A year ago at home, one of Omaha's foremost health care experts bumped his noggin.
It didn't seem like much - he had stood up quickly and struck his head on an open cabinet door. He and his wife detected only a scalp abrasion and a little swelling.
As his symptoms became pronounced, though, he learned it was much more than that - a subdural hematoma, or bleeding on the brain.
It led to left-side seizures, intensive care in a hospital, weeks of rehabilitation, walking with a cane and a new perspective for this health care leader turned patient.
The patient was Steven S. Martin, longtime CEO of Blue Cross Blue Shield of Nebraska, the state's largest commercial health insurer.
In the weeks after his head bump, he traveled a lot and took aspirin for headaches. But on Oct. 10 in Chicago, he had an episode.
"I went to get a tissue out of my pocket," he said, "and I couldn't make my hand go into my sports coat."
He called his doctor in Omaha, got on a plane and before long was home dealing with a health crisis. After scans, he was told of the bleeding between his skull and his brain.
The good news, his doctor said, was that his skull wouldn't need to be opened. The bad was that the bleed was interfering with his motor-sensory nerves and that he would face seizures and perhaps paralysis.
Painful seizures in his left arm and left leg went on for several days, Martin said, "and it got difficult even to breathe."
A lot happened between then and the end of the year, including the rehab, and he returned to work full time in January. Today he is cane-free, has been released from neurological care and is back to full health, with no lingering effects.
But his ordeal has led to self-reflection about the health care system. Though he received excellent care, he said, his stint as a patient makes him more determined than ever to speak out about something he already felt strongly about: the need for greater cooperation among health care providers.
"This has really made me double down," the 60-year-old Martin said in an interview at Blue Cross headquarters in Aksarben Village. "What I have to do with the rest of my life, whether here or someplace else, is to really get the system to work more as a team."
Failure to do so, he said, is costly in dollars and in health.
A former farm kid, Martin grew up in Horton, Kansas, but spent chunks of summers on his grandparents' Nebraska farms near Fairbury and York.
He handled chickens and pigs, learned to milk and worked around farm silos. That farmyard image of a tall, narrow structure is one that he uses in describing separate aspects of health care.
"Getting doctors, nurses, pharmacists and others to break out of their silos," he said, "is not easy."
The massive health care system, and paying for it, is complicated. It has other problems, he said, such as drug companies spending more on advertising than on research and development - nine out of 10 top companies did so, according to a 2013 study - and the high cost of administrative paperwork.
But Martin said vast savings and improved quality of care could result from a simple concept: health professionals, across specialties, talking with each other.
Blue Cross Blue Shield estimates, he said, that 30 percent of premiums result from basic errors.
He doesn't mean malpractice. Rather, he refers to a lack of communication and "bad handoffs" between specialties. Those may result in, for example, delays in starting rehabilitation, extended hospital stays and unnecessary or incorrect prescriptions.
"I'm not talking about incompetence," he said, "I'm talking about errors of omission. Errors because 'I'm not responsible for the next tower.'"
He explained the tower/silo analogy another way:
"I'm the hospital, I'm not responsible for rehab. I'm rehab, I'm not responsible for at-home care. I'm home care, I'm not responsible for the pharmacy. I'm the pharmacy, I'm not responsible for the equipment."
Better coordination at every step, he said, would help everyone.
As a 10-year-old, Steve had a "two-week scare" in a hospital over an eye issue.
It turned out to be calcification near the optic nerve, which he has been able to live with, and which required no surgery. What he remembers most, though, was the impersonal approach of doctors.
"That changed me," he said. "I was a little kid in a pediatric ward in the '60s, and they didn't really care what I thought or felt. Not a single one had a conversation with me."
Steve later played trumpet in the all-state jazz band and offensive line in football, including at Washburn University. He had a couple of concussions, he said, but with no residual effect.
He switched majors from pre-med to nursing, and upon graduation helped launch an occupational and home health services company.
His career path led him to Omaha in 1981 with the pharmaceutical company Upjohn, and in 1984 he married Amy Haddad, daughter of bandleader Eddy Haddad. Today she is director of the Center for Health Policy and Ethics at Creighton University.
Steve joined Blue Cross in 1986 and rose to president and CEO in 2002.
A boating accident had caused the death of his predecessor, Richard Guffey. Steve's accident, fortunately, didn't end so tragically.
On Sept. 3, 2015, as he and Amy prepared for a Labor Day weekend trip with friends, he crouched to search for something in the mudroom at home.
He stood quickly and - bang!
Martin isn't second-guessing his decision to forgo seeking immediate treatment. Because he had no serious symptoms, he said, doctors probably would have practiced "watchful waiting."
After the Chicago episode, when his left arm wouldn't go into his coat pocket, his Omaha physician deemed him OK to fly.
He got home, felt better except for numbness in his arm and went to bed. In the middle of the night, though, he awoke with his head spinning and having trouble with balance. Then his left arm started flapping.
Amy drove Steve to the ER at the Nebraska Medical Center. Doctors gave him phenobarbital to treat the arm and leg seizures, which continued for days but eventually stopped.
Martin received great care in his week or so at the hospital, he said, "and the nursing staff was absolutely phenomenal. They caught a number of things that, without them, I would have had to stay longer."
But he said it wasn't anybody's job to start planning beyond his hospital stay. He himself began thinking about that next step early, though, and asked whether a rehab stay at Quality Living Inc. in Omaha would be appropriate.
He ended up spending nine days at QLI, known for its work with people who have spinal-cord injuries. Said Martin: "I'm a lightweight compared to what they handle."
He wasn't always the best patient, he said, and thought he could walk himself to the bathroom - until staffers made him stop.
While at QLI, he received "reverse electrical stimulation to retrain my nerves."
Most impressive, he said, was watching the QLI staff work in concert, "all knowing what was happening with you and how they fit as a member of the team."
He entered QLI immediately after his release from the hospital. If he had waited until his hospital discharge day to explore the QLI possibility, he said, the organization may not have had a bed available and he would have gone home to wait for a week or two.
"That would have been OK," he said, "but I wouldn't have started the rehab right away."
He left QLI by the end of October, walking with the cane, and returned there for half-day rehab three or four days a week for a few weeks.
Martin was able to work part time and returned full time to his office after the first of the year.
Last Oct. 15, the company issued a statement saying its CEO was recovering from a head injury, but didn't provide details. Until now, Martin hadn't spoken about it publicly.
A former co-captain of his college football team, Martin said health care is a team sport.
"But we still have a lot of individuals not leaving the silos of their disciplines," he said, "thinking of it as an individual sport."
Practical evidence of his and his board's belief in better coordination is Blue Cross Blue Shield of Nebraska's 25 percent ownership investment in the Think clinic.
Think Whole Person Healthcare, in a new $45 million building at 7100 West Center Road, opened 14 months ago.
It's an experimental health care system in which doctors, pharmacists, patients and others work to avoid emergency room visits and hospitalizations. The goal is to save money while providing better care, especially for people with chronic illnesses.
It has 24 primary-care physicians as well as a foot doctor, dentistry, physical therapy and lab services, scanning technology and other services.
It endured startup problems, including overloaded phone lines, and cut back on some services. Martin said that glitches are understandable, but that Think is on a path to break even financially.
"We don't want to lose money on this," he said, "but we're not in it so much as a moneymaker as a laboratory. We believe it will be successful."
Martin has observed other institutions, including the Nebraska Medical Center and the Creighton University Medical Center, moving toward more interdisciplinary approaches. He said more must be done.
His colleagues at Blue Cross have gotten used to hearing the boss expound on the topic, especially in the aftermath of his health ordeal.
"Steve has always been passionate about life and about what he does," said Lew Trowbridge, company president. "But he's got a sense of urgency now that's helping everybody around here realize that now is the time: We have to start doing things differently."
The company was prepared for the possibility that its CEO might not return. But George Beattie, Blue Cross board chairman, said Martin came back far sooner than expected - and has done so with great energy for improving quality of care.
"Steve is all about trying to improve the patient experience," Beattie said, "and about seeing it from the patient side of the equation."
In his 15th year as CEO, Martin said the Blue Cross board decides how long he stays, but it may be another two to four years. "I'm a steward here."
He recently has spent much time on an executive search, and this week the company will announce four executive vice presidents - two men and two women.
It's likely that one of the four will succeed him, he said, noting that there's a 50-50 chance his successor as CEO will be a woman, which would be a first for Blue Cross in Nebraska.
Martin hasn't forgotten the two-week hospital scare of his childhood, though his eye turned out to be OK. Last fall he thought "many times" about his early, impersonal hospital experience.
"Some of the dehumanizing elements of health care don't change," he said. "The check-in, the billing system that's as bad as it was before, the payments system."
But this time around, health providers were more personal - and he said he hopes and believes that wasn't because of the job he holds.
A plus from his recovery, he said, is that his overall health has improved. At 6-foot-2, he lost weight and is down to 225 pounds, with plans to lose another 10 in the next year through better nutrition and exercise.
But people still wonder if he is OK. He and his wife were at breakfast recently, he said with a smile, "and people still have a look in their eye as if to say 'Are you all there?'"
Yes, he was covered by Blue Cross insurance. Total charges for his care, he said, were about $100,000, but that was negotiated down - as typically happens with insurance companies - to a little over $50,000.
He had a high deductible, he said, and so he personally paid "several thousand dollars."
In 2011 Blue Cross Blue Shield moved 1,200 employees to a leased building that Martin said is saving $2.5 million a year.
It sits at 1919 Aksarben Drive on the redeveloped site of the former Aksarben Thoroughbred racetrack, which closed in 1995.
Martin just ended a two-year term as president of the board of governors of the philanthropic Knights of Aksarben, and said the Aksarben coronation ball has raised more than $9 million in scholarships.
Steve said he doesn't like the limelight, and he has never been called a "wild and crazy guy" like the comedian Steve Martin, though they share an Aug. 14 birthday. (The comic is 11 years older.)
In Omaha, Steve and Amy have chaired the United Way of the Midlands annual campaign and have led fundraising efforts for many other nonprofits, including TeamMates, Voices for Children, Omaha Children's Museum and Community Alliance. In April he was inducted into the Omaha Business Hall of Fame.
Accidents happen in every family, and so do illnesses. Martin survived what seemed like just a bump on the head but soon turned serious, and is happy to be enjoying better health than before the home accident.
Health care is costly, but he believes major cost savings and better quality of care can occur with better communication between providers. Trying to overcome the "fragmentation" of care, Martin said, can feel like swimming upstream.
"It's a system that likes not to have its traditions ruffled, including our own as insurance," he said. "We're a player in that. We have to be equally accountable."
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His thoughts on health care
Steve Martin, CEO of Blue Cross Blue Shield of Nebraska, calls himself "a pragmatic pessimist but a forward optimist" - one who sees problems but remains hopeful. In a nearly two-hour interview, he commented on many aspects of health care:
"We've added more years to life in the last 50 years than in all of human history before that. Now it's about adding more years of quality life."
"The most successful wellness program in history was 'You can't smoke here!' That didn't cost anything, but it changed lung disease and it changed heart disease."
"Obamacare is the biggest conundrum I've seen in my 40 years in this industry. The cost of administering the system is a nightmare. ... The left and the right have polarized so badly in the last eight to 10 years, and fixing it means both sides need to start thinking about how to decentralize it. The new president, whoever it is, and the new Congress have to come together."
"There's no hospital food that tastes good. If you look at the regulations for nursing homes and hospitals about how to deliver and make food, it's nuts."
- Michael Kelly