Relentless Health Value
Stacey Richter
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Encore! EP450: When Your Health Plan Is $9 Million in the Hole, Who Are You Going to Call? A CPA. And Tell Them to Bring Their Spreadsheets, With Marilyn Bartlett, CPA, CMA, CFM, CGMA
From $9 Million in the Hole to $112 Million in the Black: How Marilyn Bartlett Turned Around Montana's State Employee Health Plan. What happens when a self-funded health plan is headed for bankruptcy and a CPA with a spreadsheet and her eye on the target gets to work? In roughly three years, Marilyn Bartlett, CPA, CMA, CFM, CGMA took the State of Montana's employee health plan from a $9 million deficit to a $112 million surplus — while enhancing member benefits and holding premiums flat since 2015. In this encore episode, Stacey Richter revisits her conversation with Marilyn Bartlett, who served as plan administrator for Montana's state employee health plan starting in 2015 and is now the driving force behind the NASHP Hospital Cost Tool, which version five launches in January 2026 as a resource for plan sponsors negotiating directly with hospitals. WHAT YOU'LL LEARN ✅ How Marilyn followed the dollar on day one — identifying out-of-control medical trend, non-transparent PBM rebates, and redundant point solutions — and turned those findings into immediate action, including terminating four of five wellness vendors and saving $5.5 million right off the top ✅ Why Montana hospitals represented 43% of total plan spend, how Marilyn used Medicare cost reports, 990s, and audited financial statements to build cost-plus reference-based pricing contracts, and how signing two cooperative hospitals first created the momentum to bring the rest along ✅ How pharmacy spend, which was approximately 20% of total plan costs, was brought down 23% by switching to a transparent pass-through PBM and removing CVS from the network when they would not match required pricing ✅ Why assembling the right internal and external team — including the governor's office, budget director, union leadership, a retired primary care physician, a pharmacist consultant, and a communications specialist — was the single most important factor in surviving the lobbying and political pressure that came from every direction ✅ What happened after Marilyn left in 2018: successors reversed the reference-based pricing strategy and added point solutions back, adding costs — a cautionary tale about the institutional will required to sustain these gains ✅ How the NASHP Hospital Cost Tool, now in its fifth version, can serve as a starting point for any plan sponsor approaching hospital contract negotiations WHY THIS MATTERS This is what is actually possible. Marilyn Bartlett didn't find a magic solution — she followed the dollar, eliminated waste, built a coalition with enough power to negotiate, and refused to get sidetracked by what Stacey calls transformational theater. The fact that hundreds of millions of dollars were sloshing out of a state health plan and into vendor pockets is not unique to Montana. It is the norm. What is rare is a plan administrator with the fiscal discipline and political backing to stop it. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EncoreEP450 ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 07:09 What gave Marilyn the confidence to fix Montana's state health plan? 08:35 Why Marilyn knew she would have enough power to make the changes needed in Montana's state health plan. 09:35 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan. 11:03 What were the "quick wins" Marilyn was able to achieve when she first took over as administrator? 17:55 EP453 with Claire Brockbank, which covers RFP in detail. 18:12 How Marilyn structured her plan for the Montana State Employee Health Plan. 21:42 What's the key to setting yourself up for success when doing what Marilyn was able to achieve? 25:23 Why putting together your own team is so important. 28:20 EP397 with Paul Homes. 28:24 EP418 with Mark Cuban and Ferrin Williams, PharmD, MBA. 29:28 What happened when Marilyn left the Montana State Employee Health Plan? 31:28 Have the costs of the plan gone up since Marilyn's time working on it?
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