University at Buffalo School of Management

Autumn 2016 Buffalo Business 11 OECD, American life expectancy falls short of the international average. In 2014, the Commonwealth Fund ranked the American health care system last or nearly last out of 11 developed nations in efficiency, equity, access and overall performance. Last year, the Social Progress Index ranked the U.S. 68th out of 132 countries on overall health and wellness. With the Affordable Care Act and the 2016 presidential election pushing the health care debate further into the public consciousness, experts agree the industry has reached a tipping point, forcing pol- icymakers, executives, clinicians and users of health care to address tough questions: How did we get here? And, most importantly, how can we change the system so every American can live healthier? High volume, high costs Before joining the School of Management as executive in res- idence for health care adminis- tration, Larry Zielinski spent 25 years in the health care industry, including terms as president of two health care organizations. "The first thing I did each morning was pull up a screen on my computer that told me how many sick people were in my hospital. I needed as many sick people as possible because that's what gen- erated revenue for the health system," he says. "Lead- ers should be rewarded for having every bed empty, but that's not the way the system works right now." According to Zielinski, the No. 1 problem fac- ing American health care is the fee-for-service repay- ment model that's been in place for decades. Under this system, payers — including insurance compa- nies and federal and state governments through the Medicare and Medicaid programs — reimburse pro- viders based on cost for every service provided. "Fee-for-service medicine encourages volume and high-cost procedures," Zielinski says. Therefore, Zielinski says, the American health care system spends the most health care dollars on costly acute care and a fraction of that amount on relatively inexpensive preventive and primary care. As a result, the country faces a shortage of primary care doctors and high rates of lifestyle-related chron- ic conditions, like heart disease, lung disease and Type 2 diabetes. Jennifer Wiler, MD/MBA '03, associate profes- sor and executive vice chair of the Department of Emergency Medicine at the University of Colorado, sees 30 to 40 patients each shift in the emergency de- partment. Of those patients, she says, 60 percent end up in the emergency department at least partially be- cause of lifestyle, such as poor diet, lack of exercise, drug and alcohol consumption, and not seeking or having access to appropriate care, including mental health care. "Payment models need to support high-value care and align incentives for everyone across the health care system," says Wiler, who has spoken na- tionally on health care repayments and emergency department operations. "Patient engagement is also critically important. We need to teach patients the " Payment models need to support high-value care and align incentives for everyone across the health care system." — Jennifer Wiler, MD/MBA '03 Associate Professor and Executive Vice Chair Department of Emergency Medicine University of Colorado Zielinski

• Cover