Montana woman recognized among Fortune’s greatest world leaders

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.


Talk to us

Please share your story tips by emailing editor@auburn-reporter.com.

To share your opinion for publication, submit a letter through our website https://www.auburn-reporter.com/submit-letter/. Include your name, address and daytime phone number. (We’ll only publish your name and hometown.) Please keep letters to 300 words or less.

More in Opinion

Washington Secretary of State Kim Wyman. Courtesy photo
Editorial: Keep Wyman as defender of state’s election system

Kim Wyman, a Republican, has helped expand access to voting and improved election security.

Federal Way resident Bob Roegner is a former mayor of Auburn. Contact bjroegner@comcast.net.
Republican’s write-in campaign highlights post-primary intrigue | Roegner

Can former Bothell mayor beat two Democrats for lieutenant governor post?

Rico Thomas, left, has been a clerk in the Fuel Center/Mini Mart at Safeway in Federal Way for the past 5 years. Kyong Barry, right, has been with Albertsons for 18 years and is a front end supervisor in Auburn. Both are active members of UFCW 21. Courtesy photos
Grocery store workers deserve respect and hazard pay | Guest column

As grocery store workers in King County, we experience the hard, cold… Continue reading

Editorial: Honor 100 years of suffrage with your ballot

Women’s right to vote was recognized 100 years ago; we need to use the ballots women fought for.

Don Brunell
Why we should reconsider nuclear power | Brunell

If Americans are to receive all of their electricity without coal and… Continue reading

Courtesy photo
Editorial: Make certain you count in 2020 census

The Census Bureau has been told to cut its work short, making your response even more important.

Federal Way resident Bob Roegner is a former mayor of Auburn. Contact bjroegner@comcast.net.
Primary election was big for Democrats | Roegner

Secretary of State Kim Wyman is the lone Republican who looks strong heading into November.

A large webset offset printing press running a long roll off paper over its rollers at high speed. File photo
Editorial: Tax credit proposal would aid local journalism

Bipartisan legislation in the U.S. House would offer tax credits to advertisers and subscribers.

Don Brunell
Coronavirus comeback for Alaska Airlines?

It is no secret that airlines were clobbered by the coronavirus pandemic.… Continue reading

Richard Elfers is a columnist, a former Enumclaw City Council member and a Green River College professor.
Age of insanity for the left and the right

Do you feel that, like the COVID-19 pandemic, insane behavior is spreading… Continue reading

Federal Way resident Bob Roegner is a former mayor of Auburn. Contact bjroegner@comcast.net.
Should the King County sheriff be elected or appointed? | Roegner

The question for King County residents is more complicated than it appears.