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Building transparency in health care costs Date: 08/18/14

By Lisa Pickoff-White, senior news interactive producer, KQED; Joel Withrow, product manager KPCC/SCP; and Jeanne Pinder, founder, clearhealthcosts.com

Anybody who has ever built software knows how tricky it can be (hello, HealthCare.gov!). So what’s it like to build software when the partners are in Los Angeles, San Francisco, New York, Bialystok, Kiev and Tahiti and you’re journalists and developers working against a fierce deadline?

In April, the PriceCheck team won a grant through the Prototype Fund of the John S. and James L. Knight Foundation to help shine light on health care costs.

Our goal was to create a public, non-proprietary database where users can easily contribute and look up costs. Here’s the project launch page from KQED, which links to the form; the form itself can also be found here.

We began an eight-week development sprint. The vision was a Javascript tool that would be embeddable upon the news partners’ sites, allowing community members to share their prices for common health procedures, and also to search the database for prices. The data is in a MySQL database, and a Ruby on Rails API lets the two talk to each other.

We broke up our core reporters and developers into editorial and product teams so that each team had representatives from KQED in San Francisco; KPCC/Southern California Public Radio in Los Angeles; and ClearHealthCosts.com, a New York City journalism startup bringing transparency to the health care marketplace by telling people what things cost. Each team member was responsible for reporting back needs and information to their larger organization. By empowering key decision makers, we were able to cut through red tape and move quickly.

The development team: Lisa Pickoff-White, senior news interactive producer at KQED; Joel Withrow, product manager at KPCC/SCPR; and Jeanne Pinder, founder and CEO of clearhealthcosts.com

We also had a strong starting advantage. ClearHealthCosts had done a similar pilot project on their site, and a bigger one with the Brian Lehrer show at WNYC public radio in New York in summer of 2013. In that project, more than 400 women responded to a call to share the prices of their mammograms. So, we already had a prototype to build from.

The design and coding were done by ClearHealthCosts’s partners, RevSquare, a digital agency in New York with offices in Montreal, Singapore, Paris, Bialystok and Sydney. Their client list includes Bravo, Showtime, The Associated Press, The New York Times, Scholastic, The Economist, France 24, Eurosport, RFI and other big companies, as well as small startups. Their principal and founder, Jeff Mignon, is an adjunct at the CUNY Graduate School of Journalism, where he helps Jeff Jarvis and Jeremy Caplan with the Tow-Knight Center for Entrepreneurial Journalism. (ClearHealthCosts was launched at the CUNY journalism school.)


Lisa Pickoff-White


Joel Withrow


Jeanne Pinder

Here’s some of what it looked like:

  1. The initial design was made by Elisa Riteau at RevSquare in New York. We had a lot of conversation over the look and feel of the form: The choice of the photograph, the colors in the header were all geared towards creating a friendly form for an unfriendly topic. It was also important for the design to work on all devices, including mobile.

  2. We tried to pursue the best possible scheduling and check-in procedures, knowing that San Francisco is 3 hours behind New York, which is 6 hours behind Bialystok, where Chris Lojniewski, the front-end dev, lives, and 7 hours behind Kiev, where the amazing Alex Filatov, the Rails and MySQL engineer, lives. During the process, the chief technical officer at RevSquare, Guillaume Pousseo, moved from Paris to Tahiti. We were also very conscious of the near-constant political turmoil that surrounds Alex in Ukraine.

    Throughout the project we tried Google Hangouts, Skype, Skype with video, and good old-fashioned phone calls. It didn’t matter what tool we used to connect, as long as everyone could hear each other and share links. At the beginning of the project we met twice a week, and at the end several times daily. We used Basecamp for project management, and also Revsquare’s Redmine project management and bug-tracking tool for parts of the project; this helped a great deal in tracking tasks and time-shifting around the globe. We’ve also used Google Drive for sharing documents, and join.me screenshares.

  3. In building software, learning to communicate was the biggest lesson for us all. Is it a bug, meaning it doesn’t work? Or is it a feature request, meaning new, unanticipated functionality? What hardware and software are you using to test, and have we tested on a variety of devices? Is this mission-critical, or can it go to Version 2?

  4. One of the best things we did was to leave time to respond to user testing. We conducted two types of testing: An online questionnaire to reach many users and in-person testing.

    We found different types of bugs from each test. Our larger online test helped us identify technical glitches like browser compatibility. The in-person user testing revealed points of confusion and how users responded when left to their own devices. For instance, it quickly became clear that people were confusing the provider and insurance boxes. It also helped us streamline our search.

The end result is pretty spectacular, though we all see things we’d like to change. So far the project has gathered several hundred shares and a larger number of searches. We’ve produced a number of blog posts analyzing the results, and appeared on air several times. We have high visibility throughout California, thanks to our partners’ wide reach through their communities.

And we all have a new and even deeper respect for Alex Filatov, Chris Lojniewski, Guillaume Pousseo and all our other developer friends.

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