by Cole Sinanian and Sarah-Mae McCullough
Summary
About three months into the pandemic, The New York Times started thinking about how the paper could cover COVID-19’s long term impacts on Americans 一 including financial impacts. This concern about “financial long COVID” led to The Cost of Care, a series of reporting that uses crowdsourcing to uncover trends among Americans’ medical bills for COVID-19 treatment or tests, including some illegal charges.
The Times encouraged readers to submit COVID-19 related medical bills and share their experiences through an online form. Investigative reporter Sarah Kliff examined submitted bills, followed up with many of the submitters and combined her findings with traditional reporting to write a series of pieces on surprise coronavirus bills. After going through bills submitted by over 600 readers, she’s written stories that have led to healthcare policy changes as well as the reversal of individuals’ medical debt.
Organization Background: The New York Times, a daily newspaper founded in 1851, is ranked 3rd in the US and 18th in the world by circulation. The Times has a strong background in crowdsourcing, regularly using crowdsourcing through social media or other digital call outs for everything from breaking news to features and enterprise reporting.
Snapshot
Project Goals: The Times wanted to know how COVID-19 was affecting Americans financially, particularly in the context of the US healthcare system, which is prohibitively expensive for many. Kliff and her team set out to collect a large enough sample of bills that they would be able to spot meaningful patterns in the types of charges and billing codes used for COVID-19.
Project leaders also wanted The Cost of Care to serve as a model for future engaged journalism endeavors. To Patel, engagement journalism is when reporters “ involve people in the reporting process, and when their voices are represented” and “shape the reporting in some significant way.”
Project Resources: The greatest resource The Cost of Care required was staff time. However, there were no additional staff positions or funding added for the project. Rather, Kliff, already an investigative reporter, started focusing much of her time on this series. The project made use of existing staff positions at the Times, such as the Interactive News Team members and the director of community and user generated content.
Tools & Technology: The Times’ Interactive News Team set up Attribute, an in-house tool built several years ago, to collect submissions on the website. This made it simpler to scan the bills and extract important data.
Impact: The sheer volume of bills 一 in August 2020, Kliff wrote that over 600 readers had participated in the crowdsourcing 一 allowed her to spot patterns that would have been impossible to decipher with just a handful of sources. For example, after noticing that multiple people who went to the same provider were charged an unusually high amount for COVID-19 tests, Kliff found that a doctor was “repeatedly billing insurers more than $1,000 for coronavirus tests.” Her reporting led to policy change surrounding surprise billing and, according to Kliff, “the reversal of thousands of dollars in medical debt” for individuals.
It is also important to the team to offer utility to the readers. “In all of Sarah’s reporting, she was thinking about the readers first,” Patel said. The bills gave Kliff a deeper understanding of the common challenges and frustrations Americans face in the healthcare system. But she didn’t just use this understanding to write compelling stories about these hardships; she also wrote utility-focused pieces on topics like how to navigate a medical bill or how to advocate for yourself as a patient. Readers expressed gratitude for this much needed, practical information.
“To me, part of engagement journalism is offering services and possible solutions to problems,” Patel said.
Here’s How it Happened
After the pandemic started, New York Times Director of Community & User Generated Content Sona Patel started wondering about COVID-19’s long term financial impacts on Americans. Knowing that one of the Times’ reporters, Sarah Kliff, had done crowdsourcing work with medical bills before, Patel wrote up a memo describing her vision for a crowdsourcing project called The Cost of Care and sent it Kliff’s way. The pair revised the plan and sold it to Kliff’s editors and the Graphics team, who helped The Cost of Care materialize.
The Times created an online form that allows readers to submit medical bills. The form also asks people to describe what happened (“What led you to seek care, and what was the experience like?”), if the bill caused financial hardship or included charges that surprised them and if they are insured or not. It requests that they omit sensitive data, such as their address, from their bills before submitting them.
When bills started coming in, Kliff “single-handedly” reviewed them, Patel said. Most of the submissions painted thorough pictures of the patients’ experiences. However, Kliff followed up with each person who had submitted a bill and was featured in a story to verify information or do more reporting to add context. If it seemed like a patient may have been illegally billed, Kliff would reach out to the healthcare provider for more information. She combined this crowdsourcing with traditional reporting, including analyzing COVID-19 data from state and federal governments about COVID-19 treatment and testing costs, to write stories.
While Kliff went through the medical bills and did the reporting herself, there were several players involved. The Times’ Graphics team worked to design the article pages as a series in which readers could easily navigate to previous The Cost of Care stories. The Interactive News Team set up the submissions form on the Times’ website, and the legal department advised the team on what sort of medical information they could solicit without causing liabilities.
Here’s What Worked
1. Consistent and Persistent Publication Cycle
Reporter Sarah Kliff churned out a deeply reported story every two months on average, Patel said, totalling 16 pieces published between February 2020 and May 2021. The consistent coverage was due to Kliff’s dedication and ability to focus her full attention to the project. Given the vast amount of medical bills collected over the 15-month period, Kliff was able to commit to a regular production cycle by following up on submissions and digging through the bills for the most telling anecdotes efficiently enough to produce consistently compelling and accurate stories. This tenacity allowed the series to accurately reflect the rapidly shifting nature of the pandemic and tell the whole story of the financial burden COVID placed on Americans.
2. Subject Matter
The series began in the first few months of the pandemic, right as early COVID patients were receiving their first hefty bills. It struck a nerve with thousands of Times readers, intricately illustrating a previously undocumented aspect of the pandemic. Patel recalls reading online comments on the stories from international readers who expressed gratitude about living outside the US because they didn’t have to put up with the injustices of the American healthcare system. It shined a light on a problem that many Americans were likely to face in the months to come. Millions of people were taking COVID tests daily, and the project spread awareness about the long term financial impacts of COVID before many had to deal with it. The subject matter was relevant to virtually every New York Times reader, as everyone was at risk of experiencing the financial hardships associated with COVID-19, Patel said.
3. Outreach
The Times’ crowdsourcing technology was a valuable resource during the project, Patel said. It allowed reporters to efficiently communicate submissions calls to a vast audience and gather information on a time crunch. In order to avoid would-be submitters from being paywalled out of the project, submission forms were distributed to readers as free “gift” articles. As the pieces were published, readers who submitted their bills were able to access the articles for free. “We feel strongly that if somebody is submitting to us and actively trying to help us with our reporting, that we should try to give them access to an article that they possibly contributed to,” Patel said.
Here’s What Could Have Worked Better
1. Crowdsourcing
While the Times team was successful in soliciting medical bills from a large quantity of readers, Patel acknowledged that there were limitations to using the NYT submissions page as the only method for collecting bills. The reporters did not prioritize soliciting bills from people using different forms of health insurance, which may have affected the amount people were being charged.
Reaching underrepresented communities who may not have had access to the New York Times’ website is a constant challenge for crowdsourced reporting, she said. In future projects, reporters might consider using offline crowdsourcing methods, such as physical flyers placed in community centers or publicly accessible newsletters. With a crowdsourcing project of this scale, the most significant hang-up in the reporting process was a simple lack of resources. The NYT does not have a specific crowdsourcing department; Patel handles the logistics of crowdsourcing across all desks. If there were a specific department devoted to crowdsourcing, Patel said, reporters could have spent more time developing a more inclusive crowdsourcing strategy.
2. Engagement
Patel described The Cost of Care as a great example of crowdsourced journalism, but not necessarily engagement journalism. A truly engaged project would have involved ongoing utility to readers beyond the published stories. While The Cost of Care team followed up with all reader-submitted medical bills included in the stories, the audience engagement aspect of the project was used primarily for sourcing. A possible example of a truly engaged Cost of Care might have included a regular newsletter distributed by the Times to interested readers, providing continuous current information on new legislation related to covid testing costs, Patel said.
Here’s What Else You Should Know
The Cost of Care project is ongoing. Expect to see more reportage on COVID medical bills in the coming months. The project may also end up expanding to include crowdsourced stories about hidden medical bills unrelated to COVID.
Learn More
Read The Cost of Care. To learn more about the process of creating the series, contact Sona Patel at sona.patel@nytimes.com.