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Journalists and experts have written about covering insurance and presented discussions on the topic at AHCJ conferences and workshops. This is a collection of the most useful and relevant tips. Click the title of the tip sheet that interests you and you may be asked to login because some are available exclusively to AHCJ members. Featured tip sheetsCoronavirus pandemic highlights disparities in health insurance and health care December 2020 But for non-white Americans, this good news is only part of the story because Blacks, Latinos, Native Americans, and other people of color may be reluctant to get the vaccine, as Glenn Howatt reported for the Minneapolis Star Tribune. Howatt’s article is just one example of how journalists localize the national story about the vaccine for COVID-19. Also, it’s an excellent example of why people of color are reluctant to get the vaccine. Such reluctance is born of widespread disparities in the health insurance and health care systems in the United States. Questions to consider when covering health insurance reform proposals
September 2020 For health care journalists writing about health reform now and what might happen in 2021, it’s instructive to consider what Wendell Potter, a former public relations executive for health insurers, would suggest when covering this issue. The founder of Tarbell, a donor-funded and subscription-driven health care news site, Potter is one of the co-founders of Business Leaders for Health Care Transformation, a coalition of business leaders supporting the idea of a health care system that covers everyone with essential services regardless of income. As a former executive for Humana and Cigna, Potter has good advice for health care journalists. During a recent telephone interview, offered a number of tips for reporters to consider. Employer direct contracts with doctors, hospitals and health systems
Direct employer-to-provider contracts are an example of health care payment reform. The pioneers have been large employers trying to buy better health outcomes for their workers at a lower cost than they’ve been getting through health plans. In their pursuit of lower costs and higher quality care for their workers, employers now call these arrangements, “value-based direct contracts.”
Look for additional tip sheets based on subject:Costs: Patients and providersCoronavirus pandemic highlights disparities in health insurance and health care December 2020 But for non-white Americans, this good news is only part of the story because Blacks, Latinos, Native Americans, and other people of color may be reluctant to get the vaccine, as Glenn Howatt reported for the Minneapolis Star Tribune. Howatt’s article is just one example of how journalists localize the national story about the vaccine for COVID-19. Also, it’s an excellent example of why people of color are reluctant to get the vaccine. Such reluctance is born of widespread disparities in the health insurance and health care systems in the United States. When covering disparities in maternal mortality among black women, consider payment reform
Many health journalists who cover health disparities and women’s health issues have covered disparities in infant mortality, yet we don’t often do a deep dive into what happens to the survival of women of color during pregnancy, delivery and the year after giving birth. The awareness of the disparities in pregnancy-related deaths for black women is bringing about change at the policy and legislative levels. Andrea King Collier has some suggestions for how to cover these changes. Keep this in mind when reporting on association health plans
Levey’s analysis of these comments is important because it offers a window into the concerns of health insurers and the other organizations impacted by AHPs. In maternity care, hospitals know what to do, but most fail to do it
In some states, such as California, Massachusetts and Nevada, hospitals are doing relatively well in keeping mothers safe from harm. But in other states, such as Louisiana, Georgia and Indiana, they are not. She noted that Vermont, New Hampshire and Alaska had no data available on maternal death rates. So which is it? Providers develop wide variety of definitions for population health June 2017 The terms population health and population health management have become ubiquitous among health care providers, wrote Tamara Rosin, a reporter for Becker’s Hospital Review. But, she added, “Despite their prevalence, the industry has yet to decide on a single definition of ‘population health.’” She was reporting on a panel discussion that Becker’s sponsored on the topic and included in her article definitions of the term from five hospital executives. Legal reporters explain how to cover medical funding companies that prey on patients August 2016 As they reported last year, “In the little known world of medical lending, financiers invest in operations to remove pelvic implants from women suing device makers — and reap an inflated share of the payouts when cases settle.” In their investigations for Reuters, they reported how these investors profit by financing care for desperate patients and how business groups called for a probe of medical funders. For this tip sheet, we asked Frankel and Dye for advice on how journalists could cover this story. Skepticism is one key to reporting on pharmacogenetic tests
June 2016 When writing about how these tests work, skepticism is in order. These tests are highly complex and their algorithms are proprietary. Reporter Beth Daley offers advice on what to look for in your reporting. Financial incentives for physicians may not be working as expected March 2016 In other words, physicians don’t earn enough from the financial incentives to focus on improving quality of care. For journalists this point is important because health insurers and health systems often claim that by establishing new payment arrangements, physicians and other providers will be paid more for quality and quality scores will rise. The question journalists can ask now is this: Are physicians and providers being paid enough for focusing on quality of care to make a difference in patient outcomes? How to use the Health Care Pricing Project to take a deeper look into hospital cost variations February 2016 The fact that hospital mergers drive up prices is certainly not new. But the HCPP researchers used newly released data from three large health insurers — Aetna, Humana, and UnitedHealthcare — and they controlled for factors that hospital administrators usually cite when explaining why their facilities charge more than others. It was, as Gorenstein described in his Marketplace article, “an unprecedented look at medical costs nationwide.” Little-known loophole in health insurance plans leaves some without coverage
January 2016 But reading the full story showed there was much more to it, involving a little-known loophole in health insurance plans that leaves some health plan members without coverage or recourse. The story shows that journalists might find a number of stories if they look into whether health insurers routinely deny coverage to victims of violent crimes if the insurers believe the victims are at fault. How Chicago journalist used data to show how population and insurance shifts affect hospital vacancy
The traditional sense of a hospital is fading. Advances in technology, changes in how doctors and hospitals are paid, and a big push toward outpatient care mean patients aren’t spending as much time in hospital beds as they used to. In Chicago in particular, huge population shifts have gutted many minority communities anchored by hospitals. The result? A lot of empty beds. I found quite the increase in vacancy rates while analyzing state records and interviewing dozens of people for my project, Running on Empty, which included this database that readers could search for information on every hospital in Illinois. Tips on finding patients, consumers to be sources for your stories
She says that finding a consumer each week remains, by far, her greatest challenge. While she wishes she had a brilliant, simplified process for finding the right person, she says that, "In all honesty, it can be an ugly, stressful ride right up until deadline." But she says things do almost always work out, and each week she finds someone to talk with her for the story. Here she shares some of her strategies to find patients and consumers for her stories. Angles, resources to consider when covering insurance discrimination For journalists covering insurance discrimination, the HIV cases offer important lessons about how insurers have used pharmacy benefit pricing strategies to shift the cost of medications to members. Health policy researchers and patient advocates contend that these pricing policies, including one called adverse tiering, are discriminatory.Health insurers focus so closely on the cost of care that they sometimes face charges that they discriminate against members with chronic costly conditions. Over the past year, patient advocates have complained to state and federal regulators that health insurers have failed to provide adequate insurance coverage to patients with cancer, HIV, mental health conditions and other illnesses (pdf). This tip sheet explains issues and resources journalists will find valuable when covering pharmacy benefit discrimination cases. How Pittsburgh reporter localized the price variation story When the Blue Cross Blue Shield Association published a report in January 2015 about the wide variation in the cost of hip and knee surgery nationwide, it was a national story. Many journalists treated it that way. But the report also offered journalists a way to localize the story because it offered so much detail on individual insurance markets. One good example came from journalist Bill Toland of the Pittsburgh Post-Gazette (@btoland_pg) who wrote about how the city’s hospitals ranked versus hospitals in other markets. Don't stick to experts: How to find people who acquired insurance under the ACA
May 2015 This tip sheet by Shannon Muchmore, health care reporter at the Tulsa World, gives some hints. She shares ideas on finding people, what to ask them about their insurance coverage and some story ideas, as well as some important reminders for reporters. She also shares some of the stories she's written that include consumers' experiences and perceptions. Tracking doctors' fees: An important angle to pursue when hospitals acquire physician groups May 2015 In her reporting, Sanger-Katz provides a good example of how payment strategies cause hospitals to buy physician groups. Find out why the discrepancy exists, learn about the proposal to eliminate it and find out where hospital and physician groups stand on the recommendation.
For hospital infection rate story, Connecticut journalist cites the good with the bad December 2014 Her story, “Half of State Hospitals Exceed Infection Rates New Data Show,” is important because hospitals with the worst infection rates in 2012 and 2013 will lose 1 percent of their Medicare reimbursements in fiscal 2015. It’s also important because she names 11 of Connecticut’s 30 hospitals that will likely be penalized. Hospital infections kill more people than car crashes. Here’s how to cover them better About 75,000 people a year die from nosocomial infections - infections they contracted while in the hospital. This seems like a high number, but these infections and their costs don't get a lot of coverage. It might seem difficult to approach the issue and make the data relevant to your community, but the Columbia Journalism Review has some suggestions on how to cover hospital infections, such as utilizing the National Healthcare Safety Network from the CDC. Miami journalist reports on the challenges in getting price transparency data in South Florida Price transparency is supposed to be one of the keys to controlling the cost of health care. But as journalist Michael Chang reported in The Miami Herald, getting insurers to release the figures on what they pay for health care and getting providers to release the figures on what they receive for delivering care can be difficult if not impossible. In his article, Chang reported on the struggle a consultant for a local union had in determining what Miami-Dade County paid to doctors and hospitals caring for county employees, their family members and retirees. The numbers could not be released, he reported, because data in contracts between insurers and providers are proprietary. In fact, most contracts between health plans and providers include “gag” clauses that prohibit either side from releasing price information. Even a public employer, such as Miami-Dade County, could not get the data due to gag clauses. Chang quoted Duane Fitch, the consultant for Local 1991 of the Service Employees International Union, saying, “We really need to understand where the money is being spent in order to be insightful about benefit design changes.’’ Local 1991 represents physicians and nurses at the Jackson Health System, which is a county-owned hospital. How a secretive panel uses data that distorts doctors' pay
September 2014 “Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors,” Whoriskey and Keating wrote. The problem with this secretive 31-member AMA committee called the Relative Value Update Committee (RUC) is that the AMA’s estimates of the time involved to do procedures are exaggerated by as much as 100 percent, according to an analysis by Whorisky and Keating. Programs develop to manage most costly 1 percent of patients December 2013 Direct contractingEmployer direct contracts with doctors, hospitals and health systems
Direct employer-to-provider contracts are an example of health care payment reform. The pioneers have been large employers trying to buy better health outcomes for their workers at a lower cost than they’ve been getting through health plans. In their pursuit of lower costs and higher quality care for their workers, employers now call these arrangements, “value-based direct contracts.” Insurance mergersResources to help you monitor the impact of recent health insurer mergers March 2020 With this background and the data in this new tip sheet, journalists should be able to find some new stories relevant to their area. Maternity careWhen covering disparities in maternal mortality among black women, consider payment reform
Many health journalists who cover health disparities and women’s health issues have covered disparities in infant mortality, yet we don’t often do a deep dive into what happens to the survival of women of color during pregnancy, delivery and the year after giving birth. The awareness of the disparities in pregnancy-related deaths for black women is bringing about change at the policy and legislative levels. Andrea King Collier has some suggestions for how to cover these changes. How payment reform could help the U.S. reduce its high C-section rate
August 2019 Thus, journalists who write for business or clinician audiences can find some good stories in efforts at payment reform for maternity care. "Childbirth and newborn care is the largest or second largest (after heart care) category of hospital expenditures, and it’s by far the largest category of hospital expenditures for state Medicaid programs, so even small improvements can result in large savings,” according to the Center for Healthcare Quality & Payment Reform. In maternity care, hospitals know what to do, but most fail to do it
In some states, such as California, Massachusetts and Nevada, hospitals are doing relatively well in keeping mothers safe from harm. But in other states, such as Louisiana, Georgia and Indiana, they are not. She noted that Vermont, New Hampshire and Alaska had no data available on maternal death rates. Medical homesWhat is a ‘medical home’ and why is it important?
December 2017 Medicaid/MedicareDeepen your reporting on Medicare Advantage December 2019 Anyone turning 65 has several months on either side of their birthday to choose to enroll in traditional Medicare, the government-run health insurance for older adults and certain people under 65 with disabilities. Another option is to enroll in a Medicare Advantage plan sold by private insurers, something the Centers for Medicare & Medicaid has strongly encouraged. Those plans offer a range of perks to entice enrollees. But Clark learned that it can be almost impossible to switch from an MA plan to traditional coverage if you wait too long or end up sick, creating a pre-existing condition. Journalist explains why a deep dive into comments on proposed regulations is worth time, effort
June 2019 Before the rules became final, Noam N. Levey reported extensively on the public comments federal regulators received on both proposals. His review of comments from health care groups gave him a thorough view of concerns about the proposed rules from those who work in health care and those who would implement the new rules. Also, his work was useful to at least one law firm that cited his article in a lawsuit it filed challenging the rules. Study shows Medicare’s hospital readmission reduction program effect on mortality July 2019 In December, researchers published the results of a study of HRRP’s effects on mortality in JAMA that showed a rising number of patient deaths. They also cautioned that more analysis is needed. Understanding how health advocates, legislators are wrestling with Medicaid work requirements
March 2018 The Department of Health and Human Services’ recent green light for work requirements, drug tests, premiums and other policies rejected by previous administrations is attracting the interest of states that already expanded Medicaid and are now looking to tighten restrictions on the program, as well as states that never expanded Medicaid in the first place. But for states looking to implement the newly-allowed restrictions, many difficult questions lie ahead. Here’s a guide to understanding some of the economic and ideological battles playing out in the states. Is Medicaid managed care coming to your state? Keep these coverage tips in mind
Although research is mixed about whether managed care saves money for states, programs have exploded nationwide because health plans typically are paid a fixed amount per enrollee, which helps states predict their costs for the year. This is an important story to follow in your state. Kristen Schorsch explains six things to pay attention to. 10 things reporters should know about covering Medicare
August 2016 In fact, Medicare’s complexity has been identified in research as a significant deterrent to broader consumer use of the program’s wide range of benefits. Even though Medicare has an open enrollment period each year that basically amounts to a free “do over” for consumers, seniors can be so intimidated by the process that they just stick with what they have even if it’s inferior to other options. With this in mind – and having spent the past two years answering reader’s Medicare questions for PBS NewsHour – here are 10 items (and, yes, this is a made-up number for the list gods) that health care journalists might like to know as they shape their plans for Medicare coverage. Mental health, addiction and insuranceMental health parity rule clarifies standards for treatment limits, coverage of intermediate care
January 2014 The final rules, issued in November by federal officials, spell out more specifics. Michelle Andrews, writing for Kaiser Health News, spoke with Jennifer Mathis of the Judge David L. Bazelon Center for Mental Health Law and provides some background and clarification on how the rules affect consumers. Self-insurance
September 2013 Describing this strategy, one health care consultant said: “What you’ve got is basically a loophole for the small employer to get out of the ACA requirements.” Reporting on how employers might use self-insurance to sidestep ACA rules
July 2013 But some people fear that self-insuring companies could skim too many young folks out of the small business exchanges and insurance company costs and losses could soar, insurers could exit and the exchanges could break down. Jay Hancock of Kaiser Health News explains the issues and why this is a local story that reporters should be paying attention to. PremiumsDon’t be misled by low premiums when covering short-term health plans
But reporters need to dig deeper to see how these plans affect consumers and the health insurance market in general because first looks can be deceiving. Suggestions on writing accurately about rising premiums
November 2016 But we need to do it accurately, not sloppily. Here are a few quick suggestions: Covering premium rate increases for 2015? Check out these resources first
June 2014 Premium rate review is an important story, obviously, because it begins to answer the question of what consumers will pay for insurance next year. But it’s a complex story because what health insurers propose now is not necessarily what consumers will pay next year, and, in fact, insurance rate requests are only part of the story, as Trudy Lieberman reported in the Columbia Journalism Review. Here's some background on the process of premium rate review, as well as tools, resources and tips for doing the most nuanced and accurate reporting on this important topic. Prior authorizationHere’s what you need to know when covering ‘step’ therapy January 2019 As of Jan. 1, health plans are allowed to override even more treatment decisions under a new rule from the federal Centers for Medicare and Medicaid Services. The rule allows Medicare Advantage plans use step therapy to restrict coverage when physicians prescribe drugs under Medicare Part B. In a step therapy protocol, a patient must fail to improve on a lower-priced medication before the insurer allows the patient to use a more costly drug, as Paul Sisson explained for The San Diego Union-Tribune. Also known as step protocol or fail first, step therapy is a form of prior authorization, a topic we covered in a tip sheet in August. Here's what you'll need to know when covering prior authorization
Each of these situations show that for health insurers, providers and patients, prior authorization is complex and often deeply controversial. This year, the health insurance industry issued a plan to improve prior authorization and increase timely access to treatment. Learn about that plan and how the industry intends to pursue its goal. ReformWhat you should know about new HHS rules on state control of health plans
Issues to consider when covering hospital readmission penalties
November 2016 The federal government publishes individual hospital readmission rates on its Hospital Compare website, and Medicare is in the fifth year of cutting payments to hospitals with high rates of rehospitalizations. Public scrutiny and financial hits from the penalties are prompting many hospitals to take steps to avert so many returns. Five things to know about ACA enrollment challenges for ‘young invincibles’
October 2016 Young, healthy Americans are a crucial demographic to the success of the Affordable Care Act. Their participation in Obamacare exchanges is important to help balance out the cost of older enrollees more likely to get sick and need medical care more often. Selling insurance across state lines: What reporters need to know
April 2016 How is this proposal for interstate insurance sales different than what currently exists in the marketplace, where the nation’s largest health insurers (Aetna, United HealthCare, etc.) already sell policies in multiple states? And what evidence do we have about whether the idea would be successful? What has happened in the handful of states that have already tried it? What effect would it have on the uninsured? Rachana Pradhan covers a few things you need to know. Small businessJournalist explains why a deep dive into comments on proposed regulations is worth time, effort
June 2019 Before the rules became final, Noam N. Levey reported extensively on the public comments federal regulators received on both proposals. His review of comments from health care groups gave him a thorough view of concerns about the proposed rules from those who work in health care and those who would implement the new rules. Also, his work was useful to at least one law firm that cited his article in a lawsuit it filed challenging the rules. States establish SHOP marketplaces March 2014 Research by the Commonwealth Fund has shown that small business owners and their employees have often been priced out of the health insurance market, said Commonwealth Fund President David Blumenthal, M.D. Small businesses also have limited insurance options, forcing them to choose plans with high premiums and limited benefits. The SHOP marketplaces give these businesses a chance to provide a range of affordable, comprehensive insurance options to employees, he added. This study shows that nearly all states have attracted enough competition to offer small businesses a choice of insurers and plans. The Connecticut SHOP marketplace, for example, offers 12 plans, while the SHOP exchange in the District of Columbia offers 267 plans, the report showed. SourcesJournalist explains why a deep dive into comments on proposed regulations is worth time, effort
June 2019 Before the rules became final, Noam N. Levey reported extensively on the public comments federal regulators received on both proposals. His review of comments from health care groups gave him a thorough view of concerns about the proposed rules from those who work in health care and those who would implement the new rules. Also, his work was useful to at least one law firm that cited his article in a lawsuit it filed challenging the rules. Covering health insurance? You’ll want to tap these sources on a regular basis May 2018 However, many other insurers are private or not-for-profit, or they are part of a health system, all of which makes reporting on their financial data more difficult. On top of all these complications, each state regulates health insurers differently. For journalists covering this beat, here are some resources Bob Herman uses regularly. Tips on finding patients, consumers to be sources for your stories
She says that finding a consumer each week remains, by far, her greatest challenge. While she wishes she had a brilliant, simplified process for finding the right person, she says that, "In all honesty, it can be an ugly, stressful ride right up until deadline." But she says things do almost always work out, and each week she finds someone to talk with her for the story. Here she shares some of her strategies to find patients and consumers for her stories. Value-based careWhen evaluating value-based care, consider whether costs are falling and quality is improving
August 2018 Other observers, however, aren’t so sure that value-based care is where the market is headed — or whether it’s even producing a significant shift in health care delivery. The panel’s moderator was Bruce Japsen, who writes about health care for Forbes. “Value-based care can be complicated, but journalists should think of it as all a part of the same effort to get patients medical care and treatment in the right place, in the right amount and at the right time,” Japsen said. “The key going forward will be how successful these models will be at reducing costs. We will know that when premiums stop rising or slow dramatically.” |
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For nearly two years, Lisa Zamosky has been writing a weekly health care column for the Los Angeles Times that features the personal story of one consumer dealing with the issue she is writing about.
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