Sometimes all we need is a quick suggestion from our peers to zero in on a good story. Here we turn to front-line journalists for advice, some simple insight to add to our repository of “shared wisdom.”
As an engagement reporter for ProPublica, how did you find sources who would talk about the financial losses they suffered after buying substandard health insurance?
“On the engagement team at ProPublica, our specialty is to try to identify sources by meeting people where they are. For medical and health insurance stories, that sometimes means we’re looking for patients who have had outstanding bills and who turned to GoFundMe and Reddit looking for solutions. We learned from GoFundMe that about a third to one half of their content is from people raising money for medical debt or medical costs. To identify sources, we use key words on the GoFundMe search tool such as short-term insurance or the names of companies that have dominated the short-term insurance market. We don't think people would refer to these plans as junk insurance.
“Then we build a spreadsheet of all the potential sources who might have been affected by the issue that we're investigating. At that point, we start writing copy to reach these people. We may spend a long time making sure it's the best copy because we want these people to speak to us. Usually we explain how our reporting has helped people, and we give them options for how to reach us.
“We did the same thing on Reddit by doing keyword searches and using the names of companies that offer short-term insurance. That’s how we found one of our best sources for the junk insurance article.”
When you joined AHCJ, you had never covered health care previously. How did AHCJ help you?
“I knew nothing about health care in 2006 when I became a member of AHCJ. Since then, I’ve learned so much through AHCJ’s conferences, fellowships, mentoring programs and by working on AHCJ committees. Through my experiences at AHCJ, I grew a great deal as a health care journalist. When I wrote ‘Never Pay Your First Bill’, I wanted it to be useful for consumers and for reporters interested in knowing more about how the health care system works.”
Marshall Allen (@marshall_allen) is the author of “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win,” published in June 2021. As a journalist, he spent 15 years investigating health care, including a decade at ProPublica where he helped to establish ProPublica’s Surgeon Scorecard, which published the complication rates for about 17,000 surgeons. He won the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and was a finalist for the Pulitzer Prize for local reporting for his work at the Las Vegas Sun. In July 2021, he joined the Office of the Inspector General for the federal Department of Health and Human Services. In this quote, he was not speaking on behalf of the federal agency.
In an article you wrote in 2019 for Managed Care magazine, you had some trouble getting a primary source on the record for an interview. Can you explain how you solved that problem in an unusual way?
While researching a story about direct contracting — in which large employers contract directly with health systems to provide care for their employees — I found a YouTube video of Walmart executives during a presentation at a conference discussing their experience with, plans for and enthusiasm about direct contracting. Just from watching that video, it was easy to see how Walmart was influencing the direct-contracting trend and why my readers needed to know about their plans. At first, Walmart’s public relations staff seemed amenable to my interview request but, after weeks of foot-dragging on their end, I had to accept that the interview was not going to happen.
But I still had the video, which I used to write a 650-word sidebar, using direct quotes, anecdotes and fantastic data points lifted directly from the conference presentation. I embedded a parenthetical sentence so that readers knew where I got the information.
Lola Butcher (@lolabutcher) is an independent journalist in Missouri who writes for a variety of publications including Undark, Knowable, CQ Researcher, Neurology Today, Next Avenue, and Physician Leadership Journal.
In your recent article, you cited text messages. Getting those texts seems like a brilliant strategy for journalists. Would you recommend that reporters ask about text messages when seeking to confirm such details?
The patient I profiled did not use social media or email, which are usually good sources when writing narratives.
But she found an old phone that included text exchanges between her and her landlord. Those communications turned out to be crucial because they allowed me to say with confidence that he pushed her out of her apartment knowing she was sick with cancer.
His texts also revealed the pressure she was under. And so, yes, whenever it's feasible, I would ask about whether text messages might be useful to confirm some facts.
How do you keep from getting in over your head when writing about genetic tests or breakthroughs or gene editing?
I get out of my depth on every gene story that I write.
When that happens, I know to ask experts for help and rehearse some of my language with them to make sure it’s accurate.
There’s no shame in asking for help.
Marilynn Marchione is chief medical writer for the Associated Press (@MMarchioneAP).
How does one become an investigative journalist?
There’s the adage that all journalists should be “investigative,” but that would sidestep the question. So my advice for those who are interested in learning about what it takes to be an investigative journalist is to just do one story, and follow it wherever your curiosity takes you. Keep asking questions, even after it runs, and that story will usually lead to another, and another, and another. That’s a good place to start. From there you’ll get a taste for investigative work and can pursue other ways to add to your skill set, such as working with a reporter or editor who has investigative reporting experience or consider working with ProPublica, the Center for Investigative Reporting or other similar organizations.
Cheryl Clark is a senior investigations reporter for MedPage Today and for inewsource/KPBS in San Diego. She lives in San Diego. The Hustling Hope series has won several awards, including first place in the small market investigative category in AHCJ's 2018 Awards for Excellence in Health Care Journalism.
During the Health Journalism 2019 conference in Baltimore, what advice did you offer to journalists writing about medical studies in which the claims seem to be extraordinary?
Any claims in medical studies require evidence. And extraordinary claims require extraordinary evidence. So if the claims are truly extraordinary then I want to see some replication over and over.
Regina Nuzzo, Ph.D., is a freelance science writer, statistics professor at Gallaudet University, and senior advisor for statistics communication and media innovation at the American Statistical Association. As a science journalist she writes about data, probability, statistics, and the research process. Her work has appeared in Nature, The Los Angeles Times, The New York Times, Reader’s Digest, New Scientist and Scientific American, among other publications.
Why did you make the time-consuming effort to read all the comments on the proposed rules for health plans?
There's a rich mine of information in the technical parts of these regulations, and in the comments themselves there’s the potential to see that the new rules could have an adverse impact on patients.
I would certainly advise journalists to consider at least reviewing the comments because it’s a way to get expert opinions all one place.
Noam N. Levey writes about national health care policy out of Washington, D.C. He covered passage of the 2010 Affordable Care Act and has written extensively about the landmark law and reported on its implementation from around the country. Read about his work reporting on the proposed rules.
What suggestions would you offer to journalists seeking to get public officials to respond quickly to freedom of information requests?
At The Hatch Institute, we have a lot of experience making freedom of information requests and have found that some requests are more effective than others. Before making an FOI request, get as much information as possible from the agency in question about which records the agency retains. Some agencies have records retention policies, meaning they list all the records they keep, such as quarterly or annual reports, budgets, committee actions, sexual harassment complaints and employment records. If the agency does not keep a such a list online, call the records access officer to inquire about which records it keeps.
Once you get someone on the phone, have some sympathy because these people have difficult jobs. Ask what’s the best way to request information from the agency so that you can narrow your search as much as possible. While there are advantages to asking for a wide range of information, the disadvantage is that such a request could take a long time to fill. Therefore, you are more likely to get what you need quickly if you can narrow your request to the specific reports or data you need.
Brad Hamilton (@HatchInstitute) is the editor-in-chief of The Hatch Institute, a center for independent investigative journalism. An award-winning investigative reporter and editor, Hamilton has more than 30 years of experience as a journalist and has received three New York Press Club awards.
As a freelancer, how do you compensate for the lack of interaction that you would normally get if you went to work in an office or newsroom every day?
I have found my niche writing about medicine, health, science and the environment. Formerly, I was a reporter for The Los Angeles Times and I am now a contributing editor at Discover, which means I can work from home, which can be isolating. My advice to others is to take classes and workshops and go to as many conferences every year as your time and budget allow. Always look into whether conferences you want to attend will cover your travel costs. Also, apply for fellowships. One of the benefits of winning fellowships is that they can make you more marketable because you can become an expert of sorts in some areas in which you might not have had any prior experience.
Get involved with professional organizations such as AHCJ. Usually, these organizations would welcome your help; it's important to give back, you can connect with colleagues and expand your network of contacts, and doing so increases your visibility in the journalism community.
Linda Marsa (@LindaMarsa) is the author of "Fevered: Why a Hotter Planet Will Hurt Our Health And How We Can Save Ourselves." Her work has been anthologized in the "Best American Science Writing" and has appeared in Newsweek, U.S. News & World Report, Nautilus, Men’s Journal, Playboy, Parade, High Country Times, Pacific Standard and Aeon, among others.
Can you explain how you use the Federal Register and other government sources to cover health insurance?
“I get a lot of stories from the Federal Register. I browse through postings made by federal agencies overseen by the Department of Health and Human Services. I focus mostly on the Centers for Medicare and Medicaid Services. When something new is posted, it’s highlighted in red. New notices can include rulemakings and upcoming public meetings. You can also search for comments filed on proposed rulemakings. These are candid responses by industry stakeholders on policy ideas. They’re great because they’re not filtered via a PR person and they are not widely known about. The comments are linked to on The Federal Register or you can go to www.regulations.gov. Reading these comments helps me to get good on-the-ground responses from sources who understand the issues well.”
Virgil Dickson (@MHvdickson) is the Washington bureau chief and regulatory and policy reporter for Modern Healthcare. He made these comments at the Health Journalism conference in Phoenix in April 2018.
When is the best time for journalists pursuing investigative pieces to get legal advice?
Early in his work covering the start-up lab testing company Theranos in 2015, reporter John Carreyrou learned that the company’s legal counsel was the seasoned litigator David Boies. At the time, Carreyrou had been in contact with a whistleblower and he and Senior Editor Michael Siconolfi reached out to the newspaper’s lawyer, Jason Conti.
“I would recommend to all of you who are working on tough stories, that you know are going to be an uphill battle to publish in your paper or on your website, to bring the lawyers in at an early stage and make them feel like they’re part of the process.” Doing so is much better than alerting them at the last moment because at that point lawyers may want to delay publication while they seek to understand the issues. “I found in this particular investigation, that bringing in lawyers very early was hugely beneficial.”
John Carreyrou is a Pulitzer Prize- and AHCJ Award-winning investigative reporter at The Wall Street Journal and author of “Bad Blood: Secrets and Lies in a Silicon Valley Startup” about Theranos.
You were quoted recently as saying that reporters need to be willing to engage with financial documents and that it’s not difficult to do and that if you have questions find sources who can help you understand them. Can you elaborate on how you do that?
For an article on the Affordable Care Act, “Obamacare’s Sinking Safety Net,” my main source of data for that piece was annual financial reports that insurers file with the National Association of Insurance Commissioners. Reporters can get unlimited, free access to these reports by reaching out to the NAIC’s media staff. Specifically, I was interested in health insurers’ performance on the individual market, since that’s where Obamacare customers have been getting coverage. Figuring out where to find that data can be tricky.
The best way to explain it to walk through an example. If you search for 2016 annual filings for Blue Cross and Blue Shield of North Carolina, for example, two hits will come up: “Key Annual Statement Pages” and “Non-Key Annual Statement Pages.”
To review data on the individual market, select the latter. Once you’ve acquired that data, select “Other Annual Statement Pages.” The other annual statement pages contain data broken down by the insurer’s different books of business, meaning individual, group, or Medicare supplement, for example. Look for a specific section titled, “Exhibit of Premiums, Enrollment and Utilization.”
There you’ll discover that BCBS of North Carolina collected $2.4 billion in premiums in 2016 from its roughly 375,000 individual market customers. Those members incurred medical costs of nearly $2 billion. That means the insurer spent less than 85 percent of its premiums on medical costs – which is right in the sweet spot for turning a profit on that business. By comparison, in 2015, the BCBS of North Carolina’s medical costs amounted to 102 percent of premiums, which means it lost a lot of money on that business.
Parsing this data is not particularly difficult because it’s fairly rudimentary math that most journalists should be able to do easily. But figuring out how to track this information down was not simple. That’s where I relied on experts to help me understand where to find data and what it means.
Analysts at Standard & Poor’s have done some of the best analysis of the Obamacare markets. Specifically, Deep Banerjee has authored numerous reports about the financial performance of insurers competing in these fledgling marketplaces. Banerjee was immensely helpful in walking me through the financial filings and explaining what the numbers mean.
Two other experts were helpful in looking at the data I pulled together from the NAIC filings. Allan Baumgarten is an independent insurance analyst based in Minnesota. He authors annual reports on the insurance markets in nine states. And Katherine Hempstead, who oversees coverage programs for the Robert Wood Johnson Foundation, is always on the lookout for patterns emerging in the exchange markets.
Paul Demko is a health care reporter for Politico Pro and is primarily responsible for covering health insurers. Before joining Politico, he was the Washington bureau chief for Modern Healthcare. Demko also has reported for Politics in Minnesota and City Pages. A graduate of New York University, he started his career at The Chronicle of Philanthropy.
As the state house reporter, how did you carve out time to write your Pulitzer Prize-winning series on opioid prescriptions in West Virginia?
I had been waiting for weeks for the data we needed on the number of prescription opioids that had been shipped to pharmacies in West Virginia. When I received the data in about the middle of October, I spoke to my editor about it, explaining that the data would be the basis for a big story. The data arrived in about the middle of week. I think it was a Wednesday. My editor asked, “Can we have it for Sunday?” I knew I would need more than a few days to go through the data carefully and then I would need time to write the story. So, I told my editor the story would not be ready for the Sunday paper.
Instead, I worked on the piece whenever I had time over the next several weeks. Sometimes I worked at home and sometimes I worked in my office at the State House. In the State House, I could work from about 5 to 8 pm on many nights after I filed any stories I had to cover that day. After 5 o’clock, the State House is mostly empty and so it’s a great place to write. Working on a long, complicated story in the newsroom can be challenging because there are so many distractions.
When I finally submitted the story in December, my editor turned it into two stories. The first one ran on Dec. 18, a Sunday, and the second one was published the next day, Dec. 19.
Eric Eyre is an investigative reporter with the Charleston Gazette-Mail in West Virginia. Since joining the newspaper in 1998, he has covered health, education, business and state government. His investigative stories have mostly spotlighted issues in rural West Virginia communities. His series Painkiller Profiteers took first place for investigations in AHCJ’s 2016 Awards for Excellence in Health Care Journalism and won the Pulitzer Prize for investigative reporting.
What first steps should journalists take when covering the financial health of a large nonprofit cancer center or hospital, such as the case recently in Utah regarding the Huntsman Cancer Institute?
"Start at the Securities and Exchange Commission’s Electronic Municipal Market Access (EMMA site) to look for the latest financial reporting on the hospital, cancer center, or other entity. Nonprofit hospitals that sell bonds typically do their financial reporting here and the filings are more current than the IRS Form 990 (through June 30, 2016 for Utah hospitals,” Stark said. “The audited financial statements for the University of Utah Hospitals & Clinics (where the cancer institute is based) are here. Also, there might be some good tidbits in the bond prospectus, also typically on Emma.
“Insist that you get audited financial statements, which are the gold standard of financial reporting,” he added. “And then line up a group of health care financial experts to review the documents you have. For experts in hospital finance, it’s best to look at medical or public health schools out-of-state, and sometimes retired hospital executives can help.”
Karl Stark (@kwstark) is the assistant managing editor for business, health and science at The Philadelphia Inquirer. He is president of AHCJ and leads sessions on hospital finance at the annual Health Journalism conference.
What documents and other sources would journalists need when covering how health insurers may exaggerate the illness levels among their Medicare Advantage members?
There’s no easy way to get this information because of the secrecy the federal Centers for Medicare & Medicaid impose but there does seem to be some movement toward more transparency.
While CMS has published reams of data showing billing trends for specific hospitals and doctors, the Medicare Advantage plans have largely escaped this kind of scrutiny. CMS has taken the position that much of the information about how health plans bid for Medicare business, such as how much each is paid, are trade secrets and thus not public. Obviously, journalists disagree with this stance and hope that CMS would require the same degree of transparency from MA plans that it does from fee-for-service providers. That seems fair, especially considering that MA has been expanding rapidly, currently has about 30 percent of the Medicare market and was paid more than $160 billion in 2014 in taxpayer money.
That said, there has been some movement toward transparency since our lawsuit under the Freedom of Information Act compelled CMS to release audit reports on MA plans for the first time. These reports are called RADV, or Risk Adjustment Data Validation, audits and many of them have shown that health plans cannot document that they billed correctly for large groups of their patients.
CMS has always been secretive about these audits and their findings, but in December 2015 it published a list showing which plans had been audited and would be in coming years. It is here:
This list was a major step forward in letting the public (and the industry) know which plans would be audited. It also lists overpayment amounts for the earlier audits. These amounts are small because they are based only on 201 patients whose medical files were audited at each plan. In the future, CMS plans to extrapolate the overpayment percentages to the whole MA contract, which means plans could be on the hook for a lot more money.
The best information about RADV and the controversy over whether Medicare Advantage plans have “upcoded,” or taken steps to bill higher codes than warranted, is coming out of whistleblower lawsuits. Reporters can find them in federal court dockets using Pacer, but only after they have been unsealed. This happens only after the government makes a decision whether or not to “intervene” and take over investigation of the whistleblower’s case. Unfortunately, this can take years, and so we never know if lots of these suits are in the pipeline under seal. As this issue gets more attention, patients may start to become aware of how their health plans are reporting the state of their health and may become concerned if they believe that a health plan has exaggerated their sickness level to make more money. Medicare and health plans haven’t told patients about their risk scores, but as the health plans take steps such as arranging home visits that can increase risk scores, more patients might pay attention.
Bottom line: It’s not at all easy to get inside this payment system and inform readers and taxpayers about it. Hopefully, that will change as CMS faces more pressure for transparency.
How did you prepare to interview President Obama in just 48 hours?
In November 2015, I was invited to the White House at the start of the HealthCare.gov open enrollment. As one of five local radio reporters nationwide, I was offered a chance to interview President Obama one on one. I had only 48 hours to prepare.
I was expecting to hear a long list of talking points and I knew President Obama would speak glowingly about the health insurance marketplace. I did not know how many questions I could get in with a man known for his predilection for professorial responses.
So, I asked a few colleagues for advice and opted to focus on three issues important to Floridians: the lack of Medicaid expansion in Florida, rising co-payments and deductibles, and increasing drug prices. My preparation, on the plane and in the hotel the night before, involved reading recent federal policy and political talk about these issues. I tapped most on the context I’ve built covering the Affordable Care Act.
As expected, President Obama provided stock answers on Medicaid expansion and on health costs beyond the monthly premium. I confess suppressing a giggle when he said ‘Obamacare’ while looking me in the eye.
The best question I got to ask was if he would consider allowing Americans to buy mail-order drugs from Canada. He provided a nuanced response: American companies lead the world in drug research and development–and the government doesn’t have power in negotiating drug prices. Simply: there’s no easy solution to a complicated economic problem. It was a response I hadn’t heard him address before, or explain from a consumer point-of-view. I had something different, and new to share with my audience.
My takeaways: Always be ready for ANY interview. And no matter who you interview, be sure that your questions connect with your audience. Otherwise, your once-in-a-lifetime invitation could be little more than a meet and greet.
Mary Shedden (@MaryShedden) is the news director of WUSF Public Media in Tampa and editor of Health News Florida, a collaboration of NPR stations in Tampa, Miami and Orlando.
How do you report on a health-care lawsuit without boring readers or getting sidetracked from your usual duties?
I covered a federal antitrust trial against Idaho's largest hospital system that ran for several weeks. The judge didn't allow us to observe a lot of what happened, but I spent hours at the courthouse almost every day because the lawsuit is a big deal in our community.
There were two challenges: How to make "litigation over a hospital system acquiring a multi-specialty physician group" even a little bit sexy and accessible to readers? And how to cover a trial that long without neglecting the rest of my beats?
Here's what I learned:
As early as you can, read the lawsuit and the defendant's answer, then call lawyers on all sides. Start with an off-the-record conversation to make sure you understand the dynamics of the case. Ask about each team's game plan to get a rough idea of who's testifying in court each day. And the documents – especially affidavits and exhibits – have juicy details for stories.
Go to court expecting a story – but have a Plan B. Witness testimony in a case involving the health care industry is technical, procedural, and often boring to news consumers. I quickly learned I'd have to use bathroom breaks, lunch breaks and times I wasn't allowed in the courtroom to work on backup stories in case that day was a bust. This also kept me from falling behind on my regular work.
Tweet or liveblog, if you can. The judge in this trial was OK with reporters using Twitter. Every afternoon, I'd look back on my Twitter feed and see highlights in one place, making it easier to piece together stories.
Take off your health care reporter hat. When you're five hours deep in expert-witness PowerPoints or executives explaining every word of a conversation with a competitor, it's so easy to get sucked into the weeds. I asked myself all the time, "Would my mom care about this?" If the answer was no, I'd focus on something else. Or I'd re-frame an arcane topic like insurer negotiations into a broader story about power struggles in health care, which affect all of us as consumers.
Audrey Dutton (@IDS_Audrey) covers business with an emphasis on health care for the Idaho Statesman and trains fellow reporters on investigative and computer-assisted reporting techniques.
How do you find sources for your stories?
For me, finding experts for my stories is almost never a problem. But consumers, now that’s a different issue. I write a weekly health care column for the Los AngelesTimes called Healthcare Watch, and each week I include the personal story of one consumer dealing with the issue I’m writing about. The person I feature needs to be willing to have a photo taken for inclusion in the article, and therefore, must live somewhere in Southern California so that aTimes photographer can get to him or her quickly.
After nearly two years writing this column, finding a consumer each week remains, by far, my greatest challenge. I wish I could say I’ve come up with some brilliant, simplified process for finding the right person, but alas, I have not. In all honesty, it can be an ugly, stressful ride right up until deadline. Still, miraculously things do almost always work out, and each week I find someone to talk with me for the story.
Lisa Zamosky (@lisazamosky) is an independent journalist who writes the Healthcare Watch column for the Los Angeles Times and is a nationally known expert on health insurance, the Affordable Care Act and consumer health. She writes for WebMD and the California Healthcare Foundation, and she is the author of Healthcare, Insurance, and You: The Savvy Consumer's Guide.
How do you get patients to tell their stories about health care or health insurance?
First, you have to find them. I encourage my hospital and health care sources to think about identifying patients or consumers who are willing to talk to reporters — using full names, not initials or pseudonyms — and have their photos taken.
Once I get in the door, it's usually easy to get people talking about themselves and their problems. The best strategy is to ask questions and listen. Showing a true interest in someone's life is a surefire way to get them talking. And if there's a pause, don't fill the silence. Force yourself to wait, even if it feels awkward, and let your subject speak. You'll be surprised at what you'll get when you just keep your mouth shut and listen. And always, always keep your notebook out, or your tape recorder on, until the very end. I can't count the times when I've heard one of the best lines of the interview as I'm nearly out the door.
Covering the rollout of the Affordable Care Act was a challenge because, even though people like talking about their medical bills, they're a little more reluctant to give details about their incomes. And those figures are central when writing stories about who falls into the Medicaid gap or who qualifies for subsidies on the insurance exchanges. When asking for income information, get as much as the subject is comfortable sharing. If necessary, I'll agree to use a salary range or describe their income as being above or below a certain level.
When I encounter resistance, I assure people their story will be useful for others encountering similar problems and give others the knowledge or courage to take action. This usually works. People like the idea of helping others.
Every year I try to do an in-depth narrative about an individual or family. I spent four months with a cancer patient and his family as he died at home in hospice care. And I spent several months with a couple who chose to deliver a baby with a birth defect even though they knew she wouldn't live long. These people happened to be willing to share some of the most intimate moments in their lives with me and our photographer. But when we first met, I tried to be as transparent as possible about what I would need. I told them I would ask lots of questions (some of them seemingly irrelevant and intrusive) and that I would want to spend time with them even in moments when they'd rather be alone. But I also promised that I would go over the story with them before it was published so that it would be correct, would accurately reflect their story and would not be a surprise to them when the paper came out. I was willing to let their stories go if they said no, but they trusted me — maybe because I was honest with them? — and their stories were beautiful.
When I'm interviewing people who are not elected officials or public figures, I almost always promise to check back with them before publication to make sure I've got the facts right. In some cases, like the ones above, I have read the entire story to my subjects, if the topic is personal or sensitive. Often, I just read back quotes or portions of a story to make sure I understood the material correctly. Most of the time, people don't try to rewrite the story but are good at catching mistakes that would have been embarrassing if they had made it into the paper.
Magazines used to have fact checkers. Some may still. But, as we all know, news budget cuts mean staffing cuts on copy desks and fewer eyes proofing stories. So it's worth the time to make these extra checks. I believe you'll get more people to talk to you if you prove, over time, that you can be trusted to get it right.
Karen Garloch (@kgarloch) has been writing about health and medicine for The Charlotte Observer for more than 20 years.
Would you recommend crowd funding an article of special personal or professional importance?
The answer is, yes, but only if you have a deep, abiding faith in your project — enough to take on an unusual, risky, and nontraditional approach to funding. Here’s why:
In 2010, I started pitching a story on pregnancy and condomless sex between couples affected by HIV. Between then and now, my story became a longform ebook, “Positively Negative: Love, Pregnancy, and Science’s Surprising Victory Over HIV,” that came out in July 2014.
Looking back on the experience, the book became a story of perseverance, dedication and trusting my gut. To cover most of the publishing costs, I used crowd funding. Now, the question is, would I recommend crowd funding to other journalists?
The topic itself already seemed like a radical idea: that couples in which one person has HIV could have unprotected sex, have a baby and not pass on the virus. It went against everything I’d ever heard and been taught about HIV. As far as I was concerned, “use a condom” was gospel. But not anymore, it turned out.
And so I started pitching. And pitching. And pitching. First, I heard nothing. That went on for a few years. Then, I got a bite. A well-known publication offered to buy the story and run it on its website – for $100. The advantage was that it would get lots of eyeballs and I had, after all, been pitching it for several years. I worried that the story would quickly lose its timeliness. Plus, the editor told me I could write as long as the story warranted. The disadvantage, of course, was the pay.
I weighed my options and thought, “Now or never.” I accepted the assignment, and figured I’d write it on nights and weekends, as long as I wanted and in the narrative style I preferred. If the editor offered me 5,000 words at $1 a word, I would have taken it, no question – and it would have been a very different story. As it was, the final story clocked in at nearly 9,000 words – and the editor told me to cut 2,000 of them.
By this time, I had fallen in love with the story. I’m not usually like this. As a former newspaper reporter, I am not precious about my words and am happy to follow suggestions. But somehow, not this time. I loved the characters and was committed to the structure, and interwoven narrative of two couples seeking inexpensive and safer conception options through the maze of insurance and sperm donation bans and the scientists who were proving that unprotected sex wasn’t the careless option it had long been thought to be. And I wasn’t alone. I asked journalists I respected to read the piece and they compared it to something you might read in The New Yorker – high praise, indeed.
But faced with cutting 2,000 words or being left without a venue, I considered. And decided to pitch it elsewhere. I got nibbles, and even talked to editors who expressed interest in it. I always returned to what I considered to be the power of the story in its current iteration. But, of course, it was long. So editors asked me to rewrite it, essentially. I thought about doing so – and even tried it once – but found myself uncharacteristically disinclined to agree.
In the end, I was committed to the story in its entirety. And that led me down a course I never could have imagined: crowd funding. I did an Indiegogo campaign and raised the money to hire an editor, a fact-checker and a formatter. You can read more about that here.
As I type this, my book as sold more than 100 copies. It won’t make me tons of money, but I’m heartened by the fact that it seems to be couples like those I follow in the book—couples who tell me they felt isolated and alone—that are finding it. And I can now call myself a published author. Along the way, I learned that if I let myself go, I can trust my instincts. My instincts both for character development and for marketing have been right just about every time. As I go forward, I’m holding on to these things: perseverance to keep pitching, and following my instinct to make my work the best it can be.
So, yes, I would recommend crowd funding. But only if you have enough faith in yourself and in your book, long-form article or extensive reporting project that you are willing to do whatever it takes to promote your idea to total strangers for more than an hour every day until you reach your goal.
How do you juggle a big series while not neglecting your regular beat and still have a life?
Early this year, I wrapped up an eight-part radio documentary series about hepatitis C. It took months of reporting, interviewing, writing, recording, and producing. Throughout, I’ve had to do my best to keep on top of my health care beat, churning out daily news spots and blog posts as much as possible. Here’s what I learned about juggling those competing priorities. (Not to mention a two-hour daily commute, husband, toddler, and 13-year-old at home!)
Get organized: I decided to invest a lot of time at the beginning of this project pre-interviewing key sources and using that information to draw up an initial outline, or roadmap, for the series. I came up with a list of individual stories, the scenes and sources I’d include in those stories, in an order that made sense (at the time), and then started booking interviews for recording. That work paid off. Having a roadmap to follow early on not only helped me schedule my time efficiently, it also helped me communicate the bigger picture of where I was headed to people who wanted to know, such as my boss, our development staff, and sources. Of course, I redrew parts of that roadmap as I learned more, and refined each story idea. To keep on top of my beat and daily reporting, I devoted a chunk of time each morning to scanning news and messages and then focused on my series in the afternoons.
Use technology: I use the newsfeed service from feedly.com to subscribe to news sources, Google news feeds I’ve set up, and other sources. Feedly helps me stay on top of my beat, all in one place, in addition to reading the papers and talking to sources. To help organize my series, I used Evernote, a note-taking/clipping service/database/filing cabinet all in one application that you can access on your computer or smart phone.
Ask for a little time off: Not a vacation, but a little time off – a few days or a week if at all possible. Getting this time away from the daily news cycle allowed me to think, get organized, and talk to people. I’m lucky to have a boss who values deep-dive reporting and who was kind enough to give me some time to think and plan. I work in a small, loud newsroom, so there were several months when I had to grab this time on weekends and evenings at home. I did a lot of writing then, too, because sometimes there just weren’t enough hours in the day to get it all done at work. Also, my reprieve from feeding the daily beast didn’t last more than a few days, so I had to learn to find good stories I could turn out quickly.
How can too-busy journalists find time to pursue a “big picture” project?
When you suspect that one spot news story on your beat is linked to another in a way that is not quite obvious, you may be on to an idea that deserves in-depth reporting. Start by filing away every news clipping, report, press release, notes of a random thought and names of possible sources in a single location. Meanwhile, during regular beat coverage, never pass up the opportunity to tell a source that you are gathering string for your vague idea and ask if they have any thoughts.
If the topic resonates with sources and the file accrues hundreds of “this might fit somehow…” tidbits over a period of time, you gain confidence that the idea is worth pursuing. And making the reporting plan is less daunting because the file holds so much information and a long list of sources to explore. Set aside a Saturday to read through everything you have gathered, write out the hypothesis of what you are looking for, prioritize the source list — and you are on your way.
What do journalists need to know about covering clinical laboratories (or other science/medical subjects) that they initially know nothing about?
It’s tough to write about something you know nothing about, yet that’s often where we start our stories. Here are some tips for figuring out complicated subjects, especially those that are highly technical or scientific.
Learn how something is supposed to work, then figure out how it is actually working. The difference between those two things is often a big story. That was the case with our investigation into nationwide delays in newborn screening. It’s pretty simple: Blood is supposed to be taken from a baby’s heel shortly after birth. That blood sample is to be sent quickly to a state lab for testing so babies with genetic disorders can be treated before they become extremely sick or die. But that wasn’t happening for hundreds of thousands of newborns. Instead, hospitals were not sending some blood samples quickly.
Don’t assume rules and regulations are being followed, or that they are even any good. Sometimes rules and regulations are weaker than they should be or simply are not being followed. With newborn screening, some states had regulations that required blood samples to be sent from hospitals within 24 hours. Other states had rules requiring hospitals to use state-financed courier services to transport newborn screening samples to state labs quickly. In both cases, hospitals ignored the regulations.
Be wary too of guidelines or rules that just aren’t good enough. Some state labs had their own “guidelines” where officials would refuse to test a blood sample if it was two weeks old. For some children, two weeks is far too long. They could be dead or brain damaged without treatment.
Talk to the experts, but don’t assume they’re always right. People are usually happy to talk about their areas of expertise, but sometimes they have blind spots. And sometimes they just don’t know what they’re talking about. For the newborn screening story, newborn screening experts said delayed samples might have been a problem in the past, but were not anymore. In reality, no one had ever looked at the data; therefore, they simply did not know.
Understand the science. Read everything you can find. Sources are often impressed—and more willing to spend time helping you—if you appear to know your stuff. Read academic studies, government reports and news articles.
Ask sources to explain the details as you were are 5 years old. I love “The Office” (the TV show), and there’s a great clip where Michael Scott is trying to understand what a “budget surplus” means. “Why don’t you explain this to me like I’m an 8-year-old?” Michael tells the accountant, Oscar. Oscar makes an attempt, but Michael doesn’t get it. Michael asks again, “Why don’t you explain this to me like I’m 5?” It’s the same with sources. Don’t let them intimidate you or put you off because something is a bit complicated or nuanced. Make them explain.
Figure out why a story matters. Don’t bother telling a story unless it truly matters to people. Find examples to illustrate why it’s important. Be exhaustive in your search for examples. When explaining science or medicine, don’t use jargon that the experts used and remember, you aren’t writing a research paper. Your job is to tell a story.
Ellen Gabler (@egabler) is an investigative reporter and assistant editor at the Milwaukee Journal Sentinel. She wrote recently about flaws in the nation’s newborn screening program which led to reforms throughout the country. Her team’s work for the project, Deadly Delays, received the Selden Ring Award, Scripps Howard Award for Investigative Reporting, an IRE award, and other national awards. Gabler and a colleague also won the 2013 Livingston Award for National Reporting.
How do you know if the people you're interviewing understand terminology?
For example: Do they understand co-pays and deductibles, etc., in a way that gives you confidence in writing about their costs?
We asked people to share what their insurance paid and what they paid. That got us around the deductible and co-pay conundrum.
What’s the most effective way to cover the insurance industry?
Over the past few years, there has been a strong tendency among health care journalists to write about the politics of health care. I certainly understand this tendency given the great number of compelling stories to write about the Affordable Care Act.
But what’s too often missing today is in-depth coverage of the business of health care. One way to collect excellent story ideas on the business of health insurance is to listen to the insurers’ earnings calls, which the big for-profit companies have with Wall Street analysts every quarter. Also, attend the insurers’ investor days and annual shareholders’ meetings, which can be very enlightening.
As a former PR professional for these companies, I know from experience that these events are well orchestrated. Reporters rarely show up. Yet, if they did, they would hear presentations from the top executives and may get to ask probing questions.
At WellPoint’s annual meeting earlier this month, for example, CEO Joseph Swedish was asked if WellPoint would reject an offer to take taxpayer money through the risk corridors. According to reporter Tony Cook from The Indianapolis Star, Swedish said, “The next three years, we’ll see how it plays out. But my sense is that we'll be able to take advantage of it. But our No. 1 goal is to not put ourselves in the position of having to be the beneficiaries of risk corridor payments.” So, there’s a story to follow through 2016, which is when risk corridor payments will be available.
Over the past 20 years or so, unfortunately, the number of journalists covering the insurers’ investors’ meetings has dropped steadily. And not enough reporters are covering the earnings calls.
If you can’t attend the earnings calls, you can read the transcripts which are usually available the same day or the next day. Just hearing the questions Wall Street analysts ask can give you an inside look at how these companies work.
Covering the business of health insurance in this way would mean you would be doing what any good editor might suggest, which is, “Follow the money.”
Wendell Potter (@wendellpotter) is a former public relations executive for Cigna and Humana. After 20 years as a corporate public relations executive, Potter left insurance and testified before Congress about the insurance industry. He is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.” His latest book is “Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.” He writes about health insurance for the Center for Public Integrity.
How do you recognize your source’s motivation and use that motivation to advance your story when interviewing?
When AHCJ asked me to write this Shared Wisdom piece about sourcing for insurance stories, I thought I didn’t have much wisdom to share. Compared with many of my colleagues, I know relatively little about insurance. I only write about it as it intersects with some of my primary interests: medical errors, physician oversight, painkiller abuse, and attempts to cut off access to health-related records.
But on sourcing, I can offer one simple idea that has helped me time and again. Figure out your source’s motivation quickly. Use that motivation to advance your story and be mindful of whether that motivation might compromise your story.
People often talk about whether a source “has an agenda.” Much of the hand wringing over the false 60 Minutes Benghazi story is about whether Lara Logan’s sources – and Logan herself – had an agenda. As cynical as this may sound, journalists would all be better off assuming everyone has an agenda. That’s not a bad thing. These sources wouldn’t be talking with you if they didn’t have an agenda. The trick is to make sure that their agenda advances – and does not subvert – your story.
To break it down even further, I tend to think of sources in three broad categories: Cause champion, chess player, and crank.
Cause champion. In many ways this is the easiest source to handle but often the source with the least useful information if you are trying to develop a story that nobody else has. The source has a very public agenda. He or she wants to raise money for research into childhood obesity or wants people to read a just published article on that research. Because everything from this source has been filtered through that cause, you need to un-filter it. One of the best ways to do so is to ask the cause champion herself, “Who out there would totally disagree with you on this point?” Then call that person and ask that person for others who are critical. But don’t just write a he said/she said. To serve your audience, you have to decide how the evidence stacks up. That’s where source management comes into play. If you don’t write your piece in a way that comports exactly with the source’s view of the world, be prepared for the source to be less friendly the next time you call. But, guess what? The source probably will still talk with you because cause champions talk with everyone.
Chess player. This is the most difficult source to handle because when you first call this source, you might think you know this person’s motivation. You may believe your source is talking with you because you are a reporter from the Great Falls Tribune and he or she wants want all his or her neighbors and friends to read the article. You also might think you are calling a cause champion, that you know what motivates this source and that your are fully prepared to ask questions that test the legitimacy of the information you are about to receive. But people are complicated. They might have a stated and seemingly unimpeachable purpose for talking with you. Let’s say they analyze insurance company performance for an investment bank. But they also might be staring down a round of layoffs and looking for a way to self-aggrandize and legitimize their position in the company. Many of my best sources are playing a chess game that changes from quarter to quarter depending on what’s happening in their organization or in their personal lives. For example, I have some internal sources in organizations who will tell me things – nearly always with the caveat that they not be named. Ostensibly this is because they don’t want to get in trouble with their companies. But I have learned over the years that this can also be a way for them to try to plant the same story with multiple news outlets. Maybe they are trying to get their boss fired. Maybe they are short selling with their own company’s stock. That’s why you always need to ask for primary documents. Then read those documents to see if, taken as a whole, they back up the story. As hard as it is to believe, reporters often let documents sit on their desks next to their computers without ever turning a page. Sometimes the sentence your source pointed you to is upended by the very next sentence. Read the documents, and then check those documents to see if they are legitimate. Doing so may require asking for the same documents from two different sources just to be sure.
The crank. This source has very few good things to say about anyone or anything, often even themselves. And that combination of seemingly thoughtful criticism and humorous self-deprecation can pass as wisdom. You may find yourself calling this person often because this source is so good at providing pithy quotes. What you should realize, however, is that often the crank doesn’t have much in the way of real information. He or she is playing a role, and you are the stage director. What to do with a crank? I try to avoid them. Yes, cranks can be quote machines. But try to rely mainly on sources who actually have something beyond wit to offer for a story.
In the end, you may think you are calling the shots as a reporter, but you always need to be mindful of your source’s motivation. What drives them can ultimately drive your story straight to the top of the “most read” list or straight to the correction page.
Wiliam Heisel (@wheisel) writes about investigative health reporting for Reporting on Health; blogs about health care on Antidote; and is the director of communications at the Institute for Health Metrics and Evaluation at the University of Washington. He has worked as an investigative reporter at the Los Angeles Times and The Orange County Register and helped to create a first-of-its-kind report card judging hospitals on a wide array of measures.
How did you use social media to find sources without engaging in the political discourse around this topic?
What we did was not even mention “ACA” or “Obamacare” in the shout out to minimize the political feedback. We just asked people if they wanted to talk about their experience with being uninsured and being served a large medical bill, since such experiences affect everyone regardless of their politics. One of the guys I interviewed, for example, is a Republican and he ended up making some really poignant comments in one of the videos we did. He was even surprised when I told him how much he would pay under the law and said the ACA is a lot better than he thought.
Can you explain the importance of cultivating sources, particularly when covering a big story that develops over many years?
The Affordable Care Act is a significant development for the readers of Business Insurance. An Internal Revenue Service ruling interpreting a provision of the law can have, for example, a big impact on the health insurance coverage employers offer to employees. At the same time, employers have to be analytical, meaning they must to consider the big picture when they are design their health insurance plans. The big picture for employers involves controlling costs while also ensuring that they also offer effective health insurance benefits that help them attract and retain their employees.
My challenge as a reporter is to meet these dual information needs of readers. What I have learned in doing this job is to develop a network of sources, primarily employee benefit consultants and employee benefit lobbyists. In developing this network, I’ve come to recognize that even the most informed consultants and lobbyists cannot possibly be on top of every health insurance reform development any more than I can.
As a result, I’ve made a point about tipping my sources about health insurance reform law developments – such as the release of a regulation or a report. In turn, my sources have tipped me off to developments that I otherwise would have missed.
At the same time, I always try to keep the big picture in mind. For example, the ACA will provide subsidies to pre-Medicare eligible retirees. Knowing this fact led to a story about how the role and importance of employer-provided retiree health insurance plans will decline, the first time such a story was published.
In short, reporters covering health insurance reform have to keep up with breaking news and seek the big-picture stories as well. Readers need both. To do both requires the development and maintenance of sources.
Jerry Geisel (@BusInsJGeisel) is an editor-at-large at Business Insurance magazine.
How should journalists evaluate claims and counterclaims about Obamacare?
Given that the Affordable Care Act alter much about health insurance, it may be difficult to evaluate all the claims and counterclaims about how much employer-based health coverage will change under Obamacare.
Surveys from the National Business Group on Health and from the Kaiser Family Foundation/HRET show that employer-based health insurance coverage will remain as the foundation of coverage under Obamacare for those under 65. The questions, then, for health care journalists are these: How should they monitor changes in employer-sponsored health coverage and should they believe those who blame the changes coming to health insurance on the ACA?
In my experience, brokers, insurance agents, and benefits consultants are excellent sources for tracking changes in employer-sponsored health care. National consultants or brokers such as Lockton, Mercer, and Towers Watson are great at spotting trends but they’re shy about identifying what specific clients are doing. Local agents know what’s going on in their towns including which employers are implementing which changes, even if they don’t handle the business.
To weigh claims blaming the ACA for shrinking coverage, balance the cost of the ACA components employers complain about against the overall cost of the system. The PCORI fee ($2 per life) is peanuts. The reinsurance fee ($63) disappears after a few years. Lifting the cap on annual/lifetime benefits is harder to measure. By many accounts, the Cadillac tax is considered to be a significant potential burden that employers will work hard to avoid by shrinking the value of their high-cost plans. But don’t forget that employers have been shrinking coverage in one way or another since the 1980s. And if the ACA somehow controls health costs, that will save everyone--employers included--a lot more money than the law costs.
Jay Hancock is a staff writer at Kaiser Health News. Before joining KHN in 2012, he wrote a column on business and finance for The Baltimore Sun. Previously he covered the State Department and the economics beat for The Sun and health care for The Virginian-Pilot of Norfolk and the Daily Press of Newport News.