I thought I'd frame up our conversation this morning around listening, or the art of listening really. In my experience, there are two types of people—people that listen and people that talk. And I've grown a lot less patient with the latter because my husband is deaf. He has a cochlear implant, one that he received in 1996 and Aetna paid for, so thank you. And in the 12 years that we've been married, I've had to work to become a better listener because a lot of times I'm doing the listening for both of us.
I don't think enough leaders have been listening and when people are not heard, there are problems and people get angry. This is pretty much where we find ourselves today—divisive politics, an opioid crisis, massive income inequality, and a rate of change and innovation unprecedented in the history of man. It is incredibly fertile ground for ideologues and ideologies. And my sense of you from all that I have read, is that you are a listener and a really good listener at that.
To navigate the severe chronic pain you've had to endure as a result of your ski accident in 2004, you have had to learn how to listen to your body. To quiet it when it’s screaming at you. You've had to learn how to tune in. You can call it mindfulness or thoughtful self-evaluation, but it is essentially the art of watching your thoughts because they control your mood and how you react to the world around you.
One of the greatest takeaways from Davos this year which was pointed out by a journalist that I really admire, was the enormous disconnect between what CEOs are doing and what they're saying. They talk a good game about changing culture and moving towards balance, but they are generally some of the most extreme personalities out there. They wake up at 5am, they go to bed at 1, they work out like crazy, they never see their families, they eat these crazy diets, they're scheduled in 15-minute increments, seven days a week, under pressure 24/7, and they usually have a shelf-life of about three years. And it’s hard to imagine a kinder corporate culture when the people at the top—the leaders—are so off balance. You've got to wonder, can these people really be listening to others, when they're not even listening to their own bodies?
I would argue that America's healthcare system is a catastrophic fail because it does not listen to the patient. Your vision for disrupting healthcare and the healthcare insurance sector starts with listening.
Some of the smartest doctors I know are doctors working outside of the traditional system. They’re not confined to a 15-minute time slot. And what makes them so amazing is that they want to hear my story. They want to listen to my problems, the state of my marriage, my job satisfaction, my sleep patterns, because this tells them a lot more about my state of wellness than my blood labs do. And you've said, when it comes to health your zip code matters more than your genes. The system needs to listen to people's stories—to reach them where they live, where they eat, where they sleep, where they interact with their communities or sadly, where they isolate because this is ultimately where sickness begins. And part of this means helping them re-learn how to listen to their bodies and their thoughts and to manage and mitigate stress. To this end, you've done some really revolutionary things at Aetna with your employees, like rewarding them for good sleep, It is incredible.
Stress, sleep, autonomic nervous system balance, these are topics that we write about all the time because they're the cornerstone of wellness. We had a conference on stress this summer and our keynote speaker was Dr, Robert Sapolsky who has spent three decades studying the physiological effects of stress. Sapolsky reminded the audience that the majority of us would die from stress-induced illnesses. I'm sure you know that 90% of doctor's visits are estimated to be from stress-related health complaints. I consider myself pretty well-informed about health and wellness, but I didn't even know what an HRV (Heart rate variability) was until six years ago when I went to a clinic in Switzerland. I spent my 20s and 30s thinking about keeping my body healthy, but I had not realized how my stress level was going to side-line me with adrenal fatigue when I was 40.
As a leader you have also shown what listening can achieve. If you do not listen, you cannot hear the wisdom around you. If you don't listen, you cannot identify what needs to be fixed. If you hadn’t, for example, understood what was stressing your employees out, you couldn't have helped boost customer service levels at Aetna by raising employee wages in 2015.
And then you have to know, most importantly, who to listen to. Do you listen to Wall Street or do you listen to Main Street, or at least what's left of it?
You've been putting people before profits with spectacular results. You've been doing it because it’s the right thing to do and the smart thing to do—because it was good for business, and not the other way around. And you were doing it before the anger started to boomerang and millennials were pushing BlackRock to trumpet the imperative of social purpose.
We write a lot at 13D about what we call the “Darwinian economy” and short-termism and the relentless pursuit of profits, to the point where people and the environment and the community are expendable. A backlash has been building for some time, propelled by the 2008 crisis. You’ve warned that the current model of capitalism could be death by a thousand cuts—“give a little now or a lot later.”
Kate Sokoloff: How do you see this playing out in America? Do you think it’s more that leaders are finally catching on to the fact that they can't ignore this?
Mark Bertolini: I think a lot more leaders, are getting it. You know Larry Fink of BlackRock is our largest investor and so you know, so I’ve spent time with Larry and I agree with his point of view and his latest letter sets a whole new agenda for how the people in the investing companies can change the dialogue with Wall Street to the advantage of the people that work there. But I think most important for most leaders is that they need to do this introspective work. They need to know themselves first and where they come from and who they are, and do really deep work on losing attachment because I think part of what you see in CEO behaviour and the short tenure, is they're so attached to the accoutrements of the job, to the salary, to the prestige, to the title, to the sycophants, that they play to that audience instead of their own true north, their own sort of moral imperative and I’m a huge Linkin Park fan - Chester Bennington's, suicide actually set me back for a couple of days because I had watched an interview that he had done, three days before his suicide, where he said “the most dangerous place for me to be, is between my own two ears, alone”. And I think this idea of finding yourself alone, between your own two ears and being able to do serious work is incredibly important in preparing yourself to lead. And that if you don’t do that work, the chaos and the cacophony of demands will only drag you into a place where you start attaching yourself to the things that are important for you, instead of thinking about others. And so while one person once asked me “If you got so much stuff to do, how can you pay attention to your own work” and I said, "well, I gotta take care of my own stuff before I take care of all the other stuff" and I think that part of practice, and that’s why we brought Yohan Michael the second I started that work, to the workplace is, unless we’re doing our own work and really sort of getting comfortable with ourselves alone in a room, understanding who we are, and how we can be better, we can’t possibly provide a prescription for others on how they could either approach that work or do that work or you know, find better ways of being human. And so people often ask me, what is the right work-life balance? And I grab a line from the end of the movie Tombstone when Doc Holliday asks Wyatt Erp, “what is”, as he’s lying on his deathbed, Doc Holliday says to Wyatt Erp, “What do you want out of life Wyatt?” and Wyatt Erp says “I want a normal life”. And Doc Holliday looks at him and says “There is no such thing as a normal life, there's just life”. When people say to me “what is work-life balance?”, I say, "there is no work-life balance. It’s all just life". And that’s why, if we look at it that way, and we say “where should I be and when should I be?” and we have this moral compass and we’ve done our own work, we know exactly where we need to be. So when my son got sick and ended up in the hospital with cancer, I knew I shouldn’t be at work, I should be with him.
When I got out of the hospital from my spinal cord injury and looked at what my options were, I could have stayed at home stoned on drugs or get back to work. I went back to work.
And so this idea of, there are hard and fast rules about how we ought to live, only comes from inside, and that's why I have a Yogic practice, it’s from inside, it’s not what other people tell me. And that’s probably the hardest message to give to leaders. You should do your own work. Know where you need to be. Use a moral compass that tells you how to behave. And what other people think of you, is none of your business.
Kate Sokoloff: That's a really profound statement.
Mark Bertolini: And, and that allows you to create, both in yourself and I think in the organisation, which is I think the bigger part of all this, is, Darwin talked about resiliency. And what people talk about is courage and rebounding and all that. I say, you know what, what is it that we need to do to create resilient leaders, a resilient organisation, so that we can withstand the changes in the marketplace, the slings and arrows that may come our way, and still be able to achieve what we need to achieve, for our employees, our customers first, our employees next and then our shareholders.
Kate Sokoloff: I like that ordering. But as you know, working on yourself takes a lot of hard work. It's uncomfortable and in the world we live it's very easy to hide from that hard work, to put off that hard work, or to be endlessly distracted from that hard work.
Mark Bertolini: Sharon Salzberg is a friend of ours, and she comes to the house and we sit with Sharon, she lives here in New York and Sharon does Loving Kindness Meditation. Have you ever done that?
Kate Sokoloff: I haven’t, no.
Mark Bertolini: Loving Kindness Meditation is a practice, a mantra practice, where you start first with yourself and you say “May I be safe. May I be happy. May I be healthy. May I live with ease.” And you do that for about 5 minutes, and then you move on to a benefactor, somebody who has really helped you. May he or she be safe, happy, healthy, may they live with ease. Then you move on to a neutral person and my neutral person was my dry cleaner, who’s a really cool guy, he’s eighty-two years old, he hand washes my shirts, we barely say anything to each other and I think about him, may he be happy, may he be safe, may he be healthy, may he live with ease. And then you move on to somebody who’s very difficult to be with. And when you go through this practice repeatedly, it actually has an affect. The last time I was in the dry cleaners, this guy actually looked up at me and this guy goes “I missed you, where have you been?” I'd never said a word to him.
Kate Sokoloff: Yeah. Did you tell him you’d been meditating on him?
Mark Bertolini: No, I didn’t, but I smiled, I smiled but I said “it’s good to see you. I missed you too”. And then this whole idea of... you know if we did this collectively as a group every morning, it takes fifteen minutes to do. I pick somebody different every day. Sometimes I pick, people in politics who are difficult to be with. All this idea, of thinking about, how do we as people, find a way in our hearts to do our own work first, which is often hard to start with, but then think about the broader world around us. And when you do that work and you think about it, then I think you’re very prepared to go to work.
Kate Sokoloff: Well I think that’s spot on and you know I think extending that to that level of mindfulness and awareness and paying attention to thoughts does for health is so imperative, I’m sure you’ve read Candice Perth ‘Molecules of Emotion’, knowing that our thoughts actually impact us at a cellular level and can actually turn genes on and off but it’s difficult to get people to that…it’s a bizarre concept to sort of understand that my thoughts actually could’ve changed my physiology. But if you can get people to that habit of mindfulness and the impact on their health it’s incredibly powerful, as you know. Sort of like a double-whammy, good for leaders, good for everybody on the planet, not just for getting along but for wellness in general, keeping people out of emergency rooms.
Kate Sokoloff: I wanted to hear your thoughts on trust. Right now, trust is at an all-time low. I just read yesterday that 1 in 3 Americans don't trust government to do the right thing. They have no trust in media, no trust in truth, whatever truth is anymore. There's slightly higher levels of trust in companies, they’re really having to step in to solve the problems that government put off. So how do leaders win back trust on Main Street?
Mark Bertolini: The only way you get trust, is to give it. It’s like love. The only way you get love, is to give it. You have to take the risk and you have to step forward and you have to give it first. And then hope it comes back. And when it doesn’t, you have to work on it harder.
Kate Sokoloff: And what does giving trust, from a corporate level, look like?
Mark Bertolini: So for example, we created here, a thing called ‘Service Without Borders’ where we said to our front-line employees for these things, instead of, you know, having rules and policies in place, create a capability that allows you, as an individual, to solve the problem for the member on the phone at that moment.
And we did a pilot for a quarter of a million customers. We let the team - the team set up a meeting process and a feedback process, and they came up with ‘phone a friend’, ‘dialling for help’ and we created a whole process but we put a budget on it because we thought they’d give away the farm and they only spent 20% of what we put in the budget. And employee engagement went up and our service scores went up and our retention went up and so we are now rolling it out across the company. But we had to trust them and say ‘You do it’. You tell us how it should be done. We’re gonna put some gates on it, just to make sure we don’t go off the rails. But we’re going to trust you to do the right thing and we’re going to trust you to do the right thing for the customer.
Kate Sokoloff: So you trusted your people rather than the algorithms.
Mark Bertolini: Yep.
Kate Sokoloff: Interesting.
Mark Bertolini: And so, you have to do that over and over and over again. And that then allows them to trust our customers, so one of our biggest problems was on January 1st 12:01 a.m., we’d invariably have someone walk into a pharmacy to get a prescription and the eligibility wasn’t right, either because they didn’t do it right or their employer didn’t do it right or we didn’t do it right, and we’d reject their prescription.
I said to the team, let’s look at the range of people who walk in at 12:01 a.m. on January 1st.
OK, if it’s a mother looking for a prescription for a $4 antibiotic, what do you think the chances are that she says ‘You know what, at 12:01 a.m. on January 1st, I’m gonna go to CVS and I’m gonna steal a prescription from Aetna? Its not going to happen. I mean it’s four bucks! And so, you know, we should use common sense and so you guys figure that out. And we had none of that this year on pharmacy on January 1st.
Kate Sokoloff: Well, common sense, how do you marry common sense in this drive towards greater efficiency and bringing in AI, I mean can you program algorithms and software, for common sense?
Mark Bertolini: You can’t totally, and we’re going to make mistakes but the mistakes are better to make on the side of the customer, than they are for us to disenfranchise ten times as many customers by virtually putting them through hoops they don’t need to go through.
And so my view is, as a customer of a healthcare system, one of the big lessons I learned, having been in the hospital with my son and having been in the hospital myself, is that the system isn’t really a system. It’s a disconnected group of people acting on an issue. I’m not a person even, I’m an issue and quite frankly, us holding that individual who’s in that situation - the patient, accountable for how that all works, is really ridiculous.
And so, what we have to do, is we have to provide the support, we need to provide ways for people to advocate for the patient and if there are mistakes made, it really shouldn’t be the patient’s problem, it should be ours.
And so, our opportunity… the unmet customer need in this situation is the most expensive line item in the American family budget right now… it needs transparency, needs convenience and needs a very clear sense of what it costs. There needs to be value in that solution.
Kate Sokoloff: It’s amazing to me that the system is still limping along. It’s so overripe for disruption. We're all just sitting on the edges of our chairs waiting for it to be cracked open. Waiting for a new system that's driven by price transparency and a system that rewards outcome. It’s so basic and we're so far away from it. You know the old Marx Brothers joke ‘I wouldn’t dare go to the hospital because people die there all the time’, well, it’s essentially true. Your goal as an insurer is to keep your clients out of the emergency room. So if you had a magic wand Mark, what would be the one thing that you would do across the population to help achieve that end?
Mark Bertolini: So, I think when we think about healthcare, we think about addressing diseases. And unfortunately for us, as a society, we have a lot of people with multiple diseases. And so treating a disease, doesn’t work. It’s like, your car doesn’t run and it’s got a flat tire, and so you fix the flat tire and the car still doesn’t run. You need a car that operates to take you from point A to point B. And so, we need to talk to people about why their health matters to them.
Now, I’m a spinal chord injury survivor with severe neuropathy. I do not describe myself that way. Most people when they meet me, don’t look at me that way. They don’t even know it most of the time. Unless they’ve done their homework on me.
But what I do know is that my neuropathy prevents me from enjoying certain parts of my life, I can’t play the piano like I used to play anymore, because my left hand doesn’t work. My fly fishing, my ability to tie flies don’t work anymore. And my health is defined by the barriers it creates, to the life I’d like to lead. And so we should have a discussion with people about what are their ambitions for their life, that health gets in the way of. And how can we create a plan in concert with them to address that? Because if we build that plan for them, they're engaged.
If I tell a diabetic with neuropathy that you know, we can get your feet fixed, If we get your diabetes under control and get your feet fixed and you can run the 5k next year, and they’ve never run an inch in their life before, they don’t care. If they used to take their grandchildren for a walk in the park or they used to walk to the senior centre to play cards everyday and they can do that again, now I've got their attention.
And so, it’s in that individual conversation that needs to happen in the community with people they trust, where we can build that plan and then I would argue, along with the co-pays and prior authorisation and all the other things can go away. Because it’s the right plan.
And that plan is gonna result in fewer ER visits, fewer hospital stays, fewer episodes where they need expensive care because we’re helping them lead the life they want to lead by removing barriers that they have as a result of their health.
Kate Sokoloff: What about the barrier that is the industrial food complex? The food that people put into their bodies. I think this is one of the greatest risks we face as a modern society. Processed food is not good for us, we have no idea where our food comes from. This is not a healthy disconnect for our bodies to the planet. How do we make a local food revolution affordable, not just for the whole food crowd?
Mark Bertolini: So, we started 3,850 summer urban farm vets in the last three years, as a company, through our foundation. It started four to five years ago, we had twelve urban farmers that we brought together in St. Louis, doing great things across the country including one guy from Harlem named Tony Hillery who runs a place called Harlem Grown. My better half, Mari, she’s an urban farmer, she’s a Yogi and she said ‘I’d like to come’. So she came with me, and I introduced her to everybody and we’re having this little party, and before I know it, she’s got these twelve people in the corner. I go over and say ‘What’s going on over here? And she goes ‘Well, we’re gonna build a plan on how to create urban farms. And you’re gonna pay for them!’.
And so, we got the foundation involved and we connect each of these farms to schools, to farmer’s markets, to restaurants. Most of them get self-sufficient within a year. You know Mari and I are now deeply involved in 'Harlem Grown' and acquiring more property up in Harlem. But what happens in these urban farms, is not only does it create organic food but it creates a whole different level of knowledge and community, when you do it right. So, Mari and I personally support this group in the Bronx called 'Common Threads', where they take kids, they keep them after school, the parents instead of going to a fast food restaurant, come to the school where they have organic food from a local urban farm, they cook the meal together, the parents and the children. They sit and eat it and go through their homework.
Kate Sokoloff: Amazing.
Mark Bertolini: Tony up in Harlem Grown is now helping kids fill out their applications for college. He’s taking young men coming out of prison and teaching them hydroponics. He’s got people with their hands in the earth and you know looking at worms and how they support food growth and everything else. So this whole idea of food being incredibly important, you are so right, in brain development but also in recreating community at the local level, which is so incredibly important, in socialisation, in safety and in ultimate, health.
Kate Sokoloff: That sense of community is so critically important on so many levels. There's a sizeable correlation between the advent of air-conditioning and the rise of depression and other chronic illnesses. When people decamp indoors and stop talking and interacting with their neighbours on their front porches, they became less healthy.
75% of the conditions that affect us have a significant behavioural commodity. We can affect huge changes by what we eat, how often we move, how we sleep and most importantly, our sense of belonging, our sense of community. This is that illusive, unquantifiable variable that seems to be the cornerstone of good health.
How do we get this back in a world where technology leaves us increasingly without community?
Mark Bertolini: I think the beauty of agrarian societies in the mid 1800’s is that people didn’t fall through the cracks because people in the communities took care of each other. We can re-establish that here in America, if we get back small again. And one of the things that I’ve talked often about is our governance models in corporations and in governments that are not adequate to deal with the social ecosystems we’ve created with social media, with technology and with our economies that are now global.
And one of the responses to that is, let’s make our governments bigger. Let’s make our rules harder inside of corporations, as a way of trying to control these ecosystems, when they’re uncontrollable in a lot of ways.
And so people talk about the new world order as the only way to get the economy in place, and that scares everybody including me. And I would argue, the alternative is that you go back local.
Kate Sokoloff: I think that is imperative and inevitable, sooner or later.
Mark Bertolini: You go back to community. You go back to self-governance in a lot of ways. And, you’re seeing that happen in things like our withdrawal from the Paris Accords as the United States federal government and two hundred and eighty eight organisations, companies, states, cities, saying ‘you can go out, but we’re not’.
And I think this idea of community is a way of re-establishing a governance model that’s effective in the care of people in the community, can be especially important for healthcare. In creating a gig-economy that allows people to take care of each other, that is going to have to reinvent work as we look at 5G and augmented reality and artificial intelligence.
Kate Sokoloff: Right.
Mark Bertolini: And allow us to work less but to use our leisure time in our assistance to one another, as a way of generating more economic growth.
Kate Sokoloff: It’s a beautiful vision and I hope we all step up to the plate to make it happen. Of course, we have to be a bit worried because the power is so concentrated right now, in the hands of a few really big, really powerful companies. We have to hope that they will use the power to help the larger community and not just line their pockets. I guess we're all worried about that.
And it gets back really to wealth and equality and the current version of capitalism that's causing so many Millennials to romanticize socialism. How do you get enough people at the top to start putting employees and community first, putting them first in front of shareholders? Because if the tide doesn't turn, it’s not going to end well.
Mark Bertolini: Well, I think there’s a role for local government and I hope these cities and counties, what we are doing across the country, gets at this very point. What can we do here? And how can we engage people here and I’m also on Arianna Huffington's Thrive global board. How can we get people away from their machines everyday? You know, what can we do to change the nature of how people interact with technology? Because technology is inexorable, it will always be here. How we use it and how we manage it and how we think about it, is the most important thing we can do.
Kate Sokoloff: I could not agree more. We spend a lot of time thinking about that at 13D. We call it the biggest unregulated social experiment of all-time. A long discussion for another day. But we are out of time this morning, so I have one final question. Mark, what would you most like to be remembered for as a leader?
Mark Bertolini: I don’t want to be remembered as a leader.
Kate Sokoloff: [Kate laughs] As a human being I guess.
Mark Bertolini: And what I want are those people, to pay it forward. And so if they pay it forward as the result of what me and others have taught them, then that’s good enough.
I don’t want my name on buildings, I don’t want my name in a historical document lauding me for doing something fantastic. All I want are people that pay attention and learn, and pay it forward and own the stewardship of doing the same going forward.
Kate Sokoloff: Absolutely. Well, thank you Mark. Thank you for your time. I really appreciate it.