David Wagner, Market President for South Florida, Florida Blue

Invest: spoke with David Wagner, market president for South Florida at Florida Blue, about the affordability pressures shaping health care in 2026, the role of AI and value-based care in improving outcomes, and how Florida Blue is expanding access through community-based initiatives. “The overall impression of what’s happening in 2026 is affordability and access for as many people as possible,” Wagner said.

What key trends are shaping Florida Blue’s strategy right now?

First and foremost, the priorities are being there to support individuals, families, and businesses. Being mission-driven, part of a not-for-profit, and Florida based, we are embedded in our local communities, and we are looking to grow and impact our neighbors and their well-being. The challenge is that the United States is spending about $5 trillion annually on health care, and the rising cost of premiums is outpacing inflation.

Health care costs are the biggest issue. How do we reduce costs for people and across the system, protect access to care, and impact the community? We have been taking care of South Florida and the state of Florida for more than 80 years. In the South Florida market alone, we serve about 7.5 million people across eight counties. We have a high concentration of multiethnic, multidenominational communities, so it is a dynamic place to live and work. The overall focus for 2026 is cost and access for as many people as possible.

How is Florida Blue addressing rising health care costs?

We are looking at multiple ways of doing this, starting with how we lower the cost of doing business. What is the best use of AI, not simply to automate things but to humanize care? When used right, technology can let clinicians focus on taking care of patients, or customer service teams spend quality time with a member. For example, AI helps speed up many authorizations, so providers can take care of our members. 

The first step in addressing costs is getting the authorization done quickly, getting it done right, and using technology to make it more efficient. And yes, it saves time and money. Another way to lower costs for everyone is shifting from a fee-for-service model and moving more to a value-based agreement with providers, where they are rewarded for good outcomes and experiences. If someone goes to the hospital to have a knee or hip procedure, can they have it done with a lower risk of infection or readmission?

When they are discharged, are they getting an appointment with their doctor within days? Studies show that if they see their doctor within a week, the chances of complications or returning to the hospital are greatly reduced. Are they leaving the hospital with the medications they need? If a patient gets their medicine on discharge or within 24 hours, they have a lower chance of readmission for the same diagnosis.

We are looking at value-added proposals and negotiations with our providers, where they are rewarded for high-quality, good-outcome services and delivering more value. Fewer falls, readmissions, and infections lead to lower costs, and that drives down costs which are baked into the monthly premiums people pay. That is how insurance works. If we can keep those things low while keeping quality outcomes at the forefront, then the member wins because they are getting the highest quality, and the community wins because those costs are less for everyone.

Another component of addressing rising costs is offering different health plans for people to choose. Somebody who is 26 and healthy may opt for a higher deductible plan. Somebody who is 50 or 60 and dealing with high blood pressure, obesity, or kidney issues is going to look at a different plan. Having a range of plans is key.

Lastly, it is about making sure the community understands what they are buying. Few people will read their actual contract, so we have to explain, in simple terms, what their plan and benefits cover. Most people sign up for coverage, get their card in the mail, but they may not look at the details until they are sick and need it. We have to get ahead of that, explaining and reviewing and simplifying things when and where members need us.

What innovations are you implementing to simplify the member experience and improve transparency?

One of the biggest things is speed and information. If somebody hurts their knee, goes to the ER, and then to an orthopedic doctor, and that doctor says they need an MRI, the best thing we can do is make sure they have the authorization quickly, for whatever evidence-based care they need; that everything is covered and they know the costs, and can make the appointment right away, often within minutes.

The other thing is giving members tools through an app where they can put in their ZIP code and see several MRI centers or care locations. A doctor may want to send them for a hospital-based MRI, but that is going to be more expensive than a non-hospital-based MRI center. Most members do not know that. The same goes for some surgical procedures. Does it need to be done in a hospital, or would it be more convenient and cost less at an outpatient ambulatory surgical center? Through an app, someone can compare copayments across those settings.

In a perfect world, the app should include not only costs, but outcomes. For example, here are the outcomes for surgery in the ambulatory center, and here are the outcomes in the hospital. Sometimes they are apples to apples. Some people think that if they go to the hospital, they are safer, but sometimes ambulatory centers are actually better when you look at infection and results because there are no inpatients there. Data is king. Giving our members choices, being quick in responding to what they need, and giving them access to what they need is essential.

Every person should be treated like they are our family. I was taught that really young as a caregiver. If you take care of the patient, the member, and the family, everything else takes care of itself. We need to take care of people quickly, give them good financial choices, and focus on the outcome, because if they do not get a good outcome, nothing else matters.

What initiatives are you leading around preventive care and whole-person health?

For years, the system was built on fee-for-service, and preventive care was not the priority. Now we are getting ahead of it. We are incentivizing our network physicians, nurse practitioners, and providers to do annual screenings, promote healthy eating, promote A1C and diabetes checks, and get people access before problems become more serious. For members, many plans come with a low-cost or no-cost annual wellness screening. Losing weight, reducing blood pressure, and managing diabetes all help prevent heart attacks and strokes, which are among the biggest causes of death, along with cancer.

One thing that differentiates Florida Blue is our Florida Blue Centers, where people can come in and learn about healthy eating. We do Zumba classes, yoga classes, and sessions with physicians talking about blood pressure. The key is that people do not have to be Florida Blue members to use them. Regardless of the insurance carrier they have, they can still go to a Florida Blue Center for face-to-face support. We see everybody, so we are taking care of the whole community.

In addition, we have a Growing Resilient Communities initiative where we adopt ZIP codes based on babies born in poverty. Your life expectancy should not be predicated by the ZIP code where you’re born. In Miami, one of the ZIP codes with the highest child poverty rates is 33142, the Allapattah-Brownsville area. When we began working with community leaders, we did not go in with a prescribed method to help. We listened.

What we heard was that only about 30% of the people in the area had a car or a driver’s license. That means 70% needed help with transportation. How are they getting their healthy checks, blood pressure checks, and A1C checks? They also did not have a main neighborhood grocery store. They had few places to go for fruit and vegetables.

So Florida Blue invested more than $1 million and created La Bodega inside the Allapattah YMCA, where the community can come and get fresh fruit and fresh vegetables for free. We are also working with FIU, Miami-Dade College, local schools, and Jackson Health System to get health mobiles into the community because of that transportation issue, and to get ahead of strokes and heart attacks by helping people manage blood pressure, A1C, kidney disease, and other conditions. We also look all the way down into the Keys at getting dental trucks to schools for underserved children who have teeth issues that can lead to health issues as they become adults.

We have another ZIP code, 33311, in Fort Lauderdale’s Sitrunk area, where babies are also being born into poverty at one of the highest levels in the state. We work with their neighborhood YMCA family center to offer swimming lessons and daycare. The area did not have prenatal care, so we partnered with Holy Cross Hospital and helped open an urgent care clinic on the premises of the YMCA, where young women can get ultrasounds and prenatal vitamins. Before that, many of them would not get care until they showed up in the ER pregnant.

We also have a claims office in Dillard High School. We have high school students assisting with our claims, and we are paying them while they are in school. We have a claims manager there to supervise, and we are training students in claims processing, with some of them earning $12, $14, $15, or $20 an hour. We are living our mission and our vision, and we do that every day.

How do nutrition and broader community outreach fit into that mission?

We are committed to supporting healthy living through our many community impact partnerships, including Inter Miami and the Florida Panthers. We insure both teams as well. When the Panthers score a goal, we provide 650 meals for every goal. We make sure they are healthy meals, and over the year, that can add up to around 120,000 meals for homeless or needy families. Our Florida Blue team packages the meals, and social workers go out and distribute them.

We also work with Camillus House, which supports homeless populations throughout Miami-Dade. Some people are homeless because of mental illness, and they do not want to come into a shelter. Through that program, if they cannot be brought into the shelter, a team that includes a doctor, nurses, and social workers goes out and delivers medicine and food where they are.

I could talk for hours about what Florida Blue is doing. I am blessed to be in a position to give back to the community that gave me so much. Through Florida Blue, we are doing a lot of good, and I’m honored to be able to tell that story.