Invest Like The Best - Performance During Pain

“Mari walks in the house and hands me the journals. She goes, 'The problem with their stress is you. They're working two jobs. They got their kids on Medicaid because they can't afford dependent coverage. They got people on food stamps. They're calling bill collectors while they're on break. You're not paying them enough.' 81% were women. 20% of families were on food stamps, 25% of kids were in Medicaid. So I raised minimum wage to $16. It was $75 million the first year.”— Mark Bertolini

Bringing Wellness to the Office · p. 19

Leadership & Management · Business & Entrepreneurship · Economics & Markets

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$75M wage raise, doubled stock price

“We did a bicoastal double-blind study. We had 795 employees sign up. We did cortisol levels and heart rate variability. After 12 weeks of mindfulness and yoga classes, what we found is that the people in the highest quintile of stress spent $2,500 more a year on healthcare than the average employee. After 12 weeks, heart rate variability and cortisol levels dropped 50% in this population. Our healthcare costs went down, not trend. The actual dollar cost went down 7.5% the next year.”— Mark Bertolini

Bringing Wellness to the Office · p. 19

Business & Entrepreneurship · Operations & Execution

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Yoga program: 50% stress drop, 7.5% cost drop

“The spreadsheet is the worst invention ever created for business. We created a tool that allows us to manipulate numbers on the page to get the answer we want. Then we manage to it. We create a belief system that's not real. Instead of saying, what are the five risks on this page? Let's discount all the soft benefits by 90%. The group we discounted by 90% added up to the exact same amount as the hard savings. What it meant was we were just not seeing far enough.”— Mark Bertolini

Bringing Wellness to the Office · p. 20

Strategy & Decision Making · Operations & Execution

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Spreadsheets create false belief systems

“Instead of waiting for all the perfect information to move forward, you develop a hypothesis, build a process around managing that hypothesis, take in the data as you move along, and then ultimately it becomes a better thing. If you look at all the great innovations in our society, those things didn't start as the thing that entrepreneur started with. Apple's green and orange and yellow boxes aren't what made them successful today. So it's about navigation.”— Mark Bertolini

Build, Fix, Scale, Repeat · p. 5

Strategy & Decision Making · Creativity & Innovation

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Hypothesis, process, navigate; product evolves

“It starts with just doing the basics right. It's like trading in the markets. It all starts with a T-account. Someone's asset is another person's liability. That's it. You have to show people the connections and the line of sight instead of looking at each thing and saying, 'Here, fix this, fix this, fix this.' When they start to see how it all fits together, then you've recruited everybody into a mental model about how the world works that we can share.”— Mark Bertolini

Build, Fix, Scale, Repeat · p. 6

Leadership & Management · Operations & Execution

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Show connections, not tasks: shared mental model

“I developed the concept of Platonists versus Aristotelians. Platonists are people who think the great idea, communicate it and consider their job done. Aristotelians actually have to translate it into real work. I found that being an Aristotelian was far more powerful than being a Platonist. There are a lot of people with great ideas. Not too many people can actually make them happen.”— Mark Bertolini

Build, Fix, Scale, Repeat · p. 4

Leadership & Management · Operations & Execution · Philosophy & Reasoning

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Platonists think, Aristotelians execute; execution wins

“You have to get down in the mud and crawl on your belly below the pillbox slot so you don't get shot. It's literally the work of doing deep, deep thinking. Over my time, I found that while I thought I was right 100% of the time, I'm really only right about 35% of the time. But it's the issue of making a decision and moving forward. If you have a good management process around it, it will get better as you go along.”— Mark Bertolini

Build, Fix, Scale, Repeat · p. 5

Strategy & Decision Making · Leadership & Management

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Right 35% of time, but decide and iterate

“Ron Williams is sitting there and he goes, 'Those questions you put together for everybody, why don't you actually listen to the answers instead of preparing the next question and come up with two more questions as a result of the answer? You'll be amazed at how much smarter you are.' Now I know 35% of the time I'm right, and the rest of the time I got to learn by asking questions. So it changed my style completely.”— Ron Williams

Unfinished Business · p. 32

Leadership & Management · Psychology & Behavior

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Listen to answers, not prepare next question

“There's a quote I have had under my blotter every day of my working career. It was Niccolò Machiavelli when he wrote to the Prince: there's nothing more dangerous than to initiate a new order of things, because those who are advantaged by the current order have the laws behind them and experience to continue to support the way it is. And for those who would be advantaged by the new order of things really won't embrace it until they experience it. And between the two, you run great danger.”— Niccolò Machiavelli

Barriers to Scaling · p. 13

Strategy & Decision Making · Philosophy & Reasoning · History & Geopolitics

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Machiavelli: incumbents defend, beneficiaries wait

“Health insurance was started 80 years ago as a result of soldiers coming back from war. They were worried about wage inflation. So they said we can't have any increases in wages competing for talent, but you can create benefits. There will be operating expenses that you can expense into your business and it won't be taxable to the individuals. If you create enormous capacity and you give people no sensitivity to price by giving them coverage, you have created a great inflationary monster.”— Mark Bertolini

The $75 Billion Healthcare Problem · p. 7

Economics & Markets · History & Geopolitics

DUR_CONTEXTUAL

Capacity plus price insensitivity equals inflation

“My dad said, 'Let me tell you about Jerry. Jerry's got a family. He's got responsibilities. I have an obligation to Jerry. You're 14 years old. Were you happy before? Do you want your job back? You start tomorrow at a dollar an hour.' He cut my pay. 'This is a very important lesson for you. Never count anyone else's money. Never compare yourself to anyone else on how much money you have. Make sure you share it when you have enough.”— Mark Bertolini's father

Business Success Stories · p. 24

Philosophy & Reasoning · Leadership & Management

DUR_ENDURING

Never count anyone else's money

“The Dalai Lama said: 'In your heart, you need to find compassion for the journey they're on, because everyone has their own journey in life. But physically run.' This was about people who frighten you. Find compassion for their journey, but remove yourself from their proximity.”— Dalai Lama

Memento Mori · p. 2

Psychology & Behavior · Leadership & Management · Philosophy & Reasoning

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Compassion for their journey, distance from their person

“Last year, two out of five Americans borrowed $74.9 billion to pay their out-of-pocket costs for healthcare from banks. What if I get defined contribution from my employer for what they're paying for me today and I buy a plan that suits me at a better cost? I can use the money left over to pay those out-of-pocket costs instead of going to the bank. Or I can buy dental and vision, life insurance or disability. All of a sudden, it's my plan, it's my choice, it's what I want.”— Mark Bertolini

The $75 Billion Healthcare Problem · p. 8

Economics & Markets · Strategy & Decision Making

DUR_CONTEXTUAL

$75B borrowed for out-of-pocket costs annually

“Josh Kushner called me and said, 'I hear you're in meetings asking questions. When are things going to happen?' I said, 'Josh, I have screwed up everything at least twice myself. I know I could walk in here and say, do this, do this, do this, and we'll be just fine. But what I want to do is find out where people are and how they think about it so that I can figure out how to bring them to a place where they can succeed.”— Mark Bertolini

Build, Fix, Scale, Repeat · p. 5

Leadership & Management

DUR_ENDURING

Help ordinary people do extraordinary things

“We need to eliminate employer-sponsored insurance. We need to let individuals buy their own, but we need a marketplace to do that. The economics of large networks are that they are inversely cost-effective. The larger the network you have, the less stability you have to negotiate better rates. When you give an average benefit for employees, the employees have to decide which is the best for them. They settle for whatever they get and they have to pay 15% out-of-pocket.”— Mark Bertolini

The $75 Billion Healthcare Problem · p. 7

Economics & Markets · Strategy & Decision Making

DUR_CONTEXTUAL

Larger networks, worse negotiating power

“The mental model that exists inside your head about how the world works is the most critical tool you have. If you don't constantly add new information to it and are not a continual learner, you can't possibly know what you need to know to make good decisions. I look for two things in executives: curiosity and courage. The curiosity to continue to ask questions and learn more every day, and the courage to act on it when you have a hypothesis that might be powerful.”— Mark Bertolini

How Curiosity Drives Better Decision-Making · p. 14

Leadership & Management · Philosophy & Reasoning

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Curiosity to learn, courage to act

“They said, 'You don't have intractable pain. You have neuroplastic pain, and we can fix it.' They had done MRIs on baseball hitters. The best baseball hitters, their visual, cognitive and motor cortices light up instantaneously. There's no latency. You have a baseball hitter's brain on pain. There's no latency in your system. Something touches your arm, you're in pain.”— Mark Bertolini

Overcoming Pain · p. 22

Biology, Ecology & Systems · Technology & Engineering

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Baseball hitter's brain on pain: repatterned

“A friend sent me this memento mori ring after my accident. He said, 'Remember, you will die.' Every day when you wear this ring, look at it and ask yourself: am I spending my time with the right people, doing the right things? And if you're not, run. So it's always been a thing: am I in the right place doing the right things?”— Mark Bertolini

Memento Mori · p. 1

Philosophy & Reasoning · Psychology & Behavior · Leadership & Management

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Daily mortality check: right people, right things

“I learned that there is no good bully. And the only way to beat a bully is to challenge them. I was the one who always defended my brothers from bullies. I carried that into my career. I was an autoworker on the assembly line at Ford Motor Company. Got in a fight with my union steward because I changed my work rules. I moved my stuff around and he didn't like that. I said, 'How do I get your job?' He said you need a degree, kid.”— Mark Bertolini

Life and Work · p. 3

Leadership & Management · Psychology & Behavior

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No good bully; only way to beat: challenge

“All they need to do is believe they can do it. You have to paint for them. You have to tell a story about why it matters. One of the first things I said at Oscar is, 'We are a pirate ship filled with cannons among Spanish galleons filled with gold. All we have to do is take their business. They don't think we can succeed. We're too small.' But we have none of the ballast that they carry around with them about how they run their business. They won't go where we will go, and that's how we win.”— Mark Bertolini

Build, Fix, Scale, Repeat · p. 6

Leadership & Management · Strategy & Decision Making

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Pirate ship vs Spanish galleons: narrative wins