1. Skip to content
  2. Skip to login form
  3. Skip to footer




Metrics for Transformation -
Transparency

4
States with adequate transparency
(Graded as an "A")
46
States with little to no transparency
(Graded as a "D" or "F")

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F


Price Data Sources:
Arkansas Hospital Association

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F

Price Data Sources:
Hawaii Health Information Corporation

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F

Grade - Price: F / Quality: F


Price Data Sources:
Iowa Hospital Association

Grade - Price: F / Quality: F

Grade - Price: F / Quality: D

Price Data Sources:
Maryland Health Care Commission - The Maryland Hospital Pricing Guide FY 2011

Grade - Price: F / Quality: F

Grade - Price: F / Quality: D


Price Data Sources:
Missouri Department of Social Services - MoRx Price Compare

Quality Data Sources:
Quality Health Together

Grade - Price: F / Quality: F

Price Data Sources:
Montana Hospital Association - Montana Hospital PricePoint System

Grade - Price: F / Quality: F

Price Data Sources:
Nebraska Hospital Association's Care Compare

Grade - Price: F / Quality: F

Price Data Sources:
NJ Division of Consumer Affairs

New Jersey Hosptial Association

Grade - Price: F / Quality: F


Price Data Sources:
NM Hospital Association

Quality Data Sources:
Medical Group Snapshot

Grade - Price: F / Quality: F

Price Data Sources:
North Carolina Hosptial Association

Grade - Price: F / Quality: F

Price Data Sources:
Oklahoma Hospital Association

Grade - Price: F / Quality: D


Price Data Sources:
Pennsylvania Health Care Cost Conatinment Council

Quality Data Sources:
South Central PA: Community Checkup Report

Grade - Price: F / Quality: F

Price Data Sources:
Hosptial Association of Rhode Island

Quality Data Sources:
Rhode Island - Health Insurance Bulletin 2013-1

Grade - Price: F / Quality: F

Price Data Sources:
South Carolina DOH - South Carolina Health Data

Grade - Price: F / Quality: F

Price Data Sources:
South Dakota Association of Healthcare Organizations

Grade - Price: F / Quality: F


Price Data Sources:
Tennessee Hospital Association

Tennessee Department of Health

Quality Data Sources:
Health Care Quality Matters

Grade - Price: F / Quality: F

Price Data Sources:
Texas Hosptial Association

Grade - Price: F / Quality: F

Price Data Sources:
Utah Hosptials and Health Systems Association

Utah Department of Health

Grade - Price: C / Quality: F

Price Data Sources:
State of Vermont Office of the Attorney General

Grade - Price: C / Quality: F

Price Data Sources:
Virginia Hosptial & Healthcare Association

Virginia Health Information, Inc.

Grade - Price: F / Quality: A


Price Data Sources:
Washington State Hospital Association

Quality Data Sources:
Puget Sound Alliance: Community Checkup

Grade - Price: F / Quality: F

Price Data Sources:
West Virginia Healtch Care Authority

Grade - Price: F / Quality: F

Price Data Sources:
Wyoming Hospital Association

TX

Click on states in the map (above) to see datasources where available.

What is transparency?

Markets cannot function without transparency. If a buyer cannot distinguish the differences in price and quality between suppliers, then there cannot be an efficient market. The asymmetries between buyer and seller are so significant that only the seller/supplier knows the value of the services provided/sold. The US health care industry is, by and large, completely opaque. As the number of consumers in high deductible/high co-insurance health insurance plans continues to grow, market opacity prevents consumer-patients from comparison-shopping. And since fear of market loss is a significant concern for many providers, there has been a tendency to block attempts at greater transparency.

For example, many providers (or payers) have included "gag clauses" in their contracts, which prohibits a health plan or health care provider from divulging the true costs of services rendered during the management of a patient. In addition, while quality data is more readily available thanks to public sector efforts, the availability of easy to understand quality ratings on hospitals and physicians has been spotty, at best, with the notable exceptions of the Leapfrog Group's hospital safety score, the Aligning Forces for Quality transparency efforts and the Bridges To Excellence Recognitions.

In an effort to increase price transparency, many states have enacted legislation with provisions for public reporting of pricing and quality information across providers and, in some cases, specific to certain payers operating in that state. However, the scope and depth of transparency legislation varies significantly by state – some require that pricing be posted on a state website or published in a formal annual report; others require participation in an all payer claims database (APCD) and empower the APCD manager to publish detailed quality and cost of care reports, by provider.

This variation in state regulations (barring federal regulation) seems inevitable, and suggests a process for better understanding the strength of such legislation by state. That's because until such time as all states have robust and comprehensive legislation that provides a right for individual consumer-patients to fully understand the price and quality of the services for a specific medical event, we cannot expect a functional market for health care services to be developed.

This draft legislation provides state lawmakers with a starting point for enacting legislation that would meet the needs of the different stakeholders in their State, including consumers, employers, health plans, and referring practitioners.
 

What We Are Doing To Impact This Measure

HCI3 has developed analytical tools that can calculate prices for various episodes of medical care, adjusted for the severity of a specific individual, and that price can be the officially negotiated price between a provider and a payer for the care of a specific individual. In turn, that price can be communicated, up front, to the plan member so that an individual can know ahead of time what they will have to pay out in deductibles, co-pays or co-insurance. That's an essential element of a functioning market.

In addition, we've developed INQUIREhealthcare, a free app that can be downloaded on a tablet or a smartphone and enables the user to find clinicians in their local area who demonstrate high quality care based on national standards of quality. These physicians have shown that they can manage patients with certain chronic conditions effectively. It also includes the Leapfrog Group's Hospital Safety Scores, which provide hospital safety ratings such as how well hospitals protect patients from accidents, injuries, harm and error.

Finally, we're also working with specific community leaders in helping them understand the importance of transparency to improving the affordability and quality of health care, and providing them with analytic support to publish average costs of medical episodes.
 

Measures and Data Sources

The Report Card on State Price Transparency Laws

Please refer to the Report Card on State Price Transparency for more detail regarding the measures and methodology by which health care price transparency was graded in each state.

The report card reviewed not only state laws, but state regulations and state-mandated price transparency websites. Unlike the 2013 Report Card on State Price Transparency Laws, the 2014 report did not grade on a curve. A state could receive a maximum of 150 points; 100 for its laws and regulations, and 50 points for its website. To achieve an A, a state needed at least a 90 percent or 135 points.

Price transparency legislation and regulations were reviewed according to level of transparency and the scope of price, services, and providers. State-mandated price transparency websites were review according to utility, ease of use, scope, and data accuracy. Each state received a separate grade for price transparency legislation/regulation and state-mandated websites. The two grades were combined and reported as an overall grade for the state. The table below shows the scoring methodology employed:

Grading criteria are as follows, in percentages:

A: 90 to 100
B: 80 to 89
C: 70 to 79

F: 0 to 59

Measures for the State Report Card on Transparency of Physician Quality Information

The criteria by which health care quality information transparency in each state is graded.

Transparency of physician quality was scored on three main categories consisting of the scope of transparent information, measures, and the accessibility of information and then broken down into sub-categories. The points combined in the sub-categories created a total score which was based on the grading thresholds. The table below shows the total possible points a state could receive.

Grading thresholds are as follow:

A: 61 to 100
B: 51 to 60
C: 41 to 50
D: 31 to 40
F: 0 to 30

Data Sources

Data sources for the Report Card on State Price Transparency Laws include the National Conference of State Legislatures and state-specific enacted legislation and state-specific sites devoted to public transparency of health care prices and quality. Special thanks to Catalyze Payment Reform for their support and robust research on state-specific legislation.

Data Sources for the State Report Card on Transparency of Physician Quality Information include the NPI Registry, The Robert Wood Johnson Foundation National Directory for comparing health care quality and state-specific sites devoted to public transparency of health care quality.