The last mile problem is well known in the telecommunications industry. We can get high-speed connections to every city, but the “last mile”, actually connecting it to the home so everyone can enjoy its benefits is hard and costly. By some estimates it could cost 30-40% of the total deployment. It turns out healthcare has a similar last mile problem – knowing through analysis that someone is sick and needs help is very different than getting to the person and actually helping them. This is the last mile problem in healthcare. I had a recent conversation with a health insurance executive who shared their problem of having a fantastic predictive model of who was going to get sick only to have it sit on the desk, unable to be effectively implemented in a way that drives clinical impact.
As technology begins to bring healthcare into a more modern age, it has been increasingly recognized that there is a gap between the speed and power of technology vs the last mile “on the ground” delivery of care to people. A dominant trend I am observing is a rapid shift away from health insurance companies to provider systems and 3rd party vendors with clinical staff who can physically deliver the last mile solution. Even provider systems (the corporations made up of administration and centralized services with lots of owned and affiliated clinical staff) are recognizing the last mile as a problem. In general, I’m glad we are recognizing this, because for too long we have sat in corporate offices patting ourselves for a job well done when we have not done the job at all and the patient has not experienced any better care.
But an abdication of responsibility to whoever is performing the last mile task won’t work. Why? Because the insurer is still tied in to too much of the system – they are the integrators of data, relationships, payments, providers…. they cannot be passively sitting on the sidelines when they sit squarely in the role of system integrator and are necessary for the proper functioning of the entire system (providers are not capable of taking over this function for the industry today because they currently lack the data, skills, reach and relationships). So while the last mile should be done by those who can impact patients directly – the doctors, nurses, social workers, therapists, nutritionists, pharmacists, etc… – insurers (and provider systems) must play their roles to make it work.
So the last mile problem is not just a last mile problem – there is an interconnectedness at every mile. That means the way business is organized is critical to how effective the last mile is – what data we collect, how we integrate it, how we abstract meaning from it, how we deliver insights to the right people, how we collaborate across companies, how we see and interpret issues to be addressed and then act on it (and then funnel those learnings right back into the business).
David Shaywitz wrote a powerful article that is very relevant to the discussion here – he wrote about the value of technology being realized only when we get implementation right. The last mile story is really a story about implementation, and David covers this topic very well. Please read it if you want to dig much deeper into this topic (see Forbes article here).
So whose job is it? It’s the person delivering care to the patient, and the provider system, and the insurer, and anyone else brought in to help along the way. We all have a role to play in keeping the whole system running well so that the last mile can be carried out as best as it can by the front line staff. Do not abdicate responsibility to them and hope that it will turn out well. The last mile is made up of our physicians, nurses, therapists, pharmacists, counselors, and everyone else in our system – they are asking for our help so they can do their job well and we need to be there for them.
