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Street sign comparing prices To cut its health costs, Montana implemented a reference-based pricing model with its 60 hospitals, which accounted for 43 percent of employee health care costs. (Image: Shutterstock)

Marilyn Bartlett, the director administrator of Montana’s Health Care and Benefits Division, recalls thinking “holy cow” when she got an urgent directive from state legislators in late 2014: “You have to get these costs under control, or else.”

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