Mark Bertolini, Aetna CEO – highlights from his HIMSS keynote address

Posted on March 5th, 2014 in Uncategorized by Karl

Aetna CEO Mark Bertolini made some interesting comments during his keynote address at the Healthcare Information and Management Systems Society (HIMSS) annual conference.  A Forbes Magazine article by Dan Munro captures these comments very well.  Below are some key points.  You can read the full article here:

Mark Bertolini Quotes:

On Waste in Healthcare:

[Referencing the 2009 IOM study which calculated that about 30% of healthcare spending is wasted in the United States.] “The number is over $800 billion – and when you solve that problem – if you were to solve it all – the United States could pay back half its debt over the next 10 years. So this should be the focus of our efforts.

On Consumer Out-of-Pocket Costs:

“Healthcare premiums are growing at four-times the rate of inflation. Currently today – through both premium sharing and benefit costs – employees are paying 41% of the healthcare dollar. If the trend line continues over the next 3-5 years – employees will be paying more than 50%.How do we break this?

On Health Insurance Exchanges:

Not too far away from now – in the next 6-7 years – 75 million Americans will be retail buyers of healthcare. And they’ll come to the marketplace with their own money and either a subsidy from their employer or a subsidy from their government. And it doesn’t much matter – they’ll be spending their money.”

On the Future of Aetna:

“So Aetna’s going to have two businesses. One is going to be around ACO’s enabling the provider system and the other will be not only creating but driving a consumer healthcare experience because we’re that close. Connecting the two and [then] standing back and getting out of the way. [We are] creatively destroying the current business model to enable a new one that will have an impact on our healthcare costs.

So in summary, one of the major healthcare leaders in America thinks: (1) healthcare waste is the #1 priority, (2) the consumer’s cost-share is high and growing, (3) exchanges are here to stay and (4) Aetna is repositioning itself to service ACOs and consumers.

What does this mean to employee benefits professionals and healthcare consumers?

  • Mark Bertolini may very well be right, so it would behoove us to think about his perspective.
  • There is tremendous instability in healthcare that is causing even the largest players (e.g. Aetna) to change their business models—things will likely be very different 5 years from now than they currently are.
  • Mr. Bertolini uses the phrase “Creative Destruction” to describe the current state of healthcare.  The question is, are YOU going to be on the ‘Creative’ side or the ‘Destruction’ side?

Submitted by Eric Bricker at Compass Healthcare Blog.