national average, but AnnArbor.com points out that it:
doesn’t mean patients or their insurance companies are paying those charges…Patients then pay whatever’s left after the insurance or Medicare payments.
UMHS Medicare reimbursement was also high, to which UMHS Headlines responded:

The payment we receive for treating Medicare patients is set by the federal government, not us, and takes into account how sick the patient is. Since we care for some of the most acutely ill patients in the country, including transfers from other hospitals and patients with underlying conditions that complicate their care, it is not surprising that we should be reimbursed at a higher rate.

Our Medicare reimbursement also includes payments that offset some of our costs for caring for a disproportionate share of uninsured patients, and for paying for the salaries, training and supervision of more than 1,100 resident physicians.

Read the full UMHS response here, and the AnnArbor.com article here.

To Stretch, or Not to Stretch? That is the Question.

From some previous posts, you may have gathered that our library hosts a number of joggers. Personally I am still at a fairly novice level, but I do enjoy keeping up with exercise research to make sure that I am doing everything I can to prevent injury while bolstering health and (hopefully) longevity.

Last week there was a bit of a perfect online storm in regard to stretching prior to exercise. The absolutely astounding Mind the Science Gap blog (seriously, have you read that yet?!) from the University of Michigan’s Risk Science Center tackled stretching-related myths one at a time, debunking them with evidence from multiple clinical studies.

Then my favorite popular health blog, the New York Times Well Blog, published a piece on stretching and physical performance, titled “Reasons not to Stretch,” so Ms. Reynold’s take on the debate there is clear.

Me? I do not stretch much prior to running, but do so religiously afterward. I’m simply here to lead you to the evidence and let you decide for yourselves.

Where Should One Run?

"Running" designed by aartiraghu for The Noun Project 2012, CC0

“Running” designed by aartiraghu for The Noun Project 2012, CC0

Since I am from California, you might assume that I’d be inherently prejudiced against winter. That’s really not the case (though I may have admittedly been spoiled by Michigan’s relatively mild winters over the last couple of years)! I love the sparkle of fresh snow and the sound it makes crunching under my boots, and what could be better than a crisp winter day accented by a bright blue sky?

My one complaint would be what the season entails for my running regimen: consignment to sweaty gym basements. Now some of the more extreme runners may say, “But you can still run outside in the snow and ice and that slushy grayness that develops eventually!” Sure, maybe you can – but as a winter neophyte I have enough trouble walking through it, let alone running. So, gym basement it is. And while watching muted reruns of Friends isn’t akin to utter torture, compared to Ann Arbor’s plethora of wonderful spots to jog, it’s a pretty pale comparison.

It seems I’m not the only one to favor running outside as opposed to on a treadmill – as my favorite wellness blogger, Gretchen Reynolds, reports for the New York Times:

“… emerging science suggests there are benefits to exercising outdoors that can’t be replicated on a treadmill, a recumbent bicycle or a track.

You stride differently when running outdoors, for one thing. Generally, studies find, people flex their ankles more when they run outside. They also, at least occasionally, run downhill, a movement that isn’t easily done on a treadmill and that stresses muscles differently than running on flat or uphill terrain. Outdoor exercise tends, too, to be more strenuous than the indoor version. In studies comparing the exertion of running on a treadmill and the exertion of running outside,treadmill runners expended less energy to cover the same distance as those striding across the ground outside, primarily because indoor exercisers face no wind resistance or changes in terrain, no matter how subtle.”

Read the full article here, and let’s all hope spring plans on arriving soon enough to give us the luxury of choice when it comes to selecting a location to exercise!

Your Appetite, Your Workout

If you’ve been to the gym (any gym, really) recently, I’m sure you’ve noticed the influx of patrons hopping up on the cardio machines in earnest efforts at New Years resolutions.

I’ve written before about two of the main factors for maintained weight loss: diet and exercise. And the theme arises again, in no doubt because we’re so focused on both these aspects, particularly at this time of year. A recent article from my favorite New York Times Well Blog points to new research highlighting the linkages between not only the type of exercise, but the amount of time you stick with it, and its impacts on your appetite. Namely, regular exercise helps regulate overeating. There’s a tangible benefit if I’ve ever read one!

Image from Dan Empfield at Slowtwitch

Image from Dan Empfield at Slowtwitch

There are a few catches, of course (nothing’s ever easy, is it?). Benefits such as appetite regulation took about three months to appear, and running looked to be a more effective form of exercise for that than walking, according to two recent studies.  So keep at it, New Year’s resolutions gym buffs – you’re 1/3 of the way there!

The studies mentioned in the Well Blog are linked below:

Impact of Chronic Exercise on Appetite Control in Overweight and Obese Individuals 

Influence of running and walking on hormonal regulators of appetite in women

Seasonal Flu Vaccines – A Thing of the Past?

We’ve harped on before about getting your flu shot this fall already – and why not? I’ll throw in one more shameless plug:

  • UMHS employees can attend walk-in clinics through the end of November, a full list is here
  • The public can also attend walk-in clinics at a variety of UMHS sites around Ann Arbor, a schedule is here

Carl Zimmer writes for the New York Times that our annual forays to flu shot clinics may well become an antiquated notion, replaced instead by a universal vaccine that would do double duty: “fight against seasonal flu outbreaks…and new pandemic strains.

It would be two shots we would receive as children, followed by occasional boosters, and would be fundamentally different from the annual vaccines we get now by targeting a different part of the virus structure. A universal vaccine could prevent massive pandemics – such as the one that killed millions in 1918. If you’re historically inclined, the University of Michigan’s Center for the History of Medicine just launched a digital encyclopedia chronicling that 1918 flu pandemic.

Read the full article – the delves into the two exciting new options for a universal vaccine – here.

Influenza Archive Photo

Motor Corps and Canteen volunteers from the Detroit chapter of the American Red Cross, taking a break from delivering supplies to influenza victims. Image from Influenza Archive & NARA

Happiness > Health (Motivationally Speaking, That Is)

According to a new article (based on a few studies) from my favorite health blog, people are more inclined to stick to exercise regimens if they are perceived to contribute to direct, immediate benefits – such as increased happiness – rather than a long-term future goal, such as better health.

Taking a marketing-like approach to exercise may be the key. To encourage sustained exercise, doctors (or whoever, really) should try to appeal to the “the emotional hooks that make it essential for people to fit it into their hectic lives.” 

“Yoga at the Farmer’s Market” © Ali Emanov 2011 CC BY-NC 2.0

A 2012 study from an interdisciplinary team at the University of Michigan was also cited in the New York Times Well Blog article (go blue!), indicating that gender and age all have impacts on the motivations for continued exercise. For instance,

“those of college age, for example, physical attractiveness typically heads the list of reasons to begin exercising, although what keeps them going seems to be the stress relief that a regular exercise program provides. The elderly, on the other hand, may get started because of health concerns. But often what keeps them exercising are the friendships, sense of community and camaraderie”

Dr. Segar, the lead author of the above study from the U of M Institute for Research on Women and Gender, put it simply: “What sustains us, we sustain.”

Twitter & Health

It stands to reason that when I read the phenomenal Tweeting for Student Health Care from my favorite health blog (and 2nd favorite newspaper) I immediately thought of our Emerging Technologies Librarian, who has been curating an incredible weekly post  that focuses on the flurries of health-relevant hashtags in the Twitterverse.

Composite image from Twitter and “Open Healthcare” © 2011 by Christina Hardison for opensource.com CC BY-SA 2.0

Sure – Twitter/tweets are a great way of disseminating bite-sized information (and this coming from a Twitter user quite late to jump on the bandwagon) or giving you a way to follow the breadcrumbs of evidence, like a bibliography in a relevant research paper you’ve read.

But what Arijit Guha’s (@poop_strong) experience – an Arizona State PhD student with stage IV colon cancer who had reached the University’s $300,000 lifetime insurance cap with Aetna and left with the $118,000 balance before starting a social media fundraising campaign – highlights is Twitter’s ability to do more than that, though admittedly in a small number of cases.

Access: Twitter gives anyone with a mobile (or standard) internet connection almost scarily direct access to hundreds of millions of users – many of whom would, for geographic or political reasons, would be completely unreachable otherwise. In Mr. Guha’s case, that was Aetna’s CEO, Mark T. Bertolini (@mtbert) – take a look at some of the exchanges:

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You have to give Mr. Bertolini some kudos for launching into a pointed conversation. Trying to get an actual sense of the conversation on Twitter isn’t for the faint of heart, especially when so many other users started chiming in, but if you’re curious check out the tweets arranged in a way that makes sense on Storify as the conversation flowed on.

Actual Change: After heated online discussion, ASU also got in the game and is changing its student insurance coverage with the 2012 school year – including increasing the cap from $300,000 to $2 million and not denying students with preexisting conditions.

Having gleaned these things, the next logical question is “what does it mean for those of us in health?” I’m not sure that anyone has concrete answers yet, but clearly that dialogue – and what Twitter makes clear is that it is a dialogue – is starting to take shape. How will you contribute?

Diet vs. Exercise: Which Really Keeps Weight Off?

Another fascinating New York Times article from Gretchen Reynolds on what really keeps us trim – our diets, or our activities.

Two new research publications (one of which is open access through PLoS One!) seem to argue against conventional notions that active folks are leaner (no doubt currently spurred by Olympic fervor) and that exercise boosts metabolism.

The study published in PLoS looked at metabolic rates of the Hazda people, a hunter-gatherer society in Tanzania, and concluded they although much more active than the average Westerner, Hazda metabolic rates weren’t substantially different, and that “‘active, ‘traditional’ lifestyles may not protect against obesity if diets change to promote increased caloric consumption.’ That is, even active people will pack on pounds if they eat like most of us in the West.

A new review also compounds this – our metabolic rates don’t increase, or even stay the same even as exercise increases. They can even decrease!

We need to fine tune our expectations if we think that exercise can serve as the magic solution to keeping weight off; indeed, the author of the review, Diana Thomas, has developed a new weight loss predictor to specifically help mitigate such high hopes.

Mapping our Germs

The Human Microbiome Project aims to map, and then analyze, a vast amount of data about the “100 trillion good bacteria” living on/in your body right now. Results in recent papers published in Nature and three separate Public Library of Science (PLoS) imprints – which form the beginning of a new PLoS Collection – may very well “change the research landscape” of microbiology.

Stanford’s Dr. David Relman describes humans essentially coral colonies,  “an assemblage of life-forms living together,” but one which – until very recently – we could not effectively study since so many of the inhabitants were so small and so specialized to their environments.

The Human Microbiome Project took 242 healthy people (healthy according to very strict criteria, no less) and collected samples from 15-18 locations (mouth, nose, etc.) for two years. The papers mentioned above are the results of the DNA sequencing done on those samples, which have effectively allowed the researchers to develop a map of the incredibly diverse bacteria that live with(in) us.

Streptococcus

“Streptococcus” © Josh Smith (2009) CC BY-NC-SA 2.0

The results are fascinating – each subject’s bacterial “map” was unique! Variations of these cohabitors may account for differences in how people react to various medicines, let alone our differing susceptibilities to diseases or conditions like asthma and obesity.

This work is one piece of the PR puzzle that is rehabilitating bacteria’s image. Continuing research on how these creatures impact our health will undoubtedly be fruitful too, this is an area well worth watching.

Me? I’ll be putting away my hand sanitizer from time to time.

Read the full story from the New York Times here, and Carl Zimmer’s post about the findings here.