Mark Bertolini AETNA’S
DIVERSITYINC Q&A
are dysfunctional; they don’t work
well for anybody. Health reform
is vital. If you look at the federal
deficit over the next 10 years, it’s 95
percent Medicare and Medicaid. If
you add in social security, it is a 150
percent budget-deficit increase. We
have an entitlement problem that
we need to address, and health-care is a big part of it. Tackling
healthcare is of central importance
because it is the economy going
forward. Ten years ago, [the percentage of GDP for healthcare] was
probably 13 to 14 percent. Now, it’s
16 to 17 percent—and it’s headed
to 22 percent. Getting affordabil-ity right is a very important thing,
and the way we reimburse now for
healthcare is on a process-per-unit
basis. That generates more process
and more units, but it creates a conspicuous production of resources
to be able to handle more units.
The incentives are wrong. We need
to change the incentives around
how we pay hospitals, physicians
and other providers of healthcare
services. We also need to change the
incentives around people.
We’ve been trying to figure out
why people didn’t believe that
having a body-mass index (BMI)
of greater than 30, which is over
35 percent of our population now,
or being overweight ( 62 percent
of our population) isn’t a perfectly
appropriate thing to do. Do they
understand the long-run ramifica-
tions? The economic impact? The
single biggest threat to the financial
security of everybody in America is
going to be the health status. The
single biggest threat to everyone’s
health status is the weight. We have
a pandemic in this country around
obesity. We spend all this money on
H1N1 vaccines, which is great, but
I think we’ve stemmed the tide on
it. If we put the same level of effort
on obesity, we could have a huge
impact on healthcare costs. That
personal responsibility—Jungian-
behavioral economics—doesn’t
necessarily work for long-run
behavior change and the impact of
that behavior change on your health
and financial status. So a lot of
employers are turning to Pavlovian
behavior economics: If you don’t do
this, it’s going to cost you more.
practitioner will know exactly what
a person’s medical history is? I’ve
met with congressmen and senators
and made this plea. It will generate
savings just in the elimination of
duplication.
VISCONTI Other aspects that are
incredibly wasteful are access to
medical records, the way U.S. hospital
systems are set up and how people
get healthcare.
VISCONTI How do we make sure
that doesn’t leave people on the
curve?
BERTOLINI You have to meet people where they are versus trying to
insist that they come to you. That’s
why understanding diversity in our
The biggest threat to everyone’s
health status is the weight. We have
a pandemic in this country.
BERTOLINI That’s a big behavioral
change. It’s not a technology problem; the technology exists. You can
buy toothpaste on the Internet, get a
receipt and tracking number and get
a message that says it’s been delivered at a specific time and to which
door at your home. You can do that
with toothpaste, yet when I gave my
son a kidney, we had to avoid duplication of tests. Even though we’re
in the same electronic medical-record systems, we couldn’t have
access between offices, and they
wanted to reorder tests. So I made
them give me all my test results
in my Blackberry, got the doctor’s
e-mail address [and then sent them]
through secure messaging. The
inability to accept the availability
of information is … why we do tests
over again and duplicate services;
getting it connected isn’t hard.
We have these amazing machines
that can peer into the human
body and do all these incredible
tasks. Why don’t we have the same
interests in adding a desktop with
the availability of information so a
organization is so important. Where
are the people? Where are they
transacting? Today, a lot of our tech-
nology is going on mobile devices
[and] a lot of people have mobile
phones, so mobile phones are a
great way to go. Everybody’s using
this stuff; they have the intellectual
curiosity. But when it comes to the
healthcare system, it’s like this is
too hard—“I’m just going to go with
whatever my doctor says.” What we
need to do is help people under-
stand the impact of not having that
curiosity now in the future. [With
the current] healthcare system, you
go in and get stuff that somebody
else actually [orders] for you. They
don’t tell you how much it costs
and, at the end of it all, they have
you sign a piece of paper that says
you’ll pay anything that your insur-
ance company doesn’t. Then they
send you [a bill] in 30 days on how
much you owe. Everybody does it
every day in the healthcare system.
The lack of awareness about what
things cost is starting to matter.
If you look at what premiums are
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