‘Time is short’: Mark Bertolini wears a black ring in the shape of a skull
‘Time is short’: Mark Bertolini wears a black ring in the shape of a skull © FT

When Mark Bertolini’s son, Eric, was struck by a rare type of cancer at the age of 16, his doctors said to prepare for the worst. “Forty-seven people had been diagnosed with the disease before, all of them men between the ages of 16 and 34, and they were all dead,” he recalls.

Mr Bertolini, now chief executive of Aetna, the third-largest US health insurer, refused to accept Eric’s prognosis. He found an oncologist in Boston who was willing to try an experiment — a “bad” bone marrow transplant that would kill the cancerous cells.

The transplant wiped out the cancer but Eric’s body rejected the bone marrow and he became extremely sick. “He went from 140lb to 80lb in a matter of months,” says Mr Bertolini. “He was starving.”

It was then that Mr Bertolini quit his job as an insurance executive at Cigna and moved into his son’s hospital room to manage his care personally.

He downloaded a copy of Harrison’s Principles of Internal Medicine, a bible for junior doctors, and started having fierce arguments with the medics, who thought he was in denial about his son’s chances of survival.

By 2003, Eric had made a full recovery, in part because his father had convinced regulators to let him take an unapproved medicine. Today, Eric works at State Street, the asset manager.

Mr Bertolini returned to work with radically different views about the US healthcare system. “Lesson one was that they always viewed him as the lymphoma in room four, whereas I knew him from the delivery room when he was born,” he says. “Their view of him was as a disease, not a person.”

Eric’s personal story is remarkable — not least because his father ended up giving him a kidney in 2007, following complications resulting from his cancer treatment.

The reality of dealing with health insurers in the US tends to be less uplifting, however. Aetna achieved only a middling ranking in JD Power’s annual consumer satisfaction table in 2015. Customers tend to prefer not-for-profit health plans offered by rivals such as the Kaiser Foundation.

Mr Bertolini, however, believes his personal experience can be applied to his vast employer, which has a market capitalisation of $38bn and 23m health insurance customers.

He points to three changes he has made since taking the top job in 2010. Aetna now encourages people to travel to secure the best treatment, as Eric did. “People tend to want to be near home but when they travel for more than two hours to get specialised care, they have much higher survival rates,” says Mr Bertolini; the insurer has dropped a requirement that patients cease curative treatment before being admitted to a hospice, and it is collecting anonymised genetic profiles of members to glean “big data” insights into which drugs work best for which patients.

His son’s illness has informed Mr Bertolini’s unconventional approach to running one of the larger US companies — which is poised to get even bigger with its pending $37bn acquisition of rival group, Humana — as has a horrific accident of his own.

In February 2004, a year to the day after his son was discharged, Mr Bertolini smashed into a tree while skiing in Vermont, breaking his neck and back, injuring his head and damaging nerves. When he regained consciousness a week later, he found that he was alive only because he had fallen headfirst into a freezing river, which acted like an ice-pack on his spinal cord.

His distrust of hospitals, which he says are “full of diseases”, kicked in. He discharged himself as soon as he could, clutching “all sorts of narcotics”, including the opioid painkillers that are handed out so liberally in the US.

Despite being sceptical about alternative treatments, he found relief in craniosacral therapy, which some doctors have dismissed as quackery. “I was a total doubter,” he recalls.

“Somebody’s going to hold on to my rear end and my head, and I’m going to feel better? Well, what the hell — I was all hopped up on drugs.”

Three sessions in, he says he started to feel better; three months later he stopped taking painkillers.

Unable to go on his daily run, Mr Bertolini turned to yoga, where he met his partner Mari, a yogi who trained in Chennai, India, in the 1980s. He quickly developed a passion for “the whole Hindu view of the world,” and he has tried to put this into practice at Aetna, which offers yoga and mindfulness sessions to staff.

“Our chief medical officer said, ‘this is voodoo, don’t you know’,” says Mr Bertolini. “And I said, ‘well let’s do a study’.” More than 13,000 Aetna employees have since had a 12-week stint of mindfulness or yoga, and Mr Bertolini says it has resulted in “a dramatic increase in productivity”.

He eschews the management texts beloved by other chief executives and accuses American business schools of “poisoning the economic thinking of every businessman in the world”, even though he has an MBA in finance from Cornell University. He also decries “these things called spreadsheets”.

Instead, he turns to Hindu texts such as the Upanishads and the Bhagavad Gita for insights, as well as writings by Abraham Maslow, the late humanist psychologist, and Capital in the Twenty-First Century, the seminal book on income inequality by French economist Thomas Piketty, published in 2013.

It was Mr Piketty’s book that encouraged Mr Bertolini to implement a company-wide pay increase last year, which set a $16 an hour minimum for all Aetna employees, equivalent to a one-third pay rise for some of its lowest-paid workers.

Mr Bertolini took home $15m in pay, bonus and long-term incentive award in 2014, the last year for which figures have been disclosed, on top of $31m in 2013.

Aetna has also improved its staff medical plan, which dramatically reduced the amount that low-paid employees had to contribute to their healthcare. “When I went out into the field to shake everybody’s hands, I kept hearing the same thing: ‘I can’t afford the healthcare, I’m working two jobs, my family’s on food stamps,’” he says.

Mr Bertolini says the stories reminded him of his childhood in Detroit, where his father worked in the auto industry and his mother was a part-time nurse.

“I too grew up in a family that didn’t have health insurance at times, that was on government programmes for cheese and bread and milk,” he recalls. “It wasn’t a bad life, but today it’s harder.”

The Humana deal is expected to face tough scrutiny from antitrust authorities amid claims that it will reduce competition and drive up costs.

Mr Bertolini thinks the opposite is the case, that Aetna’s size and its assured profitability will give him the freedom to experiment.

“While I may be a little different as a CEO, in how I think about how to invest and play the game, I am very, very focused on making sure we deliver on our results,” he says. “Because that’s what gives us the ability to do the rest.”

On his wrist, Mr Bertolini sports an expensive Swiss watch, a staple for many chief executives, and a nod to the conventional ways of big business, but he also wears two unusual black rings, one in the shape of a skull.

He tells colleagues it reminds him that “time is short”.

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