Nine tips for reporting on the business of health care from KHN’s Chad Terhune

Health care and business reporting can be intimidating beats for the uninitiated, all the more so when you combine them.

But that shouldn’t stop you from asking tough questions of what veteran health care reporter Chad Terhune calls the “health care industrial complex,” the vast sea of private companies that run much of the U.S. health care system

Terhune, who previously reported for The Wall Street Journal and The Los Angeles Times before joining Kaiser Health News in 2016, says he spends a lot of his time trying to understand the slew of middlemen in the health care system, an often opaque world of insurers, pharmacy benefit managers, device makers and, crucially, enormous sums on money.

Terhune shared some of his reporting strategies and secrets with fellow journalists at the 2018 Data Fellowship this week. Here are a few of his essential tips for reporting on the big business of health care:

1) “Corporations are people, my friend,” as Mitt Romney infamously said on the 2011 campaign trail. Seen another way, Terhune says it’s a useful idea for health care journalists — think of companies as the main character of a story. Are they up? Are they down? Are they trying to stage a comeback? Are two companies waging war? Let the company be the protagonist driving your story.

2) Get the contracts, RFPs and emails: Make a habit of putting in public records requests to the government agency a company is doing business with (or trying to). Review all requests for proposals, contracts and email correspondence between the two sides. “You will be surprised how stupid some of these companies are in what they’ll say in an email,” Terhune said. “Or what the state agency will say.” Maybe it’s a state official asking for a job six months down the line, or some other red flag that screams, “Story!”

3) Pray they go to court: When companies bid for government contracts, “someone invariably loses, and pray, pray, pray one of the losing bidders goes to court and sues,” Terhune explains. “Then you get a whole other window: You might have discovery, depositions, and then more dirty laundry.” Bitter representatives of the losing side in bidding wars are often willing to talk. And that dirty laundry is the cloth from which great stories can be wrung.

4) Find former employees: LinkedIn is an obvious place to find former employees of a company who might be willing to talk to a journalist, but Terhune is also a fan of Indeed resume service, which shows a person’s resume and when they last updated it. “It’s an easy gold mine to find people,” Terhune said. “People who are disgruntled and trying to find a new job, they’ll post their resume on Indeed.”

5) Show me the filings: If a company you’re reporting on is publicly traded, you’re in luck. “Just think of it as a public records act request bonanza,” Terhune said. Publicly traded companies must file Form 10-K with Securities and Exchange Commission, and this annual report is worth scanning (find them on the company’s website under Investor Relations or look them up here) for everything from profit margins to pending lawsuits. Terhune typically jumps to the “Legal Proceedings” portion of the 10-K first. “That’s where companies have to disclose a lot of embarrassing stuff they don’t want to talk about,” he said.

6) Eavesdrop on earning calls: Or better yet, scan the transcripts later that day on Seeking Alpha. Companies use these calls to talk up their profits, not their commitment to patient care or community work. “When they’re talking to Wall Street, they are actually pretty blunt about how they’re making their money,” Terhune said. “And that’s what I want to hear.” Terhune urges journalists to push past the softball questions from obsequious analysts at the start and wait for the skeptics relegated to the back of the queue. “Those analysts are the ones I want to talk to, they’re like the pebble in the shoe,” he said.

7) In case of nonprofit, dial 990: Nonprofits are required to file IRS Form 990, which you can search for on Guidestar or ProPublica’s Nonprofit Explorer. How many executives are making over $1 million a year? Are there potential conflicts of interest? Who is the organization signing contracts with? It was a 990 form that led Terhune to this story about a husband and wife raking in millions of taxpayer dollars from a Medicaid managed-care plan in San Diego. The IRS filing tipped off Terhune to the fact that the husband was serving as an outside consultant hired by his wife to help run the company.

8) Partner up: So you’ve done some reporting and maybe even crunched your own numbers, but you want to check your math. Perhaps you need help from a professional who wades through the murky waters of health care data and costs daily. Terhune points out that there a number of private organizations that you can reach out to for assistance in vetting claims, running data and contextualizing health care costs. There’s been an explosion in recent years of firms and startups specializing in big health care data. “I’ve found many of them are very eager” to work with reporters on stories, he said.

For instance, the Health Care Cost Institute sits on a huge pile of health claims data and can help you do data runs to answer specific questions; Mpirica is a great source for data on hospital care quality; Amino specializes in health care costs; and WellRithms can help you analyze confusing hospital bills. Terhune brought in Healthcare Bluebook for help in determining a fair price for a heart procedure for this story on a teacher billed $109,000 after his heart attack, despite having insurance.

9) Bonus tip: ‘So, you bought a jet?’ Does the company or executive you’re looking at keep a jet or two handy? Terhune explains how to find out. Find the plane’s registration number by visiting the FAA’s database and entering the company or owner’s name (could be an LLC, so you may have to dig a little). Once you have the jet’s tail number, you can enter it FlightAware.com to find more details about the jet and photos. Fun details for any follow-the-money story!