In the past few years, major hospitals, health organizations, and prominent leaders in health care have hopped onto Twitter. Now, just about every major healthcare and medical entity, from the New England Journal of Medicine (@NEJM) to the Mayo Clinic (@MayoClinic), has an official Twitter feed. For the most part, tweets that are officially representing a prestigious organization or prominent person in the field tend to reflect that fact. Translation: The tweets are usually boring. No one takes a stand. No one says anything interesting. For the most part, official Twitter accounts associated with medicine and health care organizations are echo chambers for well-established ideas that are not interesting to medical professionals. Sure, there’s the occasional tweet about some medical innovation or recent research. However, those are usually self-promoting and not ready for prime time. At worst, even well-respected medical centers’ Twitter accounts are in the habit of tweeting out poorly written health and medicine stories from local and national mainstream media or, regrettably, spouting pseudo-wisdom from celebri-docs and self-styled health and medicine gurus who are more style than substance. Part of the problem is that these accounts are frequently not managed by medical professionals but rather by young public relations professionals just entering the medical field who don’t distinguish between Vivek Murthy (the much-beloved Surgeon General of the United States, @Surgeon_General) and Deepak Chopra (decidedly not the Surgeon General of the United States, Twitter handle withheld.)

Enter Andy Slavitt. Mr. Slavitt has been the acting administrator of the Centers for Medicare & Medicaid Services (CMS) since 2015. While Mr. Slavitt has come under some scrutiny from some conservative news outlets and other critics for his work while at the helm of CMS, his personal Twitter feed is simply awesome. Mr. Slavitt (@ASlavitt) brings a refreshing honesty to the medium. Yes, he’s partisan, but he owns it. He’s also not afraid to mix it up with random people and accounts online. Usually famous or “well-known” people on Twitter ignore snarky comments from “normals” (ie, everyday people without any particular claim to fame trying to bait a prominent person into a Twitter battle). Not Mr. Slavitt! He’s just as apt to tweet official news about major government initiatives, such as MACRA, as he is to dispel rumors and myths about the Affordable Care Act (ACA) put forth by everyday tweeps (ie, you and me). One anonymous but politically tied Twitter account accused Mr. Slavitt of not knowing the difference between getting insurance and obtaining real medical care, a critique of the ACA. Most government officials at Mr. Slavitt’s level would let a tweet like this slide and simply ignore it. Instead, Mr. Slavitt swung back, tweeting that “unnamed people often lob clichés at you in the job … highest rates of regular [doctor] visits, script fills, and avoided deaths, notwithstanding.”

In fact, Mr. Slavitt’s Twitter persona is not random. It’s part of a plan. Mr. Slavitt has said that his Twitter presence is specifically being cultivated in order to demystify the large and often opaque government agency that he runs. Doing so, he says, “scares the crap out of my colleagues” at CMS, who aren’t used to such a frank and occasionally brusque approach to online PR. This reflects precisely why Mr. Slavitt’s tweets are so informative. When a government agency has a real person responding in real human ways, things may indeed get a little messy, but people feel like they can be a part of the process. Even critics are more likely to engage. The 12,000-plus followers Mr. Slavitt has amassed in just a few months seem to agree.

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