How Montana's State Health Plan Climbed From Near-Insolvency to $112 Million in Reserves

Marilyn Bartlett, CPA, is a senior policy advisor at the National Academy for State Health Policy (NASHP), where she works on the organization's Hospital Cost Tool. Before NASHP, she ran the Montana State Employee Health Plan, moving its projected reserves from minus $9 million to a positive $112 million in under three years while improving benefits, after earlier roles as a controller for a Blue Cross Blue Shield plan and CFO of a regional third-party administrator. Self-funded employers pay the full cost of their employees' care, yet many don't get the detailed claims data that shows where their money went. This conversation follows those dollars from the plan, through carriers and middlemen, to the hospital. Bartlett explains how Montana moved its hospitals to Medicare-based reference pricing and how Medicare cost reports show what a hospital spends to deliver care. Listeners come away knowing which contract clauses to question and what claims data to demand from a TPA. In this episode: -Taking over a Montana plan of 30,000 lives that was projected to lose $28 million in one year -Working with Allegiance Benefit Plan Management to reprice the 11 acute care hospitals that made up 87% of Montana hospital spend, starting from one paid an average of 611% of Medicare for outpatient care -Cross-plan offsetting and a California court case where an employer paid $4 million and the provider received $875,000 -Bringing state employees and union leaders on board, and the last hospital holdout that cited a most favored nation agreement with Blue Cross Blue Shield -How NASHP's Hospital Cost Tool uses Medicare cost reports, including a hospital's claimed 40% Medicaid loss that its cost report put at 18% Senate Bill 2355, the Patients Deserve Price Tags Act, and its requirement that employer plans receive their full transaction data -Hospital price transparency compliance and the updated Transparency in Coverage rules -Where a benefits director should start, from contract clauses to cutting wellness vendors for $5.5 million in savings -How the HIPAA need-to-know standard keeps claims details away from the employer Links and Resources NASHP Hospital Cost Tool and Hospital Cost Calculator https://nashp.org/hospital-cost-tool/ NASHP's hub for the interactive Hospital Cost Tool and the downloadable Excel calculator, both built on hospitals' Medicare cost reports. PatientRightsAdvocate.org https://www.patientrightsadvocate.org/ Nonprofit advocating for systemwide healthcare price transparency, which Bartlett works with on policy. PRA Eighth Hospital Price Transparency Compliance Report (September 2026) https://www.patientrightsadvocate.org... Review of 2,000 hospitals that found 49.4% in full compliance with the federal hospital price transparency rule. Patients Deserve Price Tags Act (S. 2355) https://www.govinfo.gov/app/details/B... The Senate bill Bartlett calls the Price Tags Bill, which would write hospital and insurer price transparency into federal law and was reported out of the Senate HELP Committee in July 2026. Transparency in Coverage Final Rules (CMS-9882-F) https://www.cms.gov/newsroom/fact-she... CMS fact sheet on the updated TiC rules for health plans, finalized October 5, 2026. CMS Hospital Price Transparency https://www.cms.gov/priorities/key-in... CMS hub for the rule requiring hospitals to post machine-readable files of their standard charges and negotiated rates. CMS Medicare Cost Reports (HCRIS) https://www.cms.gov/data-research/sta... Public download page for the hospital cost report data that Bartlett calls the only public source of hospitals' actual costs. Allegiance Benefit Plan Management https://www.askallegiance.com/Home/About Third-party administrator that helped Montana model and run its reference-based pricing program. State of Montana Health Care & Benefits Division https://benefits.mt.gov/ The division that manages the State of Montana Benefit Plan, the self-funded plan Bartlett ran. IRS Form 990 https://www.irs.gov/forms-pubs/about-... The annual return tax-exempt organizations file, which Bartlett uses with cost reports to map the entities a health system owns. 📖 GET THE 2026 PRICE TRANSPARENCY FIELD GUIDE Practical tips and lessons for healthcare finance leaders and analysts leveraging price transparency data. ➡️ https://payerset.com/pricetransparenc... 📊 USE OUR EMPLOYER RATE INTELLIGENCE TOOL See what an employer health plan really pays ➡️https://payerset.com/employer-rate-in... 🔔 KEEP LEARNING WITH THE PRICE OF HEALTHCARE PODCAST Subscribe to this channel for latest news and knowledge in healthcare finance. 🤝 CONNECT WITH PAYERSET ON LINKEDIN ➡️   / payerset