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When Iñaki Ereño assumed the role of Group CEO of Bupa in 2021, the global healthcare landscape was being rewritten in real time. At the helm of a company serving over a million customers worldwide, Ereño faces the challenge of transforming a large and established organization into a faster, more agile, and digitally enabled provider of care.
Founded in 1947 with the purpose of helping people live “longer, healthier, happier lives,” Bupa is more than a health insurer: It builds hospitals and dental centers, offers global private medical insurance, and invests heavily in digital health.
Ereño’s mission? To wake the sleeping giant. Through what he calls the “elephant strategy,” the 61-year-old CEO has sought to digitize the business, embed customer-centric listening (including 300,000 annual detractor calls), and align a global workforce of around 100,000 people behind a single agenda. “The elephant is now running and the majority of the people know the elephant is running. We keep reminding everyone: don’t let the elephant go back to sleep,” he says.
A self-described “fanatic of the digital economy,” Ereño believes technology will define the next era of healthcare. Bupa has accelerated its use of AI and virtual platforms such as Blua, launched initially in Spain, to connect doctors and patients digitally and make consultations faster, smarter, and more personal.
In an interview with Fortune, Ereño discussed his evolution from lawyer to retailer to healthcare CEO, explained how his triathlon training anchors his leadership, and why, for him, productivity isn’t just about profit—it’s about delivering better care, faster.
This interview has been edited for length and clarity.
Down to business
Fortune:Walk us through your career journey.
Ereño: My background is in law, and very quickly I realized I didn’t want to be a lawyer. So I did an MBA and moved into corporate life. I view my life in three distinct periods. For one period of my life, I worked as a retailer. In another, I was an entrepreneur, and in the most recent period, I have worked in healthcare.
I joined Bupa 20 years ago in Spain [in Spain, Bupa is called Sanitas]. I joined Sanitas and was appointed CEO of Sanitas, and in 2012, I was appointed CEO [of a regional division within Bupa]. My evolution has progressed from my initial role as marketing director of Sanitas, then CEO of Sanitas, followed by CEO of a region, and finally Group CEO. It’s been a bit of a journey.
What was your role in the digital shift?
Covid was a huge challenge for all healthcare systems. For Bupa, we realized that our healthcare system was not digitized enough. Health can be digitized. I was in the executive team of Bupa for many years and that was my big fight: We needed to digitize the business more quickly. [Since then] it’s been a bit of a journey.
After Covid, we started calling ourselves the “sleeping elephant,” and so we built a strategy called the “elephant strategy.” I remember I went to the board with one slide: an elephant asleep on the left, an elephant waking up in the middle, and an elephant running on the right, with a big arrow from 2020 to 2024. We needed to wake up.
The elephant is now running, and the majority of the people know that the elephant is running. We keep reminding everyone: Don’t let the elephant go back to sleep.
What are you most proud of in the last five years?
In every presentation, we highlight the Triangle of Performance. At the top of the triangle is Financial Performance, supported by the two other sides: Customer Performance and Employee Engagement. We need to be good at all.
Customers are very important. We have 25 businesses in various countries that follow the same pattern. We map businesses by micro movements, and every year we do 300,000 detractor calls asking customers: “Why don’t you like us?”
Every year, we measure the results in terms of customer experience improvement and we take this very seriously. There is a lot of engineering work and logistics involved in making this happen.
We also have a team of 100,000 people. You’d assume that all of them have health coverage provided by Bupa—especially since we are Bupa. But that was not the case.
[Despite the fact] that it would cost around 50 million pounds to do this [it was essential that our own employees] have health coverage provided by Bupa. Now in the Bupa world, every employee is supported by Bupa.
We try to find out why we are not good, and work on it.
Which long-term trend are you most bullish or positive about for society and the economy at the moment?
The digital economy. We [Bupa] started a bit late but we’re catching up very quickly. We’re now fully digitized in all countries. Blua [is an example], which Bupa launched years ago. I like the digital economy and am a fanatic because it will help health.
When you look at Europe versus the U.S., how do you think people like yourself in a leadership role can address the productivity challenge?
Bupa and the whole healthcare industry are currently more focused on growth. We [believe we] are productive, but it’s not at the top of our mind. We think about how we can be more productive so that our customers will be happier and better served, rather than thinking about, “how can we make more money?”
We’ll be implementing an AI generative project where, instead of taking seven minutes for a doctor to see you [and understand who you are and what your issues are], it will take 30 seconds. So in 30 seconds, a doctor will be able to see you and a consultation that usually happens in maybe 15 minutes will now take only 30 seconds. This is the productivity we care about and is the productivity that has a positive impact on our customers.
Being productive
When do you get up in the morning and what sets up your routine for the day?
I don’t sleep that much and usually wake up around 6 a.m. and I start reading the newspaper. I read three Spanish newspapers, the FT and the Economic Times. I have my first coffee, take a shower, go to the office, and normally am in meetings by 8 a.m.
Sports have always been a big part of my life. I’m into triathlons and usually go to the gym with my youngest son, who lives with me in London. We go to the gym together, go to the supermarket, buy dinner (we usually go to an Amazon Fresh store or Whole Foods), have dinner, and then go to bed. I live a fairly basic life and it works for me.
What kind of coffee do you have in the morning?
I have a black coffee in the morning, a double espresso. When I share [my coffee intake] with doctors, they say maybe too much, Iñaki! But I can share this with you.
So I start with a double espresso, and then I have another one in the office with a little bit of milk, like a cortado. Then, after lunch, I have another cortado. I know it’s a lot of coffee.
Do you check back in later in the evening? Are you working over the weekend?
I might sound a bit naive, but I like the job I do and I like my company. I don’t feel like I need to be disconnected. When I am away on holiday, I take my mobile phone with me and I’m checking emails. I’m paid well, I have an [important] job and we’re a big company, so I need to stay connected.
Do you have any apps that you use, or any methods that you use to be as productive as possible?
I use [most digital tools], to be honest, but I’m not mega techy.
I used to take notes with a notebook and pencil, but not anymore, because one day I realized that it was taking me more time. I asked myself, “How many times have you come back to your notes?” and it was zero. So I stopped. I prefer to be present and in listening mode.
Getting personal
Who is on your personal board and who inspires or motivates you?
I work with a coach whom I met a few years ago. He is 75, very wise, and a member of my personal board. I have a Chief Executive Committee; there are always people that you tend to call more when you have a problem or need good advice. I also have people on my team that I can call. I have great conversations with my son. We all need people who really care.
Do you have a favorite company that you admire and why?
I love Amazon. Whole Foods is also fantastic.
What is your favorite cuisine to cook and to eat?
I eat too much, but thank God I enjoy exercising. I like all types of food, including a big steak, good paella, and seafood. I also like sweet food and desserts. My coach taught me to be kind to myself and I have learnt over the years to be kind to myself. If I want to eat ice cream, I will enjoy my ice cream.
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In a major effort to close the global health equity gap, the Gates Foundation and OpenAI are partnering on “Horizon1000,” a collaborative initiative designed to integrate artificial intelligence into healthcare systems across Sub-Saharan Africa. Backed by a joint $50 million commitment in funding, technology, and technical support, the partnership aims to equip 1,000 primary healthcare clinics with AI tools by 2028, Bill Gates announced in a statement on his Gates Notes, where he detailed how he sees AI playing out as a “gamechanger” for expanding access to quality care.
The initiative will begin operations in Rwanda, working directly with African leaders to pioneer the deployment of AI in health settings. With a core principle of the Foundation being to ensure that people in developing regions do not have to wait decades for new technologies to reach them, the goal in this partnership is to reach 1,000 primary health care clinics and their surrounding communities by 2028.
“A few years ago, I wrote that the rise of artificial intelligence would mark a technological revolution as far-reaching for humanity as microprocessors, PCs, mobile phones, and the Internet,” Gates wrote. “Everything I’ve seen since then confirms my view that we are on the cusp of a breathtaking global transformation.”
Addressing a Critical Workforce Shortage
The impetus for Horizon1000, Gates said, is a desperate and persistent shortage of healthcare workers in poorer regions, a bottleneck that threatens to stall 25 years of progress in global health. While child mortality has been halved and diseases like polio and HIV are under better control, the lack of personnel remains a critical vulnerability.
Sub-Saharan Africa currently faces a shortfall of nearly 6 million healthcare workers, ” a gap so large that even the most aggressive hiring and training efforts can’t close it in the foreseeable future.” This deficit creates an untenable situation where overwhelmed staff must triage high volumes of patients without sufficient administrative support or modern clinical guidance. The consequences are severe: the World Health Organization (WHO) estimates that low-quality care is a contributing factor in 6 million to 8 million deaths annually in low- and middle-income countries.
Rwanda, the first beneficiary of the Horizon1000 initiative, illustrates the scale of the challenge. The nation currently has only one healthcare worker per 1,000 people, significantly below the WHO recommendation of four per 1,000. Gates noted that at the current pace of hiring and training, it would take 180 years to close that gap. “As part of the Horizon1000 initiative, we aim to accelerate the adoption of AI tools across primary care clinics, within communities, and in people’s homes,” Gates wrote. “These AI tools will support health workers, not replace them.”
AI as the ‘Third Major Discovery‘
Gates noted comments from Rwanda’s Minister of Health Dr. Sabin Nsanzimana, who recently announced the launch of an AI-powered Health Intelligence Center in Kigali. Nsanzimana described AI as the third major discovery to transform medicine, following vaccines and antibiotics, Gates noted, saying that he agrees with this view. “If you live in a wealthier country and have seen a doctor recently, you may have already seen how AI is making life easier for health care workers,” Gates wrote. “Instead of taking notes constantly, they can now spend more time talking directly to you about your health, while AI transcribes and summarizes the visit.”
In countries with severe infrastructure limitations, he wrote, these capabilities will foster systems that help solve “generational challenges” that were previously unaddressable.
As the initiative rolls out over the next few years, the Gates Foundation plans to collaborate closely with innovators and governments in Sub-Saharan Africa. Gates wrote that he himself plans to visit the region soon to see these AI solutions in action, maintaining a focus on how technology can meet the most urgent needs of billions in low- and middle-income countries.
When it comes to creating irresistible storylines, Netflix, the home of Stranger Things and The Crown, is second to none. And as the streaming video giant delivered its quarterly earnings report on Tuesday, executives were in top storytelling form, pitching what they promise will be a smash hit: the acquisition of Warner Brothers Discovery.
The company’s co-CEOs, Ted Sarandos and Greg Peters, said the deal, which values Warner Brothers Discovery at $83 billion, will accelerate its own core streaming business while helping it expand into TV and the theatrical film business.
“This is an exciting time in the business. Lots of innovation, lots of competition,” Sarandos enthused on Tuesday’s earnings conference call. Netflix has a history of successful transformation and of pivoting opportunistically, he reminded the audience: Once upon a time, its main business entailed mailing DVDs in red envelopes to customers’ homes.
Despite Sarandos’ confident delivery, however, the pitch didn’t land with investors. The company’s stock, which was already down 15% since Netflix announced the deal in early December, sank another 4.9% in after-hours trading on Tuesday.
Netflix’s financial results for the final quarter of 2025 were fine. The company beat EPS expectations by a penny, and said it now has 325 million paid subscribers and a worldwide total audience nearing 1 billion. Its 2026 revenue outlook, of between $50.7 billion and $51.7 billion, was right on target.
Still, investors are worried that the Warner Bros. deal will force Netflix to compete outside its lane, causing management to lose focus. The fact that Netflix will temporarily halt its share buybacks in order to accumulate cash to help finance the deal, as it disclosed towards the bottom of Tuesday’s shareholder letter, probably didn’t help matters.
And given that there’s a rival offer for Warner Bros from Paramount Skydance, it’s not unreasonable for investors to worry that Netflix may be forced into an expensive bidding war. (Even though Warner Brothers Discovery has accepted the Netflix offer over Paramount’s, no one believes the story is over—not even Netflix, which updated its $27.75 per share offer to all-cash, instead of stock and cash, hours earlier on Tuesday in order to provide WBD shareholders with “greater value certainty.”)
Investors are wary; will regulators balk?
Warner Brothers investors are not the only audience that Netflix needs to win over. The deal must be blessed by antitrust regulators—a prospect whose outcome is harder to predict than ever in the Trump administration.
Sarandos and Peters laid out the case Tuesday for why they believe the deal will get through the regulatory process, framing the deal as a boon for American jobs.
“This is going to allow us to significantly expand our production capacity in the U.S. and to keep investing in original content in the long term, which means more opportunities for creative talent and more jobs,” Sarandos said.
Referring to Warner Brothers’ television and film businesses, he added that “these folks have extensive experience and expertise. We want them to stay on and run those businesses. We’re expanding content creation not collapsing it.”
It’s a compelling story. But the co-CEOs may have neglected to study the most important script of all when it comes to getting government approval in the current administration; they forgot to recite the Trump lines.
The example has been set over the past 12 months by peers such as Nvidia’s Jensen Huang and Meta’s Mark Zuckerberg. The latter, with his company facing various federal regulatory threats, began publicly praising the Trump administration on an earnings call last January.
And Nvidia’s Huang has already seen real dividends from a similar strategy. The chip company CEO has praised Trump repeatedly on earnings calls, in media interviews, and in conference keynote speeches, calling him “America’s unique advantage” in AI. Since then, the U.S. ban on selling Nvidia’s H200 AI chips to China has been rescinded. The praise may have been coincidental to the outcome, but it certainly didn’t hurt.
In contrast, the president went unmentioned on Tuesday’s call. How significant Netflix’s omission of a Trump call-out turns out to be remains to be seen; maybe it won’t matter at all. But it’s worth noting that its competitor for Warner Bros., Paramount Skydance, is helmed by David Ellison, an outspoken Trump supporter.
It’s a storyline that Netflix should have seen coming, and itmay still send the company back to rewrite.
After nearly a year of promises tariffs would boost the U.S. economy while other countries footed the bill, a new study shows almost all of the tariff burden is falling on American consumers.
Americans are paying 96% of the costs of tariffs as prices for goods rise, according to research published Monday by the Kiel Institute for the World Economy, a German think tank.
In April 2025 when President Donald Trump announced his “Liberation Day” tariffs, he claimed: “For decades, our country has been looted, pillaged, raped, and plundered by nations near and far, both friend and foe alike.” But the report suggests tariffs have actually cost Americans more money.
Trump has long used tariffs as leverage in non-trade political disputes. Over the weekend, Trump renewed his trade war in Europe after Denmark, Norway, Sweden, France, Germany, the United Kingdom, the Netherlands, and Finland sent troops for training exercises in Greenland. The countries will be hit with a 10% tariff starting on Feb. 1 that is set to rise to 25% on June 1, if a deal for the U.S. to buy Greenland is not reached.
On Monday, Trump threatened a 200% tariff on French wine, after French President Emmanuel Macron refused to join Trump’s “Board of Peace” for Gaza, which has a $1 billion buy-in for permanent membership.
“The claim that foreign countries pay these tariffs is a myth,” wrote Julian Hinz, research director at the Kiel Institute and an author of the study. “The data show the opposite: Americans are footing the bill.”
The research shows export prices stayed the same, but the volume has collapsed. After imposing a 50% tariff on India in August, exports to the U.S. dropped 18% to 24%, compared to the European Union, Canada, and Australia. Exporters are redirecting sales to other markets, so they don’t need to cut sales or prices, according to the study.
“There is no such thing as foreigners transferring wealth to the U.S. in the form of tariffs,” Hinz toldTheWall Street Journal.
For the study, Hinz and his team analyzed more than 25 million shipment records between January 2024 through November 2025 that were worth nearly $4 trillion.They found exporters absorbed just 4% of the tariff burden and American importers are largely passing on the costs to consumers.
Tariffs have increased customs revenue by $200 billion, but nearly all of that comes from American consumers. The study’s authors likened this to a consumption tax as wealth transfers from consumers and businesses to the U.S. Treasury.
Trump has also repeatedly claimed tariffs would boost American manufacturing, butthe economy has shown declines in manufacturing jobs every month since April 2025, losing 60,000 manufacturing jobs between Liberation Day and November.
The Supreme Court was expected to rule as soon as today on whether Trump’s use of emergency powers to levy tariffs under the International Emergency Economic Powers Act was legal. The court initially announced they planned to rule last week and gave no explanation for the delay.
Although justices appeared skeptical of the administration’s authority during oral arguments in November, economists predict the Trump administration will find alternative ways to keep the tariffs.
Politics8 years ago