Axios’ Tina Reed in conversation with Oscar Health’s Mark Bertolini

I was skiing. I had just jumped off a rock and into the woods and was skiing through to my house and I caught an edge and I hit a tree and I broke my neck in five places. C2, C3, C5, C6, T1. I slid head first down into a ravine and laid in a river for two hours before they found me. And that saved my life. The cold water in the river froze my spinal cord and prevented it from rupturing. And so I'm what's called a super quad. I'm a walking quadriplegic. I have a quadriplegic injury that didn't cause more damage. And for the next 18 years after I got out of... so when I woke up in the hospital, I was in a coma for 7 days. They had me on an EEG machine. They were waiting for me to flatline. And the nurse was giving me a sponge bath. I said, 'What are you doing?' And she went running from the room going, 'Oh my god, he's alive.' Which is really comforting by the way. It wasn't a dream. And they said, 'What do you need to know?' I said, 'How do I get out of here? Because if I stay in the hospital too long, you'll kill me.' And I'd worked in hospitals. I've been a paramedic in Detroit during the beginning of the AIDS epidemic. I'd run the emergency room and receiving a hospital for four years. So, I knew what hospitals were like, and they're really well-intended institutions, but it's really hard. And what I found in leaving the hospital early is that I was on my own. I was physically structurally patent. I could still move around, but I had a whole life to try to recapture and ended up in chronic pain for 18 years. Slept an hour a night, level 7 to 10 pain, right side of my brain shut down. And I was about to end my life in Zurich, Switzerland in February of 23 at Dignitas through assisted suicide. And I had to meet with doctors about intractable pain. And the doctors all looked at me and said, 'You don't have intractable pain. We're sorry. You have neuroplastic pain and we can fix you.' And six months later, I was out of pain. So the pro... but here's the problem. Every time I went to see a doctor, I got a prescription for drugs, narcotics. When I cleaned out my safe after my pain was gone, which I didn't use. I was afraid to use them. When I cleaned out my safe and took it to the police station, the police helped me count up $450,000 worth of street value and how I could have put my neighborhood through school had I put it to better use. But the system was about a break-fix operation. It was not about somebody's life. And we did a lot of research at Aetna. We've done a lot of research at Oscar. And what we have found about people is they never describe themselves as an injury or a disease. I never describe myself as a spinal cord injury survivor. I describe myself as the limitations I have as a result of the injury I have. I was classically trained in piano. I can't play piano anymore. At least to my satisfaction. My fly fishing is horrible and my golf handicap went from 12 to 21. I can still ride my motorcycles. I can still ride my road bikes. But getting my life back was the first thing I wanted to do. And there was no one there to counsel me to say, 'You can't get it back. You have to find your new life. You have to reinvent yourself. You have to find yourself in a new place.' And so the treatment I took was simply transcranial magnetic stimulation, disconnecting the pain centers of my brain and virtual reality with psilocybin. No medicine, no special mechanism. I had nine major surgeries. And so what I said about the system is we're not looking at the human being as someone who has a life to live and has an impediment to that life that they're unable to overcome. So if you're talking to a diabetic with pedal neuropathy and you say, 'What is it about your feet that gets in the way of the life you want to lead?' They'll say, 'I used to go for a walk in the park with my kids, my grandchildren, or I used to walk to the senior center to play cards and I can't do that anymore.' If you can say to them, hey, if we get your diabetes under control, you can do that again. You now have them engaged because it's about them. It's about the life they want to lead. It's not the picture of men or women's fitness magazine saying, 'Here's a perfect human.' Not many of us in the room can qualify, no matter how hard we try. And so this idea of finding people where they are and what health does to create barriers for their life is really what we're trying to do at Oscar. We have benefit plans for diabetics. We want diabetics to join us because if they engage with us in the way we can, they can get better and they become cheaper to take care of. So the idea is to better understand personalized medicine, not population health, not a disease-specific injury. It's about how do I help these people live the life they want to lead in a way that suits the life they want to lead.

One of the things we found in people coming back from war in the Middle East, soldiers, they would have an ankle injury and they would have their ankle fused from an IED and they would eventually come around to the fact that they can't run and they want to run. So, take my leg below the knee and give me a spring so I can run. I had the debate with my doctor about my left arm. Take the arm off and give me the Bionic arm and maybe I can play piano again. But this ain't working. And the view of the medical system is this is a perfectly good biological arm. It still functions to their satisfaction, not to mine. And so this idea of finding people where they are, what they can do. I had one orthopedic surgeon who had to replace part of my humorous from my accident. And I told him I was an inch short on the left side of my brake calipers on my road bike. And so he gave me an inch bone graft longer so I could reach my calipers on my road bike. That's where medicine's headed. How can you help me live my life? And so the opportunity to do that creates a better individual who has a healthier outlook on life and they're not stuck at home staring at the TV or wondering how long the pain's going to exist and how long their life's going to last.

So we serve the ACA market. We take care of individuals who otherwise could not afford their own health insurance. We cover just short of 2 million people. We have a net promoter score of 67. That means that the people that like us are at 83 and the people that hate us are at 17. And that in an insurance industry where the average net promoter score is zero is quite an advantage. And so we play to that advantage in everything we do. If we invest in some part of the business and we have a digital platform that allows people to interact with us relatively on their own digitally if they'd like and in an operation like that, we always now look at every investment we make and it says if it doesn't improve the member's experience with us, we don't do it. Now that got the company in trouble a little bit in the beginning because they didn't pay attention to certain regulations that are required in order to run an insurance company and we fixed those like Sarbanes-Oxley and material compliance with laws but once we got those fixed the team realized that we could create a really powerful platform and so our intention with the platform over time is to extend it to health systems and put them in the business of taking care of people at risk instead of having insurance companies do it. Our moniker or our meme at the business is Mark Bertolini standing at the helm of a pirate ship among Spanish galleons filled with gold. All we have to do is provide a better product and people will come with us versus staying with them. And so it's all about this delight that people can have by working with us as a carrier.