1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,044 payer and health plan executives and more than 5 00:00:13,044 --> 00:00:16,504 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:33,969 --> 00:00:36,210 Hello, everyone. This is Elizabeth Cassello with the 14 00:00:36,210 --> 00:00:39,009 Becker's Payer Issues podcast. I'm thrilled today to 15 00:00:39,009 --> 00:00:41,570 be joined by doctor Tom Graff, chief medical 16 00:00:41,570 --> 00:00:44,104 officer of Florida Blue. Doctor Graff, thank you 17 00:00:44,104 --> 00:00:45,725 so much for joining us today. 18 00:00:46,184 --> 00:00:48,144 Yeah. My pleasure. It's exciting, to be able 19 00:00:48,144 --> 00:00:50,265 to talk about this project. Yeah. So before 20 00:00:50,265 --> 00:00:52,104 we jump into the project, could we hear 21 00:00:52,104 --> 00:00:53,884 a little bit more on your career background? 22 00:00:53,945 --> 00:00:55,324 Tell us a bit about yourself 23 00:00:55,625 --> 00:00:57,725 and your current role at Florida Blue. 24 00:00:58,079 --> 00:01:00,000 Absolutely. Happy to. So, 25 00:01:00,560 --> 00:01:02,640 thirty years in health care, I think I've 26 00:01:02,640 --> 00:01:04,000 had the privilege of, 27 00:01:04,480 --> 00:01:07,840 coming at it from literally every direction from 28 00:01:07,840 --> 00:01:08,340 patient 29 00:01:09,120 --> 00:01:10,579 to learner to physician 30 00:01:10,959 --> 00:01:13,459 to educator to academic to researcher 31 00:01:14,025 --> 00:01:16,525 to consultant, and then physician executive, 32 00:01:17,305 --> 00:01:18,125 both within, 33 00:01:18,585 --> 00:01:20,605 clinical delivery systems primarily 34 00:01:21,064 --> 00:01:21,945 as well as, 35 00:01:22,505 --> 00:01:24,424 health plans. And so that, I think, given 36 00:01:24,424 --> 00:01:25,725 me a really unique perspective. 37 00:01:26,265 --> 00:01:28,525 My career has really been centered, though, around, 38 00:01:29,560 --> 00:01:30,619 driving quality 39 00:01:30,920 --> 00:01:33,000 to reduce total cost of care. Right? How 40 00:01:33,000 --> 00:01:35,560 do we make things better for everyone in 41 00:01:35,560 --> 00:01:36,939 this equation? And, 42 00:01:37,399 --> 00:01:39,560 you know, that's led me obviously through population 43 00:01:39,560 --> 00:01:42,219 health and value based care and the ability 44 00:01:42,280 --> 00:01:42,939 to really 45 00:01:43,754 --> 00:01:45,295 change clinical model 46 00:01:45,594 --> 00:01:47,674 and payment model in a way that makes 47 00:01:47,674 --> 00:01:49,135 sense for patients, 48 00:01:49,515 --> 00:01:50,254 for physicians, 49 00:01:50,795 --> 00:01:52,875 and for the people ultimately paying for it, 50 00:01:52,875 --> 00:01:54,155 which is you and me and all the 51 00:01:54,155 --> 00:01:55,854 rest of the folks out there. So, 52 00:01:56,234 --> 00:01:57,834 the goal in in my life is really 53 00:01:57,834 --> 00:01:58,894 to make a difference 54 00:01:59,359 --> 00:02:01,599 in those areas, and this is one of 55 00:02:01,599 --> 00:02:05,459 those key areas where it's it's so clear 56 00:02:05,519 --> 00:02:08,479 around both the quality improvement and the cost 57 00:02:08,479 --> 00:02:11,699 improvement that's made it, very exciting. Obviously, GuideWell 58 00:02:11,840 --> 00:02:14,240 is also Florida Blue's parent is also the, 59 00:02:14,925 --> 00:02:16,384 mission driven organization 60 00:02:16,844 --> 00:02:17,745 that allows, 61 00:02:18,364 --> 00:02:19,905 activities like I just described 62 00:02:20,284 --> 00:02:22,625 to occur, right, focused on delivering high quality, 63 00:02:23,084 --> 00:02:25,965 affordable care with a commitment to providing exceptional 64 00:02:25,965 --> 00:02:29,250 personalized service to members. So that that constellation 65 00:02:29,469 --> 00:02:31,650 of events brought me to to Florida Blue, 66 00:02:32,110 --> 00:02:33,090 from, you know, 67 00:02:33,389 --> 00:02:35,550 having had experience in a lot of really 68 00:02:35,550 --> 00:02:36,610 innovative organizations, 69 00:02:37,469 --> 00:02:39,949 Ascension Health and their national team, Horizon Blue 70 00:02:39,949 --> 00:02:41,169 Cross in New Jersey, 71 00:02:41,629 --> 00:02:43,949 Chartus, which is a health care consulting company. 72 00:02:43,949 --> 00:02:44,444 And and, 73 00:02:44,925 --> 00:02:46,284 one of the highlights, I think, of my 74 00:02:46,284 --> 00:02:48,365 career is I spent over a decade at 75 00:02:48,365 --> 00:02:50,765 Geisinger Health System and learned a lot of 76 00:02:50,765 --> 00:02:53,245 the the basics of what is now being 77 00:02:53,245 --> 00:02:54,625 delivered across Florida, 78 00:02:55,165 --> 00:02:56,064 at that time. 79 00:02:56,800 --> 00:02:58,979 Well, thank you for giving us that context. 80 00:02:59,280 --> 00:03:01,599 And more specifically, the project that we were 81 00:03:01,599 --> 00:03:02,740 alluding to earlier 82 00:03:03,120 --> 00:03:05,840 was, related to cancer care with Florida Blue. 83 00:03:05,840 --> 00:03:06,819 So for background, 84 00:03:07,199 --> 00:03:09,280 Florida Blue has been partnered with Evelyn on 85 00:03:09,280 --> 00:03:12,159 cancer care navigation since 2021. 86 00:03:12,159 --> 00:03:14,055 Can Can you elaborate on what drove that 87 00:03:14,055 --> 00:03:17,495 initiative to translate to Medicare Advantage members and 88 00:03:17,495 --> 00:03:18,955 why focus on that population? 89 00:03:19,655 --> 00:03:21,974 Yeah. That's a great question. So so we 90 00:03:21,974 --> 00:03:22,854 had been doing, 91 00:03:23,254 --> 00:03:23,754 utilization 92 00:03:24,134 --> 00:03:26,955 management with Evelyn, really relying on their 93 00:03:27,270 --> 00:03:32,009 clinical expertise in what, is the highest value 94 00:03:32,389 --> 00:03:33,449 care based on, 95 00:03:33,909 --> 00:03:35,050 recommendations from 96 00:03:35,509 --> 00:03:36,169 from NCCN, 97 00:03:36,469 --> 00:03:38,090 from ASTRO, all of the, 98 00:03:38,709 --> 00:03:41,205 latest and greatest information. How do we make 99 00:03:41,205 --> 00:03:42,664 sure we bring that consistently 100 00:03:43,205 --> 00:03:45,064 for our members? Right? The the the challenge 101 00:03:45,125 --> 00:03:47,444 with driving quality to reduce total cost of 102 00:03:47,444 --> 00:03:50,504 care is really around that ability to reliably 103 00:03:50,965 --> 00:03:51,465 deliver 104 00:03:52,199 --> 00:03:54,360 measurably better care, and they've been they've been 105 00:03:54,360 --> 00:03:56,599 helping us with that for many years. And 106 00:03:56,599 --> 00:03:59,500 through that process, what we recognized is that 107 00:03:59,879 --> 00:04:00,379 reliably 108 00:04:00,759 --> 00:04:03,960 deliver part was, unfortunately, and this is the 109 00:04:03,960 --> 00:04:06,854 case, you know, across the country, highly varied, 110 00:04:07,814 --> 00:04:10,215 depending on where you got your cancer care, 111 00:04:10,215 --> 00:04:12,955 what part of Florida, what provider, what system. 112 00:04:13,174 --> 00:04:15,814 In in many cases, in almost all cases, 113 00:04:15,814 --> 00:04:18,214 the care was was excellent in terms of 114 00:04:18,214 --> 00:04:21,430 the technical capabilities, if you will. But what 115 00:04:21,430 --> 00:04:23,430 we did find is members that were sort 116 00:04:23,430 --> 00:04:25,829 of slipping through the cracks around, you know, 117 00:04:25,829 --> 00:04:27,110 maybe they didn't have, 118 00:04:27,589 --> 00:04:30,870 perfect pain control. Obviously, that happens to cancer 119 00:04:30,870 --> 00:04:33,430 patients. Maybe they were having side effects from 120 00:04:33,430 --> 00:04:34,169 their therapies, 121 00:04:34,814 --> 00:04:35,314 and, 122 00:04:36,495 --> 00:04:38,514 it it often leads to 123 00:04:38,975 --> 00:04:40,115 additional care, 124 00:04:40,895 --> 00:04:42,995 you know, emergency room care, 125 00:04:43,455 --> 00:04:46,194 phone calls that go unanswered, and patients were 126 00:04:46,779 --> 00:04:49,019 struggling with that. The other thing that we 127 00:04:49,019 --> 00:04:51,600 noticed, which was equally troubling, is often 128 00:04:51,979 --> 00:04:54,060 there's a gap between when the patient sort 129 00:04:54,060 --> 00:04:56,160 of notified that they have cancer 130 00:04:56,779 --> 00:04:59,180 and then getting it hooked up with a 131 00:04:59,180 --> 00:05:01,334 provider that's providing that definitive care, 132 00:05:01,814 --> 00:05:04,875 you know, medical oncology, radiation oncology, surgical oncology. 133 00:05:05,095 --> 00:05:06,475 And that gap is incredibly 134 00:05:07,254 --> 00:05:09,274 stressful for members, for their families, 135 00:05:09,974 --> 00:05:11,834 and for the delivery of care. 136 00:05:12,214 --> 00:05:15,560 And those two gaps, that that variation in 137 00:05:15,560 --> 00:05:19,160 care and that time gap between diagnosis and 138 00:05:19,160 --> 00:05:20,860 onset of definitive care, 139 00:05:21,560 --> 00:05:24,699 created the need, for a program like this. 140 00:05:24,919 --> 00:05:26,839 And so we wanted to work with Evelyn 141 00:05:26,839 --> 00:05:28,120 because at the end of the day, it 142 00:05:28,120 --> 00:05:30,574 has to work, obviously, for the patients. It 143 00:05:30,574 --> 00:05:32,995 has to work for the providers, the physicians, 144 00:05:33,214 --> 00:05:33,875 the hospitals, 145 00:05:34,334 --> 00:05:35,855 and it has to work for, 146 00:05:36,735 --> 00:05:40,095 the health plan. And typically or often these 147 00:05:40,095 --> 00:05:41,955 programs are developed in isolation, 148 00:05:42,574 --> 00:05:45,430 and they're developed either, you know, just by 149 00:05:45,430 --> 00:05:47,910 the provider, just by the the the the 150 00:05:47,910 --> 00:05:48,970 group like Evelyn, 151 00:05:49,589 --> 00:05:50,970 or just by the health plan. 152 00:05:51,430 --> 00:05:53,589 And, you know, maybe they involve members. Typically, 153 00:05:53,589 --> 00:05:56,550 they do, patients. But but often, those other 154 00:05:56,550 --> 00:05:58,754 groups are sort of left out. And what 155 00:05:58,754 --> 00:06:00,754 you get is a solution that fits great 156 00:06:00,754 --> 00:06:02,214 for one stakeholder 157 00:06:02,595 --> 00:06:04,354 and doesn't really fit too great for the 158 00:06:04,354 --> 00:06:06,435 other stakeholders. And what we wanted was something 159 00:06:06,435 --> 00:06:08,675 meaningfully different, and that gave us the the 160 00:06:08,675 --> 00:06:09,894 opportunity to 161 00:06:10,699 --> 00:06:13,899 to do that. Obviously, you know, most, certainly 162 00:06:13,899 --> 00:06:15,839 not all, but but many members, 163 00:06:16,540 --> 00:06:20,139 are Medicare aged that's that, suffer from cancer. 164 00:06:20,139 --> 00:06:22,560 And so focusing that population at least first 165 00:06:22,795 --> 00:06:24,475 makes sense. There's certainly nothing about this program 166 00:06:24,475 --> 00:06:26,475 that in any way would not translate to, 167 00:06:26,475 --> 00:06:29,115 unfortunately, any patient that's that's suffering from cancer. 168 00:06:29,115 --> 00:06:31,194 So that's, I think, the other piece to 169 00:06:31,194 --> 00:06:33,835 exercise. Although we we started with Medicare and 170 00:06:33,835 --> 00:06:35,879 focused on that as a bean point, really 171 00:06:35,879 --> 00:06:38,459 applies very, very evenly and and and appropriately 172 00:06:38,759 --> 00:06:39,259 across, 173 00:06:39,720 --> 00:06:42,300 any age group that's suffering from from cancer. 174 00:06:43,560 --> 00:06:45,419 I see. And early results 175 00:06:45,720 --> 00:06:48,039 show a forty percent reduction in hospital and 176 00:06:48,039 --> 00:06:50,699 ER visits and ninety five percent patient satisfaction. 177 00:06:50,839 --> 00:06:53,105 So what factors do you think contributed the 178 00:06:53,105 --> 00:06:54,404 most to those outcomes? 179 00:06:55,024 --> 00:06:56,464 Yeah. It's a it's a great question. I 180 00:06:56,464 --> 00:06:58,944 think that that partnership, that involvement of the 181 00:06:58,944 --> 00:06:59,845 various stakeholders, 182 00:07:00,464 --> 00:07:03,264 the very deliberate and focused approach that we 183 00:07:03,264 --> 00:07:05,925 took, we we, by, intention, 184 00:07:06,569 --> 00:07:09,209 kept our program very small, and we've been 185 00:07:09,209 --> 00:07:12,009 actually working on this for it's it's approaching 186 00:07:12,009 --> 00:07:13,310 two years at this point. 187 00:07:14,169 --> 00:07:15,529 A year and a half, two years at 188 00:07:15,529 --> 00:07:17,870 this point. And so the ability to 189 00:07:19,504 --> 00:07:20,004 implement, 190 00:07:20,705 --> 00:07:21,205 test, 191 00:07:21,824 --> 00:07:22,324 refine, 192 00:07:22,785 --> 00:07:25,745 then bring on the next element, implement, test, 193 00:07:25,745 --> 00:07:28,145 refine, and we kept going through that and 194 00:07:28,145 --> 00:07:30,805 iterating. You know? So what's the best way 195 00:07:30,865 --> 00:07:31,524 to connect 196 00:07:31,849 --> 00:07:32,589 the Evelyn 197 00:07:33,050 --> 00:07:34,669 team, which was very experienced 198 00:07:35,050 --> 00:07:36,649 in in in, 199 00:07:37,529 --> 00:07:38,509 these serious conversations. 200 00:07:39,129 --> 00:07:40,669 Right? End of life conversations, 201 00:07:41,769 --> 00:07:44,729 health care improvement conversations. What are your goals 202 00:07:44,729 --> 00:07:47,615 of therapy? They're experienced and trained specifically in 203 00:07:47,615 --> 00:07:51,535 motivational interviewing, in goal based treatment plans, in 204 00:07:51,535 --> 00:07:54,115 interacting with patients when they you know, look. 205 00:07:54,175 --> 00:07:56,095 Some of these folks are literally at their 206 00:07:56,095 --> 00:07:56,595 worst, 207 00:07:57,134 --> 00:07:59,314 of course, because they have this horrible diagnosis 208 00:07:59,454 --> 00:08:02,750 and they've got, often a bad prognosis. Sometimes 209 00:08:02,750 --> 00:08:04,930 it's good. We we like those better, obviously, 210 00:08:05,629 --> 00:08:07,870 and are struggling with side effects and problems. 211 00:08:07,870 --> 00:08:09,629 And those folks are highly trained to have 212 00:08:09,629 --> 00:08:11,729 those really high impact conversations. 213 00:08:12,430 --> 00:08:14,029 And then because of the way we built 214 00:08:14,029 --> 00:08:16,050 the model, so we tested each all individually. 215 00:08:16,294 --> 00:08:18,214 How do we best connect with patients? How 216 00:08:18,214 --> 00:08:21,035 do we best connect with the hospital systems? 217 00:08:21,334 --> 00:08:22,855 How do we manage the fact that, you 218 00:08:22,855 --> 00:08:25,095 know, some of these comprehensive cancer centers in 219 00:08:25,095 --> 00:08:26,714 the state of Florida, and there are several, 220 00:08:27,254 --> 00:08:28,074 already have 221 00:08:28,470 --> 00:08:31,750 care management and and navigation services and support 222 00:08:31,750 --> 00:08:34,309 services, and their and those members are taken 223 00:08:34,309 --> 00:08:36,149 care of very well. How do we step 224 00:08:36,149 --> 00:08:38,389 back in that scenario and let those folks 225 00:08:38,389 --> 00:08:40,230 that are getting great care continue to great 226 00:08:40,309 --> 00:08:42,235 get great care through their providers? But But 227 00:08:42,235 --> 00:08:43,514 for those where there's a gap or where 228 00:08:43,514 --> 00:08:45,115 those where they're not they're not having, maybe 229 00:08:45,115 --> 00:08:47,595 it's a smaller oncology practice and they don't 230 00:08:47,595 --> 00:08:48,735 have those kinds of resources. 231 00:08:49,035 --> 00:08:50,794 How do we jump in and support those 232 00:08:50,794 --> 00:08:53,035 members in a way? Or, you know, they 233 00:08:53,035 --> 00:08:55,195 they they weren't, for whatever reason, unable to 234 00:08:55,195 --> 00:08:58,019 reach the people that were assigned. You know, 235 00:08:58,019 --> 00:09:00,500 unfortunately, I have a a personal story. It 236 00:09:00,500 --> 00:09:01,879 impacted my family. 237 00:09:02,820 --> 00:09:04,340 One of my family members had a had 238 00:09:04,340 --> 00:09:05,320 a cancer diagnosis, 239 00:09:06,100 --> 00:09:08,660 and, you know, we we had, first of 240 00:09:08,660 --> 00:09:11,700 all, that gap between diagnosis and definitive therapy 241 00:09:11,700 --> 00:09:12,600 that was troubling. 242 00:09:13,754 --> 00:09:15,115 Maybe a little less so because we have 243 00:09:15,115 --> 00:09:16,714 a lot of folks in health care and 244 00:09:16,714 --> 00:09:18,154 the family. So we worked our way through 245 00:09:18,154 --> 00:09:20,154 that. But then, you know, we went to 246 00:09:20,154 --> 00:09:22,154 the provider organization, and and when we saw 247 00:09:22,154 --> 00:09:24,475 the medical oncologist, we got a medical care 248 00:09:24,475 --> 00:09:25,995 management person. And when we talked to the 249 00:09:25,995 --> 00:09:27,784 radiation oncologist, we got a radiation 250 00:09:28,519 --> 00:09:30,679 care management person. We talked to the right 251 00:09:30,679 --> 00:09:32,759 surgical oncologist, we had a surgical oncology, 252 00:09:34,360 --> 00:09:36,440 manager. And and so, you know, what we 253 00:09:36,440 --> 00:09:38,360 had was a ton of care management, not 254 00:09:38,360 --> 00:09:40,940 necessarily enough care, and not necessarily 255 00:09:41,240 --> 00:09:44,504 enough connectivity. And so work this program really 256 00:09:44,504 --> 00:09:45,644 designed to overcome 257 00:09:46,264 --> 00:09:48,985 all of those, types of barriers. So combination 258 00:09:48,985 --> 00:09:51,004 of high touch care, 259 00:09:51,544 --> 00:09:53,945 high-tech care. So the ability to connect, you 260 00:09:53,945 --> 00:09:55,544 know, twenty four hours a day, three hundred 261 00:09:55,544 --> 00:09:57,409 sixty five days a week. You know, the 262 00:09:57,409 --> 00:09:59,809 vast majority of the calls are managed within 263 00:09:59,809 --> 00:10:02,450 15. So if a patient calls in, if 264 00:10:02,529 --> 00:10:05,169 almost always, eighty eighty plus percent of the 265 00:10:05,169 --> 00:10:06,850 time, we're talking to them within fifteen minutes, 266 00:10:06,850 --> 00:10:09,089 a 100% within two hours. So the longest 267 00:10:09,089 --> 00:10:10,950 any patient goes with a question unanswered 268 00:10:11,329 --> 00:10:12,230 was two hours. 269 00:10:12,735 --> 00:10:15,695 And the ability to have that reassurance that 270 00:10:15,695 --> 00:10:17,855 when you need help, help is gonna be 271 00:10:17,855 --> 00:10:20,174 there. And then talking them through and doing 272 00:10:20,174 --> 00:10:22,335 those things about how can we get you 273 00:10:22,335 --> 00:10:23,934 help so you don't have to go to 274 00:10:23,934 --> 00:10:26,190 the emergency room, but you get your pain 275 00:10:26,190 --> 00:10:27,549 controlled? How can we get you help so 276 00:10:27,549 --> 00:10:29,250 you don't have to go to the hospital, 277 00:10:29,709 --> 00:10:31,629 to manage your, you know, nausea and vomiting 278 00:10:31,629 --> 00:10:33,309 or whatever it is that you're experiencing from 279 00:10:33,309 --> 00:10:35,309 a side effect? You know what? Or just 280 00:10:35,549 --> 00:10:37,629 you're just anxious, and you need somebody to 281 00:10:37,629 --> 00:10:38,845 talk to. Alright? 282 00:10:39,225 --> 00:10:41,144 Or you're struggling. You're not gonna be able 283 00:10:41,144 --> 00:10:43,004 to make your appointment. How do you get 284 00:10:43,144 --> 00:10:45,304 it rescheduled in a time frame that's still 285 00:10:45,304 --> 00:10:47,144 good for your cancer therapy, and how do 286 00:10:47,144 --> 00:10:49,144 you manage that when you're, you know, suffering 287 00:10:49,144 --> 00:10:50,504 at home and you're, like I said, not 288 00:10:50,504 --> 00:10:52,105 at your best, may not be able to 289 00:10:52,105 --> 00:10:53,929 do that. So everything from, you know, what 290 00:10:53,929 --> 00:10:56,329 I'm gonna call navigation services, I e making 291 00:10:56,329 --> 00:10:58,809 appointments and and helping manage that piece, but 292 00:10:58,809 --> 00:11:02,169 more importantly, managing those those side effects, those 293 00:11:02,169 --> 00:11:02,669 complications, 294 00:11:03,450 --> 00:11:05,850 and those issues. And then for those patients 295 00:11:05,850 --> 00:11:07,929 that are in that that gap period between, 296 00:11:07,929 --> 00:11:10,674 you know, definitive diagnosis and definitive treatment, 297 00:11:11,054 --> 00:11:12,735 how do we accelerate that? How do we 298 00:11:12,735 --> 00:11:14,495 support that person? How do we help them 299 00:11:14,495 --> 00:11:16,274 find the best care for them? 300 00:11:16,894 --> 00:11:18,754 Those are all of the pieces 301 00:11:19,294 --> 00:11:21,134 that are part of the program. And like 302 00:11:21,134 --> 00:11:22,754 I said, we we worked through 303 00:11:23,190 --> 00:11:25,669 each one of those connection points. So what 304 00:11:25,669 --> 00:11:27,509 can we do with the primary care physicians 305 00:11:27,509 --> 00:11:29,269 to make as easy as possible for them 306 00:11:29,269 --> 00:11:31,529 to refer and enroll a patient? 307 00:11:32,070 --> 00:11:33,750 How do we best connect with the patients? 308 00:11:33,750 --> 00:11:35,669 Is it telephonic? Is it through an app? 309 00:11:35,669 --> 00:11:38,125 Is it through other electronic means? We set 310 00:11:38,125 --> 00:11:39,644 up all of those pieces. We can meet 311 00:11:39,644 --> 00:11:41,964 the patient where they are. Whatever works for 312 00:11:41,964 --> 00:11:43,985 them is the way we interact with them. 313 00:11:44,924 --> 00:11:46,605 And then, you know, finally, how do we 314 00:11:46,605 --> 00:11:48,845 connect with those cancer centers and those oncologists 315 00:11:48,845 --> 00:11:50,590 to make sure that what we're doing really 316 00:11:50,590 --> 00:11:52,429 is additive and not getting in the way 317 00:11:52,429 --> 00:11:54,990 because that's certainly not the goal. That's that's 318 00:11:54,990 --> 00:11:56,669 how we've done it, and and that's what's 319 00:11:56,669 --> 00:11:57,730 produced those results. 320 00:11:58,429 --> 00:11:59,950 So a couple of follow ups to that. 321 00:11:59,950 --> 00:12:01,809 I know you said you're keeping the program 322 00:12:01,870 --> 00:12:04,404 small. How many people are involved? And then 323 00:12:04,404 --> 00:12:07,384 my other question, you mentioned the tech enabled 324 00:12:07,445 --> 00:12:11,284 components there. How is that registering for a 325 00:12:11,284 --> 00:12:12,504 Medicare age population? 326 00:12:13,284 --> 00:12:15,764 What has been the reception to different tech 327 00:12:15,764 --> 00:12:16,264 components? 328 00:12:16,580 --> 00:12:18,179 So I'm gonna take the last one first, 329 00:12:18,179 --> 00:12:19,700 and then we'll go back and cut the 330 00:12:19,700 --> 00:12:21,299 number of patients because because I agree with 331 00:12:21,299 --> 00:12:22,980 you. So it is number one, it doesn't 332 00:12:22,980 --> 00:12:25,139 work for everybody. Right? One size does not 333 00:12:25,139 --> 00:12:27,539 fit all despite what, Henry Ford said when 334 00:12:27,539 --> 00:12:29,080 he was building his model t. 335 00:12:29,779 --> 00:12:30,679 That said, 336 00:12:31,375 --> 00:12:34,115 even with our, Florida Blue portal, 337 00:12:34,495 --> 00:12:37,694 we have electronic connections with over 50% of 338 00:12:37,694 --> 00:12:39,074 our Medicare members, 339 00:12:39,774 --> 00:12:42,334 and the vast majority of those are on 340 00:12:42,334 --> 00:12:44,735 that website once a week to once a 341 00:12:44,735 --> 00:12:46,940 month. So they're using it, using a lot. 342 00:12:46,940 --> 00:12:50,320 The the tech savviness of our Medicare population 343 00:12:50,860 --> 00:12:53,179 is increasing, you know, every year. Right? Most 344 00:12:53,179 --> 00:12:54,940 of these folks at this point used a 345 00:12:54,940 --> 00:12:56,860 lot of technology, used a lot of email, 346 00:12:56,860 --> 00:12:58,379 used a lot of websites, used a lot 347 00:12:58,379 --> 00:12:59,039 of computers, 348 00:12:59,500 --> 00:13:01,605 in their work, and now they're now they're 349 00:13:01,605 --> 00:13:03,705 retiring in their in the Medicare roles. 350 00:13:04,325 --> 00:13:07,225 That said, and and the app is even 351 00:13:07,285 --> 00:13:09,384 more user friendly and can, 352 00:13:09,925 --> 00:13:12,404 easily be installed on their devices either by 353 00:13:12,404 --> 00:13:14,485 the patient or family member or remotely if 354 00:13:14,485 --> 00:13:17,019 we need to. So the ability to support 355 00:13:17,019 --> 00:13:18,559 the member in that regard 356 00:13:19,100 --> 00:13:19,600 is, 357 00:13:19,980 --> 00:13:21,740 is high. Obviously, a lot of members we 358 00:13:21,740 --> 00:13:23,279 still talk to just on the phone. 359 00:13:23,740 --> 00:13:24,480 It's amazing, 360 00:13:24,860 --> 00:13:27,019 you know, that that 100 year techno 100 361 00:13:27,019 --> 00:13:28,639 year old technology still works 362 00:13:29,084 --> 00:13:31,964 and, is able to to provide a good 363 00:13:31,964 --> 00:13:34,044 connection for them. That that that may be 364 00:13:34,044 --> 00:13:36,865 the most common, way that we're interacting, particularly 365 00:13:36,924 --> 00:13:39,404 for a lot of these more urgent needs. 366 00:13:39,404 --> 00:13:40,764 They may even if they have the app, 367 00:13:40,764 --> 00:13:42,845 they may single the need for for for 368 00:13:42,845 --> 00:13:44,459 contact through the app, and then we call 369 00:13:44,459 --> 00:13:45,579 them back and talk to them on the 370 00:13:45,579 --> 00:13:47,740 phone. Because, obviously, that that sort of, you 371 00:13:47,740 --> 00:13:49,339 know, face to face or at least voice 372 00:13:49,339 --> 00:13:51,820 to voice, although often face to face through 373 00:13:51,820 --> 00:13:53,839 the app, can can give us that ability 374 00:13:53,899 --> 00:13:55,919 to support them more fully. 375 00:13:57,195 --> 00:13:57,695 Over 376 00:13:58,394 --> 00:13:58,894 the 377 00:13:59,674 --> 00:14:02,235 the year and a half, so January excuse 378 00:14:02,235 --> 00:14:04,894 me. Yeah. From January through June 2025, 379 00:14:05,514 --> 00:14:06,475 860 380 00:14:06,475 --> 00:14:07,615 new members were identified. 381 00:14:08,075 --> 00:14:10,154 We reached out to 702 382 00:14:10,154 --> 00:14:11,455 of those either through, 383 00:14:12,809 --> 00:14:15,210 they were identified either through our, I'm gonna 384 00:14:15,210 --> 00:14:17,210 call them predictive modeling. So looking at people 385 00:14:17,210 --> 00:14:19,450 and understanding that they now had a cancer 386 00:14:19,450 --> 00:14:21,529 diagnosis and what it was, or through direct 387 00:14:21,529 --> 00:14:24,970 physician referrals or care management referrals, we identified 388 00:14:24,970 --> 00:14:26,649 those eight sixty two. We reached out to 389 00:14:26,649 --> 00:14:28,215 over 700 of them. 390 00:14:28,934 --> 00:14:30,875 Of those, 216 391 00:14:30,934 --> 00:14:33,335 were were reached, were eligible for the program, 392 00:14:33,335 --> 00:14:35,575 were interested in the program, and completed that 393 00:14:35,575 --> 00:14:36,475 initial assessment. 394 00:14:36,934 --> 00:14:38,055 And then we've had, 395 00:14:39,175 --> 00:14:40,455 about a 182 396 00:14:40,455 --> 00:14:41,035 of them 397 00:14:41,339 --> 00:14:43,500 complete the program to date. So as I 398 00:14:43,500 --> 00:14:46,539 said, purposely small, testing it at each state, 399 00:14:46,539 --> 00:14:47,759 testing different pieces, 400 00:14:48,539 --> 00:14:50,240 along the way. Since, 401 00:14:51,019 --> 00:14:53,019 since, let's say, the first of the year, 402 00:14:53,019 --> 00:14:55,595 we've really started expanding that and and making 403 00:14:55,595 --> 00:14:57,674 it a true program as opposed to a 404 00:14:57,674 --> 00:14:59,615 a build and develop kind of pilot. 405 00:15:00,315 --> 00:15:02,715 And and we're finding very similar results, very 406 00:15:02,715 --> 00:15:04,894 high engagement rates, about 84% 407 00:15:05,115 --> 00:15:07,274 engagement. About a third of the members were 408 00:15:07,274 --> 00:15:10,049 actually able to contact, recognizing that, you know 409 00:15:10,049 --> 00:15:12,049 what, a lot of the other members are 410 00:15:12,049 --> 00:15:14,129 probably folks that are already getting great care 411 00:15:14,129 --> 00:15:16,549 management support through their oncologists. 412 00:15:17,169 --> 00:15:18,850 And so we, you know, we we step 413 00:15:18,850 --> 00:15:20,450 back and let them know we're available if 414 00:15:20,450 --> 00:15:22,384 needed and and leave, you know, leave them 415 00:15:22,384 --> 00:15:24,304 alone. The only thing worse than no care 416 00:15:24,304 --> 00:15:25,845 management is too much care management. 417 00:15:26,304 --> 00:15:28,065 So, making sure we know our role and 418 00:15:28,065 --> 00:15:28,725 our place, 419 00:15:29,105 --> 00:15:31,024 but for those that that need it, that, 420 00:15:31,024 --> 00:15:32,945 you know, roughly a third, a little bit 421 00:15:32,945 --> 00:15:33,445 less, 422 00:15:33,825 --> 00:15:34,644 of the folks, 423 00:15:35,345 --> 00:15:36,945 really see value in it. And I I 424 00:15:36,945 --> 00:15:39,959 think you were mentioning this earlier. Right? Ninety 425 00:15:39,959 --> 00:15:42,620 three percent of members report the highest overall 426 00:15:42,679 --> 00:15:45,580 satisfaction. Ninety four percent reported they would recommend 427 00:15:45,720 --> 00:15:47,959 the program to others, which to me is 428 00:15:47,959 --> 00:15:48,440 is, 429 00:15:48,839 --> 00:15:50,059 pretty exciting results. 430 00:15:51,035 --> 00:15:53,514 So in terms of value, Florida Blue said 431 00:15:53,514 --> 00:15:55,514 the program is already helping to lower cost, 432 00:15:55,514 --> 00:15:57,115 which makes a lot of sense because you're 433 00:15:57,115 --> 00:15:59,195 being careful with the care management, but you're 434 00:15:59,195 --> 00:16:01,915 also having those lower hospital and ER visit, 435 00:16:02,235 --> 00:16:02,735 amounts. 436 00:16:03,110 --> 00:16:05,029 So what specific data are you looking at, 437 00:16:05,269 --> 00:16:07,769 when it comes to seeing those lower costs? 438 00:16:08,470 --> 00:16:10,090 Yeah. It's a great it's a great question. 439 00:16:10,149 --> 00:16:12,009 Just to be clear, right, we we measure 440 00:16:12,310 --> 00:16:14,330 value across six domains. 441 00:16:14,710 --> 00:16:17,085 We look at quality. Obviously, we look at 442 00:16:17,325 --> 00:16:19,725 utilization. Right? So that reduction in hospital and 443 00:16:19,725 --> 00:16:20,865 and ED rates. 444 00:16:21,245 --> 00:16:23,565 We look at at return on investment. Obviously, 445 00:16:23,565 --> 00:16:25,725 the the dollars matter, in in this day 446 00:16:25,725 --> 00:16:27,565 and age where health care is, you know, 447 00:16:27,565 --> 00:16:29,325 $5,300,000,000,000. 448 00:16:29,565 --> 00:16:31,165 Anything that we can do to slow that 449 00:16:31,165 --> 00:16:33,590 growth rate down is is important. We look 450 00:16:33,590 --> 00:16:36,149 at provider satisfaction, the physicians, the folks that 451 00:16:36,149 --> 00:16:37,750 are involved in the care. We look at 452 00:16:37,750 --> 00:16:39,590 the member satisfaction, and then and then we 453 00:16:39,590 --> 00:16:42,889 look at variation. Right? So are there variations 454 00:16:43,029 --> 00:16:45,610 in performance based on any of your typical 455 00:16:45,945 --> 00:16:49,884 demographic factors like area deprivation index or socioeconomic 456 00:16:50,184 --> 00:16:51,965 status, urban versus rural? 457 00:16:52,585 --> 00:16:55,384 Obviously, you know, age and sex and and, 458 00:16:56,024 --> 00:16:58,825 race and ethnicity are areas that we consider 459 00:16:58,825 --> 00:17:00,629 important. So we look for variation there. 460 00:17:01,190 --> 00:17:03,590 Specifically related to the cost numbers that you 461 00:17:03,590 --> 00:17:06,309 were asking about, it is directly correlated with 462 00:17:06,309 --> 00:17:08,789 the reduction in ED visits and subsequent reduction 463 00:17:08,789 --> 00:17:09,450 in hospitalizations. 464 00:17:10,069 --> 00:17:11,670 What we're finding is about a 4 to 465 00:17:11,670 --> 00:17:12,549 $500 466 00:17:12,549 --> 00:17:13,049 savings, 467 00:17:13,785 --> 00:17:15,305 per patient per month in the in the 468 00:17:15,305 --> 00:17:16,765 program. So very excited 469 00:17:17,065 --> 00:17:18,184 to be able to, 470 00:17:19,305 --> 00:17:22,105 have that increased value. The patients, right, don't 471 00:17:22,105 --> 00:17:24,025 need to go to the emergency room because 472 00:17:24,025 --> 00:17:26,505 their symptoms are managed as an outpatient. The 473 00:17:26,505 --> 00:17:28,445 patients don't end up being hospitalized, 474 00:17:29,190 --> 00:17:31,190 for the complication that they didn't have or 475 00:17:31,190 --> 00:17:33,109 that was headed off when it was small 476 00:17:33,109 --> 00:17:35,609 and easily managed at home, for instance. 477 00:17:36,069 --> 00:17:38,470 And to me, that's the perfect example of 478 00:17:38,470 --> 00:17:39,450 improving quality 479 00:17:39,750 --> 00:17:42,869 and reducing cost. Right? We're not preventing anyone 480 00:17:42,869 --> 00:17:44,569 from getting care. We're 481 00:17:45,115 --> 00:17:45,855 we're eliminating 482 00:17:46,234 --> 00:17:47,914 the need for that care because we've taken 483 00:17:47,914 --> 00:17:49,775 care of that fire when it's very small, 484 00:17:49,835 --> 00:17:51,034 and you can put it out with a 485 00:17:51,034 --> 00:17:52,554 cup of water, and you don't need the 486 00:17:52,554 --> 00:17:54,414 fire department to come and help you. 487 00:17:55,275 --> 00:17:56,954 I thank you for adding some color on 488 00:17:56,954 --> 00:17:59,769 the value and cost components there. I wanted 489 00:17:59,769 --> 00:18:02,009 to wrap up and just ask for any 490 00:18:02,009 --> 00:18:03,630 other payers who are considering 491 00:18:04,089 --> 00:18:04,589 partnerships 492 00:18:04,890 --> 00:18:07,390 or going further into cancer care navigation. 493 00:18:07,849 --> 00:18:09,470 What advice do you have for them? 494 00:18:10,410 --> 00:18:12,569 Yeah. I I I think it's, important. As 495 00:18:12,569 --> 00:18:14,714 everyone knows, cancer is one of the the 496 00:18:15,275 --> 00:18:18,315 most terrible sponges on our our health care 497 00:18:18,315 --> 00:18:18,815 system. 498 00:18:19,595 --> 00:18:20,095 There's 499 00:18:20,394 --> 00:18:22,654 tons of exciting developments in 500 00:18:22,954 --> 00:18:26,154 new cancer therapies, new treatments, new options, new 501 00:18:26,154 --> 00:18:29,054 surgeries, new radiation protocols, etcetera. 502 00:18:30,350 --> 00:18:31,730 And and those are wonderful, 503 00:18:32,430 --> 00:18:34,509 and we always want to embrace technology heavily 504 00:18:34,509 --> 00:18:36,590 in that situation. But we have to remember 505 00:18:36,590 --> 00:18:38,590 that there's a person behind all of that 506 00:18:38,590 --> 00:18:40,990 care, and there's a a person behind all 507 00:18:40,990 --> 00:18:42,369 of that health care utilization. 508 00:18:43,304 --> 00:18:45,224 And the more we can recognize a person, 509 00:18:45,224 --> 00:18:46,845 the more that we can meet their needs. 510 00:18:46,904 --> 00:18:48,984 Look. Cancer care is always going to be 511 00:18:48,984 --> 00:18:51,065 very expensive. That that that's not gonna change 512 00:18:51,065 --> 00:18:52,044 anytime soon. 513 00:18:52,585 --> 00:18:55,004 But but we can certainly make the cancer 514 00:18:55,144 --> 00:18:56,204 care experience 515 00:18:57,130 --> 00:18:59,049 far better. And the fact that that happens 516 00:18:59,049 --> 00:19:00,429 to save some money 517 00:19:00,730 --> 00:19:02,809 and make the patients happier and make their 518 00:19:02,809 --> 00:19:05,130 their caregivers, to the extent that they have 519 00:19:05,130 --> 00:19:06,650 caregivers at home with them, 520 00:19:06,970 --> 00:19:09,049 feel like they have some support and some 521 00:19:09,049 --> 00:19:09,549 recourse, 522 00:19:10,654 --> 00:19:12,835 to me, that that's incredibly meaningful. 523 00:19:13,375 --> 00:19:14,974 And, like I said, this is one of 524 00:19:14,974 --> 00:19:18,174 those perfect areas where the the value of 525 00:19:18,174 --> 00:19:21,134 improving quality is clearly seen and and and 526 00:19:21,134 --> 00:19:23,315 the dollars are recognized and the patients, 527 00:19:24,160 --> 00:19:25,720 you know, get that much better care. And 528 00:19:25,720 --> 00:19:27,640 so it's it's certainly that, you know, win 529 00:19:27,640 --> 00:19:29,180 win win kind of scenario. 530 00:19:29,720 --> 00:19:31,820 It's a great place to to look at, 531 00:19:32,359 --> 00:19:33,880 and there's a lot of different ways to 532 00:19:33,880 --> 00:19:35,559 to do the program. So, you know, you 533 00:19:35,559 --> 00:19:37,765 can build your own. You can, I'm sure, 534 00:19:37,765 --> 00:19:39,525 Evelyn would be more than happy to speak 535 00:19:39,525 --> 00:19:40,664 to you about a program. 536 00:19:41,125 --> 00:19:42,565 And there's probably other folks out in the 537 00:19:42,565 --> 00:19:45,065 field doing some more work. So excited to 538 00:19:45,125 --> 00:19:47,125 to show that this actually makes a difference 539 00:19:47,125 --> 00:19:47,785 for me. 540 00:19:48,325 --> 00:19:50,230 Well, doctor Graf, thank you so much for 541 00:19:50,230 --> 00:19:51,829 joining us today and adding a bit more 542 00:19:51,829 --> 00:19:54,169 color on the partnership you have going. 543 00:19:55,109 --> 00:19:56,869 And to our listeners, if you'd like to 544 00:19:56,869 --> 00:19:59,190 listen to more podcasts from Becker's HealthCare, you 545 00:19:59,190 --> 00:20:01,509 can visit beckers hospital review dot com. Thanks 546 00:20:01,509 --> 00:20:02,730 again, doctor Graff.