Aetna CEO takes health care personally

Aetna CEO Mark Bertolini is no stranger to navigating America's complex health care system. In 2001, his son Eric was diagnosed with terminal cancer, and he was left fighting for his son's life with no clear guidance from his insurer or health providers.

"Given all the economic power I had and political connections I had, there wasn't a cure to be bought more or less," Bertolini explained. "What I was told was he had six months and no one had ever survived his cancer."

Fortunately, his son did survive his illness, but the experience has since shaped how Bertolini runs the third largest health insurer in the U.S.

"What I learned through that experience was that the health care system is not very connected," said Bertolini. "We were the connection. We were the advocates."

Mark Bertolini, CEO of Aetna.
Adam Jeffery | CNBC
Mark Bertolini, CEO of Aetna.

Now, Aetna provides their customers with an advocate, specifically a nurse case manager, that can help patients and their families navigate the system through its compassionate care program.

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Another policy change was getting rid of the requirement that patients entering hospice care had to sign paperwork that they were going to die and would no longer seek curative services.

"We had to put Eric into hospice on July 15, 2002. We had to admit he was going to die in six months and that he could no longer seek curative services. So one of the other things that I did when he survived that experience was to come back to Aetna and say why do we have to have this requirement," revealed Bertolini. "The concern was it'll be too expensive. But we did a two-year study with some of our largest accounts and found that it was actually cheaper, more effective, and people felt better about it."

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Aetna is doing something right. The company insures more than 23 million medical members, has $47 billion in annual operating revenue and operates in North America, Asia, Europe and the Middle East. Recently, Aetna raised its 2014 earnings forecast for the third time this year, after beating analysts' expectations for the second quarter.

When Bertolini looks at America's nearly $3 trillion health care system, the highest of any industrialized nation, what does he see?

"We're paying for it the wrong way," Bertolini remarked. "We pay for every unit of service that's provided. So what we're incentivizing is more units of service; instead of saying here is an individual, we're going to pay you so much for that individual to get them well again. Your goal is to have a better outcome."

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Bertolini said the U.S. government has more control in the economics of the health-care system than any other player.

"The biggest actor in that system is CMS: Medicare and Medicaid. They pay 60 percent of all the bills today," Bertolini explained. "If they worked with private industry in a public-private partnership to come up with a new model to reimburse, we could have a dramatic impact on the use of services in the U.S."

—By CNBC's Marqui Mapp.