Latest / Becker’s Healthcare - Clinical Leadership Podcast / Michael Lauf, President & CEO of Cape Cod Healthcare

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Michael Lauf, President & CEO of Cape Cod Healthcare · Becker’s Healthcare - Clinical Leadership Podcast

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Thank you for listening to the Becker's Healthcare Podcast. I'm Molly Gamble,
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and today I have the privilege of speaking with Michael Lof. Since 2010,
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Michael has served as president and c e o of Cape Cod Healthcare,
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a regional health system with more than 450 physicians and 5,300 employees,
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which is comprised of two acute care hospitals,
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the largest home health services agency on the Cape,
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a skilled nursing and rehab facility,
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and assisted living facility in numerous health programs.
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Michael has been with Cape Cod Healthcare since 2008,
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when he first joined the system as c o o.
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He has also spent time with Bristol Medical Center,
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part of the Walmart system in Tennessee, and Kma health system in Pennsylvania.
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Michael, thank you so much for joining me today. How are you doing?
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And where do we find you?
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Hi, Molly. Thank you for having me. Um, I'm doing great,
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and I hope you are as well. And I'm in Hyannis, uh, Massachusetts at, uh,
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at the corporate offices of Cape Cod Healthcare.
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That's so great. I, I'm really interested, Michael,
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in your market and, and the region in which Cape Cod finds itself. I,
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I thought we could start there, if you don't mind. Um,
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this health system has such a distinct market in part of the country.
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Can you share more about the patient demographics and also the seasonal volume
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patterns that Cape Cod Healthcare sees?
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Yeah, well, absolutely, and, and, you know, Cape Cod is, is so unique and,
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and to be honest, my first day on the job was my first day visiting the Cape,
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and, and I was so fortunate to, to, to find this incredible community.
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Um,
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what not many people realize is we go 40 miles out into the Atlantic Ocean,
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whether it's a peninsula or an island, depending upon who you ask.
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And we have 235,000 year round residents. Um,
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and what's so unique about that is we're the third oldest county in the country,
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so over 32% of our residents are over the age of 65. Um, so that creates,
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you know,
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a lot of interesting challenges with regard to access and chronic care,
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et cetera. Um, but what makes Cape Cod so, um,
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unique is the fact that we are an incredible destination for tourists.
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So from May through October, um,
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we swell from 235,000 people, um, in March,
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uh, by June, right? We're at 400,000. And by July, July 4th,
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there's 750,000 people on the Cape, and they stay for the next two months.
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Uh, and then we gradually go back to down to 235,000 by, by November. Um,
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so that, that incredible swell of people, you know,
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coupled with a really robust population that year-round, you know,
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creates so many incredible opportunities,
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but also challenges from a healthcare access perspective as well as treatment
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perspective. So, um, we're a little bit older. Uh, we have a big, uh,
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year-round population, but also that, that triples in size during summer months.
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Um, and our task is to treat, you know,
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everybody the same regardless of what day of the week or what month of the year
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you're here.
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Wow. You just shared a lot there, Michael and I,
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I am one of those people I did not realize the Cape is 40 miles out into the
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Atlantic Ocean. Um, the geography, I'm familiar with it, of course,
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but when you put it like that, I mean, that,
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that's a really important stat to keep in mind. And then, like you said, over a,
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about a third of the population, over 65,
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also some really staggering figures from March to June,
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July tripling as, as you just illustrated with, with tourist season. Um,
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I'm, I'm curious,
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how does the tourism aspect of Cape Cod affect how you think about
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population health or social determinants of health, given how,
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how much the flex the population can fluctuate and the people coming and going?
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Yeah, you know, it really does. It makes us think, uh,
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really I think proactively and creatively all year long. I mean, so, you know,
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how do we take care of and address the equity issues and social determinants of
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health issues, you know, on a year-round basis? Um, and, and,
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and they're really, you know, cross-cutting as well as as consistent, right? So,
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so we clearly know that, that, that we have to create access to care,
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and we are a safety net organization. We take care of everybody. Uh,
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regardless of, of what you have or, or where you're from,
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it's simply what's wrong. And I, I love that about our mission, but to create,
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you know, opportunities, we believe that primary care should be 15 minutes, uh,
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within where people live specialty care within 30 and, and pri and,
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and acute care within an hour. And, and that's not a, you know, a, a scientific,
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uh, rationality for that hour.
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It's how long it takes for an ambulance to get from Provincetown to Hyannis.
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That's how far out into the, into the ocean we go. So, you know,
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we focus really on creating those access points.
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We have six urgent care centers. We have 88 locations across the Cape,
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whether it be primary care and all the other,
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all the other assets that you mentioned in the introduction. Um,
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when we get into, you know,
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how are we going to improve the health of our population, whether it be,
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you know, on the shoulder months or whether it be, you know, in the, in, in, in,
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in the prime months, um, we're really thinking about first with access.
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Secondly, how can we get people there? Transportation is a,
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is a major issue for us.
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So we work so proactively with our local transit authority and actually have de
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dedicated bus routes, uh,
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across the Cape to both of our acute care hospitals as well as our outpatient
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locations. You know, we think about behavioral health access and,
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and how do we lessen, um, um,
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some of the delays in care and treatment that we can do. And,
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and we do that by number one, partnering with others across the cape,
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whether it be from community health centers to having our own, uh,
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institutions as well as private practitioners to creating the access that we
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need for behavioral health, food insecurity, instability. Um,
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we work really hard with all of our school systems, all of the local shelters,
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all of the pantries. How do we make sure that people have food? You know,
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there's, so, there's such a unique program on the Cape in which, you know,
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three or 400 kids go home on Fridays with backpacks full of food to get them
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through the weekend. And we do that very discreetly.
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This is a local organization that, that we, we just help support. But, you know,
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those types of programs exist here on the Cape that I think are, are so unique,
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um, and necessary. Um, and then just really going out,
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understanding who our population is, right? What are the surveys? What are,
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what are the, what's the demographic information, you know, we have,
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we have a robust interpreter services, uh, uh, program here on the Cape,
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and which 11 different languages can be addressed in real time. And,
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and we do that, um, across the Cape. And we do that because we're really a,
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a melting pot for the world here at Cape Cod. Um,
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people from all over the world come here to vacation, they come here to work,
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they come here to live. Um,
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so we have to be able to support that and make sure that we're addressing
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language barriers that exist. So, you know, and, and, and all that,
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the housing issues, we have housing issues here on the Cape that,
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that we're working hard to address collectively as a community,
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but they still impact our ability to recruit, impact, our ability to retain, um,
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because we're a very popular por tourism destination. And it also leads to,
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to other issues with regard to second homes, et cetera, et cetera. So, you know,
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we're trying to, to sit and proactively work to understand the needs,
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address the needs with our partners,
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partner with the Commonwealth of Massachusetts, uh, to create, uh,
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creative programs to address key needs and hopefully impact our community in a
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very positive way. Uh, that's the goal each and every day. Mm-hmm.
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and, and Michael,
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given that there's 235 residents that are on the Cape Year round, you know,
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when you talk about the population and community needs, is,
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is there one that listeners might find interesting or surprising, or,
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or that initially surprised you,
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just given how associated Cape Cod is with tourism and vacationers?
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Um, is there something you can share about the patient base you're working with
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that, that can illustrate the needs that are ongoing in year round?
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Well, I, you know, I think primary, primary healthcare needs, I, you know,
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what was so unique during the pandemic was how reliant
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some of our vulnerable populations were on our urgent care centers and how we
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were able to treat, and how we were able to test,
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and how we were even able to vaccinate all through a very,
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very confidential process where people felt comfortable coming to us. You know,
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we were one of the few communities that had, uh, our own, um,
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testing site, um, our own vaccination site.
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And I can't tell you how many people came with, with one appointment slot,
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but actually eight people were in the car, uh, all wanting to get vaccinated.
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And, and how we worked through that process to ensure that we protected our
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community. I think, as I mentioned, also, our interpretive services,
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being able to meet people where they are from a language perspective, um,
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make sure that that healthcare, which is very scary to so many, um, um,
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had a, had a, uh, a more, uh, respectful and, and, and,
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and polite approach,
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making sure that we underst they understood what was going on, uh,
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what was being prescribed, what was needed, what was necessary. Um, I think,
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as I mentioned also, uh,
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some of our vulnerable populations when it comes to housing and when it comes
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to, to food, those, those basic necessities and transportation. Um,
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how do we make sure that we address those in real time? And, and it's not easy.
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It's not easy,
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but being able to go and actually be a part of programs to go in to people's
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homes to help them with heating issues, to help them with, um, with,
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with,
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with food issues to ensure that we're not leaving these vulnerable populations
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behind. So, you know, gaining that trust, working with, um,
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leadership of these, of these communities and, and,
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and ensuring that we're being a part of, of the solution with them, um,
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not walking in as, as if we have all the answers,
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but wanting to be a part of a process that empowers them and can really empower
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them to, to receive the healthcare they need and ultimately improve their lives.
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I think what's so unique and,
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and gratifying about the opportunity ahead with health equity,
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it's how do we really create meaningful strategies and plans with
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our communities, with our governmental leaders and ensure that,
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that we're actually making a big difference. Not a little difference.
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I know you have to crawl before your walk, but ultimately,
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a big difference in improving the lives of so many by simply improving their
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healthcare status. Um, so those are some of the programs that we work on as,
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as I said, as, as, as simple as it may sound to many,
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having dedicated bus routes for people to be able to,
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to get a free ride to their doctor, doctor's appointment or,
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or to the hospital if necessary. Those things make a difference collectively.
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Um, you build up trust, and at the end of the day,
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we hope to improve their health status.
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Mm-hmm. and at a time when the physician shortage and,
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and staffing is posing such a challenge to hospitals universally and health
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systems universally across the country,
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I'm really curious about how you count for going from about, you know,
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one fourth to three quarters of a million in,
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in terms of the population Cape Cod sees in just a matter of months.
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How do you rightsize that with your physician workforce,
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Michael h how can you talk to us about physician recruitment, retention, um,
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flexibility throughout the course of a year?
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H how is your organization fairing and like, what,
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what levers do you really lean on to account for that big change?
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You know, we, we are very self-reliant on the Cape. Um, you know,
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a place like ours never goes on diversion. It's just not an option for us.
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We understand how busy the hospitals in Boston are right now,
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particularly with the impact of the pandemic. But the fact of the matter is,
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we've gotten really good at treating and taking care of 750,000 people when they
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need us. I, I think the single best thing we did is start, uh,
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six urgent care locations over the past 10 years,
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all staffed with board certified ER physicians. Um,
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and the same staff that you see in the urgent care centers are the same staff
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that you're going to see in our ERs.
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And the commitment to lowering the cost by half and improving efficiency,
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you know, 95% out, uh, within, within 60 minutes,
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really adds value.
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And that really reduces the number of people coming to our ERs.
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The biggest in increases we see are, are, are frankly pretty obvious, right?
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Urgent care.
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We saw 128,000 people in our urgent care spaces last year,
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coupled with the busiest ERs in the Commonwealth for three months,
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the summer months. So, you know,
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we will see literally 600 people on the 4th of July. Um,
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and that's just in our ERs,
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that doesn't call into account all of the urgent care touches outpatient is
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exponentially busier. Um,
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and then you see an increase in surgery because with 750,000 people here,
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you can imagine the accidents that occur and even the health related conditions
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that occur. So that's where we see most of our increases year round.
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We're running above 90% from an inpatient perspective, uh, in terms of capacity.
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Um,
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so all of the additive services are really in the locations and services that I
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just mentioned. For instance,
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we need a hundred additional RNs to handle the population in the summer months.
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Um, we'll add another 15 to 20 docs to round out all the different touches and
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locations, whether it be in radiology, whether it be in outpatient testing,
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urgent care surgery, we just have to add. But what's,
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what's so interesting in many of those areas,
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we're not just getting random locums in,
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these are people that come back on an annual basis.
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And what's so interesting about most of our travelers in the summer is they've
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been coming to us from for five and 10 and 15 years.
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So they'll come for 13 week stints. They build it into their schedule, and,
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and they're part of our culture.
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So that's really where you see the increases really associated with those
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buckets. And, and frankly, we're used to doing it.
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We like to do it and we're ready to do it. Mm-hmm.
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. Well, Michael, I wanna thank you for your patience. And I,
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I'm really fascinated by Cape Cod. You've been there, you know,
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leading the system as c e O since 2010.
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So you are walking me through what I'm sure is just ordinary motions and dances
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for you and your system, but I find it none, nonetheless, really interesting.
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Um, if we zoom out a little bit, you know, Massachusetts,
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if we can talk about the state, it, it consistently ranks, or commonwealth,
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I should say, it consistently ranks among the healthiest in the nation.
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This holds, uh, it holds a number of rankings and, and data methodologies.
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Massachusetts comes out on top. Um, last summer, for instance,
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it ranked number one in the country for overall wellbeing,
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holding top spots for healthcare access, transportation, housing,
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finances, community food, a access and more. What contributes to this,
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what makes Massachusetts such a stellar symbol of health in America?
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And I'm curious from your perspective, is it come down to state investments?
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Does it invest differently than other states?
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And if there's anything scalable that Massachusetts is doing that could be
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replicated elsewhere?
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Well, I think one thing we learned from the pandemic is, um,
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how vital and necessary public health is.
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And I think that Massachusetts, uh, their approach,
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our approach to public health, um, is, is really, um,
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I think one of the best in the country. And, and I think the,
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the data and the statistics that you just said, you know, proves that out.
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You know, whether it be, uh, from the governor, um,
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right down through the department of, of public health,
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health and human services, you know, there's really a,
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a bidirectional loop of information occurring.
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So the plan is at the state level. Um,
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there's also additional plans at the local level,
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and the centralized approach to public health in Massachusetts really has this,
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this loop and the loop of information is closed, so we understand what,
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what has to occur and,
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and what the state wants us to do and how we partner with them to do it.
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And this isn't just in, in the, you know, Medicaid space. It's, it's, it's,
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it's a cross, uh, cross cutting of, of all the populations.
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And then we take that, and then each of our towns, um, have, you know,
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public health coordination, uh, and the state, you know, again, uh,
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details their plan. Um,
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then the local forces also get to add and give feedback to those
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plans, um, once implemented, um, whether it be immunizations,
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whether it be screenings, whether it be food, uh, you know, we,
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we work to ensure that people, um, get the services that they need.
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We have a lot of,
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a lot of social and public services here in Massachusetts.
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People can access them readily.
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And what's important is that information is then shared. Um, you know,
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we have so many things happening due to, again, a very diverse population,
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people coming in from all over the world. Um, and that, that, that,
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that sharing of information on information in a bidirectional manner,
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I think really adds value to what we're trying to achieve. Um,
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so I think really what separates us from many others is just this coordinated
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and dedicated approach to strong public health. Um,
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a lot of the incredible institutions are always, including us,
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are always working to try new ways to solve complex, um,
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situations and health crises. And, and, and again,
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there isn't really ego when it comes to public health.
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It's who's doing it well and how do we follow them. Mm-hmm. . So,
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um, that sharing of information, strong communication, I think separates us.
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And the strong investment into public health, uh,
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has really led to our positive results.
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Mm-hmm. , can, can you give an example?
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When you describe this closed loop of information,
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can you give an specific example of what that can look like and kind of contrast
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it with what might be a otherwise open loop of communication or a one
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way form of communication, Michael?
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Cause I think it seems like that's a really important distinction that you just
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made.
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Well, I, I, you know, if, if you think about immunizations and, and,
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and whether it be with, uh, the coronavirus or whether it be just with,
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with flu and, and, and, and other, uh, kids, particularly with pediatrics,
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you know, that, that information and immunization,
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which isn't new across the country, but it's,
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it's shared in real time back and forth,
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and the education actually occurs right at the local level and the state level.
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And that education plays such a key role in people trusting their physician,
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trusting their public health advisors,
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and getting those immunizations and all that information is shared.
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And I think something else that Massachusetts has done very well. Um,
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and when you think about capacity management and where people can really be
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treated, uh, proactively, uh,
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that information is shared real time across the state.
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And we work to make sure that we load balance, uh, to help, uh,
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people when they are full,
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when crises happen within specific communities or institutions that, you know,
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there's, there's really a, a call to action and, and how can we all jump in, uh,
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to alleviate some of the concerns and stressors out there. So, um,
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I just think those are, are small examples of, of what we really do well.
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And again,
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I think having a centralized approach to what we're trying to solve and then
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having the additive nature of what we do locally,
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and then the sharing of all that information leads to good outcomes.
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Mm-hmm. , well, I have to say as, as someone who has, you know,
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a bird's eye view so often,
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and although I'm sure Massachusetts two struggles with its setbacks and
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imperfections, like any state, any community, it is,
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it is inspiring Michael to see how, how much it's mastered. Um,
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I think there's a lot to learn there from, for other states, um,
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including my own of Illinois. So I,
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I just wanna give some credit in the tip of the hat because it seems like when
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it comes to public health and long-term and downstream effects of health and
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wellbeing, there's a lot that's going right.
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Yeah, there absolutely is. And, and, you know,
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we do the extraordinary exceptionally well in, in America, uh,
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what,
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what we try to do on the Cape and what I think is reflective of where we need to
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go as a country is doing the ordinary, exceptionally well mm-hmm. ,
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and that means a, a strong, dedicated focus on public health.
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How do we avoid people getting sick?
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We're never gonna solve all the issues that are out there. Um, but if we make,
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you know, incremental steps, focus on small stuff,
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make sure that small stuff doesn't become big stuff,
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and that's how you win with public health. Make the investments,
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do the education, see positive results. Um, I, I don't think it's that hard.
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I think just, just, uh, parking the egos and,
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and the territorial disputes, um, solves a lot of problems. Mm-hmm.
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mm-hmm. , I love that. Doing the ordinary,
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extraordinarily well, a really good point. And before we wind down, Michael,
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I also just wanted to get a, a touch of information from you, if you will,
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about what you're seeing with the newer entrants that are trying to,
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or I shouldn't say trying to, um,
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I'm used to talking like it's still five years ago.
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They are in the healthcare delivery space, you know, c v s Minute Clinic,
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Walgreens, Kroger, seems like every 18 months there's another one. Um,
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how has this affected Cape Cod healthcare strategy, volumes,
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patient expectations,
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or given the defined market and being 40 miles into the Atlantic,
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is it not so much a, a threat or risk for Cape Cod?
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Well, I always believe in, you can contr, you know,
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you should focus on controlling what you can control. And, and that's why from,
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you know, our philosophy on where we want our services to be urgent care,
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uh, to community health, um, you know, control what you can control,
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and then you earn what you get. And, and we don't make excuses for that.
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We try to, you know, we know there's competition. Uh,
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we know that there's MinuteClinics, we know that there's new entrance.
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We know that there's new telemedicine entrance.
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We know that there's hospital at home. We know that there's new VNA services,
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that there's, there's everybody wants something,
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and how can we differentiate ourselves? And, and we, we try to do it through,
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through really the empowerment of our, of our physicians and workforce.
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We try to refine process, um,
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to ensure that we take variation out of it and improve what we do.
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And that's why urgent care is so successful. I mean, you think about it,
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we have board certified physicians.
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How many urgent care centers can say that ED physicians in urgent care, right?
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And we actually can still lower the cost by 50, 60%. So we believe in,
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in quality, we believe in efficiency, uh,
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we believe in taking variation out of process, and then you earn what you get.
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Now, what I think is so unique is, I know that a lot of companies just,
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or a lot of people just focus on the CBS's of the world and the Walgreens of the
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world and how everybody's become a healthcare company, right? Everybody's, oh,
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we're a healthcare company, everyone's rebranded, but oh, by the way,
22:44
you can also go there and buy Twizzlers and Cokes and get your, you know,
22:47
household goods. Um, we're a little different. Uh,
22:50
we're a safety net institution,
22:52
and I think that's what separates hospitals and health systems from everybody
22:56
else. When the pandemic needed us,
22:58
we proved that we had the ability to not only manage it,
23:02
but do it exceptionally well to be here for everybody. Um, but I think, so I,
23:07
you know,
23:07
my point isn't just about the surgery centers and the walk-in centers and the
23:11
MinuteClinics, it's also what's changed in healthcare today is now,
23:16
you know,
23:17
your competitor next door that used to be your friend trying to get your
23:21
physicians and trying to recruit your nurses and trying to recruit X, Y, and Z.
23:26
It's, we've, we've absolutely lost, in my opinion, rationality, it's,
23:31
let's go pick the other person's pocket so we can really hide our ills.
23:36
Um, so the rules of engagement, I think have changed in this space, and it,
23:39
it really is more of a, a all hands on deck and, and, and look out for yourself.
23:44
And, and I don't think that that's necessarily healthy. Um, but the fact is,
23:48
it's here. Um,
23:50
so you have to really show why your healthcare institution is different, um,
23:54
how, how you can, you know, grow when you're employed here with us,
23:58
and you have to focus on quality, and you have to focus on the patient. So,
24:03
you know, that's where we are. We, we focus, you know,
24:05
Molly on controlling what we can control, and, uh,
24:08
we generally like where we end up.
24:10
Mm-hmm. , that makes so much sense. My client,
24:12
I even think that's probably contributing to my slip of saying that they're
24:15
trying to move into healthcare delivery and, and that space,
24:18
because it's been coming for years and years, it's been discussed.
24:21
And then I still,
24:22
I still mentally quite see health systems in a completely different box than I
24:27
do c v s, MinuteClinics, Walgreens, and perhaps wrongfully.
24:31
So perhaps I really need to challenge that thinking.
24:33
But from everything you just described in terms of the mission, the safety net,
24:37
um, in terms of how integrated you are in the community, um, I,
24:41
I have yet to see them move close to that, um,
24:45
not only for Cape Co,
24:46
but for many of the other great safety nets in the country too.
24:49
Yeah. I,
24:50
I think what was so unique about coming out of this pandemic is how quickly
24:53
people forgot the vital role that hospitals played in it,
24:57
whether it be through funding and, and, and,
24:59
and the fact of the matter is we're not out of the financial crisis, right? The,
25:04
the, the, the traveler issues, the locums issues, people have changed their,
25:08
their practices. Some people just wanna go from community to community. Now, um,
25:13
the one thing is clear. Our mission is incredible,
25:17
but we also need to evolve. We can't simply stand by and say, oh,
25:22
look at us. Look what we did. We have to evolve with the times.
25:25
We know that employees are only gonna be with us x number of years now,
25:29
not the the 30 year strategy of 10 or 15 years ago.
25:32
So how do we invest in them with the hope that if they do leave,
25:35
they'll come back? Um, how do we empower our workforce? Um,
25:39
how do we make sure that vulnerable communities have access to great jobs and
25:42
career ladders?
25:43
And we're doing that with English as a second language employment program,
25:47
working with our community college to, to offer scholarships to, uh,
25:51
to these incredible young people that want to enter this even better profession.
25:55
How do we create those,
25:56
those meaningful opportunities for employment all at the same time, uh, while,
26:00
uh, meeting our mission? Um, I think we are different,
26:03
but it doesn't mean we can rest on our laurels and not evolve.
26:07
We have to evolve and we have to change with the times as well.
26:11
Michael, I wanna thank you.
26:12
You've been so great about painting a realistic and textured picture about Cape
26:16
Cod Healthcare today, while also, as you just did,
26:18
signaling what's to come and the needed evolution in the, in moving ahead.
26:23
Is there anything we didn't touch on in our time together that you'd be re
26:27
remiss not to make mention of? No.
26:29
I'd just always like to end by thanking, um, everybody that works in healthcare,
26:33
our frontline staff, um, our physicians, um, our volunteers.
26:38
Healthcare is the consummate team sport. Everybody plays a role,
26:41
whether you're in finance, whether you're in it, whether you're a nurse or, or,
26:46
or, or an e vs staffer. Um, everybody plays such a vital role to this mission.
26:50
And I, I just wanna thank all of all of the people that work within this space.
26:56
Great. I will return the thanks to you, Michael,
26:58
president and c e o of Cape Cod Healthcare for being my guest today and joining
27:02
the Becker's Healthcare Podcast. Thank you.
27:04
Molly. Thank you so much. Have a great day.