Thank you for listening to the Becker's Healthcare Podcast. I'm Molly Gamble,
and today I have the privilege of speaking with Michael Lof. Since 2010,
Michael has served as president and c e o of Cape Cod Healthcare,
a regional health system with more than 450 physicians and 5,300 employees,
which is comprised of two acute care hospitals,
the largest home health services agency on the Cape,
a skilled nursing and rehab facility,
and assisted living facility in numerous health programs.
Michael has been with Cape Cod Healthcare since 2008,
when he first joined the system as c o o.
He has also spent time with Bristol Medical Center,
part of the Walmart system in Tennessee, and Kma health system in Pennsylvania.
Michael, thank you so much for joining me today. How are you doing?
And where do we find you?
Hi, Molly. Thank you for having me. Um, I'm doing great,
and I hope you are as well. And I'm in Hyannis, uh, Massachusetts at, uh,
at the corporate offices of Cape Cod Healthcare.
That's so great. I, I'm really interested, Michael,
in your market and, and the region in which Cape Cod finds itself. I,
I thought we could start there, if you don't mind. Um,
this health system has such a distinct market in part of the country.
Can you share more about the patient demographics and also the seasonal volume
patterns that Cape Cod Healthcare sees?
Yeah, well, absolutely, and, and, you know, Cape Cod is, is so unique and,
and to be honest, my first day on the job was my first day visiting the Cape,
and, and I was so fortunate to, to, to find this incredible community.
Um,
what not many people realize is we go 40 miles out into the Atlantic Ocean,
whether it's a peninsula or an island, depending upon who you ask.
And we have 235,000 year round residents. Um,
and what's so unique about that is we're the third oldest county in the country,
so over 32% of our residents are over the age of 65. Um, so that creates,
you know,
a lot of interesting challenges with regard to access and chronic care,
et cetera. Um, but what makes Cape Cod so, um,
unique is the fact that we are an incredible destination for tourists.
So from May through October, um,
we swell from 235,000 people, um, in March,
uh, by June, right? We're at 400,000. And by July, July 4th,
there's 750,000 people on the Cape, and they stay for the next two months.
Uh, and then we gradually go back to down to 235,000 by, by November. Um,
so that, that incredible swell of people, you know,
coupled with a really robust population that year-round, you know,
creates so many incredible opportunities,
but also challenges from a healthcare access perspective as well as treatment
perspective. So, um, we're a little bit older. Uh, we have a big, uh,
year-round population, but also that, that triples in size during summer months.
Um, and our task is to treat, you know,
everybody the same regardless of what day of the week or what month of the year
you're here.
Wow. You just shared a lot there, Michael and I,
I am one of those people I did not realize the Cape is 40 miles out into the
Atlantic Ocean. Um, the geography, I'm familiar with it, of course,
but when you put it like that, I mean, that,
that's a really important stat to keep in mind. And then, like you said, over a,
about a third of the population, over 65,
also some really staggering figures from March to June,
July tripling as, as you just illustrated with, with tourist season. Um,
I'm, I'm curious,
how does the tourism aspect of Cape Cod affect how you think about
population health or social determinants of health, given how,
how much the flex the population can fluctuate and the people coming and going?
Yeah, you know, it really does. It makes us think, uh,
really I think proactively and creatively all year long. I mean, so, you know,
how do we take care of and address the equity issues and social determinants of
health issues, you know, on a year-round basis? Um, and, and,
and they're really, you know, cross-cutting as well as as consistent, right? So,
so we clearly know that, that, that we have to create access to care,
and we are a safety net organization. We take care of everybody. Uh,
regardless of, of what you have or, or where you're from,
it's simply what's wrong. And I, I love that about our mission, but to create,
you know, opportunities, we believe that primary care should be 15 minutes, uh,
within where people live specialty care within 30 and, and pri and,
and acute care within an hour. And, and that's not a, you know, a, a scientific,
uh, rationality for that hour.
It's how long it takes for an ambulance to get from Provincetown to Hyannis.
That's how far out into the, into the ocean we go. So, you know,
we focus really on creating those access points.
We have six urgent care centers. We have 88 locations across the Cape,
whether it be primary care and all the other,
all the other assets that you mentioned in the introduction. Um,
when we get into, you know,
how are we going to improve the health of our population, whether it be,
you know, on the shoulder months or whether it be, you know, in the, in, in, in,
in the prime months, um, we're really thinking about first with access.
Secondly, how can we get people there? Transportation is a,
is a major issue for us.
So we work so proactively with our local transit authority and actually have de
dedicated bus routes, uh,
across the Cape to both of our acute care hospitals as well as our outpatient
locations. You know, we think about behavioral health access and,
and how do we lessen, um, um,
some of the delays in care and treatment that we can do. And,
and we do that by number one, partnering with others across the cape,
whether it be from community health centers to having our own, uh,
institutions as well as private practitioners to creating the access that we
need for behavioral health, food insecurity, instability. Um,
we work really hard with all of our school systems, all of the local shelters,
all of the pantries. How do we make sure that people have food? You know,
there's, so, there's such a unique program on the Cape in which, you know,
three or 400 kids go home on Fridays with backpacks full of food to get them
through the weekend. And we do that very discreetly.
This is a local organization that, that we, we just help support. But, you know,
those types of programs exist here on the Cape that I think are, are so unique,
um, and necessary. Um, and then just really going out,
understanding who our population is, right? What are the surveys? What are,
what are the, what's the demographic information, you know, we have,
we have a robust interpreter services, uh, uh, program here on the Cape,
and which 11 different languages can be addressed in real time. And,
and we do that, um, across the Cape. And we do that because we're really a,
a melting pot for the world here at Cape Cod. Um,
people from all over the world come here to vacation, they come here to work,
they come here to live. Um,
so we have to be able to support that and make sure that we're addressing
language barriers that exist. So, you know, and, and, and all that,
the housing issues, we have housing issues here on the Cape that,
that we're working hard to address collectively as a community,
but they still impact our ability to recruit, impact, our ability to retain, um,
because we're a very popular por tourism destination. And it also leads to,
to other issues with regard to second homes, et cetera, et cetera. So, you know,
we're trying to, to sit and proactively work to understand the needs,
address the needs with our partners,
partner with the Commonwealth of Massachusetts, uh, to create, uh,
creative programs to address key needs and hopefully impact our community in a
very positive way. Uh, that's the goal each and every day. Mm-hmm.
and, and Michael,
given that there's 235 residents that are on the Cape Year round, you know,
when you talk about the population and community needs, is,
is there one that listeners might find interesting or surprising, or,
or that initially surprised you,
just given how associated Cape Cod is with tourism and vacationers?
Um, is there something you can share about the patient base you're working with
that, that can illustrate the needs that are ongoing in year round?
Well, I, you know, I think primary, primary healthcare needs, I, you know,
what was so unique during the pandemic was how reliant
some of our vulnerable populations were on our urgent care centers and how we
were able to treat, and how we were able to test,
and how we were even able to vaccinate all through a very,
very confidential process where people felt comfortable coming to us. You know,
we were one of the few communities that had, uh, our own, um,
testing site, um, our own vaccination site.
And I can't tell you how many people came with, with one appointment slot,
but actually eight people were in the car, uh, all wanting to get vaccinated.
And, and how we worked through that process to ensure that we protected our
community. I think, as I mentioned, also, our interpretive services,
being able to meet people where they are from a language perspective, um,
make sure that that healthcare, which is very scary to so many, um, um,
had a, had a, uh, a more, uh, respectful and, and, and,
and polite approach,
making sure that we underst they understood what was going on, uh,
what was being prescribed, what was needed, what was necessary. Um, I think,
as I mentioned also, uh,
some of our vulnerable populations when it comes to housing and when it comes
to, to food, those, those basic necessities and transportation. Um,
how do we make sure that we address those in real time? And, and it's not easy.
It's not easy,
but being able to go and actually be a part of programs to go in to people's
homes to help them with heating issues, to help them with, um, with,
with,
with food issues to ensure that we're not leaving these vulnerable populations
behind. So, you know, gaining that trust, working with, um,
leadership of these, of these communities and, and,
and ensuring that we're being a part of, of the solution with them, um,
not walking in as, as if we have all the answers,
but wanting to be a part of a process that empowers them and can really empower
them to, to receive the healthcare they need and ultimately improve their lives.
I think what's so unique and,
and gratifying about the opportunity ahead with health equity,
it's how do we really create meaningful strategies and plans with
our communities, with our governmental leaders and ensure that,
that we're actually making a big difference. Not a little difference.
I know you have to crawl before your walk, but ultimately,
a big difference in improving the lives of so many by simply improving their
healthcare status. Um, so those are some of the programs that we work on as,
as I said, as, as, as simple as it may sound to many,
having dedicated bus routes for people to be able to,
to get a free ride to their doctor, doctor's appointment or,
or to the hospital if necessary. Those things make a difference collectively.
Um, you build up trust, and at the end of the day,
we hope to improve their health status.
Mm-hmm. and at a time when the physician shortage and,
and staffing is posing such a challenge to hospitals universally and health
systems universally across the country,
I'm really curious about how you count for going from about, you know,
one fourth to three quarters of a million in,
in terms of the population Cape Cod sees in just a matter of months.
How do you rightsize that with your physician workforce,
Michael h how can you talk to us about physician recruitment, retention, um,
flexibility throughout the course of a year?
H how is your organization fairing and like, what,
what levers do you really lean on to account for that big change?
You know, we, we are very self-reliant on the Cape. Um, you know,
a place like ours never goes on diversion. It's just not an option for us.
We understand how busy the hospitals in Boston are right now,
particularly with the impact of the pandemic. But the fact of the matter is,
we've gotten really good at treating and taking care of 750,000 people when they
need us. I, I think the single best thing we did is start, uh,
six urgent care locations over the past 10 years,
all staffed with board certified ER physicians. Um,
and the same staff that you see in the urgent care centers are the same staff
that you're going to see in our ERs.
And the commitment to lowering the cost by half and improving efficiency,
you know, 95% out, uh, within, within 60 minutes,
really adds value.
And that really reduces the number of people coming to our ERs.
The biggest in increases we see are, are, are frankly pretty obvious, right?
Urgent care.
We saw 128,000 people in our urgent care spaces last year,
coupled with the busiest ERs in the Commonwealth for three months,
the summer months. So, you know,
we will see literally 600 people on the 4th of July. Um,
and that's just in our ERs,
that doesn't call into account all of the urgent care touches outpatient is
exponentially busier. Um,
and then you see an increase in surgery because with 750,000 people here,
you can imagine the accidents that occur and even the health related conditions
that occur. So that's where we see most of our increases year round.
We're running above 90% from an inpatient perspective, uh, in terms of capacity.
Um,
so all of the additive services are really in the locations and services that I
just mentioned. For instance,
we need a hundred additional RNs to handle the population in the summer months.
Um, we'll add another 15 to 20 docs to round out all the different touches and
locations, whether it be in radiology, whether it be in outpatient testing,
urgent care surgery, we just have to add. But what's,
what's so interesting in many of those areas,
we're not just getting random locums in,
these are people that come back on an annual basis.
And what's so interesting about most of our travelers in the summer is they've
been coming to us from for five and 10 and 15 years.
So they'll come for 13 week stints. They build it into their schedule, and,
and they're part of our culture.
So that's really where you see the increases really associated with those
buckets. And, and frankly, we're used to doing it.
We like to do it and we're ready to do it. Mm-hmm.
. Well, Michael, I wanna thank you for your patience. And I,
I'm really fascinated by Cape Cod. You've been there, you know,
leading the system as c e O since 2010.
So you are walking me through what I'm sure is just ordinary motions and dances
for you and your system, but I find it none, nonetheless, really interesting.
Um, if we zoom out a little bit, you know, Massachusetts,
if we can talk about the state, it, it consistently ranks, or commonwealth,
I should say, it consistently ranks among the healthiest in the nation.
This holds, uh, it holds a number of rankings and, and data methodologies.
Massachusetts comes out on top. Um, last summer, for instance,
it ranked number one in the country for overall wellbeing,
holding top spots for healthcare access, transportation, housing,
finances, community food, a access and more. What contributes to this,
what makes Massachusetts such a stellar symbol of health in America?
And I'm curious from your perspective, is it come down to state investments?
Does it invest differently than other states?
And if there's anything scalable that Massachusetts is doing that could be
replicated elsewhere?
Well, I think one thing we learned from the pandemic is, um,
how vital and necessary public health is.
And I think that Massachusetts, uh, their approach,
our approach to public health, um, is, is really, um,
I think one of the best in the country. And, and I think the,
the data and the statistics that you just said, you know, proves that out.
You know, whether it be, uh, from the governor, um,
right down through the department of, of public health,
health and human services, you know, there's really a,
a bidirectional loop of information occurring.
So the plan is at the state level. Um,
there's also additional plans at the local level,
and the centralized approach to public health in Massachusetts really has this,
this loop and the loop of information is closed, so we understand what,
what has to occur and,
and what the state wants us to do and how we partner with them to do it.
And this isn't just in, in the, you know, Medicaid space. It's, it's, it's,
it's a cross, uh, cross cutting of, of all the populations.
And then we take that, and then each of our towns, um, have, you know,
public health coordination, uh, and the state, you know, again, uh,
details their plan. Um,
then the local forces also get to add and give feedback to those
plans, um, once implemented, um, whether it be immunizations,
whether it be screenings, whether it be food, uh, you know, we,
we work to ensure that people, um, get the services that they need.
We have a lot of,
a lot of social and public services here in Massachusetts.
People can access them readily.
And what's important is that information is then shared. Um, you know,
we have so many things happening due to, again, a very diverse population,
people coming in from all over the world. Um, and that, that, that,
that sharing of information on information in a bidirectional manner,
I think really adds value to what we're trying to achieve. Um,
so I think really what separates us from many others is just this coordinated
and dedicated approach to strong public health. Um,
a lot of the incredible institutions are always, including us,
are always working to try new ways to solve complex, um,
situations and health crises. And, and, and again,
there isn't really ego when it comes to public health.
It's who's doing it well and how do we follow them. Mm-hmm. . So,
um, that sharing of information, strong communication, I think separates us.
And the strong investment into public health, uh,
has really led to our positive results.
Mm-hmm. , can, can you give an example?
When you describe this closed loop of information,
can you give an specific example of what that can look like and kind of contrast
it with what might be a otherwise open loop of communication or a one
way form of communication, Michael?
Cause I think it seems like that's a really important distinction that you just
made.
Well, I, I, you know, if, if you think about immunizations and, and,
and whether it be with, uh, the coronavirus or whether it be just with,
with flu and, and, and, and other, uh, kids, particularly with pediatrics,
you know, that, that information and immunization,
which isn't new across the country, but it's,
it's shared in real time back and forth,
and the education actually occurs right at the local level and the state level.
And that education plays such a key role in people trusting their physician,
trusting their public health advisors,
and getting those immunizations and all that information is shared.
And I think something else that Massachusetts has done very well. Um,
and when you think about capacity management and where people can really be
treated, uh, proactively, uh,
that information is shared real time across the state.
And we work to make sure that we load balance, uh, to help, uh,
people when they are full,
when crises happen within specific communities or institutions that, you know,
there's, there's really a, a call to action and, and how can we all jump in, uh,
to alleviate some of the concerns and stressors out there. So, um,
I just think those are, are small examples of, of what we really do well.
And again,
I think having a centralized approach to what we're trying to solve and then
having the additive nature of what we do locally,
and then the sharing of all that information leads to good outcomes.
Mm-hmm. , well, I have to say as, as someone who has, you know,
a bird's eye view so often,
and although I'm sure Massachusetts two struggles with its setbacks and
imperfections, like any state, any community, it is,
it is inspiring Michael to see how, how much it's mastered. Um,
I think there's a lot to learn there from, for other states, um,
including my own of Illinois. So I,
I just wanna give some credit in the tip of the hat because it seems like when
it comes to public health and long-term and downstream effects of health and
wellbeing, there's a lot that's going right.
Yeah, there absolutely is. And, and, you know,
we do the extraordinary exceptionally well in, in America, uh,
what,
what we try to do on the Cape and what I think is reflective of where we need to
go as a country is doing the ordinary, exceptionally well mm-hmm. ,
and that means a, a strong, dedicated focus on public health.
How do we avoid people getting sick?
We're never gonna solve all the issues that are out there. Um, but if we make,
you know, incremental steps, focus on small stuff,
make sure that small stuff doesn't become big stuff,
and that's how you win with public health. Make the investments,
do the education, see positive results. Um, I, I don't think it's that hard.
I think just, just, uh, parking the egos and,
and the territorial disputes, um, solves a lot of problems. Mm-hmm.
mm-hmm. , I love that. Doing the ordinary,
extraordinarily well, a really good point. And before we wind down, Michael,
I also just wanted to get a, a touch of information from you, if you will,
about what you're seeing with the newer entrants that are trying to,
or I shouldn't say trying to, um,
I'm used to talking like it's still five years ago.
They are in the healthcare delivery space, you know, c v s Minute Clinic,
Walgreens, Kroger, seems like every 18 months there's another one. Um,
how has this affected Cape Cod healthcare strategy, volumes,
patient expectations,
or given the defined market and being 40 miles into the Atlantic,
is it not so much a, a threat or risk for Cape Cod?
Well, I always believe in, you can contr, you know,
you should focus on controlling what you can control. And, and that's why from,
you know, our philosophy on where we want our services to be urgent care,
uh, to community health, um, you know, control what you can control,
and then you earn what you get. And, and we don't make excuses for that.
We try to, you know, we know there's competition. Uh,
we know that there's MinuteClinics, we know that there's new entrance.
We know that there's new telemedicine entrance.
We know that there's hospital at home. We know that there's new VNA services,
that there's, there's everybody wants something,
and how can we differentiate ourselves? And, and we, we try to do it through,
through really the empowerment of our, of our physicians and workforce.
We try to refine process, um,
to ensure that we take variation out of it and improve what we do.
And that's why urgent care is so successful. I mean, you think about it,
we have board certified physicians.
How many urgent care centers can say that ED physicians in urgent care, right?
And we actually can still lower the cost by 50, 60%. So we believe in,
in quality, we believe in efficiency, uh,
we believe in taking variation out of process, and then you earn what you get.
Now, what I think is so unique is, I know that a lot of companies just,
or a lot of people just focus on the CBS's of the world and the Walgreens of the
world and how everybody's become a healthcare company, right? Everybody's, oh,
we're a healthcare company, everyone's rebranded, but oh, by the way,
you can also go there and buy Twizzlers and Cokes and get your, you know,
household goods. Um, we're a little different. Uh,
we're a safety net institution,
and I think that's what separates hospitals and health systems from everybody
else. When the pandemic needed us,
we proved that we had the ability to not only manage it,
but do it exceptionally well to be here for everybody. Um, but I think, so I,
you know,
my point isn't just about the surgery centers and the walk-in centers and the
MinuteClinics, it's also what's changed in healthcare today is now,
you know,
your competitor next door that used to be your friend trying to get your
physicians and trying to recruit your nurses and trying to recruit X, Y, and Z.
It's, we've, we've absolutely lost, in my opinion, rationality, it's,
let's go pick the other person's pocket so we can really hide our ills.
Um, so the rules of engagement, I think have changed in this space, and it,
it really is more of a, a all hands on deck and, and, and look out for yourself.
And, and I don't think that that's necessarily healthy. Um, but the fact is,
it's here. Um,
so you have to really show why your healthcare institution is different, um,
how, how you can, you know, grow when you're employed here with us,
and you have to focus on quality, and you have to focus on the patient. So,
you know, that's where we are. We, we focus, you know,
Molly on controlling what we can control, and, uh,
we generally like where we end up.
Mm-hmm. , that makes so much sense. My client,
I even think that's probably contributing to my slip of saying that they're
trying to move into healthcare delivery and, and that space,
because it's been coming for years and years, it's been discussed.
And then I still,
I still mentally quite see health systems in a completely different box than I
do c v s, MinuteClinics, Walgreens, and perhaps wrongfully.
So perhaps I really need to challenge that thinking.
But from everything you just described in terms of the mission, the safety net,
um, in terms of how integrated you are in the community, um, I,
I have yet to see them move close to that, um,
not only for Cape Co,
but for many of the other great safety nets in the country too.
Yeah. I,
I think what was so unique about coming out of this pandemic is how quickly
people forgot the vital role that hospitals played in it,
whether it be through funding and, and, and,
and the fact of the matter is we're not out of the financial crisis, right? The,
the, the, the traveler issues, the locums issues, people have changed their,
their practices. Some people just wanna go from community to community. Now, um,
the one thing is clear. Our mission is incredible,
but we also need to evolve. We can't simply stand by and say, oh,
look at us. Look what we did. We have to evolve with the times.
We know that employees are only gonna be with us x number of years now,
not the the 30 year strategy of 10 or 15 years ago.
So how do we invest in them with the hope that if they do leave,
they'll come back? Um, how do we empower our workforce? Um,
how do we make sure that vulnerable communities have access to great jobs and
career ladders?
And we're doing that with English as a second language employment program,
working with our community college to, to offer scholarships to, uh,
to these incredible young people that want to enter this even better profession.
How do we create those,
those meaningful opportunities for employment all at the same time, uh, while,
uh, meeting our mission? Um, I think we are different,
but it doesn't mean we can rest on our laurels and not evolve.
We have to evolve and we have to change with the times as well.
Michael, I wanna thank you.
You've been so great about painting a realistic and textured picture about Cape
Cod Healthcare today, while also, as you just did,
signaling what's to come and the needed evolution in the, in moving ahead.
Is there anything we didn't touch on in our time together that you'd be re
remiss not to make mention of? No.
I'd just always like to end by thanking, um, everybody that works in healthcare,
our frontline staff, um, our physicians, um, our volunteers.
Healthcare is the consummate team sport. Everybody plays a role,
whether you're in finance, whether you're in it, whether you're a nurse or, or,
or, or an e vs staffer. Um, everybody plays such a vital role to this mission.
And I, I just wanna thank all of all of the people that work within this space.
Great. I will return the thanks to you, Michael,
president and c e o of Cape Cod Healthcare for being my guest today and joining
the Becker's Healthcare Podcast. Thank you.
Molly. Thank you so much. Have a great day.