1 00:00:00,280 --> 00:00:03,180 Thank you for listening to the Becker's Healthcare Podcast. I'm Molly Gamble, 2 00:00:03,240 --> 00:00:07,180 and today I have the privilege of speaking with Michael Lof. Since 2010, 3 00:00:07,180 --> 00:00:10,540 Michael has served as president and c e o of Cape Cod Healthcare, 4 00:00:10,660 --> 00:00:15,060 a regional health system with more than 450 physicians and 5,300 employees, 5 00:00:15,060 --> 00:00:17,660 which is comprised of two acute care hospitals, 6 00:00:18,000 --> 00:00:20,820 the largest home health services agency on the Cape, 7 00:00:21,300 --> 00:00:22,940 a skilled nursing and rehab facility, 8 00:00:23,040 --> 00:00:25,820 and assisted living facility in numerous health programs. 9 00:00:26,230 --> 00:00:28,880 Michael has been with Cape Cod Healthcare since 2008, 10 00:00:28,880 --> 00:00:30,800 when he first joined the system as c o o. 11 00:00:31,220 --> 00:00:33,040 He has also spent time with Bristol Medical Center, 12 00:00:33,110 --> 00:00:37,000 part of the Walmart system in Tennessee, and Kma health system in Pennsylvania. 13 00:00:37,390 --> 00:00:40,760 Michael, thank you so much for joining me today. How are you doing? 14 00:00:40,860 --> 00:00:41,920 And where do we find you? 15 00:00:43,230 --> 00:00:46,130 Hi, Molly. Thank you for having me. Um, I'm doing great, 16 00:00:46,230 --> 00:00:51,130 and I hope you are as well. And I'm in Hyannis, uh, Massachusetts at, uh, 17 00:00:51,350 --> 00:00:53,290 at the corporate offices of Cape Cod Healthcare. 18 00:00:53,470 --> 00:00:56,530 That's so great. I, I'm really interested, Michael, 19 00:00:56,830 --> 00:01:01,370 in your market and, and the region in which Cape Cod finds itself. I, 20 00:01:01,410 --> 00:01:03,810 I thought we could start there, if you don't mind. Um, 21 00:01:03,810 --> 00:01:06,610 this health system has such a distinct market in part of the country. 22 00:01:07,190 --> 00:01:11,210 Can you share more about the patient demographics and also the seasonal volume 23 00:01:11,210 --> 00:01:13,690 patterns that Cape Cod Healthcare sees? 24 00:01:15,120 --> 00:01:19,330 Yeah, well, absolutely, and, and, you know, Cape Cod is, is so unique and, 25 00:01:19,470 --> 00:01:23,730 and to be honest, my first day on the job was my first day visiting the Cape, 26 00:01:23,830 --> 00:01:28,450 and, and I was so fortunate to, to, to find this incredible community. 27 00:01:29,070 --> 00:01:29,560 Um, 28 00:01:29,560 --> 00:01:34,450 what not many people realize is we go 40 miles out into the Atlantic Ocean, 29 00:01:34,450 --> 00:01:37,690 whether it's a peninsula or an island, depending upon who you ask. 30 00:01:37,830 --> 00:01:42,810 And we have 235,000 year round residents. Um, 31 00:01:43,070 --> 00:01:46,570 and what's so unique about that is we're the third oldest county in the country, 32 00:01:46,670 --> 00:01:51,650 so over 32% of our residents are over the age of 65. Um, so that creates, 33 00:01:51,910 --> 00:01:52,370 you know, 34 00:01:52,370 --> 00:01:56,130 a lot of interesting challenges with regard to access and chronic care, 35 00:01:56,150 --> 00:02:00,250 et cetera. Um, but what makes Cape Cod so, um, 36 00:02:00,310 --> 00:02:04,210 unique is the fact that we are an incredible destination for tourists. 37 00:02:05,190 --> 00:02:07,770 So from May through October, um, 38 00:02:08,110 --> 00:02:12,730 we swell from 235,000 people, um, in March, 39 00:02:13,350 --> 00:02:17,930 uh, by June, right? We're at 400,000. And by July, July 4th, 40 00:02:17,930 --> 00:02:22,690 there's 750,000 people on the Cape, and they stay for the next two months. 41 00:02:23,190 --> 00:02:28,130 Uh, and then we gradually go back to down to 235,000 by, by November. Um, 42 00:02:28,630 --> 00:02:32,010 so that, that incredible swell of people, you know, 43 00:02:32,010 --> 00:02:36,690 coupled with a really robust population that year-round, you know, 44 00:02:36,690 --> 00:02:38,770 creates so many incredible opportunities, 45 00:02:38,870 --> 00:02:42,570 but also challenges from a healthcare access perspective as well as treatment 46 00:02:42,570 --> 00:02:47,490 perspective. So, um, we're a little bit older. Uh, we have a big, uh, 47 00:02:47,490 --> 00:02:51,690 year-round population, but also that, that triples in size during summer months. 48 00:02:52,350 --> 00:02:54,530 Um, and our task is to treat, you know, 49 00:02:54,530 --> 00:02:57,930 everybody the same regardless of what day of the week or what month of the year 50 00:02:57,930 --> 00:02:58,763 you're here. 51 00:02:59,870 --> 00:03:01,490 Wow. You just shared a lot there, Michael and I, 52 00:03:01,610 --> 00:03:05,850 I am one of those people I did not realize the Cape is 40 miles out into the 53 00:03:05,970 --> 00:03:09,530 Atlantic Ocean. Um, the geography, I'm familiar with it, of course, 54 00:03:09,590 --> 00:03:11,410 but when you put it like that, I mean, that, 55 00:03:11,410 --> 00:03:15,570 that's a really important stat to keep in mind. And then, like you said, over a, 56 00:03:15,570 --> 00:03:18,530 about a third of the population, over 65, 57 00:03:19,120 --> 00:03:22,530 also some really staggering figures from March to June, 58 00:03:22,760 --> 00:03:27,490 July tripling as, as you just illustrated with, with tourist season. Um, 59 00:03:27,870 --> 00:03:28,630 I'm, I'm curious, 60 00:03:28,630 --> 00:03:33,530 how does the tourism aspect of Cape Cod affect how you think about 61 00:03:33,660 --> 00:03:37,210 population health or social determinants of health, given how, 62 00:03:37,230 --> 00:03:41,010 how much the flex the population can fluctuate and the people coming and going? 63 00:03:42,750 --> 00:03:45,480 Yeah, you know, it really does. It makes us think, uh, 64 00:03:45,480 --> 00:03:50,000 really I think proactively and creatively all year long. I mean, so, you know, 65 00:03:50,100 --> 00:03:53,840 how do we take care of and address the equity issues and social determinants of 66 00:03:53,840 --> 00:03:57,760 health issues, you know, on a year-round basis? Um, and, and, 67 00:03:57,780 --> 00:04:02,240 and they're really, you know, cross-cutting as well as as consistent, right? So, 68 00:04:02,380 --> 00:04:06,080 so we clearly know that, that, that we have to create access to care, 69 00:04:06,500 --> 00:04:11,080 and we are a safety net organization. We take care of everybody. Uh, 70 00:04:11,520 --> 00:04:14,400 regardless of, of what you have or, or where you're from, 71 00:04:14,470 --> 00:04:18,600 it's simply what's wrong. And I, I love that about our mission, but to create, 72 00:04:18,600 --> 00:04:23,040 you know, opportunities, we believe that primary care should be 15 minutes, uh, 73 00:04:23,040 --> 00:04:27,040 within where people live specialty care within 30 and, and pri and, 74 00:04:27,040 --> 00:04:31,600 and acute care within an hour. And, and that's not a, you know, a, a scientific, 75 00:04:32,260 --> 00:04:34,000 uh, rationality for that hour. 76 00:04:34,030 --> 00:04:37,360 It's how long it takes for an ambulance to get from Provincetown to Hyannis. 77 00:04:37,540 --> 00:04:41,800 That's how far out into the, into the ocean we go. So, you know, 78 00:04:41,900 --> 00:04:44,520 we focus really on creating those access points. 79 00:04:44,580 --> 00:04:48,200 We have six urgent care centers. We have 88 locations across the Cape, 80 00:04:48,230 --> 00:04:50,440 whether it be primary care and all the other, 81 00:04:50,780 --> 00:04:54,040 all the other assets that you mentioned in the introduction. Um, 82 00:04:54,040 --> 00:04:55,240 when we get into, you know, 83 00:04:55,240 --> 00:04:58,480 how are we going to improve the health of our population, whether it be, 84 00:04:58,740 --> 00:05:02,120 you know, on the shoulder months or whether it be, you know, in the, in, in, in, 85 00:05:02,140 --> 00:05:05,840 in the prime months, um, we're really thinking about first with access. 86 00:05:06,280 --> 00:05:09,200 Secondly, how can we get people there? Transportation is a, 87 00:05:09,300 --> 00:05:10,720 is a major issue for us. 88 00:05:10,900 --> 00:05:15,880 So we work so proactively with our local transit authority and actually have de 89 00:05:15,950 --> 00:05:17,840 dedicated bus routes, uh, 90 00:05:17,860 --> 00:05:21,760 across the Cape to both of our acute care hospitals as well as our outpatient 91 00:05:22,080 --> 00:05:25,640 locations. You know, we think about behavioral health access and, 92 00:05:25,640 --> 00:05:28,640 and how do we lessen, um, um, 93 00:05:28,710 --> 00:05:31,520 some of the delays in care and treatment that we can do. And, 94 00:05:31,520 --> 00:05:34,520 and we do that by number one, partnering with others across the cape, 95 00:05:34,520 --> 00:05:38,120 whether it be from community health centers to having our own, uh, 96 00:05:38,120 --> 00:05:41,920 institutions as well as private practitioners to creating the access that we 97 00:05:41,920 --> 00:05:45,560 need for behavioral health, food insecurity, instability. Um, 98 00:05:45,660 --> 00:05:50,120 we work really hard with all of our school systems, all of the local shelters, 99 00:05:50,500 --> 00:05:54,560 all of the pantries. How do we make sure that people have food? You know, 100 00:05:54,560 --> 00:05:58,020 there's, so, there's such a unique program on the Cape in which, you know, 101 00:05:58,310 --> 00:06:02,580 three or 400 kids go home on Fridays with backpacks full of food to get them 102 00:06:02,580 --> 00:06:05,100 through the weekend. And we do that very discreetly. 103 00:06:05,290 --> 00:06:10,100 This is a local organization that, that we, we just help support. But, you know, 104 00:06:10,100 --> 00:06:14,180 those types of programs exist here on the Cape that I think are, are so unique, 105 00:06:14,680 --> 00:06:17,940 um, and necessary. Um, and then just really going out, 106 00:06:18,490 --> 00:06:22,820 understanding who our population is, right? What are the surveys? What are, 107 00:06:22,820 --> 00:06:26,020 what are the, what's the demographic information, you know, we have, 108 00:06:26,120 --> 00:06:30,260 we have a robust interpreter services, uh, uh, program here on the Cape, 109 00:06:30,260 --> 00:06:33,900 and which 11 different languages can be addressed in real time. And, 110 00:06:34,120 --> 00:06:38,940 and we do that, um, across the Cape. And we do that because we're really a, 111 00:06:38,980 --> 00:06:41,980 a melting pot for the world here at Cape Cod. Um, 112 00:06:41,980 --> 00:06:44,900 people from all over the world come here to vacation, they come here to work, 113 00:06:44,900 --> 00:06:46,500 they come here to live. Um, 114 00:06:46,600 --> 00:06:49,300 so we have to be able to support that and make sure that we're addressing 115 00:06:49,620 --> 00:06:52,980 language barriers that exist. So, you know, and, and, and all that, 116 00:06:52,980 --> 00:06:55,780 the housing issues, we have housing issues here on the Cape that, 117 00:06:55,810 --> 00:06:58,740 that we're working hard to address collectively as a community, 118 00:06:58,800 --> 00:07:03,340 but they still impact our ability to recruit, impact, our ability to retain, um, 119 00:07:03,340 --> 00:07:07,060 because we're a very popular por tourism destination. And it also leads to, 120 00:07:07,200 --> 00:07:11,860 to other issues with regard to second homes, et cetera, et cetera. So, you know, 121 00:07:12,150 --> 00:07:15,620 we're trying to, to sit and proactively work to understand the needs, 122 00:07:15,690 --> 00:07:17,460 address the needs with our partners, 123 00:07:17,570 --> 00:07:21,420 partner with the Commonwealth of Massachusetts, uh, to create, uh, 124 00:07:21,700 --> 00:07:25,700 creative programs to address key needs and hopefully impact our community in a 125 00:07:25,700 --> 00:07:28,980 very positive way. Uh, that's the goal each and every day. Mm-hmm. 126 00:07:29,020 --> 00:07:30,460 and, and Michael, 127 00:07:30,710 --> 00:07:35,540 given that there's 235 residents that are on the Cape Year round, you know, 128 00:07:35,540 --> 00:07:38,220 when you talk about the population and community needs, is, 129 00:07:38,240 --> 00:07:42,620 is there one that listeners might find interesting or surprising, or, 130 00:07:42,640 --> 00:07:44,060 or that initially surprised you, 131 00:07:44,450 --> 00:07:48,860 just given how associated Cape Cod is with tourism and vacationers? 132 00:07:49,320 --> 00:07:52,140 Um, is there something you can share about the patient base you're working with 133 00:07:52,250 --> 00:07:57,070 that, that can illustrate the needs that are ongoing in year round? 134 00:07:57,820 --> 00:08:01,990 Well, I, you know, I think primary, primary healthcare needs, I, you know, 135 00:08:01,990 --> 00:08:06,510 what was so unique during the pandemic was how reliant 136 00:08:06,780 --> 00:08:11,630 some of our vulnerable populations were on our urgent care centers and how we 137 00:08:11,630 --> 00:08:13,950 were able to treat, and how we were able to test, 138 00:08:13,970 --> 00:08:17,390 and how we were even able to vaccinate all through a very, 139 00:08:17,500 --> 00:08:21,790 very confidential process where people felt comfortable coming to us. You know, 140 00:08:21,970 --> 00:08:26,550 we were one of the few communities that had, uh, our own, um, 141 00:08:26,550 --> 00:08:29,230 testing site, um, our own vaccination site. 142 00:08:29,770 --> 00:08:33,430 And I can't tell you how many people came with, with one appointment slot, 143 00:08:33,450 --> 00:08:37,390 but actually eight people were in the car, uh, all wanting to get vaccinated. 144 00:08:37,530 --> 00:08:41,310 And, and how we worked through that process to ensure that we protected our 145 00:08:41,310 --> 00:08:44,750 community. I think, as I mentioned, also, our interpretive services, 146 00:08:44,840 --> 00:08:48,630 being able to meet people where they are from a language perspective, um, 147 00:08:48,630 --> 00:08:53,350 make sure that that healthcare, which is very scary to so many, um, um, 148 00:08:53,610 --> 00:08:58,220 had a, had a, uh, a more, uh, respectful and, and, and, 149 00:08:58,280 --> 00:08:59,540 and polite approach, 150 00:09:00,160 --> 00:09:03,900 making sure that we underst they understood what was going on, uh, 151 00:09:03,900 --> 00:09:08,340 what was being prescribed, what was needed, what was necessary. Um, I think, 152 00:09:08,340 --> 00:09:10,140 as I mentioned also, uh, 153 00:09:10,650 --> 00:09:14,500 some of our vulnerable populations when it comes to housing and when it comes 154 00:09:14,640 --> 00:09:19,060 to, to food, those, those basic necessities and transportation. Um, 155 00:09:19,320 --> 00:09:23,660 how do we make sure that we address those in real time? And, and it's not easy. 156 00:09:23,850 --> 00:09:24,560 It's not easy, 157 00:09:24,560 --> 00:09:28,980 but being able to go and actually be a part of programs to go in to people's 158 00:09:28,980 --> 00:09:33,620 homes to help them with heating issues, to help them with, um, with, 159 00:09:33,770 --> 00:09:34,130 with, 160 00:09:34,130 --> 00:09:38,300 with food issues to ensure that we're not leaving these vulnerable populations 161 00:09:38,400 --> 00:09:42,460 behind. So, you know, gaining that trust, working with, um, 162 00:09:42,470 --> 00:09:45,780 leadership of these, of these communities and, and, 163 00:09:45,800 --> 00:09:50,500 and ensuring that we're being a part of, of the solution with them, um, 164 00:09:50,600 --> 00:09:53,100 not walking in as, as if we have all the answers, 165 00:09:53,240 --> 00:09:57,700 but wanting to be a part of a process that empowers them and can really empower 166 00:09:57,700 --> 00:10:01,060 them to, to receive the healthcare they need and ultimately improve their lives. 167 00:10:01,460 --> 00:10:04,020 I think what's so unique and, 168 00:10:04,120 --> 00:10:07,260 and gratifying about the opportunity ahead with health equity, 169 00:10:07,610 --> 00:10:12,500 it's how do we really create meaningful strategies and plans with 170 00:10:12,520 --> 00:10:17,140 our communities, with our governmental leaders and ensure that, 171 00:10:17,170 --> 00:10:20,980 that we're actually making a big difference. Not a little difference. 172 00:10:21,020 --> 00:10:23,020 I know you have to crawl before your walk, but ultimately, 173 00:10:23,100 --> 00:10:27,540 a big difference in improving the lives of so many by simply improving their 174 00:10:27,620 --> 00:10:31,580 healthcare status. Um, so those are some of the programs that we work on as, 175 00:10:31,600 --> 00:10:34,700 as I said, as, as, as simple as it may sound to many, 176 00:10:34,720 --> 00:10:37,460 having dedicated bus routes for people to be able to, 177 00:10:37,680 --> 00:10:41,380 to get a free ride to their doctor, doctor's appointment or, 178 00:10:41,440 --> 00:10:45,660 or to the hospital if necessary. Those things make a difference collectively. 179 00:10:46,120 --> 00:10:48,460 Um, you build up trust, and at the end of the day, 180 00:10:48,460 --> 00:10:49,780 we hope to improve their health status. 181 00:10:50,280 --> 00:10:53,680 Mm-hmm. and at a time when the physician shortage and, 182 00:10:53,740 --> 00:10:58,240 and staffing is posing such a challenge to hospitals universally and health 183 00:10:58,240 --> 00:10:59,680 systems universally across the country, 184 00:11:00,340 --> 00:11:05,000 I'm really curious about how you count for going from about, you know, 185 00:11:05,620 --> 00:11:08,200 one fourth to three quarters of a million in, 186 00:11:08,200 --> 00:11:12,480 in terms of the population Cape Cod sees in just a matter of months. 187 00:11:13,020 --> 00:11:15,560 How do you rightsize that with your physician workforce, 188 00:11:15,560 --> 00:11:19,920 Michael h how can you talk to us about physician recruitment, retention, um, 189 00:11:20,190 --> 00:11:22,320 flexibility throughout the course of a year? 190 00:11:22,880 --> 00:11:25,200 H how is your organization fairing and like, what, 191 00:11:25,430 --> 00:11:28,680 what levers do you really lean on to account for that big change? 192 00:11:30,310 --> 00:11:34,810 You know, we, we are very self-reliant on the Cape. Um, you know, 193 00:11:35,090 --> 00:11:38,610 a place like ours never goes on diversion. It's just not an option for us. 194 00:11:38,830 --> 00:11:42,130 We understand how busy the hospitals in Boston are right now, 195 00:11:42,290 --> 00:11:47,210 particularly with the impact of the pandemic. But the fact of the matter is, 196 00:11:47,300 --> 00:11:52,010 we've gotten really good at treating and taking care of 750,000 people when they 197 00:11:52,010 --> 00:11:55,500 need us. I, I think the single best thing we did is start, uh, 198 00:11:55,520 --> 00:11:57,860 six urgent care locations over the past 10 years, 199 00:11:58,320 --> 00:12:01,820 all staffed with board certified ER physicians. Um, 200 00:12:02,040 --> 00:12:05,620 and the same staff that you see in the urgent care centers are the same staff 201 00:12:05,620 --> 00:12:06,980 that you're going to see in our ERs. 202 00:12:07,280 --> 00:12:11,660 And the commitment to lowering the cost by half and improving efficiency, 203 00:12:12,120 --> 00:12:15,700 you know, 95% out, uh, within, within 60 minutes, 204 00:12:16,240 --> 00:12:17,540 really adds value. 205 00:12:17,640 --> 00:12:21,180 And that really reduces the number of people coming to our ERs. 206 00:12:21,640 --> 00:12:25,660 The biggest in increases we see are, are, are frankly pretty obvious, right? 207 00:12:25,880 --> 00:12:26,713 Urgent care. 208 00:12:26,920 --> 00:12:31,220 We saw 128,000 people in our urgent care spaces last year, 209 00:12:31,690 --> 00:12:35,140 coupled with the busiest ERs in the Commonwealth for three months, 210 00:12:35,680 --> 00:12:37,300 the summer months. So, you know, 211 00:12:37,320 --> 00:12:41,340 we will see literally 600 people on the 4th of July. Um, 212 00:12:41,400 --> 00:12:42,620 and that's just in our ERs, 213 00:12:42,690 --> 00:12:47,300 that doesn't call into account all of the urgent care touches outpatient is 214 00:12:47,300 --> 00:12:49,220 exponentially busier. Um, 215 00:12:49,220 --> 00:12:53,300 and then you see an increase in surgery because with 750,000 people here, 216 00:12:53,300 --> 00:12:56,980 you can imagine the accidents that occur and even the health related conditions 217 00:12:56,980 --> 00:13:01,300 that occur. So that's where we see most of our increases year round. 218 00:13:01,300 --> 00:13:05,740 We're running above 90% from an inpatient perspective, uh, in terms of capacity. 219 00:13:06,320 --> 00:13:06,600 Um, 220 00:13:06,600 --> 00:13:10,700 so all of the additive services are really in the locations and services that I 221 00:13:10,700 --> 00:13:12,260 just mentioned. For instance, 222 00:13:12,280 --> 00:13:16,660 we need a hundred additional RNs to handle the population in the summer months. 223 00:13:17,240 --> 00:13:21,780 Um, we'll add another 15 to 20 docs to round out all the different touches and 224 00:13:22,100 --> 00:13:25,820 locations, whether it be in radiology, whether it be in outpatient testing, 225 00:13:26,360 --> 00:13:30,020 urgent care surgery, we just have to add. But what's, 226 00:13:30,020 --> 00:13:31,740 what's so interesting in many of those areas, 227 00:13:31,830 --> 00:13:33,860 we're not just getting random locums in, 228 00:13:34,070 --> 00:13:36,260 these are people that come back on an annual basis. 229 00:13:36,800 --> 00:13:40,020 And what's so interesting about most of our travelers in the summer is they've 230 00:13:40,020 --> 00:13:42,820 been coming to us from for five and 10 and 15 years. 231 00:13:43,280 --> 00:13:46,860 So they'll come for 13 week stints. They build it into their schedule, and, 232 00:13:47,000 --> 00:13:48,300 and they're part of our culture. 233 00:13:48,960 --> 00:13:52,340 So that's really where you see the increases really associated with those 234 00:13:52,340 --> 00:13:54,740 buckets. And, and frankly, we're used to doing it. 235 00:13:55,000 --> 00:13:57,580 We like to do it and we're ready to do it. Mm-hmm. 236 00:13:57,620 --> 00:14:00,860 . Well, Michael, I wanna thank you for your patience. And I, 237 00:14:01,000 --> 00:14:03,380 I'm really fascinated by Cape Cod. You've been there, you know, 238 00:14:03,380 --> 00:14:05,340 leading the system as c e O since 2010. 239 00:14:05,360 --> 00:14:09,540 So you are walking me through what I'm sure is just ordinary motions and dances 240 00:14:09,540 --> 00:14:12,900 for you and your system, but I find it none, nonetheless, really interesting. 241 00:14:13,520 --> 00:14:16,380 Um, if we zoom out a little bit, you know, Massachusetts, 242 00:14:16,920 --> 00:14:20,580 if we can talk about the state, it, it consistently ranks, or commonwealth, 243 00:14:20,660 --> 00:14:24,460 I should say, it consistently ranks among the healthiest in the nation. 244 00:14:24,850 --> 00:14:28,900 This holds, uh, it holds a number of rankings and, and data methodologies. 245 00:14:29,010 --> 00:14:32,900 Massachusetts comes out on top. Um, last summer, for instance, 246 00:14:32,900 --> 00:14:35,300 it ranked number one in the country for overall wellbeing, 247 00:14:35,300 --> 00:14:39,660 holding top spots for healthcare access, transportation, housing, 248 00:14:39,980 --> 00:14:44,780 finances, community food, a access and more. What contributes to this, 249 00:14:45,090 --> 00:14:49,980 what makes Massachusetts such a stellar symbol of health in America? 250 00:14:50,240 --> 00:14:55,180 And I'm curious from your perspective, is it come down to state investments? 251 00:14:55,330 --> 00:14:56,940 Does it invest differently than other states? 252 00:14:57,400 --> 00:15:01,180 And if there's anything scalable that Massachusetts is doing that could be 253 00:15:01,180 --> 00:15:02,260 replicated elsewhere? 254 00:15:03,870 --> 00:15:08,040 Well, I think one thing we learned from the pandemic is, um, 255 00:15:08,260 --> 00:15:10,840 how vital and necessary public health is. 256 00:15:11,660 --> 00:15:15,920 And I think that Massachusetts, uh, their approach, 257 00:15:16,300 --> 00:15:20,840 our approach to public health, um, is, is really, um, 258 00:15:21,400 --> 00:15:25,280 I think one of the best in the country. And, and I think the, 259 00:15:26,100 --> 00:15:29,360 the data and the statistics that you just said, you know, proves that out. 260 00:15:29,980 --> 00:15:33,120 You know, whether it be, uh, from the governor, um, 261 00:15:33,370 --> 00:15:36,440 right down through the department of, of public health, 262 00:15:36,460 --> 00:15:39,640 health and human services, you know, there's really a, 263 00:15:39,680 --> 00:15:42,080 a bidirectional loop of information occurring. 264 00:15:42,140 --> 00:15:44,280 So the plan is at the state level. Um, 265 00:15:44,280 --> 00:15:47,120 there's also additional plans at the local level, 266 00:15:47,980 --> 00:15:52,520 and the centralized approach to public health in Massachusetts really has this, 267 00:15:52,590 --> 00:15:57,120 this loop and the loop of information is closed, so we understand what, 268 00:15:57,190 --> 00:15:58,920 what has to occur and, 269 00:15:58,940 --> 00:16:02,360 and what the state wants us to do and how we partner with them to do it. 270 00:16:02,360 --> 00:16:07,360 And this isn't just in, in the, you know, Medicaid space. It's, it's, it's, 271 00:16:07,470 --> 00:16:10,960 it's a cross, uh, cross cutting of, of all the populations. 272 00:16:11,500 --> 00:16:15,960 And then we take that, and then each of our towns, um, have, you know, 273 00:16:15,960 --> 00:16:20,000 public health coordination, uh, and the state, you know, again, uh, 274 00:16:20,000 --> 00:16:21,920 details their plan. Um, 275 00:16:22,150 --> 00:16:26,920 then the local forces also get to add and give feedback to those 276 00:16:26,930 --> 00:16:31,040 plans, um, once implemented, um, whether it be immunizations, 277 00:16:31,040 --> 00:16:35,000 whether it be screenings, whether it be food, uh, you know, we, 278 00:16:35,140 --> 00:16:39,720 we work to ensure that people, um, get the services that they need. 279 00:16:39,740 --> 00:16:40,960 We have a lot of, 280 00:16:41,160 --> 00:16:44,840 a lot of social and public services here in Massachusetts. 281 00:16:45,300 --> 00:16:46,880 People can access them readily. 282 00:16:47,300 --> 00:16:51,320 And what's important is that information is then shared. Um, you know, 283 00:16:51,540 --> 00:16:55,840 we have so many things happening due to, again, a very diverse population, 284 00:16:55,840 --> 00:16:59,480 people coming in from all over the world. Um, and that, that, that, 285 00:16:59,480 --> 00:17:04,280 that sharing of information on information in a bidirectional manner, 286 00:17:04,480 --> 00:17:08,080 I think really adds value to what we're trying to achieve. Um, 287 00:17:08,260 --> 00:17:12,320 so I think really what separates us from many others is just this coordinated 288 00:17:12,380 --> 00:17:15,640 and dedicated approach to strong public health. Um, 289 00:17:15,920 --> 00:17:19,680 a lot of the incredible institutions are always, including us, 290 00:17:19,860 --> 00:17:24,080 are always working to try new ways to solve complex, um, 291 00:17:24,410 --> 00:17:27,680 situations and health crises. And, and, and again, 292 00:17:27,680 --> 00:17:29,640 there isn't really ego when it comes to public health. 293 00:17:29,670 --> 00:17:33,120 It's who's doing it well and how do we follow them. Mm-hmm. . So, 294 00:17:33,260 --> 00:17:37,160 um, that sharing of information, strong communication, I think separates us. 295 00:17:37,180 --> 00:17:40,080 And the strong investment into public health, uh, 296 00:17:40,180 --> 00:17:41,800 has really led to our positive results. 297 00:17:42,300 --> 00:17:44,320 Mm-hmm. , can, can you give an example? 298 00:17:44,350 --> 00:17:46,760 When you describe this closed loop of information, 299 00:17:46,860 --> 00:17:51,660 can you give an specific example of what that can look like and kind of contrast 300 00:17:51,720 --> 00:17:56,540 it with what might be a otherwise open loop of communication or a one 301 00:17:56,540 --> 00:17:58,420 way form of communication, Michael? 302 00:17:58,420 --> 00:18:01,100 Cause I think it seems like that's a really important distinction that you just 303 00:18:01,100 --> 00:18:01,933 made. 304 00:18:02,450 --> 00:18:05,700 Well, I, I, you know, if, if you think about immunizations and, and, 305 00:18:05,700 --> 00:18:10,340 and whether it be with, uh, the coronavirus or whether it be just with, 306 00:18:10,340 --> 00:18:15,100 with flu and, and, and, and other, uh, kids, particularly with pediatrics, 307 00:18:15,480 --> 00:18:17,820 you know, that, that information and immunization, 308 00:18:17,820 --> 00:18:20,140 which isn't new across the country, but it's, 309 00:18:20,330 --> 00:18:22,060 it's shared in real time back and forth, 310 00:18:22,120 --> 00:18:26,660 and the education actually occurs right at the local level and the state level. 311 00:18:27,040 --> 00:18:30,620 And that education plays such a key role in people trusting their physician, 312 00:18:30,620 --> 00:18:32,420 trusting their public health advisors, 313 00:18:32,640 --> 00:18:35,540 and getting those immunizations and all that information is shared. 314 00:18:35,880 --> 00:18:39,380 And I think something else that Massachusetts has done very well. Um, 315 00:18:39,380 --> 00:18:43,180 and when you think about capacity management and where people can really be 316 00:18:43,180 --> 00:18:45,860 treated, uh, proactively, uh, 317 00:18:45,930 --> 00:18:48,740 that information is shared real time across the state. 318 00:18:48,840 --> 00:18:52,620 And we work to make sure that we load balance, uh, to help, uh, 319 00:18:52,620 --> 00:18:53,780 people when they are full, 320 00:18:54,050 --> 00:18:58,180 when crises happen within specific communities or institutions that, you know, 321 00:18:58,180 --> 00:19:02,900 there's, there's really a, a call to action and, and how can we all jump in, uh, 322 00:19:02,900 --> 00:19:06,860 to alleviate some of the concerns and stressors out there. So, um, 323 00:19:07,660 --> 00:19:11,260 I just think those are, are small examples of, of what we really do well. 324 00:19:11,600 --> 00:19:12,180 And again, 325 00:19:12,180 --> 00:19:16,020 I think having a centralized approach to what we're trying to solve and then 326 00:19:16,020 --> 00:19:18,260 having the additive nature of what we do locally, 327 00:19:18,520 --> 00:19:21,380 and then the sharing of all that information leads to good outcomes. 328 00:19:21,960 --> 00:19:25,520 Mm-hmm. , well, I have to say as, as someone who has, you know, 329 00:19:25,520 --> 00:19:27,040 a bird's eye view so often, 330 00:19:27,220 --> 00:19:31,000 and although I'm sure Massachusetts two struggles with its setbacks and 331 00:19:31,000 --> 00:19:34,280 imperfections, like any state, any community, it is, 332 00:19:34,620 --> 00:19:39,080 it is inspiring Michael to see how, how much it's mastered. Um, 333 00:19:39,120 --> 00:19:42,400 I think there's a lot to learn there from, for other states, um, 334 00:19:42,400 --> 00:19:44,680 including my own of Illinois. So I, 335 00:19:44,720 --> 00:19:47,560 I just wanna give some credit in the tip of the hat because it seems like when 336 00:19:47,560 --> 00:19:52,000 it comes to public health and long-term and downstream effects of health and 337 00:19:52,000 --> 00:19:53,800 wellbeing, there's a lot that's going right. 338 00:19:55,780 --> 00:19:58,390 Yeah, there absolutely is. And, and, you know, 339 00:19:58,610 --> 00:20:03,390 we do the extraordinary exceptionally well in, in America, uh, 340 00:20:03,700 --> 00:20:03,990 what, 341 00:20:03,990 --> 00:20:07,350 what we try to do on the Cape and what I think is reflective of where we need to 342 00:20:07,350 --> 00:20:10,910 go as a country is doing the ordinary, exceptionally well mm-hmm. , 343 00:20:11,010 --> 00:20:13,910 and that means a, a strong, dedicated focus on public health. 344 00:20:14,210 --> 00:20:15,790 How do we avoid people getting sick? 345 00:20:16,040 --> 00:20:20,510 We're never gonna solve all the issues that are out there. Um, but if we make, 346 00:20:20,690 --> 00:20:23,630 you know, incremental steps, focus on small stuff, 347 00:20:24,100 --> 00:20:26,550 make sure that small stuff doesn't become big stuff, 348 00:20:26,810 --> 00:20:29,750 and that's how you win with public health. Make the investments, 349 00:20:29,770 --> 00:20:34,070 do the education, see positive results. Um, I, I don't think it's that hard. 350 00:20:34,350 --> 00:20:37,710 I think just, just, uh, parking the egos and, 351 00:20:37,790 --> 00:20:41,870 and the territorial disputes, um, solves a lot of problems. Mm-hmm. 352 00:20:41,910 --> 00:20:43,790 mm-hmm. , I love that. Doing the ordinary, 353 00:20:43,790 --> 00:20:47,330 extraordinarily well, a really good point. And before we wind down, Michael, 354 00:20:47,450 --> 00:20:51,250 I also just wanted to get a, a touch of information from you, if you will, 355 00:20:51,250 --> 00:20:55,010 about what you're seeing with the newer entrants that are trying to, 356 00:20:55,010 --> 00:20:56,930 or I shouldn't say trying to, um, 357 00:20:56,990 --> 00:20:58,810 I'm used to talking like it's still five years ago. 358 00:20:58,810 --> 00:21:01,810 They are in the healthcare delivery space, you know, c v s Minute Clinic, 359 00:21:01,960 --> 00:21:06,850 Walgreens, Kroger, seems like every 18 months there's another one. Um, 360 00:21:07,030 --> 00:21:10,130 how has this affected Cape Cod healthcare strategy, volumes, 361 00:21:10,130 --> 00:21:11,170 patient expectations, 362 00:21:11,790 --> 00:21:15,930 or given the defined market and being 40 miles into the Atlantic, 363 00:21:16,110 --> 00:21:19,570 is it not so much a, a threat or risk for Cape Cod? 364 00:21:21,380 --> 00:21:23,910 Well, I always believe in, you can contr, you know, 365 00:21:23,910 --> 00:21:28,270 you should focus on controlling what you can control. And, and that's why from, 366 00:21:28,410 --> 00:21:32,550 you know, our philosophy on where we want our services to be urgent care, 367 00:21:33,370 --> 00:21:36,950 uh, to community health, um, you know, control what you can control, 368 00:21:36,970 --> 00:21:40,510 and then you earn what you get. And, and we don't make excuses for that. 369 00:21:40,510 --> 00:21:43,710 We try to, you know, we know there's competition. Uh, 370 00:21:43,710 --> 00:21:46,310 we know that there's MinuteClinics, we know that there's new entrance. 371 00:21:46,410 --> 00:21:48,510 We know that there's new telemedicine entrance. 372 00:21:48,570 --> 00:21:52,510 We know that there's hospital at home. We know that there's new VNA services, 373 00:21:52,700 --> 00:21:54,590 that there's, there's everybody wants something, 374 00:21:55,610 --> 00:22:00,030 and how can we differentiate ourselves? And, and we, we try to do it through, 375 00:22:00,380 --> 00:22:03,830 through really the empowerment of our, of our physicians and workforce. 376 00:22:03,970 --> 00:22:06,550 We try to refine process, um, 377 00:22:06,610 --> 00:22:09,950 to ensure that we take variation out of it and improve what we do. 378 00:22:09,950 --> 00:22:12,990 And that's why urgent care is so successful. I mean, you think about it, 379 00:22:13,130 --> 00:22:14,710 we have board certified physicians. 380 00:22:14,770 --> 00:22:18,550 How many urgent care centers can say that ED physicians in urgent care, right? 381 00:22:18,930 --> 00:22:23,510 And we actually can still lower the cost by 50, 60%. So we believe in, 382 00:22:23,530 --> 00:22:25,910 in quality, we believe in efficiency, uh, 383 00:22:25,910 --> 00:22:29,190 we believe in taking variation out of process, and then you earn what you get. 384 00:22:29,370 --> 00:22:32,830 Now, what I think is so unique is, I know that a lot of companies just, 385 00:22:32,890 --> 00:22:37,190 or a lot of people just focus on the CBS's of the world and the Walgreens of the 386 00:22:37,190 --> 00:22:40,910 world and how everybody's become a healthcare company, right? Everybody's, oh, 387 00:22:40,910 --> 00:22:44,030 we're a healthcare company, everyone's rebranded, but oh, by the way, 388 00:22:44,030 --> 00:22:47,950 you can also go there and buy Twizzlers and Cokes and get your, you know, 389 00:22:47,950 --> 00:22:50,670 household goods. Um, we're a little different. Uh, 390 00:22:50,670 --> 00:22:52,190 we're a safety net institution, 391 00:22:52,210 --> 00:22:56,270 and I think that's what separates hospitals and health systems from everybody 392 00:22:56,380 --> 00:22:58,630 else. When the pandemic needed us, 393 00:22:58,690 --> 00:23:02,310 we proved that we had the ability to not only manage it, 394 00:23:02,410 --> 00:23:07,030 but do it exceptionally well to be here for everybody. Um, but I think, so I, 395 00:23:07,250 --> 00:23:07,610 you know, 396 00:23:07,610 --> 00:23:11,830 my point isn't just about the surgery centers and the walk-in centers and the 397 00:23:11,830 --> 00:23:16,150 MinuteClinics, it's also what's changed in healthcare today is now, 398 00:23:16,920 --> 00:23:17,300 you know, 399 00:23:17,300 --> 00:23:21,060 your competitor next door that used to be your friend trying to get your 400 00:23:21,060 --> 00:23:25,860 physicians and trying to recruit your nurses and trying to recruit X, Y, and Z. 401 00:23:26,930 --> 00:23:31,060 It's, we've, we've absolutely lost, in my opinion, rationality, it's, 402 00:23:31,060 --> 00:23:35,740 let's go pick the other person's pocket so we can really hide our ills. 403 00:23:36,320 --> 00:23:39,740 Um, so the rules of engagement, I think have changed in this space, and it, 404 00:23:39,740 --> 00:23:44,660 it really is more of a, a all hands on deck and, and, and look out for yourself. 405 00:23:44,720 --> 00:23:48,820 And, and I don't think that that's necessarily healthy. Um, but the fact is, 406 00:23:48,820 --> 00:23:50,020 it's here. Um, 407 00:23:50,040 --> 00:23:54,700 so you have to really show why your healthcare institution is different, um, 408 00:23:54,960 --> 00:23:58,100 how, how you can, you know, grow when you're employed here with us, 409 00:23:58,560 --> 00:24:03,140 and you have to focus on quality, and you have to focus on the patient. So, 410 00:24:03,160 --> 00:24:05,580 you know, that's where we are. We, we focus, you know, 411 00:24:05,580 --> 00:24:08,500 Molly on controlling what we can control, and, uh, 412 00:24:08,500 --> 00:24:09,900 we generally like where we end up. 413 00:24:10,200 --> 00:24:12,690 Mm-hmm. , that makes so much sense. My client, 414 00:24:12,810 --> 00:24:15,850 I even think that's probably contributing to my slip of saying that they're 415 00:24:15,850 --> 00:24:18,050 trying to move into healthcare delivery and, and that space, 416 00:24:18,050 --> 00:24:21,450 because it's been coming for years and years, it's been discussed. 417 00:24:21,550 --> 00:24:22,450 And then I still, 418 00:24:22,890 --> 00:24:27,650 I still mentally quite see health systems in a completely different box than I 419 00:24:27,670 --> 00:24:31,250 do c v s, MinuteClinics, Walgreens, and perhaps wrongfully. 420 00:24:31,270 --> 00:24:33,530 So perhaps I really need to challenge that thinking. 421 00:24:33,670 --> 00:24:36,890 But from everything you just described in terms of the mission, the safety net, 422 00:24:37,110 --> 00:24:40,930 um, in terms of how integrated you are in the community, um, I, 423 00:24:41,170 --> 00:24:45,410 I have yet to see them move close to that, um, 424 00:24:45,550 --> 00:24:46,530 not only for Cape Co, 425 00:24:46,530 --> 00:24:48,850 but for many of the other great safety nets in the country too. 426 00:24:49,950 --> 00:24:50,480 Yeah. I, 427 00:24:50,480 --> 00:24:53,920 I think what was so unique about coming out of this pandemic is how quickly 428 00:24:53,920 --> 00:24:57,360 people forgot the vital role that hospitals played in it, 429 00:24:57,710 --> 00:24:59,920 whether it be through funding and, and, and, 430 00:24:59,920 --> 00:25:04,080 and the fact of the matter is we're not out of the financial crisis, right? The, 431 00:25:04,140 --> 00:25:08,640 the, the, the traveler issues, the locums issues, people have changed their, 432 00:25:08,640 --> 00:25:13,360 their practices. Some people just wanna go from community to community. Now, um, 433 00:25:13,900 --> 00:25:17,480 the one thing is clear. Our mission is incredible, 434 00:25:17,740 --> 00:25:22,080 but we also need to evolve. We can't simply stand by and say, oh, 435 00:25:22,310 --> 00:25:25,640 look at us. Look what we did. We have to evolve with the times. 436 00:25:25,820 --> 00:25:29,200 We know that employees are only gonna be with us x number of years now, 437 00:25:29,260 --> 00:25:32,480 not the the 30 year strategy of 10 or 15 years ago. 438 00:25:32,740 --> 00:25:35,560 So how do we invest in them with the hope that if they do leave, 439 00:25:35,560 --> 00:25:39,080 they'll come back? Um, how do we empower our workforce? Um, 440 00:25:39,100 --> 00:25:42,840 how do we make sure that vulnerable communities have access to great jobs and 441 00:25:42,840 --> 00:25:43,660 career ladders? 442 00:25:43,660 --> 00:25:47,080 And we're doing that with English as a second language employment program, 443 00:25:47,350 --> 00:25:51,320 working with our community college to, to offer scholarships to, uh, 444 00:25:51,380 --> 00:25:55,040 to these incredible young people that want to enter this even better profession. 445 00:25:55,420 --> 00:25:56,600 How do we create those, 446 00:25:56,600 --> 00:26:00,840 those meaningful opportunities for employment all at the same time, uh, while, 447 00:26:00,900 --> 00:26:03,560 uh, meeting our mission? Um, I think we are different, 448 00:26:03,700 --> 00:26:06,800 but it doesn't mean we can rest on our laurels and not evolve. 449 00:26:07,260 --> 00:26:09,680 We have to evolve and we have to change with the times as well. 450 00:26:11,220 --> 00:26:12,510 Michael, I wanna thank you. 451 00:26:12,530 --> 00:26:16,470 You've been so great about painting a realistic and textured picture about Cape 452 00:26:16,530 --> 00:26:18,670 Cod Healthcare today, while also, as you just did, 453 00:26:18,670 --> 00:26:22,990 signaling what's to come and the needed evolution in the, in moving ahead. 454 00:26:23,370 --> 00:26:26,910 Is there anything we didn't touch on in our time together that you'd be re 455 00:26:27,150 --> 00:26:28,990 remiss not to make mention of? No. 456 00:26:29,410 --> 00:26:33,550 I'd just always like to end by thanking, um, everybody that works in healthcare, 457 00:26:33,650 --> 00:26:38,390 our frontline staff, um, our physicians, um, our volunteers. 458 00:26:38,640 --> 00:26:41,710 Healthcare is the consummate team sport. Everybody plays a role, 459 00:26:41,710 --> 00:26:45,940 whether you're in finance, whether you're in it, whether you're a nurse or, or, 460 00:26:46,080 --> 00:26:50,780 or, or an e vs staffer. Um, everybody plays such a vital role to this mission. 461 00:26:50,780 --> 00:26:54,660 And I, I just wanna thank all of all of the people that work within this space. 462 00:26:56,020 --> 00:26:58,130 Great. I will return the thanks to you, Michael, 463 00:26:58,130 --> 00:27:02,210 president and c e o of Cape Cod Healthcare for being my guest today and joining 464 00:27:02,210 --> 00:27:04,050 the Becker's Healthcare Podcast. Thank you. 465 00:27:04,920 --> 00:27:06,670 Molly. Thank you so much. Have a great day.