Back Button
Menu Button

Motivation Needed to Improve Price Transparency in Iowa

Iowa Report Card on Price TransparencyIn Iowa, we can do better. Indeed, we must, as we really can’t get any worse.

Report cards are important for many different reasons. Whether for students, organizations, institutions, legislators, communities or countries, report cards can summarize overall progress by using comparable benchmarks that use similar metrics. If generated appropriately, report cards can serve as a motivator to improve on less-than-desired results – and behaviors.

While attending parochial school in Fargo, N.D., my third grade report card was…embarrassing. Ok, it was downright atrocious. Most subject matter grades were usually ‘Ds.’ My care-free attitude reflected that school was not a central priority for someone my age. In fact, it seemed that many of my friends were equally unmotivated to elevate their grades. When I did care, I would only compare my grades with my closest peers. In that regard, I was still below average.

Report card comments stated that I ‘needed to improve my attitude.’ Fair enough. But it took me another three years to eventually become tired of having less-than-exemplary grades, especially when I began to compare my grades with a broader audience of classmates who had greater academic aspirations. This delayed ‘epiphany’ pointed me in a new direction of pursuing better results – and, I might add, making my parents happier!

Embracing this new transition required a motivation that would alter my behavior(s) to perform differently. To elicit a positive change, finding the ‘right’ motivation is tricky. It must cause a person, organization or community to repeat certain behaviors and actions over and over before it finally becomes ingrained in who we ultimately wish to become. Whether you’re a student pursuing employment after graduation, becoming the employer of choice, or being the healthiest community, motivation is key. Our attitudes, beliefs, intentions and efforts will ultimately drive the cycle of desired change.

In this vein, I was keenly interested in learning about the newly-released the ‘2016 Report Card on State Price Transparency Laws’ by the Health Care Incentives Improvement Institute (HCI3) and Catalyst For Payment Reform (CPR) that graded each state on healthcare price transparency laws. I will refrain from specifics, other than only three states (Colorado, Maine and New Hampshire) earned an “A,” one (Oregon) received a “B,” two (Virginia and Vermont) given a “C,” while one (Arkansas) received a “D.” What about the other 43 states? According to HCI3, they all failed.

The 18-page Report Card provides a good overview on this subject for each state. Each high-scoring state provides a legislated website that shares consumer-friendly resources in formats that are relevant to healthcare prices.

What about Iowa?

Based on this report card, it appears that Iowa must make improvements to:

This report card serves as just one measure – price transparency. The quality of care received by patients is not measured.

APCDs may collect data from all state sources including Medicaid, private health insurers, children’s health insurance and state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans (ERISA) and Medicare.

APCDs are often believed to be the best price information resource because they include actual paid amounts, not merely charged amounts. Until we can get real-time ‘settled’ prices by provider for each procedural event, APCDs may be the best option, although somewhat problematic, due to a recent Supreme Court ruling. Some insurers may offer their own ‘transparency’ tools for their customers. However, limitations make it a ‘buyer beware’ proposition when it comes to paying the final price – given the specific medical procedures and services that are eventually delivered.

According to this report card, Iowa has received a failing grade on price transparency tools for the healthcare ‘consumer.’ The question for employers and their employees, along with other payers and consumers of healthcare: Is this grade acceptable? Are we better served clinging to the past and continuing to blindly shoot in the dark while purchasing care?

Iowa can choose to be led by more forward-thinking states that appear to be trendsetters in price and quality transparency initiatives, or we can decide to break from the masses and choose a new mindset to improve a nagging problem that continues to persist for our population.

It’s about having the right motivation and behavior. Most importantly, it is about having the will to break through complacency and self-interests. The word ‘transparency’ is frequently used in healthcare – whether spoken or written – but unfortunately, it is underutilized in the practices and policies in which we live.

Seeking and finding the right motivation and behavior can be done. Take it from a ‘reformed’ third grader!

To stay abreast of employee benefits and other tangential issues, we invite you to subscribe to this blog.


  1. Perry Meyer says

    Appreciate the article on transparency. Just wanted to provide some information to you as transparency has been and continues to be a key focus area of the Iowa Hospital Association and Iowa hospitals. We would like to call you and your readers attention to the public website: On this web site is a great deal of data and information available to the public including Iowa Hospital Charges Compare and a link to the Iowa Healthcare Collaborative and the Iowa Report which provides over 40 indicators of quality and patient safety on Iowa hospitals. Both are provided in Iowa without government mandates. We would also like to point out that the All Payer All Claim programs in several states throughout the U.S. are now failing because of the Supreme Court ruling you highlight that exempts ERISA exempted claims from entering the data base. This can result in less than 50% of all claims populating the APCD which renders the data incomplete and not of use.

    • David Lind says

      Thank you very much for your comments, Perry. I am very aware of the resources provided by the IHA and the IHC to the public, and find them helpful. The particular report that I referred to in this blog deals specifically with ‘legislated’ websites, which Iowa does not currently have. Does this mean that Iowa has ‘failed’ because we do not have a mandated clearinghouse of such information? Not necessarily. To clarify, I am not a big believer that government mandates are necessary in well-advanced marketplaces – unless, however, the private industry fails to proactively provide useful and ongoing information in which the consumer can depend to be: 1) easy to use, 2) relevant and timely, and most importantly, 3) trusted. I also agree that APCDs may not be the best resource in which to compare price’s, as we simply don’t know whether fully-insured data collected by APCDs are similar enough to ERISA-exempted claims. In a perfect world, having REAL TIME prices by episode and provider would be the ultimate price transparency. We have the means to get there…much like we had the means to land on the moon in the ’60s using technology from the ’60s. The work at IHA and IHC are well-noted. Thank you again, Perry!

Join the Conversation