Of Mark Bertolini’s many strategies for improving health care delivery, the ones that resonated most with a Columbia Nursing audience emphasized the importance of engaging patients in care close to home—before they get sick—and ensuring that this care reflects the social and economic realities of their lives.
20 Hours A Year In The Health Care System
“The average person spends 20 hours a year in the health care system, which means we spend 99.6 percent of our waking hours outside the health care system, where social determinants drive our life expectancy,” Bertolini, the former chairman and CEO of Aetna Inc., told a roomful of students and clinicians during a talk in February. Thus, he said, quality care must address the individual factors of patients’ lives that are making them sick. “What is preventing people from leading the lives they want, and how can their health plan help them?” he posed. “Every human being should have a personal approach to their health.”
It was during his tenure at Aetna that Bertolini first came to appreciate how social determinants affect health. He had introduced yoga and meditation classes to reduce employee stress, after these practices had helped him recover from a near-fatal 2004 skiing accident that broke his neck and left him with ongoing nerve pain. He soon learned that his employees’ stress was financially driven: Most of his lowest-paid workers, who earned only $12.50 per hour, were single mothers who partially depended on food stamps and Medicaid. He responded by raising the minimum hourly wage to $16 and abolishing health care costs for those living below 300 percent of the federal poverty level. He also gained important insight into how life circumstances—including financial struggles—affect health.
Learn The Challenges of Patients' Lifes
To provide the most effective and personalized care possible, therefore, nurses must learn as much as possible about the challenges in their patients’ lives, Bertolini said. “Unless health care providers get into homes and communities, we’re going to have a hard time addressing social determinants of health.”
Essential to effective health care is engaging patients before they are “broken,” and as close to their homes as possible, he added. This means making health care local and easily accessible by creating patient-centered medical homes in pharmacies or other places with a strong community presence. “Why should anyone go for a flu shot inside a hospital?” he asked. “We should be giving flu shots in the community.”
Bertolini, who is now a board director of CVS Health Corporation, the product of CVS Health’s acquisition of Aetna Inc., explained CVS pharmacies are moving toward becoming patient-centered medical homes by offering, among other things, free health and wellness screenings and comprehensive health assessments, as well as helping people access local resources like Meals on Wheels, free clinics, and community health centers. “I think everybody in the world should be a community health care provider,” he said, scanning the audience. “That’s the role you can play as part of the Columbia Nursing community.”
Commending nurses for the high-quality, compassionate care they provide, he said, “Patients are living longer because of nurses.” And, as patients receive better care, they will demand better care. “There’s going to be a lot more patient-centered care, because, if patients don’t feel cared about, they’re going to go someplace else.”
Shanelly Singh, DNP-FNP Candidate ’21, said, “Bertolini’s approach to healthcare reiterates that we as nurses have plenty of work to do as leaders, but he exudes the full confidence that we can do it.”
This piece is based on the event held at Alumni Auditorium on February 26, 2019, A Health Care Leader’s Personal Journey: Why Nurses are the Future of Nursing, an evening with Mark Bertolini, Former Chairman and CEO of Aetna. The event was sponsored by Dean Frazier, Columbia Nursing’s Student Council, and Columbia Nursing’s Office of Alumni Relations.