image3 in 4 people in America will buy health care at retail with a subsidy within just a few years, according to Mark Bertolini, CEO of Aetna. Bertolini was the first keynote speaker this week at the 2014 HIMSS conference convened in Orlando.

Bertolini’s message was grounded in health economics 101 (about which frequent readers of Health Populi are accustomed to hearing). A healthy community drives a healthy local economy, and healthier people are more economically satisfied, Bertolini explained. The message: health care can move from being a cost driver to being an economic engine.

But getting to a healthy community is hard to do when you’re wasting 30% of health spending, Bertolini warned, citing the IOM’s report on building a sustainable health system in the U.S. “If you solve the health care waste problem, you can pay off 50 percent of the nation’s debt in 10 years,” he calculated. This does what Simpson-Bowles tried to do with deficit reduction, Bertolini judged.

As a health plan working to get more up-close-and-personal with consumers, Bertolini noted that “you have a different customer sitting in front of you (today). 41% of health costs are borne by the consumer.”

How to deal with this? Let’s build a new foundation for health, Bertolini recommends, with 3 prescriptions:

1. Align incentives
2. Take care of chronically ill people
3. Invest in wellness.

Let’s make wellness simple: put it in palm of peoples’ hands, Bertolini asserted. He illustrated this point by sharing a personal story about his daughter who found a sweater she wanted to purchase at Macy’s. Bertolini then pulled out his smartphone and searched online for the garment, identifying the lowest-cost retailer for the item, then mapping out via GPS how to get to that store.

He ended up buying 2 of the sweaters: one for his daughter, and one to bring to work to show his team to explain why this simple model should become the norm for health care consumers –not just for fashion shoppers.

(I would point to the GoodRx app for an example of where this works in health care today).

There’s an iron triangle in health care: of access, quality and cost. Overlay this with the 3 key stakeholders of consumers, providers and employers, and you can figure out what might work in moving toward a better system for the 3 constituents.

One key to bending the cost curve will be to move care to lower cost settings — “far away from the hospital” Bertolini proposes – as close to home and family as possible.

“It’s all about you,” Bertolini says, meaning health care consumers. All players in the ecosystem must put people at the center.