Fred Goldstein, President and Founder Accountable Health, LLC

Fred Goldstein is the founder and president of Accountable Health, LLC, a healthcare consulting firm focused on population health, health system redesign, new technologies and analytics. He has over 30 years of experience in population health, disease management, HMO and hospital operations. Fred is considered an expert in population health, care management, behavioral health, risk management, HIT and health system design and development. During his career, he founded a disease management company that provided services to employer groups and 10 state Medicaid programs, operated a Medicaid/Commercial HMO that was ranked the highest quality Medicaid Health Plan in Florida, developed an award-winning mobile health app and worked with employers. health systems, and vendors to develop population health programs, services and platforms. He was also directly responsible for the inclusion of the Medicare Annual Wellness Visit in the Affordable Care Act.

Fred is an Instructor at the John D. Bower School of Population Health at the University of Mississippi Medical Center, an advisor to the Validation Institute, and serves on the editorial Board of the journal Population Health Management, the founding Advisory Board of Population Health News, and is Past Chair of the Board of Directors of the Population Health Alliance. Fred has testified before the legislature in the states of Alaska, Florida, Kentucky and Texas on disease and population health management and their application to state employees and Medicaid. He is also the co-founder and lead host of PopHealth Week, a weekly podcast featuring thought leaders and companies working in population health. Fred received his MS in Health Care Administration from Trinity University.

Video discussion learning points & time stamps

1. COVID-19 and population health: Opportunities to address improving the population’s health. 1:02

2. Payment incentives and how that impacts access to care 2:08

3. Championing the voice of underserved patient populations to advocate for change and equitable health 4:11

4. Effectively addressing health disparities to ultimately improve health outcomes 5:23

5. Population health from a community framework: funding and policy considerations amid COVID19 6:37

6. Population health, COVID-19, addressing social determinants of health and healthcare disparities 8:03

COVID-19 and population health: Opportunities to address improving the population’s health. 

The unfortunate thing we’re seeing with COVID-19 is it is clarifying to a lot of people the strong impact that this disease is having on disadvantaged populations. Those who are struggling with social determinants of health are really struggling with this illness, both from an infection rate and obviously from an outcomes rate, seeing higher death rates, etc. So I think it’s allowing us to begin to expand the message from those of us who have spoken about this. There’s much more work we can do and should be doing to focus on those social determinants of health because there’s a clear disparity and outcomes that we’re seeing with the illness. So the sad part obviously is what’s happening. And that’s giving us an opportunity to let people know that we can do better and should be focusing more on these other issues. Besides just straight-up health care and ensuring that healthcare is appropriate.

Payment incentives and how that impacts access to care

The way the healthcare system is structured today is, you get paid for delivering a service, which typically has a CPT code for a physician or an NDC code for a drug, or a DRG code for the hospital admission. And because of that, we’ve created this system where people focus on doing those, and the more they do, the more they generate. But many of the issues that we face as to why we have high healthcare costs and poor outcomes are due to issues that have typically been looked at as outside of the healthcare system.

The social determinants of health, where you live, as we now know your zip code is a much better predictor of your health status than your health care system. I live here in Jacksonville, Florida. We have a very strong healthcare system. We have a University Hospital, we have a Mayo, we have Baptist, we have St. Vincent’s, and others. Our health care system, I think ranks  about 10th out of 67 counties in the state. For the top is number one, obviously. But our outcomes, I believe, are still in the mid-40s. So although we have a great health care system, we have poor outcomes because of these other issues.

What we need to figure out what to do is how do we move the funds to be able to address social determinants of health. And most people would say, we can do that, by adding a new billing code, we should build for transportation, we should bill for housing, we should build for this. That’s a good idea in one sense, but the reality is about 30%, or 25% of healthcare in the most recent study is considered waste, fraud, and abuse. That’s probably somewhere in the order of $800 billion. So imagine what we could do, if we could take that out and move that into addressing the social determinants of health. And that’s what we talked about when I think about payment reform is setting up systems where for physicians in the health care systems, it makes sense to solve the housing problem. Because they’ll actually do better than just worrying about the medical problem. And we’re getting there with some ideas, but it’s early.

Championing the voice of underserved patient populations to advocate for change and equitable health

One of the big issues that the underserved populations had is that they don’t get listened to. Its a question of how much they can resonate with their own voice and obviously speak up, but we need to help. We need other people to assist and speak for them. And we have them all over the country, there are leaders in the communities who are out there, voicing their concerns and saying we can do better. And there are some other leaders outside of the community. I think we need to come together and put together a message from all of us, that it’s time that we effectively These underlying issues that are causing these great disparities we have in our health outcomes, whether it’s, maternal mortality rates for African American women, preterm babies, higher rates of diabetes and obesity, etc. And much of that is being driven obviously, by these systematic things that are in place today that we need to correct.

Effectively addressing health disparities to ultimately improve health outcomes

We need to focus on social determinants of health, we need to come up with adequate funding for those areas. But we also need to recognize that it’s going to take a diverse group to solve it. The healthcare system alone is not going to solve this. They need to actually figure out how to take their waste out and their inefficiencies out so we can free up the dollars and then we should be looking to community groups, government schools, activists and not for profits, etc. and create a larger organization in the community. My colleague  David Nash and I wrote about this A number of years ago. The founding dean Emeritus of the School of Population Health at Jefferson called it an accountable health organization, which essentially takes what was originally the idea for an accountable care organization, it is just healthcare and broadened it to include all of those other groups. For example, the city set up an overarching group that includes healthcare, the government, the schools, the not for profits, with the goal of them looking at the health of the community and the allocation of resources.

Population health, COVID-19, social determinants of health and healthcare disparities

Unfortunately, those of us in my generation, in some sense have left you with this health care system. And it needs to be fixed, it can be fixed. There are many good people out there trying to do the right thing. We just need to make it happen. And so if anything, your generation will have to adjust the healthcare system, so it creates health for everyone in the United States, and not just for the select few of those who can access a hospital to those who can get to a first-rate facility. There’s a whole bunch that we could do. Imagine how much less we would spend if we solve the diabetes problem. The pre-diabetes problem, the obesity problem The preterm delivery issues that we know many of these are based on, well, I live in this neighborhood and this is all I have access to, or I have this type of resources to buy food, and this is all I can get. We just need to improve that and there are groups starting it, you’re seeing some of the larger insurers suddenly saying, let’s pay for housing. Let’s do food out in the community. Let’s figure out how to solve education and health literacy. We need to pull all those resources together and once and for all, fix it.