Using the Internet to Navigate the Health Care System

Over the past decade, the Internet has drastically changed the way Americans view health care.
Today, we have more access than ever to finding top-quality doctors and hospitals. But learning to navigate the system can be tricky.

Dr. Manny Alvarez, senior managing health editor of, sat down with the CEO of, Kerry Hicks, to talk about how his company’s website is helping to improve the quality of health care, through monitoring and compiling data on American hospitals in their “2011 Healthcare Consumerism and Hospital Quality in America” report.

Dr. Manny: Tell me about – what is it exactly?

Hicks: The mission of is to improve the quality of health and actually guide Americans to their best health. We do that by rating 5,000 hospitals in 14 specialty areas in 27 procedures and diagnoses. A procedure would be bypass surgery or joint replacement. A diagnosis would be stroke or congestive heart failure.

Dr. Manny: How does it differ from other websites that offer doctor and hospital ratings?

Hicks: We have 11 million patients coming to our website each and every month and our core principles of transparency, empowerment, and accountability have remained unchanged since the late 1990s.

So for us, we've been doing this longer than anyone else. We are the gold standard when it comes to both physician quality information as well as hospital quality information. If you look at our traffic, it's roughly two or three times higher than our nearest competitor. And we do not allow, for instance, just open reviews by patients.

We do score reviews, so we have surveys. Was the doctor prompt? Was the doctor staff courteous? But we don't just allow open text comments on behalf of patients to write about a doctor for instance.

Dr. Manny: Who are the people visiting your site and how is it improving the consumer health care experience?

Hicks: Patients focus predominately, because we test this and we survey it all the time, on outcomes. So you talk about process measures and safe practice and we believe in all of that, but ultimately patients want to know how they’re going to fare at their hospital.

Our role is predominately to put information out in the marketplace that consumers can both understand and act upon. In my view, though, the industry is awash in data, but it lacks objective, actionable information. What is interesting, is that the growth of consumers seeking health care information on the Internet is increasing at four times the rate of the growth of the overall Internet.

We look at it based on the proxy from health care information sample and by using traffic to health grades. So the No. 1 city per capita adjusted is D.C. followed by New York City, and then Kansas City.

Dr. Manny: Tell me about the “2011 Healthcare Consumerism and Hospital Quality in America” report.

Hicks: It’s a considerable undertaking, and our goal is again to provide greater insight ultimately to empower patients to be better informed decision makers and to choose their care wisely because it's one of the most important decisions a patient will make.

So for us, and our latest study, if you look at the chasm between the best performing and the poorest performing hospitals, a patient would have a 73 percent higher likelihood of living if they choose a five-star hospital instead of a one-star hospital.

So that's important, although all hospitals are improving in our study in that case there’s about a 13 percent improvement in quality over the last 3 reporting years. But again that chasm between the best performing and the poorest performing still remains substantial.

Dr. Manny: How do you compile your data for the report to make sure it’s credible?

Hicks: We analyze 40 million in-patient records, we get that information from the federal government. It's actually billing information to Medicare for payment to the hospitals, and it's actually a criminal offense to fraudulently report or manipulate the data.

We look at hospital quality over a three-year period of time. We look at 27 of the top procedures and diagnoses. They account for roughly 60-90 percent of all hospital admissions. We look at how hospitals perform. All 5,000 hospitals, you can't opt in or opt out, in 14 specialty areas.

Dr. Manny: What kinds of improvements have you noticed in your report?

Hicks: We see physicians having much closer working relationship with their hospital partners. I think the best evidence of that is that I think now over 50 percent of physicians in the country have some employment relationship with their hospital. That's a fundamental change and I think that is inevitably a very good thing.

So for instance the hospital you [Dr. Manny] work at, Hackensack, has the most five-star designations and the most awards of any hospital in the country, so that is not an accident. It takes real work. There are thousands of moments of truth every day. And the ones who do it the best do it by design.

Dr. Manny: What are some of your tips for patients trying to navigate the system and find top-quality doctors?

Hicks: We're launching a new site in January, and what I would look at if I was a patient – and I was indeed two years ago – I'd look at which hospital, by which specialty performs the best, and then we have a unique application where we link the best hospitals with the doctors who actually perform or admit patients there.

And that's always a great starting point, because as great as a physician as you are, and most doctors are, there's still substantial variability. But within the hospital, the variability lies not only with the doctor but with the entire team. It's a very complex system both operationally and technologically if you think about just the complexities of delivering health care, done by humans on other humans. It’s a very team oriented fort.