Blue Cross To Administer Marylyn’s Reference Based Pricing Plan

With its employee health plan in financial crisis, Montana hired a former insurance insider who pushed back against industry players with vested interests in keeping (health care) costs high. Now we learn a major industry player is back in the saddle.

It took a little ole “ I don’t give a shit I’ve got Medicare” lady to bring sanity back to health care financing in contrast to which Blue Cross and all the other BUCAs have historically failed to do.

Marilyn Bartlett is the little ole lady who fought the system and won.

Now we learn the state has hired BCBS to administer the state’s Reference Based Pricing plan. How strange is that!

BlueCross BlueShield of Montana Will Be State Plan’s Medical TPA Vendor in 2023 Department of Administration

MyHealthGuide Source: Belinda AdamsMontana Department of Administration (DOA), 9/15/2022

Helena, MT – The Montana Department of Administration (DOA) announced it awarded the contract for third-party administrator for medical benefits and claims administration for the State of Montana Benefit Plan (State Plan) to BlueCross BlueShield of Montana (BCBSMT) effective January 1, 2023.

“Contracting with BCBSMT will allow us to enhance our ability to be responsible stewards of State Plan contributions while ensuring accessibility to high-quality medical care for State employees,” said DOA Director Misty Ann Giles. “This contract will result in nearly immediate savings for the self-funded State Plan in 2023, with a projected total savings of $28 million over the next three years, benefiting State agencies, State employees, and the taxpayers of Montana.”

The Request for Proposal (RFP) was released in March 2022 with the goal of finding a qualified vendor to help the DOA streamline the administration of State Plan medical benefits and also modernize its multiple of Medicare reimbursement strategy. BCBSMT was one of six vendors who submitted a bid. A diverse evaluation committee reviewed all submissions then scored the bids using consensus scoring. BCBSMT received the highest score and was subsequently awarded the contract.

“I applaud everyone involved in this RFP process for taking the time to evaluate thoroughly the State Plan’s third-party administrator needs, analyze State Plan data to identify opportunities, set goals, and then develop a comprehensive proposal to meet objectives. From there, our team conducted a fair and transparent procurement process resulting in a qualified vendor being selected to help the State become more flexible to reach its goals efficiently,” said Director Giles.

The State will continue to offer one medical plan for all eligible plan members. Minimal impact is anticipated for members as the transition is completed. Monthly benefit contributions for State employees will remain stable, as will plan member access to participating facilities and care providers. The new contract allows the State Plan to continue improving upon its multiple of Medicare reimbursement strategy by setting specific benchmark levels of reimbursement that BCBSMT is responsible for maintaining.

“This new partnership will allow us to effectively continue serving our 28,000 members who rely on State Plan coverage for affordable and reliable health insurance coverage,” said Health Care & Benefits Division Administrator Amy Jenks. “Additionally, it will provide broader opportunities for member engagement and management of medical conditions, including access to additional programs and services for our members.”

Open Enrollment for 2023 will take place October 23 – November 5, 2022. Open Enrollment is an annual opportunity for plan members to review benefit elections and changes plans or covered dependents for the coming calendar year. BCBSMT will begin administering medical plan benefits on January 1, 2023.

The State Plan is self-funded by the State and includes medical, prescription drug, dental, and vision plans. The State provides health benefits to State employees, retirees (non-Medicare and Medicare), legislators, Consolidated Omnibus Budget Reconciliation Act (COBRA) enrollees, and their respective dependents who are collectively referred to as plan members. DOA’s Health Care & Benefits Division is responsible for the administration of the State Plan which includes the self-funded medical plan.

The State contract with BCBSMT has been issued for an initial term of three years, with the option to renew for a total of ten years.

BCBSMT has operated in Montana since 1940 and currently provides more than 300,000 members with comprehensive, affordable plans statewide. BCBSMT employs nearly 600 people in five locations across Montana, with offices in Helena, Billings, Bozeman, Great Falls, and Kalispell