“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
The cultivation, transportation, sale, use, and possession of marijuana is illegal under federal law in the U.S. However, the federal government has articulated that if a state passes a law to decriminalize marijuana for medical or recreational purpose, they can do so if a regulation system for cannabis is in place.
Marijuana is listed as a Schedule I drug under the Controlled Substance Act of 1970—the topmost classification under the legislation. One of the reasons why cannabis still remains illegal at the federal level is because it’s classified as a Schedule | drug, as identified by the DEA, a substance that has a great potential of being abused by its user and has no acceptable medical uses.
However, a recent review from the National Academies of Sciences, Engineering, and Medicine evaluated more than ten thousand scientific studies on the medical benefits of marijuana, one of which was the use of medicinal cannabis to treat chronic back pain.
Furthermore, certain cannabis strains are known to provide a good deal of energy, enabling you to stay active and crush the fatigue keeping you down.
In spite of all the health benefits of cannabis, it’s likely to remain illegal in workplaces, which is why it’s important to know how to detox.
Pink prescription bottle for medical marijuana; image by LexScope, via Unsplash.com.
Individual state laws don’t always conform to federal standards. State-level proposals for cannabis rescheduling have had mixed success.
On November 9, 2016, the use of both medicinal and recreational cannabis was legalized in the states of California, Washington, Colorado, Alaska, Maine, Nevada, Oregon, and Massachusetts.
Another 15 states, including the U.S. Virgin Islands, have also decriminalized. The commercial distribution of marijuana is allowed in all jurisdictions where it’s been legalized, except Vermont and Columbia.
Prior to January 2018, the Cole Memorandum gave some protection against the enforcement of federal law in the legalized states. Later, however, it was rescinded by former Attorney General Jeff Sessions.
The use of marijuana remains federally illegal, but some of its derivative compounds were approved by the FDA for prescription use. Cannabidiol is now sold by various online retailers who claim their products are extracted from industrial hemp; hence legal.
Although the DEA considers non-Epidiolex CBD a Schedule I drug, it has not yet taken any action to shut down these sales.
Top Five Predicted Changes In Cannabis Law
We’re in a time of unparalleled growth and rapid change for the marijuana industry across the U.S.
As we look ahead at problems in the law at both the federal levels and Oregon state, here are five main changes we see on the horizon.
#1: Social Consumption
The Oregon Legislature is considering social consumption bills, which would allow the possession, consumption, and sale of cannabis products at temporary events, as well as licensed cannabis cafes and lounges.
Social consumption bills have previously failed, partly because of the necessary amendments to the Oregon Indoor Clean Air Act that legislators are hesitant to address. As the public hearings have already begun, this issue may grow enough legs for a tailored version of one of the bills in order to pass this session.
#2: Access to Banking
Limited access to financial companies creates a sub-optimal brand model for marijuana businesses and fuels safety concerns.
The SAFE Banking Act is likely to prevent federal banking regulators from hurting banks for working with marijuana-related companies that are obeying state laws.
In March 2019, the House Finance Committee made a vote to pass the bill to the House, with advocates expecting a floor vote in May.
With over 150 co-sponsors and strong bipartisan support to date, the bill is predicted to pass in the House. Also, advocates are hopeful that the support may put enough pressure on the Senate to pass the bill.
#3: Interstate Commerce
The Oregon Legislature is taking a bill into account that will allow for an interstate compact with states having legalized cannabis and that share borders (OR, WA, NV, and CA).
Creating an exchange of marijuana between these states could help combat overproduction problems and spillage into the unregulated market. It could also position Oregon to be a leading cannabis exporter in the future.
#4: Social Equity Issues
A Social Equity Program was first introduced in 2018 by the City of Portland to help small marijuana businesses and those impacted by marijuana prohibition directly.
In addition, a portion of the local tax revenue gained from cannabis sales goes toward grants to minority—and women-owned local marijuana businesses. Oregon, however, has made no movement on prior cannabis convictions’ expungement.
Local jurisdictions in cities like Oakland are setting a precedent on the problem of expungement. We can expect that Oregon will take this issue as a nudge in the right direction.
#5: Federal Legislation
Is 2019 going to be the year of weed?
Ten states, along with the District of Columbia have marijuana laws in place that allow the legal use of cannabis for both recreational and medical purposes.
New York, Connecticut, Illinois, and New Jersey are each expected to legalize marijuana in the coming years. Public support for cannabis legalization is always high, and bills like the STATES Act will exempt legal-marijuana states from federal law enforcement.
We don’t quite have a crystal ball, but the dominoes are lining up with a goal of federal legalization on the horizon!
Wrapping Up
So, these were five of the main predicted changes we see in cannabis law.
The year 2019 feels different.
Cannabis enthusiasts have long celebrated 4/20—the cannabis culture, but now that companies are seeing profit potential, they’re getting involved as well with things like CBD-infused Carl’s Jr. hamburgers and $4.20 Lyft credits.
Cannabis is a huge business, even if it’s not legal everywhere yet. In this post, we tried to give you a comprehensive review of the legality of cannabis by U.S. jurisdiction.
So, what will be the future of cannabis businesses?
Perhaps, only time will tell.
Nonetheless, did you find this article helpful? Share your thoughts and suggestions with us in the comments below!
In the past five to seven years, domestic meth labs have decreased in the U.S. as Mexican drug cartels brought cheaper and purer drugs in. Kara Berg, Lansing State Journal
LANSING — When Battle Creek police and parole officers inspected a home May 6 on the city’s south side, they found something unusual.
The methamphetamine, marijuana and syringes they seized were almost expected, but the one-pot meth cooker was a surprise. It’s something police don’t see often anymore.
As recently as five years ago, meth was commonly made at home in plastic 2-liter pop bottles with ingredients bought at drug stores. Police and first responders would find dumpsites littering rural roadways, or would rush to fires caused by exploded home cookers.
But those days are mostly over, Michigan law enforcement officials say.
Now, the meth is coming from Mexico.
With that comes an increase in meth-related overdoses, said Stephen VerDow, a Michigan Drug Enforcement Administration assistant special agent. The Mexican meth is purer, cheaper and increasingly has been reported to be mixed with fentanyl, a deadly combination.
“Methamphetamine has been a scourge for many years and continues to wreak havoc across the country,” VerDow said.
Why your city might be an ideal target for Mexican cartels
In the past five to seven years, the number of domestic meth labs have decreased in the U.S. as Mexican drug cartels brought in cheaper and purer drugs, VerDow said. The cartels bring the drugs into the U.S. with commercial and personal vehicles, making any cities near major highways – like Lansing, Battle Creek, Howell and Brighton – ideal areas to target.
“The increased commercial vehicle traffic in these areas help them blend in better with legitimate commercial business,” VerDow said. “Drugs can be distributed in very remote areas as well, but the (cartels) want to stay under the radar as much as possible.”
They aggressively and violently market and sell their products, VerDow said, leading to the ability to sell meth in the U.S. with “huge profit margins.”
This has fueled the decrease of what officials call “one-pot” domestic meth laboratories, VerDow said.
Michigan State Police Detective Lt. Bill Eberhardt said the number of one-pot meth labs Tri-County Narcotics, which covers Ingham, Eaton and Clinton counties, responds to have dropped dramatically.
The number of domestic meth laboratories rose throughout the early 2000s and peaked in 2004 before dropping to the lowest numbers since 2000, VerDow said.
Eberhardt said people run less of a risk purchasing the drug than making it. Because of that, Mexican drug cartels are the greatest criminal drug threat in the U.S., according to the DEA’s 2018 National Drug Threat Assessment report.
The mystery of the missing medical records has been solved.
But how do you actually get to them? That’s a whole other problem.
PainMD, a Nashville-area pain management company that recently shuttered clinics and stranded patients without medicine, disclosed in a court filing this week they’ve lost access to countless patient medical records that are stuck in storage units spread across Tennessee, Virginia and South Carolina.
PainMD said it can no longer reach the records because, as the company has been crumbled into bankruptcy while accused of widespread fraud, all the employees with access the storage units have left.
This is a huge conundrum for former patients, many of whom need those records now. Some ex-patients have been without access to their records since six PainMD clinics — recently re-branded under the name Rinova — closed their doors without warning in May.
The closures sent patients searching for new pain clinics, but due to concerns about the opioid crisis, many pain management doctors will only accept new patients with both a medical referral and up-to-date medical records.
PainMD left its patients with neither.
That’s exactly what happened to Esther Jeffries, 59, an ex-patient of the PainMD clinic in Cookeville. Since the clinic closed, Jeffries has been without her medical records and unable to find a new doctor to refill her prescription. Her medication ran out last week.
“I’ve been going through withdrawals. I’ve been sick,” Jeffries said. “I feel like I’m climbing the walls and my husband is about ready to take me to the emergency room to see if I can get any help.”
PainMD accused of injecting patients for pure profit
PainMD and its parent company, MedManagement, once owned or operated as many as 30 clinics in Tennessee, Virginia and North Carolina. Federal and state authorities have sued PainMD and its owners of defrauding the government out of millions by pressuring patients into unnecessary painful injections, then intentionally mislabeling the injections while billing Medicare, Medicaid and TriCare. Three PainMD nurse practitioners were indicted on these same allegations in April.
While these court cases were ongoing, PainMD sold its clinics to company insiders, then re-branded six clinics in Tennessee and Virginia under the new name of Rinova. The Rinova clinics operated for a few more months before abruptly closing on May 8.
Rinova promised to help patients by mailing a final prescription extension and releasing their medical records, but these promises have not been kept. Since the closures, The Tennessean has spoken with at least 25 ex-patients who said they’ve struggled to find a new pain doctor because they can’t access their medical records.
The likely location of those records was revealed last Friday when PainMD filed for bankruptcy, saying it has only $2.8 million in assets but more than $13 million in debts.
Medical records locked in storage
As part of bankruptcy filing, the company revealed that some patient medical records are maintained electronically, but that “many” patient records are kept in file boxes in storage. Medical records and charts are currently kept in at least 23 storage units spread across 10 companies. PainMD claims it can no longer enter any of these storage units because “everyone with access is no longer employed with company.”
That’s a problem for the storage companies too.
Danny Sutton, the owner of SelfStor Solutions in Cookeville, said he rented two units to PainMD, which abruptly stopped paying or answering his calls this month. Sutton is now stuck with two units that he can’t rent because PainMD abandoned stuff inside.
Sutton is legally forbidden from opening the units and checking what was left behind.
“If there are medical records inside, that’s news to me,” Sutton said. “But if they are medical records, there has to be somebody that will be needing those records.”
PainMD could not be reached for comment. Messages left with PainMD’s civil attorney, Jay Bowen, and its bankruptcy attorney, Robert Mendes, were not returned.
The bankruptcy filing also reveals PainMD’s primary owner , Michael Kestner, borrowed $178,000 from the company in 2015. The debt has not been replayed.
Dig Deeper
Opioid crackdown in Tenn.
Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.
The organization’s new opioid recommendations include state-level legislative and regulatory revisions that would foster the goal of a national PDMP database, Steven C. Anderson, NACDS president and CEO, tells Drug Topics.
Proposed PDMP requirements include daily reporting of controlled substance dispensing information to state PDMPs, data standardization to improve PDMP usefulness, a check to the state PDMP by providers prior to issuing a controlled substance prescription, and enabling interstate access to PDMP data.
In Missouri, the only state without a PDMP, NACDS is continuing to work with its two in-state partners on a statewide PDMP that builds on the current county-based program that covers nearly 80% of that state’s population, according to Anderson.
NACDS now recommends that naloxone be coprescribed for some opioid prescriptions. Because certain patient populations are at increased risk of overdose due to the nature of their condition or to the combination of medications they take, coprescribing ensures immediate access naloxone that could prove life-saving in emergencies, Anderson says.
“NACDS will pursue state legislation that ensures all patients taking potentially dangerous combinations have access to naloxone when the initial opioid prescription is filled. NACDS urges the authorization of pharmacists to prescribe and dispense naloxone immediately upon identifying patients at potential risk of overdose, or an individual that presents with possible abuse of heroin,” Anderson says.
NACDS is also urging for reforms in the design of health plans to help identify and treat patients with substance use disorders (SUDs) and is urging improved coverage for pain management treatments other than opioids.
“Opportunities exist to leverage the role of the pharmacist in services that improve access to medications for SUDs and addiction, incentivize screenings for SUDs, and improve access to medication assisted treatment at the physician- and community-pharmacy levels,” says Anderson.
NACDS proposes to pursue federal and state policies that require coverage of alternative, non-opioid drug therapies for chronic pain management at the same formulary and cost-sharing tier. NACDS also proposes to require coverage of complementary or integrated health pain management services, according to Anderson.
Pharmacists’ role in opioid abuse prevention is warranted and welcome—70% of Americans support leveraging pharmacy’s role to help solve issues related to opioid abuse, says Anderson.
In addition, a national survey conducted in January 2019 by Morning Consult and commissioned by NACDS found that, by a 2-to-1 margin, pharmacies and pharmacists are considered to be a solution, not a contributor, to the problem of opioid abuse.
I have been told by pt of Pharmacists/Pharmacies INSISTING that chronic pain pts that have been taking opiates for years NOW REQUIRE THEM TO PURCHASE NARCAN… in order to get their opiate Rx now filled.
At least one pt has told me that husband picked up her opiate Rx at the pharmacy and when he got home they found a Narcan kit in the bag.. Did not tell the pt’s husband that it was in there and no instruction on how to use it.
Pts telling me that they LIVE ALONE and take opiates long term and pharmacist/pharmacies insist on them purchasing Narcan.. and who is going to administer the Narcan if they OD.. which they haven’t done for all the years they have been taking opiates for their chronic pain…
Does this sound like a good way to boost store revenue and “kiss up” to the DOJ/DEA that the chains are doing their part in helping to curtail/address the opiate crisis… which is mostly involving illegal opiate products.
From living with back pain for years to a life-changing procedure. Only the change was not at all what he expected.
NEW BRAUNFELS, Texas — David Winnett has seen a lot. He retired from the Marines as a captain after spending 20 years and countless tours around the world.
“I did three tours in Okinawa. I did a tour down in Guantanamo Bay before 9/11,” said Winnett.
The training took its toll.
“I developed degenerative discs. I started developing severe back pain the last two to three years of my career,” he said.
Push to get patients off pain pills
For years, pain pills helped. Then doctors pushed Winnett to consider an alternative – a spinal cord stimulator (SCS).
“They told me I could relieve the back pain and get off the opiates,” he said.
Stimulators use electrical currents to block pain signals before they reach the brain. Each year, 50,000 are implanted worldwide.
Courtesy of the Mayo Clinic
Mayo Clinic
He scheduled surgery for September 2017, a one-week trial to see if he should get the permanent implant.
“I came out of recovery and, within about a minute of waking up, I felt a very intense pain in my left groin,” he recalled.
He stood up for what he did not realize would be the last time.
“I laid back down and the exact same thing began happening on the other side – intense pain – and then the pain hit my back. It was like someone was stabbing me in the spine. It was just horrible, I just started screaming,” Winnett said. “Around that same time, my legs went to sleep.”
Doctors flew Winnett to Austin for emergency surgery, removing the stimulator first.
“I thought the pain at the clinic in my groin was bad. Oh, no, this was like a thousand times worse,” he said. “The next day I woke up in ICU. The doctor who put the device in came to visit me and he was apologizing to me and I said, ‘Hey doc, that pain, when they took that thing out, was horrendous.’ And he said, ‘Didn’t they turn it off?’ He looks at me. And I think, why didn’t he turn it off?”
He took a video while recovering in the hospital that showed the lights were still flashing, the power to the stimulator was still on.
“It literally felt like I had sparks inside my spine – it was that bad,” he said. “An MRI taken right after they pulled them out in Austin showed that one of the leads had taken a wrong turn. It hadn’t gone straight in.”
Doctors determined the stimulator hit a blood vessel, causing blood to fill his spinal column killing the nerves of his spine. The life-changing surgery changed him in ways he never imagined.
“I’m a paraplegic. This has just been a nightmare.”
Winnett is not alone. Device Events.com found 681 people have been paralyzed by spinal cord stimulators and more than 100,000 other injuries – most since 2008.
Dan Ross, an Austin attorney, represents Winnett and has represented a number of other patients with medical device injuries.
“There are many heartbreaking stories including David’s,” said Ross. “Companies have been successful in getting judges to throw out these cases because they are preempted by a law that doesn’t offer any remedies.”
The device Winnett had implanted was approved a month before his surgery through the pre-market approval (PMA) process, meaning it did undergo some human clinical trials.
People harmed, killed or disabled by a medical device that the U.S. Food and Drug Administration classifies as Class III cannot sue the manufacturer. Class III devices have the highest risk – they include cardiac stents, pacemakers and stimulators.
This is due to a 2008 U.S. Supreme Court ruling. The case Riegel vs. Medtronic granted “pre-emption” protection to makers of devices that undergo PMA. The court ruled that, because the devices undergo clinical trials and studies, they are subject to liability protection.
That means Winnett cannot sue the manufacturer for what happened. It’s a loophole Congressman Lloyd Doggett and others want to fix with the Medical Device Safety Act.
“It’s important that doctors get this information in and that we have the right. Everyone has the right to seek redress for their injuries and that these companies don’t hide behind the FDA,” said Doggett.
Retirement plans altered
It is too late for Winnett.
“I did not plan to spend my retirement this way,” said Winnett. “Ironically, even after this paraplegia, I still have the same back pain because I’m paralyzed below that level.”
He makes the best of each day sharing his story in hopes of helping others know the risks.
“I tried to do the right thing, what’s politically correct nowadays, to get off the opiates. Well, look what happened to me as a result. If I’d had it to do over, I would have slept in that day,” he said.
Comment from NANS
The North American Neuromodulation Society issued a statement about spinal cord stimulation this fall. It can be found here.
It states that “approximately 60,000 SCS therapies were implanted in the U.S. in 2016. Up to one-third of patients implanted with a SCS system will experience a complication, the vast majority of which are minor. “
It goes on to state, “Reported severe neurologic complications, including paralysis, occur in less than 1%.”
Hamilton, Ontario—Despite past reports of serious health issues with proton pump inhibitors (PPIs), pharmacists can offer some reassurance to patients using the drugs to treat gastroesophageal reflux disease or related diseases.
A new study published in Gastroenterology found no evidence that PPI use increases risk for pneumonia, chronic kidney disease, diabetes, or dementia. Results came from a large, multiyear, randomized trial of patients receiving rivaroxaban or aspirin.
McMaster University–led researchers said there is no reason to limit PPI prescriptions because of concerns about long-term harm, although the medication should be used only when the benefits are expected to outweigh the risks and according to recommended dose and duration of treatment.
“Our research provides welcome news for the countless patients who rely on PPIs to control their symptoms, as well as the physicians who prescribe this medication,” said lead author Paul Moayyedi, MB, ChB, PhD, The Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. “To our knowledge, this is the first prospective randomized trial to evaluate the many long-term safety concerns related to PPI therapy. It is reassuring that there was no evidence for harm for most of these events.”
Noting that the drugs are effective at treating acid-related disorders, the study team points out that although the drugs have been shown to be well-tolerated in the short term, observational studies have raised questions about long-term treatment. The trial of 17,598 participants with stable cardiovascular disease and peripheral artery disease was designed to answer those concerns.
The study randomly assigned 8,791 patients to 40 mg of pantoprazole daily and 8,807 to placebo. In addition, participants were divided into groups receiving rivaroxaban (2.5 mg twice daily) with aspirin (100 mg once daily); rivaroxaban (5 mg twice daily); or aspirin (100 mg) alone.
Researchers tracked any development of pneumonia, Clostridium difficile infection, other enteric infections, fractures, gastric atrophy, chronic kidney disease, diabetes, chronic obstructive lung disease, dementia, cardiovascular disease, cancer, hospitalizations, and all-cause mortality every 6 months, with follow-up of a median of 3.01 years.
Results indicate no statistically significant difference between the pantoprazole and placebo groups in safety events except for enteric infections (1.4% vs. 1.0% in the placebo group; odds ratio, 1.33; 95% CI, 1.01-1.75).
Study authors point out that, for all other safety outcomes, proportions were similar between groups except for C difficile infection, which was approximately twice as common in the pantoprazole versus the placebo group; only 13 events occurred, however, so the difference was not considered statistically significant.
“In a large placebo-controlled randomized trial, we found that pantoprazole is not associated with any adverse event when used for 3 years, with the possible exception of an increased risk of enteric infections,” researchers conclude.
If drug interdiction can be compared to a giant game of whack-a-mole, federal law enforcement officials delivered one mighty wallop this week when they raided a container ship at Philadelphia’s port and discovered a staggering amount of cocaine.
Hidden inside seven shipping containers were 33,000 pounds (15,000 kilograms) of the illicit drug, one of the largest caches ever intercepted on U.S. shores and a quantity that’s almost “beyond comprehension,” as Patrick Trainor, a spokesman for the U.S. Drug Enforcement Agency in Philadelphia, put it Wednesday. Federal officials estimated the seized drugs had a street value of more than $1 billion.
The feds’ find was another sign that traffickers are turning to East Coast seaports as a result of increased law enforcement pressure along the country’s southwest border, a development cited by the drug enforcement agency in its latest national threat assessment. It was at least the third major bust in Philadelphia and New York since February.
“As soon as interdiction puts pressure on one place, it just pops up somewhere else. We’ve continually seen that,” said Nicholas Magliocca, a University of Alabama researcher who studies how traffickers adapt to interdiction. “As long as the demand is there, and there’s money to be made, traffickers are going to find a way.”
Cocaine use and overdose deaths are on the rise in the U.S. after years of decline as production has surged to record levels in Colombia, the source of about 90% of the U.S. supply.
Agents were doing another sweep Wednesday through thousands of containers on MSC Gayane, a cargo ship owned by Swiss firm MSC Mediterranean Shipping Co., but had not found any cocaine since their initial search on Monday, according to Stephen Sapp of U.S. Customs and Border Protection in Philadelphia.
Two members of the crew have been charged with conspiracy to possess cocaine aboard a ship, but details of their case are sealed.
An affidavit obtained by The Associated Press said that MSC Gayane was at sea off the west coast of South America when it was approached by more than a dozen boats loaded with cocaine. Crew members aboard the larger ship helped transfer the drugs, authorities said.
The cargo ship docked in Colombia, Peru, Panama and the Bahamas before arriving in Philadelphia early Monday. Federal authorities raided the ship later that day. The ship’s second mate was arrested after agents swabbed his hands and arms and detected traces of cocaine, an affidavit said.
“The 500 kilos that we got in March, good hit, good hit,” said Trainor, the Philadelphia DEA agent. “But was that a huge loss to the cartels? Probably not. But 15,000? Oh yeah. I’m sure somebody had a really, really bad day yesterday somewhere in South America.”
Former Aetna CEO Mark Bertolini says that the most stressed-out workers at the health insurer during his tenure spent $1,500 more on health care each year.
He drove a cultural change that included multiple stress-management programs, from animal therapy to yoga and sleep management.
Bertolini says these changes contributed to a 600% stock gain and eventual sale to CVS for $69 billion.
VIDEO08:01
Watch CNBC’s full interview with former Aetna CEO Mark Bertolini
When Mark Bertolini took over as Aetna’s CEO in April 2011, shares of the health insurance company were trading just over $30. When the company was sold to CVS in 2017, the pharmacy giant paid more than $212 a share in a $69 billion acquisition.
One secret to this success: Bertolini began letting his employees take yoga and pet dogs during their lunch break.
“What we found … was that if we actually invest in people, they actually got better and health-care cost went down,” Bertolini, the former Aetna CEO and author of “Mission-Driven Leadership: My Journey as a Radical Capitalist,” said at CNBC’s Evolve event in New York City on Wednesday.
This transformation began when Bertolini noticed how far a focus on prevention rather than treating medical problems went.
We had dogs, cats, guinea pigs and rabbits that would come into our building. People would line up at lunchtime to go pet the animals to reduce stress.
An internal Aetna study found that employees in the top 20% of stress levels had $1,500 a year more in health-care costs.
To help fight this, Bertolini pitched a company yoga program. Although some upper-level management thought he was crazy, many of the employees responded positively.
“The company just went crazy from a cultural standpoint, where all the employees started coming in, ‘Can we do this? Can we do this? Can we have pet therapy?’” Bertolini said. “We had dogs, cats, guinea pigs and rabbits that would come into our building. People would line up at lunchtime to go pet the animals to reduce stress.”
Bertolini suffers from neuropathy in his arm and practices mindfulness and yoga. He has a pet, too.
“I have a dog. She is the best medicine for me every night, you know, a German Shepard, Keeva. I should have brought her. I should have brought her this morning to come along,” he said.
One of the factors Bertolini wanted to focus on most was ensuring employees got a sufficient amount of sleep every night. To encourage this, Aetna began paying $300 for employees who received 7.5 hours of sleep at night for 20 nights in a row. The company also doubled their tuition assistance program and increased their efforts to pay back student loans.
He said at the time of the CVS deal, the company was spending $120 million to $125 million a year more in employee expenses related to all those cultural changes.
While the holistic health alternatives were key, there also were serious socioeconomic factors at work in stress levels of employees, Bertolini said. Compensation, for one. Many employees were working two jobs. And most of the frontline employees were not being paid enough — 81% were single mothers, and 20% of their families were on food stamps and their children on Medicaid.
“I said, ’We have to change this.,” Bertolini recalled.
Aetna raised wages from $12 to $16 for its frontline employees.
After the crash
After the financial crash, Aetna was “was crawling out of a deep hole. … We had to rethink the way we thought about our company,” Bertolini said.
The key variable the company came up with at the time was that for every 50 basis points changed in health-care costs, there was $480 million improvement in underwriting margin, and another $480 million for the client. So it developed this model and team of people that did nothing but look for ways to improve the quality of care, to improve the quality of life, to reduce another 50 basis points.
“Every year we went after 350 basis points,” he said. “And so in 2010, we added 8% operating margin. [Wall] street said we couldn’t keep it. We actually grew it to 9.1%, and that was by literally looking for ways to improve the quality of care and improve the quality of life to individuals and reduce the costs by virtually keeping them away from the medical-industrial complex.”
“What we did was, we turned around the organization culturally and said, ’Oh, wow. We can take care of each other and it doesn’t hurt the company,” Bertolini said.
The impact of this cultural change was immediate. Health-care costs in the company went down 7.5% and engagement scores skyrocketed 1,200%.
It also created a new way to measure leadership. “That became the secret. That was the CEO metric, if you had to have a CEO metric. The CEO metric was, ‘Where do I find the next 50 basis points?’”
Bertolini credits this cultural shift for being one of the main reasons the company’s stock price soared more than 600% during his time as CEO. “The cultural energy that was created in the organization as a result was a power that you could never measure,” Bertolini said, but he added, “Our people were engaged with our customers, and we got a really high return on that.”
