Former CEO of Aetna Mark Bertolini on How Holistic Insurance and Preventative Healthcare Can Fix Our Broken System

Mark Bertolini had worked in private health insurance for his whole adult life, and never considered any sort of integrative therapies. Then, two personal health crises showed him firsthand the importance of holistic healthcare and the failures of the current system. As CEO of Aetna — a role he left in late 2019  when he sold the company to CVS — he implemented sweeping changes that reflected his newfound viewpoint. Read on to learn about his own transformative health journey, how he changed the culture of Aetna, why he believes holistic insurance and preventative healthcare can help fix the U.S. healthcare system, and more. 

*This is a short clip of our interview with Mark Bertolini. Click here to watch the whole thing!*

You can also listen to our interview with Mark Bertolini on The WellBe Podcast.

The Two Health Crises that Shaped Mark Bertolini’s Outlook on Healthcare

Years before becoming CEO of Aetna, Bertolini faced two serious health challenges: one related to his son’s health, and the other related to his own. First, his son was diagnosed with a rare form of cancer at age 16, and Bertolini was told that his chances of survival were slim. Bertolini refused to accept that news, and quit his job at the insurance company Cigna to take care of his son full-time and advocate for experimental and aggressive approaches to treatment. His son ended up making a complete recovery.

One year later, Bertolini had a massive ski accident, breaking his neck and back and doing damage to his nerves. He was in a coma for a week, but after awakening, he got himself discharged as quickly as he possibly could. He left the hospital alive, but with a laundry list of narcotics and other prescription opioids to manage his pain.

These two events would change the course of anyone’s life, but Bertolini says that it was actually the repercussions in the years to come that had a bigger impact. Years after both he and his son had been ostensibly “cured,” they both still lived with the fallout of their respective health crises and struggled to navigate life with their now chronic health issues. Bertolini’s son still dealt with immunology issues, while Bertolini himself suffered from persistent pain that prevented him from doing things that were central to his ability to lead a full life: playing piano, riding his bike, going fishing.

“Once you get out, you realize that what they fixed was the acute event, and they didn’t really prepare you to somehow gather what remained of your life together and move forward,” Bertolini says. He suddenly saw clearly how disconnected the system was. He saw how its extreme emphasis on acute conditions meant that countless people deemed “cured” by the healthcare system were, in all actuality, prevented from living full lives because of their health. 

Bertolini wanted to cut down all the barriers preventing him from living the life he wanted, and after realizing that “nobody’s around to help you figure it out but yourself,” he set out to achieve that. He dove into the research, just as he had when he’d been his son’s advocate, and ended up finding the answer somewhere that he would have never expected it: integrative medicine.

Before his own health challenges, he hadn’t thought very highly of holistic or integrative therapies. He remembers that, when he was sitting in his son’s hospital room all those years ago, a Reiki practitioner came in and performed Reiki on his son. After finishing, she turned to Bertolini and asked if he’d like to try, and Bertolini accepted. After a minute or two, he told her to stop — he found it irritating and pointless. 

“I just put it on the back shelf and forgot about it,” he says. “Until I was trying to solve my own problems after my accident, when I was on seven different narcotic medications to control my pain and not feeling any better. It was either kill myself or find my way out. And it was in that journey of finding my way out that I discovered complementary medicine in a more meaningful way.”

Bertolini ended up trying craniosacral therapy. “Someone’s going to hold onto my head and my sacrum and I’m going to feel better? Ok, wacky, but maybe I’ll try it,” he says. “After the 4th visit I started coming off my meds, and a year later I was off all [seven] of my [narcotic painkiller] meds as a result.” He still uses a variety of different integrative practices to manage his pain and neuropathy, including craniosacral therapy, yoga, and meditation.

Promoting Holistic Healthcare as CEO of Aetna

While Bertolini was immersing himself in integrative therapies to treat his health issues, he was also the CEO of Aetna. Perhaps needless to say, his experience with the former began to seep into his decisions in the latter. 

“I go to work one day and I start meeting with my team and I say, ‘We should all have our employees do meditation and yoga,’” Bertolini remembers. “Everybody sitting at the table said sure boss, that’s a great idea, good one. And I get into my office and almost immediately the chief medical officer follows me in and says, ‘Yeah, that’s crazy.’”

But, just as he had with his son’s cancer prognosis, Bertolini refused to accept this as fact. Undeterred, he asked the CMO what would need to be done to objectively prove the effectiveness of yoga and meditation in order to implement his plan. The CMO replied that they would need a double-blind study — and so that’s what they did.

In the study, they looked at populations on both coasts of the country, measuring their stress levels based on heart rate variability and cortisol levels. The participants then underwent a 12-week yoga and meditation program (designed by a trained yoga instructor) and then had their stress levels measured again. They found that the program led to a dramatic reduction in stress in the participants — but, more importantly to the company executives, this also meant a reduction in cost to Aetna. As it turned out, the people that were in the highest quintile of stress consumed $2,500 a year more in healthcare than the average employee population. “What it did was it reduced our healthcare costs by seven and a half percent the next year, because we got those people well again,” says Bertolini. This was his first empirical evidence that natural medicine could be a game-changer.

Why Preventative Healthcare & Holistic Insurance Are Key to Solving The American Healthcare Crisis 

There’s no question about the fact that the American healthcare system is broken. We have the lowest health outcomes of 34 OECD nations, our life expectancy has been going down for the past few years after decades of rising, and it’s the most expensive system per capita in the world. So what’s the solution? With a new democratic administration and Congress in place, there’s the potential for some sweeping healthcare reform, but there’s no clear sense of what that reform might look like. Bertolini, unsurprisingly, has strong thoughts on the matter. 

First off, he believes that the current debate over whether or not to support Medicare for all completely misses the point. “We keep trying to perfume the pig here by financing the system differently. It’s not gonna work,” he says. The problem is that all the discussion is centered around how to refinance the current system, which works well for acute care but completely fails when it comes to chronic care — and in a country currently swept up in a chronic disease epidemic, this is a huge issue. Instead, Bertolini believes that the focus should shift to a preventative healthcare model, one where practitioners, insurance providers, and the public focus, first and foremost, on addressing the root causes of chronic health issues.

As an example of preventative healthcare, he points to Medicare Advantage, an insurance plan in which Medicare benefits are provided through a private insurance company. He explains that with Medicare Advantage, insurance companies invest in the social determinants of health, and have seen great results: health outcomes improve, costs go down, and satisfaction ratings rise. 

“The average Medicare person spends 120 hours in the healthcare system every year. That’s less than 5% or 6% of their waking hours,” he says. “So for 94, 95% of our waking hours, we’re in the world, and the doctor never has a clear picture of what’s going on out there.” He explains that all of the things that happen outside of the doctor’s office — diet, exercise, stress, relationships — have a much bigger impact on health than those short visits to the doctor, and that focusing on these factors has significant benefits, both in terms of individual health and costs to the insurer.  

The takeaway from Medicare Advantage is clear to Bertolini. The system needs to provide people with preventative healthcare and the social determinants of health rather than just treating acute problems. Providing support for food, transportation, heat, and socialization is the same investment as the cost of an ER visit. “What we need to do is fix that stuff. If we don’t, it doesn’t matter if the federal government is paying for everything,” he says. 

In order to achieve that goal, Bertolini says, healthcare needs to become outcome-oriented. That means putting the desired health goal first and the financing second, the reverse of our current system. “We need to say to people, when you’re worried about your health, come and talk to us and let’s have a conversation where people ask ‘What about my health is getting in the way of the life I want to lead?’” he says. “That will then steer you toward the type of people you should go see. And then, let’s put together a plan.” In this holistic insurance model, the financing gets worked out last rather than first, with people thinking about what they want and need to keep themselves well first, then shopping for the most effective plan based on that, not the other way around. 

He also believes that preventative healthcare is an essential component of this outcome-based model, with an investment in social determinants that can have an impact on health. As an example, he points to a holistic insurance plan in San Diego called SCAN, which is a “social HMO” that covers any sort of preventative lifestyle activities that prevents you from needing the healthcare system. 

In terms of the question of financing healthcare and whether “Medicare for All” is a good idea — the question that seems to dominate all discussion of the issue — Bertolini says that a public-private partnership, which is what currently exists, will always be necessary. As he explains, while the government is good at certain things, financing things well isn’t one of them. “I don’t know that the U.S. government is really a good purveyor of good financing of effective, efficient systems,” he says. But with industry leaders forging a new path and leading by example with holistic insurance and preventative healthcare, he believes that they can join forces with the government to begin fixing our broken system. 

Watch our full interview with Mark Bertolini to learn why he believes state-based licensure is the biggest barrier to coverage of integrative healthcare practitioners, the role that remote or telemedicine plays in healthcare reform, little-known ways that people can use their HSA/FSA accounts to access integrative medicine and preventative healthcare, why doctors need to be separated from the administrative aspects of healthcare, what we as consumers can do to advocate for a better system, what he sees as the biggest driver of health problems among Americans, whether he thinks COVID will change the financial approach of insurance companies, how an epidemic of hopelessness contributes to American health and life expectancy decline, and much more.

You can also listen to our interview with Mark Bertolini on The WellBe Podcast.

 

Citations:

1. Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA. 2019;322(20):1996–2016. 

2. Raghupathi, Wullianallur, and Viju Raghupathi. “An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach.” International journal of environmental research and public health vol. 15,3 431. 1 Mar. 2018.

The information contained in this article comes from our interview with Mark Bertolini, the former CEO of Aetna. Bertolini received a B.A. from Wayne State University and an M.B.A. from Cornell. He worked at Cigna, NYLCare Health Plans, and SelectCare before joining Aetna and serving as its CEO from 2010-2018. He is author of the book Mission-Driven Leadership: My Journey As a Radical Capitalist

The recovery story above is anecdotal and specific to this particular individual. Please note that this is not medical advice, and that not all treatments and approaches mentioned will work for everyone.

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