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.”

Increasing health care costs in the state workers’ health plan were helping hold down workers’ wages. The plan’s financial reserves were dwindling, heading for negative territory.

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