Fearless 9.15.25

Good morning, Fearless readers:

On Thursday of last week, I had the pleasure of attending Taking Up Space, a networking and panel event in Des Moines that highlighted powerful women leaders and encouraged attendees to take up space in the way they deserve.

I will be sharing more next week, but I wanted to share a moment in the event that really resonated with me.

In her opening speech, host Abi Reiland referenced the heart monitor that sat on her chest just above her silver, sparkly (and adorable) top. She had wondered if she should buy a different outfit, something with a high-neck that didn't really feel like her but wouldn't draw attention to the medical device.

“If I wear this outfit, am I being too loud? Too attention-seeking?” she asked herself.

This is something I relate to personally. I use an insulin pump and a continuous glucose monitor to manage my Type 1 diabetes, and both are visible on my body most of the time. It can sometimes feel like the first and only thing people notice about me.

When Abi chose to not only show her medical device but also discuss it with the entire room, it was a wonderful reminder how when we take up space, we encourage other women to take up space, too.

Thank you, Abi, for that moment of clarity.

In this week’s Fearless e-newsletter, you will find:

Three women business leaders sharing how their company is approaching flexible work five years after the pandemic.
A column from Dr. Rachel Preisser about changes in health insurance law for breast exams.
In the headlines: The 2025 honorees of the Iowa Women of Achievement Awards were announced.
In case you missed it: A closer look with Tami Nielsen.
Lots more!

— Macey Shofroth, Fearless editor

The COVID-19 pandemic caused employers around the world to undertake the dramatic shift to remote work to reduce transmission of the virus.

This was the beginning of a new way of working, one that brought the importance of flexibility and having space for personal lives to the forefront for employees. According to the U.S. Census Bureau, the percentage of employees working from home grew from 5.7% of all workers in 2019 to 17.9% in 2021, an increase of almost 19 million employees.

Five years later, flexible work remains a top priority for employees and job seekers. A report from LiveCareer states 76% of Millennials, 69% of Gen Z and 64% of Gen X expect flexibility in work options.

But the definition of flexibility has also evolved beyond just remote work to include other benefits that support employee’s post-pandemic lifestyles.

Several Central Iowa businesses that have in-person work requirements are finding a balance between satisfying workers’ desires for flexible policies and benefits and maintaining workplace culture through transparency, open communication and effective change management.

The desire for work-life balance
To Lisa Coulson, senior vice president and chief human resources officer at Principal Financial Group, employees wanting flexibility in their jobs is nothing new.

“It’s always been important, and it’s always been important to us,” Coulson said. “The emphasis, I think, on listening to employees has evolved. We’re getting more real time information about what people value, and then you’re able to find solutions that help meet those needs.”

“I do believe that a lot of people during that time did a lot of reflecting and thought, ‘OK, what’s important in life?’ I don’t know that anyone’s quite the same after that,” said Sarah DeKock, senior vice president and partner at Flynn Wright.

Research has shown that working from home remains a highly coveted benefit by jobseekers. A LinkedIn State of the Labor Market report in October 2024 showed hybrid and remote jobs make up 1 in 5 job postings on LinkedIn but receive 3 of every 5 applications.

We talked with executives at Principal, Flynn Wright and Holmes Murphy about company culture, leadership and benefits that help them compete in today’s recruiting environment.

Principal Financial Group
With about 6,000 employees in Des Moines alone, Principal Financial Group is operating on a wide spectrum of what flexibility means to each employee. Coulson said the company’s definition has intentionally evolved over her 18-year tenure.

“We’ve always been flexible. When I came to Principal, I had been a working mom and was trying to define what flexibility meant for me,” she said. “Flexibility and work-life balance evolve based on your personal situations, and we all define it differently. If you’re employee-centric, you want to understand what the possibilities are in order for you to meet your client needs and to allow for that.”

Principal employs a hybrid work schedule that requires employees to be in the office three days a week if they live within a 30-mile radius of the company’s offices in Des Moines and Charlotte, N.C. Employees in some roles and locations can work 100% remote, and others spend the full week in the office based on client needs.

With such a large and diverse workforce, Principal approaches benefits with the philosophy that different people need different things at different stages of their lives. Its goal is to offer supportive policies and programs that employees are able to tailor to their lives, Coulson said.

Those benefits range from Maven, a 24/7 virtual support program for employees and their partners as they navigate family planning and women’s health, to on-site child care, to financial planning seminars. They also offer education assistance and pet insurance.

“As you think about the different profiles of employees, we try to offer different alternatives that allow people to have their mix,” Coulson said. “We listen to what’s important to folks.”

Health and wellness is one area that remains of high value to Principal employees. Employees have access to a health and wellness center at the company’s four building campus in Des Moines, with yoga studios, fitness equipment, basketball courts and more. Many of their other locations have similar centers, and employees who work at sites without one are offered reimbursement to use at other facilities.

Coulson said the center was a major selling point for employees who wanted to return to the office after working remotely. The transition period of bringing more and more employees back to the office required effective change management to ease the company into the new normal.

“Once we decided that we were going to a hybrid model, we listened, pulled together a communication plan and provided a transition timing so folks knew that as of a certain date, this is what it would look like,” Coulson said. “Then we had a period of time where people could work through personal transition issues.”

Coulson believes the transition to a hybrid model both supports employees’ well-being and the needs of their clients.

“Being in the office is being able to share real-time information as things come up. When I was growing in my career, not only did I take training classes but it was through some of the interactions that I had over the wall or as people were brainstorming that gave me exposure to different things,” Coulson said. “When I think about the way work gets done, having the opportunity to do it both in person and remotely, I personally believe there’s a good blend.”

Holmes Murphy
As vice president - client service leader, employee benefits and shareholder at Holmes Murphy, Becky Hammond sees what employees are asking for from their employers both internally at the organization and externally with her clients.

She said that strong leadership and transparency are key to building a workplace that values both personal wellness and a culture of togetherness.

“There’s something to be said about presenteeism and being together and collaborating and having the energy. But we also know that gone are the days of clocking in at 8 a.m. and leaving at 5,” Hammond said. “We can’t recruit competitive talent if we can’t afford them the opportunity to care for themselves outside of the workplace.”

Holmes Murphy has a hybrid work schedule where employees are required to be in the office four days a week and can choose which day they’d like to work elsewhere. Before the pandemic, employees were expected to be in the office five days a week from 8 a.m. to 5 p.m. unless there were extenuating circumstances.

Leaders at Holmes Murphy maintain transparency in the recruiting process to ensure employees buy in from the beginning, Hammond said.

“We’re very transparent around our culture of flexibility but also that our expectation is that you’re in the office four days a week,” Hammond said. “We really try to help them understand the why behind it as well. It’s not just that we want to have you sitting in a desk. It’s more so around the collaboration and propelling the business forward.”

Holmes Murphy’s culture of flexibility relies on open communication and trust. They don’t have strict rules around when employees can attend to their personal lives, but expect employees and managers to communicate about what’s needed for everyone to be successful.

“The people we have here care about our clients, and so they’re going to do what it takes to get their work done. We feel like we can give them the autonomy to make their day what it needs to be based on their personal demands,’ Hammond said.

Hammond has also seen many of her consulting clients land on a hybrid work schedule as the most beneficial solution for their company. Her clients are also focused on recruiting competitive talent, so they offer additional benefits as incentives.

These benefits often relate to employees’ caregiving responsibilities. Some employers offer on-site child care. Others provide backup care when parents can’t access their regular daycare. She’s even seen a company offer dog-walking services for those employees who adopted a pet during the pandemic and needed support when they had to return to the office.

Other types of benefits differ by industry. Health care workers in patient-care settings typically can’t work from home, so they’re offered consolidated work weeks. Other employers may offer paid volunteer time off or a day to celebrate your birthday that doesn’t come out of your regular PTO bank.

No matter the benefits offered, Hammond said the cultures that are most successful have involved leadership that really adopt the company’s philosophy on work-life balance.

“You definitely have to have leadership adoption of having a flexible work environment. Sometimes, that’s really hard for leaders, because they’ve been kind of brought up in their career or leadership journey by really keeping tabs on people, so it’s hard for them to change that mindset,” Hammond said. “But you really have to lay out the foundation, the framework and support it and gather everyone around them to support it. You have to walk the walk and talk the talk.”

Flynn Wright
Des Moines-based advertising agency Flynn Wright decided early in the pandemic that as soon as it was safe to do so, they wanted their employees back in the office full time.

“The culture that we have, people love to work together because it’s a creative industry,” DeKock said. “That collaboration is so important to what we do.”
DeKock described the company’s culture as collaborative and creative and said in-person work is crucial to serving their clients.

“Service is a huge part of what we do, and creativity is king in our business because we’re always trying to find ways to differentiate our clients from their competition,” she said. “When you’re ideating and spitballing, it’s important you have those collaboration moments where it’s organic. You want people giving their opinion. We’ve actually designed our office in a way that allows for a lot of pop-up meetings.”

Flynn Wright has experienced rapid growth over the last few years. When DeKock began working there in 2004, they had 40 employees. Today, it’s over 100. They recently opened another office in downtown Des Moines above the Americana restaurant.

Intentional and open recruitment has helped them bring in high-performing talent, even without offering hybrid or remote work.

DeKock said that advertising is a “business [that] doesn’t really sleep,” and those looking to work at Flynn Wright buy in to their philosophies from the beginning.

“We spend a lot of time looking for the right individuals that work within our culture and that have the same expectations and core values as we do,” she said. “We’re very clear from day one that this is an in-office choice. We want people that want that, and there’s, surprisingly, a lot of people that do.”

DeKock said that advertising employees often skew younger, and being in office offers more opportunities for those younger employees to gain valuable exposure.
It can even lead to more opportunities for career growth. The Wall Street Journal reported that in 2023, employees working remotely were promoted 31% less frequently than those working in the office. This has led to a widening career gap for women, who have worked remotely at higher rates than men since the pandemic.

“If you’re not in the office, you might not be the first person called over to help with something. Those are the people that get a chance to stand out a little bit,” DeKock said.

Flynn Wright designed their space with collaboration and aesthetics in mind, so the office is an attractive place to work. New hires also start with 25 days of PTO. DeKock said managers understand when life events come up and allow employees to adjust where they’re working when needed.

“We need everyone to be their whole self. Sometimes life calls, and so when that happens, we want to give everyone the flexibility,” DeKock said. “No one abuses it, because I think everyone understands what we’re trying to build.”

When the company decided to bring everyone back to the office full time in 2021, they set a return to work date and gave everyone time to adjust. DeKock said clients expressed gratitude for Flynn Wright staff being in the office and able to support them when needed.

“We’re a really successful agency that is doing really well, so it’s fun to be a part of,” she said. “We have incredible talent, really smart people, and I think when people are going through the interview process they realize, ‘Wow, I want to be a part of something like this.’ Everyone is aligned on that idea of working together to service our clients, and that we’re better together.”

As our state leads the nation in cancer rates, consistently ranking second-highest in overall cancer rate, navigating the financial landscape to access lifesaving breast cancer screening and diagnostic evaluation has become increasingly murky for both patients and physicians alike.

When the Affordable Care Act passed in 2010, screening mammograms were one of the few preventative exams that became available without patient cost sharing, meaning co-insurance, deductibles and copayments did not apply. Studies have shown that the rate of women getting a mammogram went up as much as 9% after this action.

For women’s health, that is a success; screening mammograms are the bedrock of any breast cancer surveillance program. They are the highest-resolution study of all breast-imaging modalities, enabling a breast imager to catch breast cancer in its earliest, most treatable stages or even prevent cancers by detecting precancerous or atypical cells that can be removed before they progress onto cancer.

While the implementation of widespread screening has been a major driving force in the 44% reduction in breast cancer deaths over the past 40 years, screening mammograms in many cases are not stand-alone exams. Roughly 10% of all screening mammograms will be considered incomplete, requiring additional specialized pictures or even an ultrasound for more information. For many women, supplemental screening such as a breast MRI is recommended by the American College of Radiology.

Thus, screening mammograms are only stand-alone exams when they are normal and when the patient does not fit any other criteria. For women who have dense breast tissue (about 50%), or who have an increased risk of breast cancer (approximately 30% of my practice here in Iowa), a screening mammogram is only a starting point to completely evaluate their breast health.

Unfortunately, women who need supplemental screening will find that the tests are not mandated to be covered as screening mammography is. To follow the screening plan that is right for them, they are at the whim of the insurer when it comes to what and how much is covered. Whether the supplemental screening is due to an abnormal mammogram or because the patient is at a heightened risk (e.g., dense breast tissue or certain genetic markers), the financial burden often falls heavily on the patient.

In order for a screening program to be successful, there must be robust participation of everyone who is eligible. Even with the ACA mandated coverage of screening mammography, fewer than 70% of eligible women in Iowa are participating. Furthermore, there are many women who are at elevated risk and should be starting before the standard age of 40 who are not necessarily tracked by this statistic.

In May 2024, House File 2489 was signed into law. It went into effect on January 1, 2025, and the impact for patients was both swift and paradoxical. The original bill was penned by the Iowa Army of Pink, in collaboration with contributions from other stakeholders including Susan G. Komen Foundation and this author. The intent of the bill was clear: to increase access to life-saving breast cancer care by eliminating financial barriers.

House File 2489 in its final version required insurance companies and policies in Iowa to cover supplemental and diagnostic breast examinations (including diagnostic mammograms, ultrasound, and MRI) and that the coverage be “no less favorable” than coverage provided for screening mammograms. By federal law, screening mammograms are to be covered with no out-of-pocket cost. However, at some point in the legislative process, all specific references to the elimination of cost sharing as originally written were stripped. The resulting ambiguous language prompted the Insurance Commissioner to issue clarifications after the bill’s passage stating, “Carriers may apply cost-sharing amounts to the covered services under the terms of the consumer’s policies.”

I and many of my colleagues across the state noticed an immediate shift for our patients. The bill required coverage, which meant insurance companies could no longer deny coverage for breast exams as they often had in the past. However, many insurers compensated for the inability to deny by slashing reimbursements. As a result, the unpaid balance was passed on to the patient. There is no recourse for patients or physicians – the bill designed to reduce out-of-pocket costs to patients had exactly the opposite impact for many as individual insurance plans adjusted their math to protect their already substantial profits while anticipating expanded payment demands. This results in most plans having substantial yearly increases in their premiums; patients are paying more for insurance companies to cover less.

I consulted on the crafting of the original bill. I lobbied in subcommittee hearings for its passage. I celebrated its signing. But now I have serious concerns about what the current bill, and subsequent efforts to revise the bill to include language addressing the patient cost sharing component, will do for access unless there is deliberate attention to address the “how-low-can-you-go” mentality of insurance providers. As a small, independent clinic, we review claims on a very granular level, something most physicians in our specialty can not often do. In the setting of screening mammograms, we are legally prohibited from billing a patient as they are federally protected from cost sharing. Our only payment is whatever the insurance company independently decides.

Sometimes what the insurance companies decide to pay does not cover the cost to provide the exam and our practice ends up providing that service at a loss. In fact, coverage from some insurance providers is so poor that many health care providers in our market will refuse to see patients with that plan. If this same model is expanded to all breast imaging, those that provide breast imaging services will not be able to cover their overhead and the services will no longer be available. Since 1989, when mammography began becoming more readily available, we have seen breast cancer deaths decrease by 44%. I shudder to think what will happen when one of the best tools we have in the fight against breast cancer becomes harder to access if not completely inaccessible due to financial avarice.

Axios recently cited a new study by Kaufman Hall showing that physicians are carrying markedly increased workloads, and providing more and more services, while net revenues are barely keeping pace with inflation. This setting of sharply rising costs and stagnant to decreased reimbursements is chipping away at already razor-thin margins. A common response to these statistics is to declare physician salary to be a root cause, when in fact physician salaries make up less than 10% of all health care spending in the country.

Instead, physicians are working more and more and, especially for those of us in private practice, struggling to keep the lights on and our payroll funded while insurance reimbursements continue to be skimmed year after year. Too many independent physician practices are finding that the math doesn’t work, fueling the shift in medicine towards corporatization and private equity.

This is a particularly hard pill to swallow for me as an employer; I see nearly double-digit rate increases for the premiums I pay for my employees, meanwhile insurance companies are slashing reimbursements for the care we provide. The stresses of this system have a fulcrum in physicians who rise again and again to bridge gaps and provide quality care for patients. Financial instability and physician burnout directly impact patient access to quality care. As volume is stressed over quality, patient outcomes suffer and care gaps widen. Physicians train hard to attend their patients and provide them with quality care; it is agonizing that doing so is balanced against mitigating the threat of bankruptcy of their practice.

The health care industry is complex and there are no silver bullet solutions. There has been a rise in direct primary care models, which certainly provide a path to reduced health care cost. However, not every patient has the liquidity to pursue a cash-based care delivery model. Oversight of for-profit insurance companies, particularly their growing practice of setting prices not just well below what is billed, but well below the actual cost to provide care, is a critical component to the puzzle in order to ensure that physicians are even able to provide crucial services. Supporting policies that ensure fair reimbursements to physicians that keep pace with inflation and allow for independent physician direct care to be a sustainable model of care delivery is not just good for physicians, but for all the patients under their care.

In the fight to mitigate the impact of breast cancer in our state, it is often one step forward, many steps back.

Dr. Rachel Preisser is a radiologist who co-founded GRACE Breast Imaging & Medical Spa, Iowa’s only woman-owned imaging center. She is board-certified and fellowship-trained in breast imaging, with over 15 years of experience in the field. Preisser also serves as director of breast imaging services for MercyOne Northeast Iowa acting as co-director of their NABPC accredited Breast Center. She is involved in breast cancer awareness advocacy at a state and national level. She has previously served on the board of directors for Fighting Through Kinship and was a recurring panelist in the Society of Breast Imaging Summer Series. She currently serves on the board of directors for the Iowa Medical Society and has previously chaired a committee for the Society of Breast Imaging. In her free time, she likes to go on family adventures with her husband and three boys.

Three honored with Iowa Women of Achievement Awards. Women Lead Change has announced Mary Armbrecht, Susan Clark and Ann Hutchinson as recipients of the 2025 Iowa Women of Achievement Award, which honors historical Iowa women for their significant and lasting contributions. Armbrecht was the state's first sworn female police officer and detective, Clark paved the way for school desegregation in Iowa through a landmark 1868 court case and Hutchinson served as mayor of Bettendorf and was a community leader for over a decade. Permanent plaques for the honorees will be placed on the Iowa Women of Achievement Bridge in Des Moines and an awards luncheon will be held during the Women Lead Change Conference on Oct. 15 at the Iowa Events Center. To register for the event, click here.

Local celebrities announced for 16th annual YWRC Celebrity Servers Night. Tickets are now available for the Young Women's Resource Center annual Celebrity Servers Night. Participants can choose to attend a celebrity server's table at Centro or Django for a three-course meal. All proceeds benefit the Young Women's Resource Center. Learn more and purchase tickets here.

West Des Moines Chamber of Commerce to host Eighth annual Mentoring for Women Conference. The West Des Moines Chamber of Commerce will host its Eighth annual Mentoring for Women Conference on Sept. 19, at the West Des Moines Marriott. The event features keynote speakers from Des Moines leaders, including Emily Abbas, Dianne Bystrom, Renee Hardman and more. Learn more and purchase tickets here.

A sweet assignment: New Girl Scout cookie created with help from Iowa CEO. Girl Scouts of Greater Iowa CEO Beth Shelton worked with a team from across the country on research and development to create the Girl Scouts' newest cookie, the Exploremore. The cookie is inspired by rocky road ice cream and will sold in early February. It can be sampled early at the Girl Scouts' Cookies on Tap fundraiser at the Iowa Taproom on Oct. 9, according to KCCI.

Not just resisting, but leading the fight: Five women who refuse to be ignored (The Guardian). In Trump's federal workforce cuts, Black women are among the hardest hit (New York Times). Albuquerque fire department makes history with all-female crew (KCRA). The gender gap in math widened in the pandemic. Schools are trying to make up lost ground (AP). New Mexico will be the first state to make child care free (The 19th). Probing the pain: Katie Burns is helping uncover the role of the immune system in endometriosis — while managing the disease herself (Science).

Tami Nielsen, the new president and CEO of the Food Bank of Iowa, remembers a classmate who came to school hungry when she was in fifth grade in Des Moines.

He came to school “ravenous” on Monday morning, she said, and the teacher reached into his drawer and gave him food.

“I always had plenty; we were very fortunate, but a lot of my classmates didn’t,” Nielsen said. “As I got older, I recognized that, and certainly in retrospect, I can see that more maybe, than I even realized at the time. I remember as a young kid thinking, ‘That’s just not right.’ … I just felt very deeply about that, so that’s probably what led me here. I still think about that, and it still drives me to this day.”

Nielsen took the helm at the Food Bank of Iowa June 1. Her appointment followed a national search after Michelle Book retired from the role at the end of 2024.

She is the food bank’s fourth leader since its founding 43 years ago. Nielsen joined Food Bank of Iowa in 2016 as a regional partnership coordinator. Since then, she has served in various roles before becoming chief operating officer in 2023. Before Food Bank of Iowa, Nielsen worked as a retail buyer for 11 years. She began her career as a resident and family counselor at House of Mercy in Des Moines.

We recently caught up with Nielsen to talk about her new role. The conversation has been edited and condensed for clarity.

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