Yeah, I made a meme for the show with Marilyn Bartlett. My very first meme ever.
In this meme, I picture that Olympic silver medalist shooter from Turkey who showed up in a T-shirt and his hand in his pocket versus the others with all their fancy equipment that, turns out, may or may not be necessary, regardless of who might swear up and down that complexity requires even more complexity and plenty of expensive gear to shoot straight. Point being, it’s amazing what a dedicated CPA with a spreadsheet and their eye on the target can accomplish in the real world when they just do their thing and follow the dollar.
For a full transcript of this episode, click here.
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And with that, Marilyn Bartlett has entered the chat. Marilyn Bartlett isn’t called the “Queen of Healthcare” for no good reason, and nobody is joking when they say this. She was probably the first person (or one of the first, at a minimum) to truly identify the amount of money getting sucked out of the wallets of taxpayers and employers and plan members and into the pockets of the healthcare and insurance and consulting industries. She is a through and through numbers person but also deeply cares. She is truly a senior stateswoman in our field.
Let’s start from the beginning here. But you’ll have to listen to the interview that follows for the end and most of Marilyn’s really sage advice and words of inspiration for any of you, for all of us, trying really hard to fix healthcare and, any day of the week, taking two steps forward and/or five steps back.
It’s what Mike Tyson was talking about when he said...
“Everybody has a plan until [you] get punched in the face.” And yeah, I’d say pretty confidently that everyone in the Relentless Health Value tribe trying to fix healthcare has been there at some point or another.
So, here’s where I begin the conversation with Marilyn Bartlett today. One day in 2014 or 2015, Marilyn was minding her own business as a CFO at a regional TPA (third-party administrator) firm about ready to retire when the state of Montana reached out. They asked if she would consider being the plan administrator for the state employee health plan, which was, turned out, headed for bankruptcy.
Marilyn took the job, and she took the state health plan from $9 million in the hole—they were in debt $9 million—to $112 million to the good. Well, meanwhile, plan members got better benefits. Think about that: $9 million in the hole to $112 million in the good. In fact, the plan had so much money in 2018 when Marilyn left that the state took some of it to pay for other things in the budget.
This is truly mind blowing. I mean, get a CPA with their eye on the ball, and this is the difference that is possible to be made in a state health plan. It also just needs to be said that this same state plan, the one that was going bankrupt, clearly had seen over $100 million of taxpayer money exit stage left and wind up in the bank account of their vendors.
Now might be a good time to mention something that Chris Deacon wrote about: the Federal Employees Health Benefits Program. This is a $55 billion program, once again funded by taxpayers. As per an OIG (Office of the Inspector General) audit, there are no written policies or procedures over approval and payment of funds to the carriers via ACH (Automated Clearing House).
Wait, what? This is just one example, along with a whole lot of other things that kind of make you go, “Hmmm … can a CPA with a spreadsheet please get in there and do your thing?”
In the conversation that follows, I ask Marilyn to tell me what she did in roughly three short years to do her thing and save the state of Montana over $100 million while improving benefits of the state workers.
And she tells me, short version, she created a why—that’s step one. Step two, she looked at her spreadsheets and financial analyses and quantified the situation. She was able to identify a few big hairy problems, which she then hit fast and hard with solutions. This is gonna accomplish a couple of things if you do this, find a solution for a big enough problem.
First, it creates a quick win; and quick wins are needed to get some momentum to get started. Second, she knew that by solving big hairy problems, the solutions would have an outsized impact given the scope of these original problems. This is kind of Strategy 101.
And then step three, she dug in on assembling the right team with the right skills to make it through what amounts to a change management process, I’m gonna say.
What did Marilyn not do in those three years? She did not get captivated or sidetracked by any, I’m gonna call it, transformational theater—which is not easy because a lot of transformation theater has more glitter than a Las Vegas show and is really hard to look away from. It’s as magical as most magical thinking.
Also, Marilyn stayed the course in the face of what I am sure were many opportunities for personal gain that would have not been a win-win for the state of Montana or its employees. To emphasize how one should not take this for granted, I was talking to a benefits leader the other day and you know what she told me? She said she always goes with this one carrier every year because if you go with that one, when you get invited to their box at the NFL games, you can go out on the field afterwards. I mean, it’s really fun to meet the players.
Unfortunately, for so many in positions of power, when doing the right thing by taxpayers and/or plan members stands between them and box seats, the right thing gets escorted out of the building. Mentioned in this show, we have Cora Opsahl and Claire Brockbank, who both will be featured in upcoming shows about RFPs (request for proposals) and best practices and how they can go right and also occasionally take a left turn. Check the links to episodes about pharmacy benefits and PBMs (pharmacy benefit managers). I might think of some others, but you’ll definitely want to listen to the show with Paul Holmes (EP397); the one with Mark Cuban and Ferrin Williams, PharmD, MBA (EP418); and also AJ Loiacono (EP379).
Also mentioned in this episode are Chris Deacon; Cora Opsahl; Claire Brockbank; Mark Cuban; Ferrin Williams, PharmD, MBA; AJ Loiacono; and Shawn Gremminger.
You can learn more by connecting with Marilyn on LinkedIn.
Marilyn Bartlett, CPA, CGMA, CMA, CFM, serves as a consultant focused on lowering healthcare costs and empowering employer health plans and state policymakers with data to support cost-saving initiatives. She recently developed the Hospital Cost Tool for the National Academy for State Health Policy (NASHP), an interactive online tool which utilizes hospital Medicare Cost Report data to calculate various hospital metrics used to support hospital and health system financial analysis and health policy.
As administrator of the Montana State Employee Health Plan, she disrupted the status quo by implementing Medicare rate reference-based contracting with all Montana hospitals, enhancing primary care through near-sight health centers, moving to a transparent, pass-through PBM, eliminating duplication of vendor services, and improving data access and analytics. These efforts increased plan reserves from actuarial projections of -$9 million to $112 million in two years. For her efforts, Fortune magazine selected Marilyn as #13 of the World’s 50 Greatest Leaders.
06:45 What gave Marilyn the confidence to fix Montana’s state health plan?
08:11 Why Marilyn knew she would have enough power to make the changes needed in Montana’s state health plan.
09:11 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan.
10:38 What were the “quick wins” Marilyn was able to achieve when she first took over as administrator?
17:33 Stay tuned for an upcoming episode that covers RFP in detail.
17:50 How Marilyn structured her plan for the Montana State Employee Health Plan.
21:21 What’s the key to setting yourself up for success when doing what Marilyn was able to achieve?
25:02 Why putting together your own team is so important.
29:07 What happened when Marilyn left the Montana State Employee Health Plan?
31:08 Have the costs of the plan gone up since Marilyn’s time working on it?
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn, Dr Tom Lee, Paul Holmes (Encore! EP397), Ann Kempski
