How One Florida Newspaper Went Beyond Reporting to Spur Original Research

(This blog was originally published by the USC Annenberg Center for Health Journalism.)

By Maggie Clark, Sarasota Herald Tribune

Some of the best ideas are the ones that initially sound the craziest.

I was about four months in on my reporting on Florida’s Medicaid managed care program, and I was hitting a wall. I’d been talking with pediatricians, who were seeing hundreds of Medicaid-enrolled kids each year, and they kept telling me that the system was getting in the way of them taking care of their patients.

But there was no research on what effect the state’s new program was having on these doctors and their businesses.

I was griping about this to an editor one afternoon, and he innocently asked, Could we get that information on our own? I initially shrugged it off as a rhetorical question, but then I recalled a paper I’d read months back where Joan Alker and researchers from the Georgetown University Health Policy Institute’s Center for Children and Families had conducted with doctors in two Florida counties at the start of the Medicaid managed care program in 2007. The research itself was far too old and narrow to use today, but the methods could work for a new project based on a similar concept.

I knew I was going to see Alker at a conference in a few weeks. I pitched her my idea of updating her survey and taking it statewide, fully expecting her to say no. I assumed the center wouldn’t want to get involved so closely with a newspaper.

But Alker didn’t say no, and seemed excited at the idea of coming back to a research question she’d been wondering about ever since that first small survey in 2007. She would, however, need to secure funding for the research.

I went back to my newsroom and talked with our executive editor, Bill Church, about how we might connect Georgetown with funding. He found a willing supporter in the Community Foundation of Sarasota County, whose donors saw the survey research as a way to better understand why Medicaid-enrolled children were falling behind in school and not reading on grade level, a priority for the foundation’s philanthropy.

At the same time, Alker and her team created a survey for doctors and worked it through Georgetown’s institutional research board. While I suggested questions based on my reporting, they had final say over what questions went in the survey.

Alker also secured the willingness of the American Academy of Pediatrics to distribute the survey to their more than 4,000 members. We needed their support to make sure pediatricians responded to the survey, and Alker had an existing relationship with them, which made the ask a lot smoother.

We had our partnerships in place, but as happens in the real world, news intervened.

In early April, just as our survey response window was closing, pediatricians, parents and dentists announced a settlement in a decade-long case they’d brought against Florida’s Medicaid program. In an agreement in federal court, the state Medicaid program agreed to improve access to care for children and to work with health providers to make sure kids get the care they’re entitled to under federal law.

It’s unclear what effect the settlement had on the number of pediatricians who responded, but the overall response rate was pretty low — only 6 percent.

The rate was really too low for our findings to be generalizable, but it did offer more in-depth interviews with more pediatricians than I could reach on my own, as well as a look into the practices of over 100 pediatricians who see a very high volume of children on Medicaid. Before our survey, there was no large-scale look at what was happening in pediatric practices as a result of the transition to Medicaid managed care.

The group of pediatricians surveyed confirmed many of the anecdotes I’d heard before — health plans are interfering with pediatricians prescribing needed medical treatment, children are switched between insurance companies without their parents’ consent, and difficulties in finding certain specialists who are willing to treat Medicaid-enrolled children. Georgetown also highlighted national data that show Florida lags behind other state Medicaid programs in connecting children with required medical and dental care.

At the Herald-Tribune, we wrote about the survey findings on the Sunday before the survey was released to the wider media. We got some statewide media interest, although once again, news happened.

The tragic shootings at the Pulse nightclub in Orlando occurred on June 12, the day before we released the survey. There was no way we could have — nor did we want to — supersede coverage of such a horrific event in our state so we didn’t get as much interest in the report as I expect we otherwise would have.

Looking back on the project, a few lessons stand out to me:

1. You have to trust each other. Trust was a huge piece of this effort. I had to trust the Georgetown team to conduct independent research, the foundations had to trust that the survey and report would be worth the investment, and Joan had to trust that I would correctly interpret the findings. The research process began in early October 2015, and the window for pediatricians to return the surveys was open for six weeks, ending in early April 2016. Joan shared pieces of the survey responses with me, but not everything. I saw a draft of the report before it was published, but I did not have any say (nor did I want any) in the way the findings were characterized.

2. Know your goals. We at the Herald-Tribune were facilitating research, not trying to get a scoop. I had to be patient and know that the time put into the work would ultimately add to the validity of the research. Additionally, it was important that we all knew the goals each party had for the research. For the Herald-Tribune, it was to build on the work I’d done in my Medicaid reporting and contribute to the information available to the public and policymakers charged with managing the Medicaid program. For Georgetown, it was building on their 10-year body of work on the Medicaid program in Florida. For the Community Foundation of Sarasota County, it was gaining more insight as to why Medicaid-enrolled children miss more days of school and are less likely to read on grade level than their upper-income peers.

3. Anticipate potential responses to the project. Unsurprisingly, we received some pushback on the survey. About a month after the survey was published, the Herald-Tribune published a guest editorial from the Florida Agency for Healthcare Administration that referred to the study as “biased.” They criticized the low response rate and said that they have not received complaints about the problems identified by pediatricians.

Georgetown and the agency have a slightly adversarial relationship — Alker and her center advocate for Medicaid expansion, which Florida has rejected — but she is also well respected in Florida by a diverse coalition of experts and advocates, and had the knowledge to complete the survey better than anyone else. We knew state officials might take issue with the findings, and made sure everyone was ok with that possibility going in. We were all on the same page.

4. Journalism as convener. This was a concept shared with me by Cole Goins, community engagement editor at the Center for Investigative Reporting, and my mentor during my 2015 National Health Journalism Fellowship. Sometimes our role as journalists is simply to bring people together, and start conversations. We often know a lot about people’s work, and we can make connections that they may not make on their own. These eventual partners were all groups working towards similar goals — improving children’s health — but who didn’t know each other yet. My role was to bring them together and the share the results with our community.

The results of our partnership have been really rewarding. We got nearly 1,200 viewers of our community forum discussing the report via Facebook Live, and several statewide media outlets wrote stories in the weeks after the report was released. Alker was featured in a statewide call of advocates and researchers to discuss the report, and over 100 people listened in. She’s also gotten inquiries from other groups about potentially replicating the study in other states.

Looking back on the project, I’m glad that I was willing to ask people a seemingly crazy question. For journalists interested in this type of work, don’t assume researchers aren’t interested in pursuing a project that dovetails with your journalism.

Ask, and be open to the partnerships and collaborations that unfold. You’ll be amazed what can happen.

Maggie Clark is a Program Director at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.