Montana woman recognized among Fortune’s greatest world leaders | Don Brunell

Marilyn Bartlett ranked No. 16 for her effort to save her state employee health insurance plan.

Imagine sitting home and learning Fortune Magazine just listed you among the world’s greatest leaders? That’s exactly what happened to Marilyn Bartlett who led the effort to save Montana’s state employee health insurance plan from bankruptcy.

In April, Bartlett was ranked No. 16 on a list which featured global leaders including Bill and Melinda Gates, New Zealand Prime Minister Jacinda Ardern, Michael J. Fox and Apple’s Tim Cook.

“Our sixth annual leaders list is the home of the brave,” Fortune Magazine wrote. “These thinkers, speakers, and doers make bold choices and take big risks — and move others to do the same.”

When Bartlett took over the Montana’s employee health plan in 2014, the state spent $200 million a year to cover its 30,000 employees and their families. The plan’s losses were projected to top $50 million and state officials predicted it would go broke without radical changes. By the time she departed the plan was on solid footing and the state was saving millions without cutting benefits to employees or raising their rates.

Bartlett came with some unique qualifications. She had just spent 13 years on the insurance industry side, first as a controller for a Montana’s Blue Cross Blue Shield plan, then as the chief financial officer for a company that administered benefits.

Montana, like many large employers, self-funds its plan. That means it pays the bills and hires an insurance company or other firm to process the claims. More than half of American workers are covered by self-funded plans. Today, many employers are starting to follow Bartlett’s blueprint which starts with transparency.

As the boss in this arrangement, Bartlett assumed she would have access to detailed information about how much the plan, which was managed by Cigna, paid for procedures at each hospital. When Cigna told her the information was secret and not available, Bartlett’s demanded all of the information and began examining every detail of the contracts.

Her plan turned the payment system upside down. The state would set its own prices for the hospitals, insurers and drug companies based on rates set by Medicare as a reference point. Montana’s plan now pays hospitals a set percentage above the Medicare amount, a method known as “reference-based pricing,” making it impossible for the hospitals to arbitrarily raise their prices.

From the start, she knew she would have to tackle the staggering bills from the state’s hospitals, which made up the bulk of the plan’s expenses. It wouldn’t be popular because they also made up a significant chunk of hospitals’ profits, National Public Radio’s Marshall Allen reported last October.

Bartlett found a new pharmacy benefit manager that would not take any “spread” and would pass along all rebates in full. The immediate savings was $16 per prescription. “Spread” is the practice where a pharmacy benefit manager, for example, will tell an employer it cost $100 to fill a prescription that actually cost $60, allowing the pharmacy benefit manager to pocket the extra $40. The fine print in the contracts often allows it.

“Most importantly, Bartlett understood something the state officials didn’t: the side deals, kickbacks and lucrative clauses that industry players secretly build into medical costs. Everyone, she had observed, was profiting except the employers and workers paying the tab,” Allen reported.

In Bartlett’s view, employers should be pushing back against the industry and demanding that it justify its costs. They should ask for itemized bills to determine how prices are set. And they should read the fine print in their contracts to weed out secret deals that work against them.

That’s good advice for any purchaser whether it be government, business or non-profit.

Don C. Brunell is a business analyst, writer and columnist. He recently retired as president of the Association of Washington Business, the state’s oldest and largest business organization, and now lives in Vancouver. He can be contacted at theBrunells@msn.com.

More in Business

50 years of Gamblin Motors

Art Gamblin moved to Enumclaw in 1965 — his family has made it their home ever since.

New law aims to protect employees, job applicants

It’s now illegal for potential employers to ask you how much you made in your previous job.

Cascadia Pizza back in business

The brick and mortar shop had to close in June due to heavy smoke damage from a rag fire.

Battery-operated locomotives on their way | Don Brunell

Freight railroads have emitted less carbon dioxide since 2000, but a battery-powered train could make those gains even better.

Wapiti Woolies legacy continues with new owners

John and Karlyn Clark just bought the Greenwater business in June. But don’t worry — the huckleberry ice cream isn’t going anywhere.

Restoring affordable college education vital to America | Don Brunell

In 2018, 70 percent of students had to take out loans.

The rare earth metal dilemma | Don Brunell

These 17 elements are critical for many products, from smart phones to major weapon systems.

Family-owned businesses are the backbone of America | Don Brunell

Family businesses account for 50 percent of our country’s GDP.

Clark touts benefits of Sound Birth method

Kelly Clark has a rather specific audience for her professional services. As… Continue reading

Tourists bring dollars to mountain communities

More than 1.5 million people came to Mount Rainier in 2018, and spent $55 million in nearby communities.

Keeping things natural come Hell or High Water

Desiree and Kevin Helfrick started their garden in a Seattle apartment. Now they’re in charge of 5 acres, growing organic veggies and taking care of their chickens.

Rogers opens chiropractic practice

Beau Rogers played college baseball until a career-ending injury, leading him down the path of chiropractics.