PHILADELPHIA – An increase in Twitter sentiment (the positivity or negativity of tweets) is associated with an increase in state-level enrollment in the Affordable Care Act’s (ACA) health insurance marketplaces — a phenomenon that points to use of the social media platform as a real-time gauge of public opinion and provides a way for marketplaces to quickly identify enrollment changes and emerging issues. Although Twitter has been previously used to measure public perception on a range of health topics, this study, led by researchers at the Perelman School of Medicine at the University of Pennsylvania and published online in the Journal of Medical Internet Research, is the first to look at its relationship with the new national health insurance marketplace enrollment.  

The study examined 977,303 ACA and “Obamacare”-related tweets — along with those directed toward the Twitter handle for and the 17 state-based marketplace Twitter accounts — in March 2014, then tested a correlation of Twitter sentiment with marketplace enrollment by state. Tweet sentiment was determined using the National Research Council (NRC) sentiment lexicon, which contains more than 54,000 words with corresponding sentiment weights ranging from positive to negative. For example, the word “excellent” has a positive sentiment weight, and is more positive than the word “good,” but the word “awful” is negative. Using this lexicon, researchers found that a .10 increase in the sentiment of tweets was associated with a nine percent increase in health insurance marketplace enrollment at the state level. While a .10 increase may seem small, these numbers indicate a significant correlation between Twitter sentiment and enrollment based on a continuum of sentiment scores that were examined over a million tweets.

“The correlation between Twitter sentiment and the number of eligible individuals who enrolled in a marketplace plan highlights the potential for Twitter to be a real-time monitoring strategy for future enrollment periods,” said first author Charlene A. Wong, MD, a Robert Wood Johnson Foundation Clinical Scholar and Fellow in Penn's Leonard Davis Institute of Health Economics. “This would be especially valuable for quickly identifying emerging issues and making adjustments, instead of having to wait weeks or months for that information to be released in enrollment reports, for example.”

The researchers collected a random sample of 977,303 tweets from March 2014 to use as a control group for comparison of sentiment. They also further validated the NRC lexicon by randomly sampling 300 of the tweets and having human raters score them, finding a significant correlation between the computer and human ratings.

“Twitter is a powerful tool when it comes to examining trends in health and health policy,” said senior author Raina M. Merchant, MD, MSHP, director of the Penn Social Media and Health Innovation Lab and assistant professor of Emergency Medicine. “We can see this methodology being used to improve health care in real-time as health policy is implemented, in order to stay on top of any issues and adjust accordingly.”

The other study authors, all of whom are from Penn, include Maarten Sap, Andrew Schwartz, PhD, Robert Town, PhD, Tom Baker, JD, and Lyle Ungar, PhD. The investigators are funded in part by the Robert Wood Johnson Foundation. In addition, Baker and Town are two of the co-founders of Picwell, Inc., a health information/technology company that leverages big data and predictive analytics to help consumers optimize health plan choice.

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $8.9 billion enterprise.

The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $496 million awarded in the 2020 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center—which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report—Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; and Pennsylvania Hospital, the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

Penn Medicine is powered by a talented and dedicated workforce of more than 44,000 people. The organization also has alliances with top community health systems across both Southeastern Pennsylvania and Southern New Jersey, creating more options for patients no matter where they live.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2020, Penn Medicine provided more than $563 million to benefit our community.

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