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Former nurse Mary Brandt has gone from supervising bottoms on a bedpan to managing the bottom line.

As president and general manager of CIGNA Healthcare of Indiana, the exuberant executive manages $1/2 billion in medical costs at the health maintenance organization, which has sold more than $100 million in new business this year.

Brandt was born in Lima, Ohio, 38 years ago. As a toddler, she lived in Daleville, Ind., until the family moved to Van Wert, Ohio, in 1970. She is the youngest or four children born to now retired independent insurance agency manager Edward and homemaker Gloria Conkle.

Her brother, Mike Conkle, is a retired Free Methodist minister who lives in Indianapolis. While in remission from his own battle with non-Hodgkin’s lymphoma, Mike serves others as a volunteer at Clarian’s Ruth Lilly Hospice. Older sister Cindy Conkle is also an R.N. She lives near their parents in St. Petersburg, Fla., where she owns her own business in risk management.

Brandt learned how to dispense compassionate care at her mother’s knee. "I had another older sister," she says, clearing her throat. "Her name is Stephanie and she had cerebral palsy. She died on Palm Sunday when she was 19 years old. She never weighed more than 35 pounds and she never spoke a word. She was like an infant. My parents took care of her at home and they did a remarkable job."

"I think our children benefited from sharing the responsibility of having a special needs sibling, Gloria Conkle says reflectively. "Stephanie was brain-damaged at birth due to a difficult delivery. So we were so thrilled when Mary was born. She was like a princess and possibly somewhat spoiled by all of us because we no longer took normal development for granted.

"None of the children seemed affected by having a handicapped sister or were embarrassed or uneasy when friends came into our home. But I think Stephanie shaped their lives."

Mike Brandt agrees. "My parents refused to institutionalize her because they didn’t think she would get the care that she would get at home. There were a lot of sacrifices made, but it probably shaped us all in a lot of ways. Early on, we got a heart for these things."

"Dealing with Stephanie’s special needs let us know that life isn’t perfect and that you just deal with obstacles and disappointments without letting them destroy you, concurs Sister Cindy. "Maybe that’s why Mike, Mary and I got into the service industry. It was just an extension of how we lived every day."

"I didn’t get to know the real joy of Mary until we were adults because I was in college when she entered the first grade," recalls Mike, who is 11 years older than his baby sister. "But she could talk your leg off when she was a kid," he says, laughing heartily. "Even then, she was a high energy person, always on the go. She’s a very, very aware person. There’s not much that goes on around her that she’s not aware of. She picks up on things that a lot of people wouldn’t."

Gloria Conkle refers to her youngest as a born leader. "She showed excellent social and leadership qualities early in life. She could influence a group both positively and negatively. In the first grade, she took swimming lessons. But because of her fear of the water, the class of beginners got so frightened that they wouldn’t go into the water.

"Her instructor called to tell us that she had never had a class like this one and it was all because of Mary," says her mother, laughing. "When Mary got over her fear of water, the class got over theirs!"

Conkle brags about her daughter’s involvement in Campfire Girls and 4-H. Mary remained in Campfire Girls through her senior year in high school. "I graduated with (its) highest award, the Wohelo. I was in 4-H from the seventh grade until I graduated from high school in 1982. My activities centered mostly on homemaker-type activities. I remember making a great-looking three-piece suit," says the snappy dresser who had a childhood fantasy of becoming a fashion designer.

"Did she tell you that she was the 4-H junior fair queen in our county?" asks her proud mother.

No. But she did tell about playing the clarinet and baritone for the Van Wert High School Cougars. "I did it for marching season. My uniform was red with a big hat. It was really dorky," says Brandt with her machine-gun Julia Roberts laugh. "I was class secretary my junior and senior years but I don’t remember ever taking a note. I also played singles and doubles on the tennis team."

"Did she tell you that she was elected homecoming queen?" quizzes her mother.

No. But she did tell about working ever since she was 10 years old. She earned money babysitting until she was 16, when she worked at Nationwide Insurance, giving quotes on home and auto insurance. "I loved it! It was great!" she says. "Oh, and I worked at Wendy’s for five weeks until they kept making me put my hair back in one of those ridiculous scarves. You weren’t allowed to show bangs and that’s when bangs were really in. I thought, ‘I’m not going to look like some goof ball!’ " remembers the petite brown-eyed beauty whose bangs often flip over her eyes when she gets animated.

Her Campfire community service work as a Candy Striper at Van Wert County Hospital convinced Brandt to try a career in nursing. "I really wanted to be a defense attorney," says the fast talker. "But I knew that it wouldn’t be as practical as a nursing degree."

In 1984, she earned her ADN (nursing) degree from Hesston (Kan.) College. "My first nursing job was at Williams County Memorial Hospital in Kingstree, S.C. "It was a pretty backward town located smack dab in between Myrtle Beach and Charleston. The hospital served the indigent and it was a great experience. I did everything from OB to oncology."

Deciding she didn’t want to live in the middle of the woods any longer, Brandt moved to St. Petersburg, taking a job as a charge nurse at Humana Hospital. "I worked on the surgical floor from 3 to 11 p.m. But I was also a home health care nurse. My territory was right on the beach. I saw five to six patients in the morning and then went to the hospital," says the high-energy woman who has the metabolism of a chihuahua.

She was 21 years old when she met California aerospace engineer Jim Brandt. "We got married and I moved to Los Angeles. I worked full time while going to Chapman University where I got my B.S. (health sciences) in 1989." The couple divorced ll years later.

"My first job in California was with a home care company. I loved floor nursing but I was much more interested in management." She got her chance in 1989 when she first joined CIGNA as plan manager of medical affairs of their Private Practice Plan of California.

It took only two years for Brandt and her team to turn around a health plan that was bleeding a million dollars a month to one that was making money. Bert Wagener, the general manager of all the California plans and one of the three authors of the original business plan for CIGNA Healthcare, became her mentor.

Now senior vice president of CIGNA, he says, "There was chemistry with Mary. I just knew that she had all the skill sets to move quickly and far. She is the type of person you wish you had 10 of just like her. Her energy is contagious. She displays enthusiasm and drive in all of her activities."

With her career taking off like high blood pressure, she moved to Atlanta three years later where she became director of managed care programs for the company. Her job was to implement medical expense reduction strategies for health plans throughout the Southern and Western regions of the country.

At the same time, she developed and managed operations of $100 million in revenue for the 140,000-member managed care plan in Puerto Rico. "I love Puerto Rico! I love the beautiful people and the warm culture. When you’re in business there, you have the same friends for life. They take their relationships very seriously," she says.

In 1995, she took a shot in the dark and joined Arthur Andersen Healthcare Consulting as a senior managed care practice leader. While in training, she met Spiros Zorbalas. "It was 100 percent love at first sight," says the handsome Zorbalas, who owns Minneapolis-based Uptown Classic Properties. Last year, he bought nine apartment buildings for $21 million. Besides the new purchases, he owns 14 other apartment buildings in the Twin Cities.

Five years after the two met, they married last year in Puerto Rico. The newlyweds have a commuter marriage, spending their weekends together at either their Carmel home or their home in Naples, Fla.

"Why do people always assume that the woman is going to move?" Brandt asks. "And I’m not changing my last name to his, because nobody could pronounce it!" she says, laughing.

There’s no humor in her voice when she describes leaving Andersen for Maternicare as vice-president of business development, Southeast Region. "I missed a whole bunch of IPOs (initial public offerings). I just kept turning down start-ups and I thought, ‘I’m taking the next one that looks like it’s going to be one.’ But it didn’t work out because they weren’t going to make it and I knew it. So I called one of my old bosses at CIGNA and said, ‘I’m ready to come back!’ He said, ‘Are you going to stay this time?’ This was after CIGNA bought Healthsource." She took her present position in 1997.

"Mary has parlayed her nursing experience into the group health insurance business," says Indianapolis insurance company owner Dave Englehart. "She is a very unique person. She’s very personable, very outgoing and attractive. She’s as smart as she can be. When she makes a business decision, she’s right. And she’s organized to the hilt. Her employees respect her ability, knowledge and position and they like working for her. She runs a tight ship."

Since joining CIGNA Healthcare in 1989, the vivacious Brandt has been a rising star with parent company CIGNA, which was formed in 1982 by combining INA Corp. and Connecticut General Corp. It’s the third largest publicly owned provider of managed health care and health insurance products in the United States. As of March, 237,000 Hoosiers were insured by the HMO, which began doing business in Indiana in 1987.

As CEO, Brandt has flown so many miles that she became one of few women in Delta Airlines’ Million Miler Club. She puts in killer days supervising her staff of 106, but she flinches at being called a workaholic. "I am not a workaholic. I work hard and I play hard. I have a good balance. Workaholics don’t have balance. I rarely experience stress. In fact, I’m not sure I would even know it!" she says, her eyes crinkling in mirth.

Balance is what the company offers its 80 female employees. For the 10th consecutive year, Working Mother magazine has named CIGNA to its list of the top 100 companies for working mothers. "It’s because of our family-friendly programs," brags Brandt. "This is a company that understands the differences between males and females. That’s why women like this organization.

"We have flexible work arrangements, adoption program benefits, child care programs such as discounts, referral services, YMCA sponsorship during the holidays through gift-giving to children, United Way program involvement, and Working Well Programs/Fitness Programs.

"And we’re a national sponsor for the March of Dimes," says Brandt, who is a state and chapter board member of the March of Dimes. She is also a member of the Rotary Club and a committee member of the Columbia Club.

"Mary is always prepared for any meeting," praises Eli Lilly & Co.’s Joyce Irwin, who met Brandt when Irwin was a consultant with KSM Healthcare Consultants and negotiated managed care contracts on behalf of various clients with CIGNA. "She remembers everything that is discussed and is true to her world. She is trustworthy and always the most prepared," says Irwin. "She knows the health care business backward and forward and is constantly challenging to learn new ideas and apply them to her business."

It’s a business that some say is making people sick, with health care spending rising to an average $4,637 per person, up from $4,377 in 1999, according to a report by the Health and Human Service Department’s Centers for Medicare and Medicaid Services.

The higher spending is attributed to the increased bargaining power of hospitals and health providers for higher insurance payments and to the aging of baby boomers.

According to Dr. Henry Simmons, president of the National Coalition on Health Care, private health insurance premiums rose 8 percent in 2000, 11 percent last year, and they are expected to jump 15 percent this year.

In addition, prescription drug spending continues to skyrocket. According to IMS Health Inc., National Prescription Audit Plus, the average price of brand name drugs rose from $27 to $65 in 10 years. Brandt says, "Clearly, we’re using prescription drugs more than ever before. Drugs can prevent longer-term illnesses and we’re living longer, so we’re using more drugs.

"People need to realize that pharmaceutical companies are for-profit organizations. And they need to be more prudent in their purchase of medications. If there is a generic that is available for $20 or not a generic that is available for $400, people will probably buy the $400 medication if it’s not their money."

Another recent trend is drug companies advertising directly to consumers. "People rip out ads in magazines and take them into their doctors, demanding, ‘I want this medication.’ Even if it’s not necessarily indicated. Consumers are demanding certain products and I think some physicians are afraid to say, ‘No. I’m not going to give it to you.’ This is really a tough problem," she says, shaking her head.

"I grew up with somebody always being ill," she reveals. "Stephanie was always there. My grandmother, Gladys Conkle, was diagnosed with multiple sclerosis when she was in her early 40s. She lived in a nursing home down the street from us. And my grandfather had similar symptoms that proved to be Lou Gerig’s disease. He lived with us for the final seven months of his illness.

"Through all of that, I realized how difficult health care is. Unless you really know how to maneuver in this system, it’s very confusing. When you’re sick, you don’t have the energy or expertise to do it, and it’s a maze. Managed health care companies really deliver great quality care.

"You know, we don’t have a real healthy population in Indiana. Between big smokers and obesity, we have a lot of heart disease. I believe preventive care is the answer. If we can get the preventive care early, then we’re not going to have train wrecks at the end."

She acknowledges that the prognosis for the solution to the high cost of health care is poor as long as Americans view health care as an entitlement. "People are going to have to get used to paying more for their own health care. We are seeing employers who are deciding that they have to pass the health care costs along to their employees because they can’t afford to fund it any longer. We’re seeing much larger co-payments."

There are an estimated 39 million to 44 million Americans who are without health insurance. "We need to find a way to provide services for them," she admits. She doesn’t think a nationalized system is the cure. "You don’t see people lining up to go to those countries to have services performed. Our health care system is still the best in the world."

Unless the American health care system undergoes major legislative "elective" surgery, it faces a Code Blue alert. Taking its vital signs are CEOs like Mary Brandt and CIGNA, whose slogan is, "A Business of Caring." Their fingers on the pulse of commerce could be critical in the treatment plan for the system’s survival and recovery.

Taking two aspirin and calling in the morning just won’t cut it.