Podcast Summary

Episode Overview

Podcast: Becker’s Healthcare Podcast
Episode: Improving Cancer Care Quality and Costs at Florida Blue, part of GuideWell with Thomas Graf, MD
Date: February 14, 2026
Host: Elizabeth Casale
Guest: Dr. Tom Graf, Chief Medical Officer, Florida Blue

This episode centers on Florida Blue’s innovative efforts to improve cancer care quality and manage costs through a partnership with Evolent Health, focusing particularly on their Medicare Advantage population. Dr. Tom Graf shares how their targeted cancer navigation program aims to address care gaps, reduce unnecessary hospital utilization, and improve member experiences, all while managing costs more effectively and providing actionable insights for other payers.

Dr. Tom Graf’s Background and Approach

• Dr. Graf’s Experience: Over 30 years in healthcare across multiple roles—patient, learner, physician, educator, researcher, consultant, and executive.

  • Specializes in population health and value-based care models, focusing on quality improvement and cost reduction.
  • Notable past organizations: Ascension Health, Horizon Blue Cross, Chartist, and Geisinger Health System.
  • Quote:

    "My career has really been centered around driving quality to reduce total cost of care. How do we make things better for everyone?" — Dr. Graf [01:15]

• Current Mission at Florida Blue: Leveraging GuideWell’s mission-driven structure to enable innovative, high-quality, affordable healthcare with an emphasis on personalized service.

Why Cancer Care Navigation? (Context & Rationale)

• Identified Gaps:

  • Significant variation in cancer care quality and timing across Florida, impacting both patient outcomes and satisfaction.
  • Noted common issues: Delay between diagnosis and initiation of definitive oncology care; insufficient pain and side-effect management; fragmented care management.
  • The stress of these gaps is compounded for patients and families.
  • Quote:

    "[T]here's a gap between when the patient [is] notified that they have cancer and then getting hooked up with a provider... That gap is incredibly stressful for members, for their families, and for the delivery of care." — Dr. Graf [04:25]

• Choosing Medicare Population:

  • High prevalence of cancer among Medicare-aged individuals made them a logical focus for initial implementation, but the program’s benefits are applicable across age groups.
  • Aim: Create a solution valuable for patients, providers, and payers, avoiding one-sided approaches often seen in isolation.

Program Design & Implementation

• Stakeholder Involvement:

  • Deliberate multi-stakeholder design: input from patients, providers, health plans, and navigators.
  • Continuous, iterative improvement—testing, refining each element before full rollout.

• Features:

  • High-touch and high-tech: Personalized care navigation, rapid access (calls answered within 15 minutes over 80% of the time), 24/7 support, flexible communication (phone, app, web).
  • Bridge gaps between diagnosis and treatment, and reduce care fragmentation.
  • Designed to supplement, not duplicate, existing care management services at large cancer centers.

• Personal Touch:

  • Dr. Graf shares a family story about care fragmentation to illustrate the problem and motivation behind the program.
  • Quote:

    "[W]e had a ton of care management, not necessarily enough care and not necessarily enough connectivity. And so this program really designed to overcome all of those types of barriers." — Dr. Graf [08:44]

Early Results and Member Reception

• Population Reached:

  • January–June 2025: 862 members identified, 702 contacted, 216 enrolled after assessment, 182 completed the program as of recording. Program intentionally kept small to test elements.

• Engagement & Satisfaction:

  • Engagement rate: ~84% among eligible members.
  • High member satisfaction:
    • 95% patient satisfaction overall; 93% reported highest satisfaction; 94% would recommend the program.
  • Quote:

    “100-year-old technology still works... may signal the need for contact through the app and then we call them back... Whatever works for them is the way we interact.” — Dr. Graf [13:05]

• Technology Use Among Medicare Members:

  • Tech-savviness increasing; over 50% use the Florida Blue portal regularly. Phone remains the most common and reliable contact method, but app and digital contacts are well-utilized.

Impact on Cost and Utilization

• Performance Outcomes:

  • 40% reduction in hospital and ER visits.

  • Reported savings: $400–$500 per patient per month (directly linked to reduced emergency and hospital utilization).

  • Quality Domains Measured:

    1. Quality
    2. Utilization
    3. Return on Investment
    4. Provider satisfaction
    5. Member satisfaction
    6. Variation (demographics/geography)

  • Quote:

    "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... To me, that's the perfect example of improving quality and reducing cost." — Dr. Graf [16:43]

Challenges and Lessons Learned

• One Size Does Not Fit All:
  • Flexibility was critical—program responds to differing patient needs, varying technological comfort.
  • Recognizes both gaps in care and risks of excessive care management.
  • Quote:

    “The only thing worse than no care management is too much care management. So making sure we know our role and our place.” — Dr. Graf [14:49]

Advice for Other Payers (18:10)

• Dr. Graf’s Recommendations:
  • Remember the person at the center: “We have to remember that there's a person behind all of that care and... utilization.”
  • Value comes from improving member experience as much as managing costs and utilization.
  • Explore adaptable models—solutions can be built internally or with vendors; the approach should fit the health plan and its population.
  • Quote:

    "This is one of those perfect areas where the value of improving quality is clearly seen and the dollars are recognized and the patients get that much better care." — Dr. Graf [18:55]

Memorable Quotes and Timestamps

• “My career has really been centered around driving quality to reduce total cost of care.” — Dr. Graf [01:15]
• "...that gap is incredibly stressful for members, for their families, and for the delivery of care." — Dr. Graf [04:25]
• “We had a ton of care management, not necessarily enough care and not necessarily enough connectivity.” — Dr. Graf [08:44]
• “100-year-old technology still works... Whatever works for them is the way we interact.” — Dr. Graf [13:05]
• “The only thing worse than no care management is too much care management.” — Dr. Graf [14:49]
• "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." — Dr. Graf [16:43]
• "This is one of those perfect areas where the value of improving quality is clearly seen and the dollars are recognized..." — Dr. Graf [18:55]

Key Takeaways

• Florida Blue’s cancer navigation model has demonstrated impressive early results, including high member satisfaction and reduced costs, through a combination of personalized attention and flexible, tech-enabled support.
• Success stemmed from integrating perspectives of patients, providers, and payers, and deliberately designing to fill gaps without duplicating existing good care.
• As cancer care navigation evolves, flexibility, multi-channel communication, and focusing on the patient experience are critical.