Blog by Joe Babaian

In healthcare, the last mile is the link between you and the healthcare network touch point – where care is delivered – the entire healthcare system of people, services, goods, and organizations. This last mile can be as simple and critical as a ride to the clinic or as complex as the smooth exchange of your personally generated healthcare data (wearables, etc.) with and between providers and tools.

The limited bandwidth or available resources of healthcare’s last mile impacts your ability to connect in all the meaningful ways with the system at large. What types of last-mile access do we all need to the healthcare network? If we were cable modems, we would only need a coax connection to the nearest network interconnect. But as people, we have tremendously diverse needs for this first step of access and that’s before the real “work” of healthcare even begins. Some types of last-mile access are:

• Physical access
• Financial access
• Cultural access/needed competencies
• Data access/sharing with portals, providers, tools – data liquidity/portability/standardization
• Emotional access – those with mental health needs and challenges
• Language competencies/level
• Educational attainment level (to even know how to use what is available)
• And, sadly, geographical access based on local politics

An example of financial access as a barrier is seen in insulin access for Type 1 and Type 2 diabetics in the U.S. As discussed in The High Cost of Insulin in the United States: An Urgent Call to Action from the Mayo Clinic Proceedings –

Reasons for the High Cost of Insulin

The number 1 reason for the high cost of insulin is the presence of a vulnerable population that needs insulin to survive. This population, which numbers in the millions, is willing to pay anything to have access to a lifesaving drug. The desperate need for a lifesaving product allows insulin to be priced at high levels because it is not a luxury item that one can forego. The manufacturers of insulin know that patients who need it will spend whatever it takes to acquire it, regardless of price. It is a matter of life and death.

Bridging the last mile in healthcare is paramount and is often a barrier. When you can’t pass through the last mile connection to the healthcare system, you never even get an opportunity to take the next steps to engage with healthcare up close. Knowing a clinic exists is not the same as visiting the clinic and being evaluated. You can think of the implications!

While knowing what the last mile is, one thing, being able to bridge it – is something more difficult. One of the major factors that exacerbate this crunch in the last mile for healthcare springs from changing patient and caregiver expectations. Ted Quinn mentions as much in MedCity News:

Patients and caregivers now expect rapid and personalized communication, to be an active participant in their care, and to be able to manage and access this information and their care team anytime and anywhere. Patients are now consumers, and they have high demands. Providers need to include patients and caregivers as part of the care team and engage with them through communication channels they use in their daily lives.

We all experience these expectations in one way or another. We want communication with our providers, be it text/messaging/email – anything but fax (!), in a timely and personal way. Think of your frustration getting a simple refill approved when the system is saying you need a new visit, a new approval, a new diagnosis – all the while you know your PCP would be able to make this happen if you could just reach them for just a moment. Barriers. The bandwidth just isn’t there for many in this situation.

Primary care is a notable example of transformative change. Jonathan Harvey, MD has several suggestions on how primary care is transforming itself to help eliminate the barriers we face. In NEJM Catalyst’s How Primary Care Is Transforming Itself, Harvey lists these transformative changes:

• Holistic, not disease-driven, care.
• Patient-centeredness, not physician-centeredness.
• Smart use of new care-delivery venues.

Today, let’s not just consider how the bottleneck created in the last mile of healthcare creates barriers to the system itself, but what we can do now the open this real and virtual pipe, creating connections that allow the last mile to become truly transparent.

Please join the #hcldr community of friends and peers as we work to make a difference, one idea and one action at a time. Join us on Tuesday, May 10th, 2022 at 8:30pm Eastern as we discuss the following topics:

• T1: Which aspects of healthcare’s last mile create the biggest barriers for patients? Personally?
• T2: How will healthcare’s last mile ever be cleared of all bottlenecks? What access issues can be cleared with the least difficulty?
• T3: Where does responsibility rest in assuring last-mile healthcare access: government, industry, individuals, and/or educational system?
• T4: How will the current healthcare technology environment/trends lead to more or less access? Why or why not?

Resources for Further Study

Battaglia, Tracy A., Julie S. Darnell, Naomi Ko, Fred Snyder, Electra D. Paskett, Kristen J. Wells, Elizabeth M. Whitley, et al. “The Impact of Patient Navigation on the Delivery of Diagnostic Breast Cancer Care in the National Patient Navigation Research Program: A Prospective Meta-Analysis.” Breast Cancer Research and Treatment 158, no. 3 (August 1, 2016): 523–34. doi:10.1007/s10549-016-3887-8.

“Cultural Competence in Health Care: Is It Important for People with Chronic Conditions?”  https://hpi.georgetown.edu/agingsociety/pubhtml/cultural/cultural.html.

Dams-O’Connor, Kristen, Alexandra Landau, Jef St De Lore, and Jeanne Hoffman. “Access, Barriers, and Health Care Quality after Brain Injury: Insiders’ Perspectives.” Archives of Physical Medicine and Rehabilitation 97, no. 10 (October 1, 2016): e129. doi:10.1016/j.apmr.2016.08.403.

Harvey, MD, Jonathan. “How Primary Care Is Transforming Itself.” NEJM Catalyst, February 5, 2017. http://catalyst.nejm.org/primary-care-transforming-itself/.

“Healthcare Disparities and Barriers – Factsheets – Rural Health – Stanford University School of Medicine.”  http://ruralhealth.stanford.edu/health-pros/factsheets/disparities-barriers.html.

Herzlinger, Regina E. “Why Innovation in Health Care Is So Hard.” Harvard Business Review, May 1, 2006. https://hbr.org/2006/05/why-innovation-in-health-care-is-so-hard.

Hignett, Sue, Alexandra Lang, Laura Pickup, Christine Ives, Mike Fray, Celine McKeown, Sarah Tapley, Matthew Woodward, and Paul Bowie. “More Holes than Cheese. What Prevents the Delivery of Effective, High Quality and Safe Health Care in England?” Ergonomics, October 7, 2016, 1–10. doi:10.1080/00140139.2016.1245446.

QUINN, Ted. “Overcoming Healthcare’s Last Mile.” MedCity News, April 12, 2015. http://medcitynews.com/2015/04/overcoming-healthcares-last-mile/.

Rajkumar, MD, S. Vincent. “The High Cost of Insulin in the United States: An Urgent Call to Action.” Mayo Clinic Proceedings, Jan 1, 2020. https://www.mayoclinicproceedings.org/article/S0025-6196(19)31008-0/fulltext DOI:https://doi.org/10.1016/j.mayocp.2019.11.013

Rashidian, Mitra, Victor Minichiello, Synnove F. Knutsen, and Mark Ghamsary. “Barriers to Sexual Health Care: A Survey of Iranian-American Physicians in California, USA.” BMC Health Services Research 16 (2016): 263. doi:10.1186/s12913-016-1481-8.

Slabodkin, Greg. “Senate Bill Expands Use of Telehealth, Remote Patient Monitoring.” Health Data Management. https://www.healthdatamanagement.com/news/senate-bill-expands-use-of-telehealth-remote-patient-monitoring.

Wallace, Amy. “Language Barriers Lead to Negative Outcomes in Home Healthcare.” UPI, May 4, 2017. http://www.upi.com/Health_News/2017/05/04/Language-barriers-lead-to-negative-outcomes-in-home-healthcare/9461493915404/.

Zweynert, Astrid. “More Community Workers Needed for the ‘Last Mile’ on Healthcare: Doctor.” Reuters, April 6, 2017. http://www.reuters.com/article/us-global-health-healthworkers-idUSKBN1772W5.

Photo by Lance Asper on Unsplash