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CEO seeks a sustainable health care system

James Kaskie has a lot on his plate these days.

As CEO of Kaleida Health and Great Lakes Health -- the new parent of Kaleida and Erie County Medical Center -- Kaskie oversees the region's largest and most influential hospital system and health care provider.

He has overseen Kaleida's integration and collaboration with ECMC, the closing of Millard Fillmore Gates Circle Hospital, the construction and opening of the new Gates Vascular Institute, the opening of a new long-term care facility on the Buffalo Niagara Medical Campus to consolidate two older ones, and the planned move of Women & Children's Hospital to the medical campus.

And he has worked with the region's health insurers and other providers on efforts to improve medical care and lower costs in Western New York.

>Q: Do the Obama health care reforms go far enough or too far?

A: Well, I find the principle of the call to action for health care reform is an essential public discussion. I think one of the things the act has done, the court proceedings, all of the literature, is it's really brought the national debate alive about health care, health care costs, access, quality, issues of end of life, all of those different features.

I think the act itself is problematic. It's complicated. It overregulates. It's, what, 2,700 pages or something. It's more focused on insurance reform, and it's just too complicated and too political.

>Q: Does more need to be done specifically on health care costs?

A: Well, I think it's a complicated question of health policy. When I started in graduate school in '75, I think we spent 4.7 percent of the GNP. Here now, 35, 37 years later, we're facing 18 percent of the GNP.

Never would have imagined it could go to that level.

So clearly it's not just about costs, in that we have to reduce the price or reduce the spend. I think there's fundamental policy issues about society, about consumer expectation. I think there are issues about device manufacturers, the pharma business. All of these issues need to have a level of transparent debate about them in order for us to say what is the best method for us to ensure that health care services are available, that we promote wellness within our communities, that we have individuals who have personal responsibility for their health.

The ACA, the Affordable Care Act, just kind of goes across the spectrum and sprays at all of these issues, but really doesn't, I don't believe, create any fundamental change.

That being said, there's huge change under way in the industry, as a result of society, government, employers, everybody saying, wait a minute, we can't afford this trend line for sure.

>Q: What is driving the spiraling health care costs year after year?

A: I think it's a multifaceted set of circumstances that are driving costs. One is, I think, we have very sophisticated, very amazing technology, physicians, services that can intervene on people's problems. Look at the ability now to have joints replaced. We can go in to your brain and take a clot out if you're having a stroke. We can intervene without opening your chest to do heart surgery. We can avoid having to amputate legs and limbs because of our ability to intervene on vascular services.

That's at a very complex level of care. That's very expensive. The technology, the devices, the things that are implanted, are all very expensive. So you have a very sophisticated product. It's like flying a very large jet plane. It costs a lot of money to fly a plane; it costs a lot of money to provide very complex services.

So we need to unbundle that problem. There's very little regulation over pharma, the amount of medications that are used. The vendors always get paid. They can charge what they want for the device that's put in, and we're expected to pay it. The patient doesn't have any responsibility. The vendor doesn't. It's just all on us. So I think that adds to it. And I think that's tied to the macroeconomic questions.

Then you come to the social issues of lifestyle, demographics, aging population, wellness or lack of, be it obesity, be it hypertension, diabetes. Those kind of maladies are all a result, to some extent, of what your DNA is, but they're also lifestyle and environmentally driven.

So you put all that together and we're supposed to solve it, through a health care policy? I think we have to unbundle the problem and solve the components.

>Q: What kind of role do health care reimbursements from insurers play in this crisis?

A: Nowhere else in the economy do I know that you can walk into the front door of an organization, of a supermarket, of a grocery store, of a department store, of a gas station, and you can have unbridled demand. You can just have an expectation and then have a regulatory environment that requires everyone to be served.

Nowhere else in the economy can you find that you can come in without a penny out of your pocket, without any individual responsibility for how you got there -- whether it's your lifestyle, whether you were speeding on a motorcycle, or whatever -- and have access to a million dollars worth of services.

And so we need to rebalance the classic economic equation, and that's where user, buyer and payer are somehow linked.

I don't think the payers can determine policy. I think they need to align with the providers to figure out how best do we spend this money. I think they need to align with those that they insure, to say what consequences do you have and what incentives do you have to be healthy, and then go from there.

Is there a different way to create an economic model? I think there is. And right now all of these pieces are separated and conflicting, versus aligned, around how best to spend the health care dollar.

>Q: On executive pay, are the salaries and compensation excessive? Are they needed?

A: We clearly look at that question all the time, because we do have a duty to the community to pay competitively, to pay reasonably. We make sure we do that, be it that you're a nurse in our organization or you're the CEO.

When you look at what we accomplish, there aren't a lot of people that can do this, and so that usually commands a higher salary than what other people might be making.

So I think there's no apology, but you have to be careful. You have to be reasonable. And you have to be competitive.

>Q: What kind of potential do you see for the medical campus?

A: We now have this fulcrum called the Buffalo Niagara Medical Campus. That virtually was an emerging idea when I got here eight years ago. But by collaboration and the synergies created by collaboration we've been able to do things that people didn't think were possible because we aligned around a common vision, a common plan. If we keep doing that, that only will grow.

If you look at what's happened with our partners at ECMC, we took all of that competitive energy and we made it collaborative. As a result, we've taken competing transplant programs and we've made one center of excellence and we have a wonderful facility on the Grider campus. We have an application to bring our behavioral health departments together. Rather than having two, let's create one really good one, because this market is only so big.

>Q: Other communities also have well-established medical corridors. How can Buffalo succeed?

A: This is a demonstrated strategy. It's like good airports. You can't have more than one Buffalo Niagara International Airport, but one good one really makes a difference. And look what's happened? It's been very successful. Does that mean that because Buffalo has an airport, that means Pittsburgh can't have an airport? No, it just means that for the region, for the population being served, you need to size what you're doing to match the population.

So we're able to compete. The question is, if we don't get our act together, then we become a feeding area. People can take what they want and move it to Pittsburgh or Cleveland. We need to serve the people of Western New York, and that's what this mission is about.

>Q: Can you get a piece of the governor's $1 billion economic development money?

A: We just need to get our act together as a community. I think we've been doing that on a better and better basis in health care. We're not perfect. But if you're collaborating we can create wonderful things.

It's not a silver bullet There's a lot of right-sizing that needs to happen in the economy to be more sustainable for Western New York. But our responsibility is to contribute to a sustainable health care system for Western New York and that's my goal, to make sure people have access to health care in Western New York.