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Speaker 1: Hello, everyone. This is Elizabeth Cassello with the Becker's Payer Issues podcast. I'm thrilled today to be joined by doctor Tom Graff, chief medical officer of Florida Blue. Doctor Graff, thank you so much for joining us today.

Speaker 2: Yeah. My pleasure. It's exciting, to be able to talk about this project.

Speaker 1: Yeah. So before we jump into the project, could we hear a little bit more on your career background? Tell us a bit about yourself and your current role at Florida Blue.

Speaker 2: Absolutely. Happy to. So, thirty years in health care, I think I've had the privilege of, coming at it from literally every direction from patient to learner to physician to educator to academic to researcher to consultant, and then physician executive, both within, clinical delivery systems primarily as well as, health plans. And so that, I think, given me a really unique perspective. My career has really been centered, though, around, driving quality to reduce total cost of care.

Right? How do we make things better for everyone in this equation? And, you know, that's led me obviously through population health and value based care and the ability to really change clinical model and payment model in a way that makes sense for patients, for physicians, and for the people ultimately paying for it, which is you and me and all the rest of the folks out there. So, the goal in in my life is really to make a difference in those areas, and this is one of those key areas where it's it's so clear around both the quality improvement and the cost improvement that's made it, very exciting. Obviously, GuideWell is also Florida Blue's parent is also the, mission driven organization that allows, activities like I just described to occur, right, focused on delivering high quality, affordable care with a commitment to providing exceptional personalized service to members.

So that that constellation of events brought me to to Florida Blue, from, you know, having had experience in a lot of really innovative organizations, Ascension Health and their national team, Horizon Blue Cross in New Jersey, Chartus, which is a health care consulting company. And and, one of the highlights, I think, of my career is I spent over a decade at Geisinger Health System and learned a lot of the the basics of what is now being delivered across Florida, at that time.

Speaker 1: Well, thank you for giving us that context. And more specifically, the project that we were alluding to earlier was, related to cancer care with Florida Blue. So for background, Florida Blue has been partnered with Evelyn on cancer care navigation since 2021. Can Can you elaborate on what drove that initiative to translate to Medicare Advantage members and why focus on that population?

Speaker 2: Yeah. That's a great question. So so we had been doing, utilization management with Evelyn, really relying on their clinical expertise in what, is the highest value care based on, recommendations from from NCCN, from ASTRO, all of the, latest and greatest information. How do we make sure we bring that consistently for our members? Right?

The the the challenge with driving quality to reduce total cost of care is really around that ability to reliably deliver measurably better care, and they've been they've been helping us with that for many years. And through that process, what we recognized is that reliably deliver part was, unfortunately, and this is the case, you know, across the country, highly varied, depending on where you got your cancer care, what part of Florida, what provider, what system. In in many cases, in almost all cases, the care was was excellent in terms of the technical capabilities, if you will. But what we did find is members that were sort of slipping through the cracks around, you know, maybe they didn't have, perfect pain control. Obviously, that happens to cancer patients.

Maybe they were having side effects from their therapies, and, it it often leads to additional care, you know, emergency room care, phone calls that go unanswered, and patients were struggling with that. The other thing that we noticed, which was equally troubling, is often there's a gap between when the patient sort of notified that they have cancer and then getting it hooked up with a provider that's providing that definitive care, you know, medical oncology, radiation oncology, surgical oncology. And that gap is incredibly stressful for members, for their families, and for the delivery of care. And those two gaps, that that variation in care and that time gap between diagnosis and onset of definitive care, created the need, for a program like this. And so we wanted to work with Evelyn because at the end of the day, it has to work, obviously, for the patients.

It has to work for the providers, the physicians, the hospitals, and it has to work for, the health plan. And typically or often these programs are developed in isolation, and they're developed either, you know, just by the provider, just by the the the the group like Evelyn, or just by the health plan. And, you know, maybe they involve members. Typically, they do, patients. But but often, those other groups are sort of left out.

And what you get is a solution that fits great for one stakeholder and doesn't really fit too great for the other stakeholders. And what we wanted was something meaningfully different, and that gave us the the opportunity to to do that. Obviously, you know, most, certainly not all, but but many members, are Medicare aged that's that, suffer from cancer. And so focusing that population at least first makes sense. There's certainly nothing about this program that in any way would not translate to, unfortunately, any patient that's that's suffering from cancer.

So that's, I think, the other piece to exercise. Although we we started with Medicare and focused on that as a bean point, really applies very, very evenly and and and appropriately across, any age group that's suffering from from cancer.

Speaker 1: I see. And early results show a forty percent reduction in hospital and ER visits and ninety five percent patient satisfaction. So what factors do you think contributed the most to those outcomes?

Speaker 2: Yeah. It's a it's a great question. I think that that partnership, that involvement of the various stakeholders, the very deliberate and focused approach that we took, we we, by, intention, kept our program very small, and we've been actually working on this for it's it's approaching two years at this point. A year and a half, two years at this point. And so the ability to implement, test, refine, then bring on the next element, implement, test, refine, and we kept going through that and iterating.

You know? So what's the best way to connect the Evelyn team, which was very experienced in in in, these serious conversations. Right? End of life conversations, health care improvement conversations. What are your goals of therapy?

They're experienced and trained specifically in motivational interviewing, in goal based treatment plans, in interacting with patients when they you know, look. Some of these folks are literally at their worst, of course, because they have this horrible diagnosis and they've got, often a bad prognosis. Sometimes it's good. We we like those better, obviously, and are struggling with side effects and problems. And those folks are highly trained to have those really high impact conversations.

And then because of the way we built the model, so we tested each all individually. How do we best connect with patients? How do we best connect with the hospital systems? How do we manage the fact that, you know, some of these comprehensive cancer centers in the state of Florida, and there are several, already have care management and and navigation services and support services, and their and those members are taken care of very well. How do we step back in that scenario and let those folks that are getting great care continue to great get great care through their providers?

But But for those where there's a gap or where those where they're not they're not having, maybe it's a smaller oncology practice and they don't have those kinds of resources. How do we jump in and support those members in a way? Or, you know, they they they weren't, for whatever reason, unable to reach the people that were assigned. You know, unfortunately, I have a a personal story. It impacted my family.

One of my family members had a had a cancer diagnosis, and, you know, we we had, first of all, that gap between diagnosis and definitive therapy that was troubling. Maybe a little less so because we have a lot of folks in health care and the family. So we worked our way through that. But then, you know, we went to the provider organization, and and when we saw the medical oncologist, we got a medical care management person. And when we talked to the radiation oncologist, we got a radiation care management person.

We talked to the right surgical oncologist, we had a surgical oncology, manager. And and so, you know, what we had was a ton of care management, not necessarily enough care, and not necessarily enough connectivity. And so work this program really designed to overcome all of those, types of barriers. So combination of high touch care, high-tech care. So the ability to connect, you know, twenty four hours a day, three hundred sixty five days a week.

You know, the vast majority of the calls are managed within 15. So if a patient calls in, if almost always, eighty eighty plus percent of the time, we're talking to them within fifteen minutes, a 100% within two hours. So the longest any patient goes with a question unanswered was two hours. And the ability to have that reassurance that when you need help, help is gonna be there. And then talking them through and doing those things about how can we get you help so you don't have to go to the emergency room, but you get your pain controlled?

How can we get you help so you don't have to go to the hospital, to manage your, you know, nausea and vomiting or whatever it is that you're experiencing from a side effect? You know what? Or just you're just anxious, and you need somebody to talk to. Alright? Or you're struggling.

You're not gonna be able to make your appointment. How do you get it rescheduled in a time frame that's still good for your cancer therapy, and how do you manage that when you're, you know, suffering at home and you're, like I said, not at your best, may not be able to do that. So everything from, you know, what I'm gonna call navigation services, I e making appointments and and helping manage that piece, but more importantly, managing those those side effects, those complications, and those issues. And then for those patients that are in that that gap period between, you know, definitive diagnosis and definitive treatment, how do we accelerate that? How do we support that person?

How do we help them find the best care for them? Those are all of the pieces that are part of the program. And like I said, we we worked through each one of those connection points. So what can we do with the primary care physicians to make as easy as possible for them to refer and enroll a patient? How do we best connect with the patients?

Is it telephonic? Is it through an app? Is it through other electronic means? We set up all of those pieces. We can meet the patient where they are.

Whatever works for them is the way we interact with them. And then, you know, finally, how do we connect with those cancer centers and those oncologists to make sure that what we're doing really is additive and not getting in the way because that's certainly not the goal. That's that's how we've done it, and and that's what's produced those results.

Speaker 1: So a couple of follow ups to that. I know you said you're keeping the program small. How many people are involved? And then my other question, you mentioned the tech enabled components there. How is that registering for a Medicare age population?

What has been the reception to different tech components?

Speaker 2: So I'm gonna take the last one first, and then we'll go back and cut the number of patients because because I agree with you. So it is number one, it doesn't work for everybody. Right? One size does not fit all despite what, Henry Ford said when he was building his model t. That said, even with our, Florida Blue portal, we have electronic connections with over 50% of our Medicare members, and the vast majority of those are on that website once a week to once a month.

So they're using it, using a lot. The the tech savviness of our Medicare population is increasing, you know, every year. Right? Most of these folks at this point used a lot of technology, used a lot of email, used a lot of websites, used a lot of computers, in their work, and now they're now they're retiring in their in the Medicare roles. That said, and and the app is even more user friendly and can, easily be installed on their devices either by the patient or family member or remotely if we need to.

So the ability to support the member in that regard is, is high. Obviously, a lot of members we still talk to just on the phone. It's amazing, you know, that that 100 year techno 100 year old technology still works and, is able to to provide a good connection for them. That that that may be the most common, way that we're interacting, particularly for a lot of these more urgent needs. They may even if they have the app, they may single the need for for for contact through the app, and then we call them back and talk to them on the phone.

Because, obviously, that that sort of, you know, face to face or at least voice to voice, although often face to face through the app, can can give us that ability to support them more fully. Over the the year and a half, so January excuse me. Yeah. From January through June 2025, 860 new members were identified. We reached out to 702 of those either through, they were identified either through our, I'm gonna call them predictive modeling.

So looking at people and understanding that they now had a cancer diagnosis and what it was, or through direct physician referrals or care management referrals, we identified those eight sixty two. We reached out to over 700 of them. Of those, 216 were were reached, were eligible for the program, were interested in the program, and completed that initial assessment. And then we've had, about a 182 of them complete the program to date. So as I said, purposely small, testing it at each state, testing different pieces, along the way.

Since, since, let's say, the first of the year, we've really started expanding that and and making it a true program as opposed to a a build and develop kind of pilot. And and we're finding very similar results, very high engagement rates, about 84% engagement. About a third of the members were actually able to contact, recognizing that, you know what, a lot of the other members are probably folks that are already getting great care management support through their oncologists. And so we, you know, we we step back and let them know we're available if needed and and leave, you know, leave them alone. The only thing worse than no care management is too much care management.

So, making sure we know our role and our place, but for those that that need it, that, you know, roughly a third, a little bit less, of the folks, really see value in it. And I I think you were mentioning this earlier. Right? Ninety three percent of members report the highest overall satisfaction. Ninety four percent reported they would recommend the program to others, which to me is is, pretty exciting results.

Speaker 1: So in terms of value, Florida Blue said the program is already helping to lower cost, which makes a lot of sense because you're being careful with the care management, but you're also having those lower hospital and ER visit, amounts. So what specific data are you looking at, when it comes to seeing those lower costs?

Speaker 2: Yeah. It's a great it's a great question. Just to be clear, right, we we measure value across six domains. We look at quality. Obviously, we look at utilization.

Right? So that reduction in hospital and and ED rates. We look at at return on investment. Obviously, the the dollars matter, in in this day and age where health care is, you know, $5,300,000,000,000. Anything that we can do to slow that growth rate down is is important.

We look at provider satisfaction, the physicians, the folks that are involved in the care. We look at the member satisfaction, and then and then we look at variation. Right? So are there variations in performance based on any of your typical demographic factors like area deprivation index or socioeconomic status, urban versus rural? Obviously, you know, age and sex and and, race and ethnicity are areas that we consider important.

So we look for variation there. Specifically related to the cost numbers that you were asking about, it is directly correlated with the reduction in ED visits and subsequent reduction in hospitalizations. What we're finding is about a 4 to $500 savings, per patient per month in the in the program. So very excited to be able to, have that increased value. The patients, right, don't need to go to the emergency room because their symptoms are managed as an outpatient.

The patients don't end up being hospitalized, for the complication that they didn't have or that was headed off when it was small and easily managed at home, for instance. And to me, that's the perfect example of improving quality and reducing cost. Right? We're not preventing anyone from getting care. We're we're eliminating the need for that care because we've taken care of that fire when it's very small, and you can put it out with a cup of water, and you don't need the fire department to come and help you.

Speaker 1: I thank you for adding some color on the value and cost components there. I wanted to wrap up and just ask for any other payers who are considering partnerships or going further into cancer care navigation. What advice do you have for them?

Speaker 2: Yeah. I I I think it's, important. As everyone knows, cancer is one of the the most terrible sponges on our our health care system. There's tons of exciting developments in new cancer therapies, new treatments, new options, new surgeries, new radiation protocols, etcetera. And and those are wonderful, and we always want to embrace technology heavily in that situation.

But we have to remember that there's a person behind all of that care, and there's a a person behind all of that health care utilization. And the more we can recognize a person, the more that we can meet their needs. Look. Cancer care is always going to be very expensive. That that that's not gonna change anytime soon.

But but we can certainly make the cancer care experience far better. And the fact that that happens to save some money and make the patients happier and make their their caregivers, to the extent that they have caregivers at home with them, feel like they have some support and some recourse, to me, that that's incredibly meaningful. And, like I said, this is one of those perfect areas where the the value of improving quality is clearly seen and and and the dollars are recognized and the patients, you know, get that much better care. And so it's it's certainly that, you know, win win win kind of scenario. It's a great place to to look at, and there's a lot of different ways to to do the program.

So, you know, you can build your own. You can, I'm sure, Evelyn would be more than happy to speak to you about a program. And there's probably other folks out in the field doing some more work. So excited to to show that this actually makes a difference for me.

Speaker 1: Well, doctor Graf, thank you so much for joining us today and adding a bit more color on the partnership you have going. And to our listeners, if you'd like to listen to more podcasts from Becker's HealthCare, you can visit beckers hospital review dot com. Thanks again, doctor Graff.