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