How a public accountant saved her state health plan from going into the red.
Montana’s state benefits plan was a sinking ship, with 30,000 employees and their families on board.
The losses could top $50 million if something wasn’t fixed ASAP. That’s when Marilyn Bartlett boarded the ship and made some major changes, saving the program from insolvency and amassing a $112 million cash reserve in only three short years.
You may have heard Marilyn’s story on National Public Radio last week. What she did was nothing short of heroic, especially if you have a soft spot for using taxpayer dollars responsibly. We captured her entire story in a webinar earlier this week, which you can now get on-demand.
Here’s a taste.
Marilyn was hired as the new benefits administrator for Montana with decades of experience in the private insurance industry. She was a controller for a Blue Cross Blue Shield plan and a CFO for a third-party administrator. She knew it all, because she’d seen it all – including the side deals, kickbacks and lucrative clauses that industry players secretly build into medical costs.
As an accountant, Marilyn naturally followed the money. But she couldn’t get the data she needed from the state’s ERP system. Also, the state’s contracts with the Montana hospitals were secret. She couldn’t see what each hospital was charging for each procedure — and neither could the taxpayers.
Eventually, Marilyn got the data she needed, but the hospitals disputed her findings. Fortunately, Marilyn is a very, very good accountant. Just like Clark Kent is a very, very good reporter. Armed with the right data validated by a third party, she shared side-by-side comparisons of 11 large hospitals that showed the state was paying between 239% and 611% of established Medicare prices — and that was just on out-patient claims. So, they set a target reimbursement level based on the performance of the most efficient hospitals in the state and within 15 months they had a new pricing arrangement in place.
So ends the first 20 minutes of Marilyn’s 50-minute presentation.
There’s so much more to share than we have space for here; a blog just wouldn’t do this story justice. The $7.4 million in pharmacy savings in the first year. The efficiencies of bringing in a new benefits administration platform. The $500,000 saved in administrative fees. The Q&A session with webinar participants. It’s all there.
Marilyn’s presentation is valuable for anyone who works with self-funded plans, especially those that are publicly funded. Set aside an hour on your calendar, listen to the on-demand webinar, and let us know what you think!