According to an annual report card released by the Health Care Incentives Improvement Institute and Catalyst for Payment Reform, the vast majority of states aren’t meeting the groups’ minimum standards for providing consumers with easily accessible information on the prices of healthcare services.

Despite the fact 43 states were given a failing grade, this actually represents an improvement in national performance over earlier reports. Three states received an A grade for the first time, with Colorado and Maine joining New Hampshire. All three of those states have data collected in an all-payer claims database (APCD), which includes information on providers and specific prices, presented in what the report considers to be an easily navigable website.

Virginia and Vermont received C grades for having “poor websites,” while Arkansas was given a D grade for not making its claims database available online.

The one state to move from an F to a passing grade in this year’s report was Oregon. The state launched a price transparency website, OregonHospitalGuide.org, in 2015, displaying price data including the statewide median price for common inpatient and outpatient procedures and the median price commercial insurers pay for each procedure at hospitals around the state. The report added Oregon’s grade could be improved if data from practitioners was included, along with adding prices on a greater number of procedures.

Judith Hibbard, MD, health policy research professor at the University of Oregon, wrote in the report that grades are influenced by how the information is displayed to consumers, not just whether or not it’s provided.

“People’s attention is pulled in many directions; the key is to provide information that is quickly and easily understood, before you lose their attention” Hibbard wrote. “The longer it takes, the more effort that is required, the more likely it is that fewer consumers will end up using the information. To make your transparency efforts pay of, make it as easy and simple as possible for consumers to use the information to inform their choices.”

Not all states were given a failing grade for the same reasons:

• 9 states have no transparency laws (Alaska, Alabama, Hawaii, Idaho, Mississippi, Montana, North Dakota, Oklahoma, Wyoming).
• 13 only collect and posts data from providers without offering a publicly accessible site (Arizona, Connecticut, Florida, Iowa, Illinois, Indiana, Kentucky, Massachusetts, Minnesota, North Carolina, Nevada, Ohio, South Dakota).
• 11 have limited information available publicly (Delaware, Georgia, Maryland, Missouri, New Jersey, New Mexico, Pennsylvania, South Carolina, Tennessee, Texas, Utah).
• 4 have transparency laws with unclear data sharing standards (Kansas, New York, Rhode Island, West Virginia.
• 2 have voluntary ACPDs (California, Wisconsin).
• 2 have enacted ACPD laws but haven’t set up public websites yet (Louisiana, Washington).
• Michigan’s transparency law called for “studying the potential for a price and quality database.”
• Nebraska enacted a law to have a committee evaluate an ACPD for the state.

While healthcare price transparency is becoming a more popular topic in state legislatures (and was mentioned in Donald Trump’s healthcare proposals in March), other research has said such laws aren’t likely to have much effect on reducing healthcare spending. A claims analysis released in March by the Health Care Cost Institute said as of 2011, only 7 percent of out-of-pocket spending goes to the “shoppable” services which are typically displayed on ACPDs.