Staring death in the face taught Aetna’s former CEO how to be a more human leader

Mark Bertolini wears a large, black skull ring on his right hand. It’s a memento mori for the former Aetna CEO, a symbol of his mortality. He bought it after waking up from a six-day coma in 2004, when a skiing accident broke his neck in five places and resulted in his left arm being permanently disabled. It happened just a year after his teenage son Eric managed to beat lymphoma. When he looks at the skull, he’s reminded that “who you spend your time with and how you spend it every day are the two most important decisions you will make,” he told Business Insider.

We spoke with Bertolini in late February, at the CECP‘s CEO Investor Forum, and ahead of the release of his new memoir, “Mission-Driven Leadership.”

The exec, who grew up in Detroit, says he was the first member of his blue-collar family to attend college. He worked his way through the healthcare industry before making it to the top job at Aetna in 2010.

Bertolini’s last act as CEO was closing the $69 billion sale of Aetna to CVS Health in a deal that made CVS CEO Larry Merlo the chief executive of both companies and left Aetna president Karen Lynch as Bertolini’s successor.

His time at the health-insurance provider was marked by an average of 20% annual growth of earnings per share, and a revamping of employee benefits that included a minimum wage increase to $16 an hour and the widespread implementation of yoga and meditation classes. He developed a passion for the latter after kicking a painkiller habit that arose in the wake of his accident. These healthier habits also led to the adoption of Buddhism and the abandonment of a ruthless executive persona employees once characterized as “Darth Vader.”

“I often say to people that I’ve been uniquely prepared to do the work I do given the personal experiences I’ve had and the things I’ve had to live with,” he said. “And while I wouldn’t change a bit of it if I had the chance, I would not recommend it as a developmental pathway!”

We talked about some of these experiences, and how writing his book gave him a chance to reflect on them.

The following interview was edited for clarity and length.

Letting go of Darth Vader

Mark Bertolini: It was 2001 when Eric got sick. I’d sold my first company in ’94, and my second company in 1998. I got paid a lot of money, and I was living in this mansion on the mountain in Avon, Connecticut. I was just back from Italy, and all of a sudden my son got sick and my money didn’t matter, my position didn’t matter. What I realized over a period of three or four months is that I had to personally engage. What I realized in that personal engagement is how little time I had spent with him. So I literally lived in his hospital room with him — I even moved a bed in there.

He was in the hospital about a year, and then in and out for a few months after that. But I just left work.

I had PubMed on the laptop, “Harrison’s [Principles of] Internal Medicine” text with a bunch of little sticky notes, and I grilled the medical team every morning: “What are we doing today? Why does it matter? Where do I read about it?” And it was through that process that we got two drugs approved for him and ultimately, it saved his life and then it was five years later, I gave him my left kidney because his kidneys were damaged by the cure. But all of that was so humbling.

And then my injury happened. I was the guy that, at 184 pounds, 8% body fat, ran four miles every morning, worked out at the gym. I was in tip-top shape. I was 47 years old and all of a sudden, I hit a tree and none of that worked anymore, and I was like, “Oh my God, what a disaster.” After my son’s illness and then that, it was like, “OK, this isn’t about me.”

Richard Feloni: Are you referring to life in general?

Bertolini: Yes, life in general. In the middle of all that, I left the Catholic church over the whole Boston abuse revelations. And so I was all of a sudden non-religious. I was in incredible pain. I was on seven different narcotics, and to come out of that, you have to reinvent who you are. I first tried to get it all back and realized that wasn’t going to work if I had my motorcycles, if I had my bicycle.

I had to reinvent everything, and in that reinvention come face-to-face with the narcissism, the lack of humility, all those other sorts of things.

Feloni: Weren’t you known as “Darth Vader” before this?

Bertolini: Yes, yes I was, [because] I was not afraid to make decisions. If you’re willing to make [a decision] and you’re willing to monitor the progress of the decision you made, you’ll make it better as you go along. But most people won’t make a decision because they’re afraid of being wrong, which most decisions are until you get into it.

Feloni: Did thinking about things that were bigger than yourself help you become a more empathetic leader?

Bertolini: It did. I went through an evolution of having all the answers to realizing I had very few answers, and I started engaging the group and learning from them. I had some brain injury from the accident, so I had to go through all of that realizing who I was and what my role was going to be. Not working was not an option for me — although I could’ve done that.

Investing in employees before it was cool

Feloni: How long from this point did it take you to get to this idea of being (as you’ve put it) a “radical capitalist”?

Bertolini: I did things before anybody else was talking about doing them: Raising minimum wage, waiving out-of-pocket costs, paying back student loans, paying people to sleep, investing in the employees. I had come up with the notion that talent was more scarce than capital, and I was asking, “What is it we need to believe in order to take this set of risks and be successful?”

It was actually the yoga and mindfulness that opened the whole door for the rest of it. I was doing that to deal with my pain. I wasn’t taking opioids — I still don’t — and I came to work and said to the senior team, “I think we should have everybody learn yoga mindfulness.” And they all nodded politely because I was the president at the time, and then about an hour later, the chief medical officer came in and said, “Mark, this is voodoo medicine. You’re crazy. We all think you’re crazy. Just because you do it doesn’t mean everybody else has to do it.” And I said, “OK, well what do you need to do to believe it?” And he said, “We need to do a double-blind study.”

So we did, and two months after the double-blind study with Duke was done, he came and said, “You’re not going to believe this: It actually works.”

It took a long time, way longer than I wanted to, but it was about a year where I finally said to the team, OK, I’m tired of talking about spreadsheets. We’re gonna raise minimum wage from $12 to $16 an hour, and we’re going to wipe out healthcare costs for everybody under 300% of the poverty level.

And when we did that and watched the results, it was amazing. Our employee engagement went up 1,200% not only in those employees, but in the whole company. What happened next was the most profound piece: Everybody started coming back to me with ways we could take care of each other.

I talk about the four levels of leadership. The first level is your employees hate you. The second level is your employees fear you. The third level is your employees praise you. The fourth level, you’re invisible because your organization takes care of itself and that’s what happened the last three, four years.

That’s the legacy I want to leave: An organization of people that get it, they make it better, they keep it going. I don’t need to tell people what to do.

How to know when it’s time to move on

Feloni: With the book, you took time to look back on your career. What’s next for you, and what do you want to accomplish?

Bertolini: I don’t live the lifestyle of the traditional CEO — I come from a pretty humble background. When the deal closed, I had almost three million shares of stock, and I never used it because I didn’t need it. So the vast majority of that has gone into taxes, my family foundation (called Anahata), and then trusts for grandchildren and children. My wife and I kept a little bit of it, but the majority of it is in the foundation.

The idea there is to use that foundation to create community, and to focus on three things. First, in education. My wife works in the Harlem schools with kids on literacy. Second is the environment, and we’ve invested heavily in preserving carbon sinks, so buying forest land that will never be built on or chopped down. And then sustainability, how do we create sustainable communities. That will be the work, and I’ll be engaged in that because it’s interesting to me and exciting for me. I’m on a number of boards of directors.

So that’s sort of occupying my time. I probably won’t jump into a full-time job unless I’m dragged back into it. I want a portfolio of interesting things to do. I’ve been working since I was 13, so it would be kind of nice at 62 not to have to work anymore and make decisions tougher than what kind of coffee do I grind this morning.

Feloni: What’s your best leadership advice?

Bertolini: Setting goals only establishes disappointment. The deeper understanding one should have is what is it that you do really well, that you love to do, and look for work that supports that. And if you do that, you’ll have an incredible career.

My proclivities are to fix broken things and build new things. I hate just making sure the trains run on time. I always hire people that can do that part really well, and I’ve been surrounded by people like that for the last 20 years. I’ve been able to look at what’s next, what can we fix, what can we make better. Because if things are running really well, I’ll tinker with them just to see if they can be better than they are.

I’ve never looked for a job other than my first job. The phone’s always rang to offer me something. People will call me and say [they’ve] got this issue or that issue. If it’s something I like, I’ll offer to help. That’s how I’ve gotten every job I’ve had — and because it’s work I love to do and I do it well, I have a lot of fun doing it.

Probably the hardest part [of retiring] is you should be prepared when you’re done to have things you need to do that are just as interesting, otherwise you’ll regret the fact that you don’t have a job anymore. I think that’s where a lot of CEOs in particular fail.

Feloni: Did you leave Karen Lynch with strategic insights before departing your role?

Bertolini: Oh yeah, Karen worked with me for a long time. It was a very purposeful development process for her, and I think she’s going to be in a great place. She has every opportunity to run that company [CVS] one day and I think she can do it, and I’m going to support her in trying to achieve that.

When I handed her the president’s job, I said to her, “At some point you will realize you’ve been doing the president’s job too long because you’ll see an issue and you’ll go, ‘I know how to do that. I did that [back then],’ and that’s when you make mistakes.”

The leading cause of failure is success. When it became too rote for me, I knew I needed to have somebody else do it. She’s taken it to a whole different level. Again, the legacy is that she took things I had figured out and she made them better, and she has built her own things that she’ll pass on to somebody else. And that’s what [former Aetna CEO] Ron Williams did with me. That’s what real legacies are, the work they leave behind. She’s got a big job to do. I think she’ll do fine.

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