Back in the late 90’s there was a popular term in telecom called “The Last Mile”. As fiber optic cabling was bringing high speed connectivity to unlock the potential of the masses, one big problem still existed: how do we actually get these speeds to consumer’s homes in a cost effective way? The resulting services were a patchwork of new technology and old copper wiring from the last century. With one foot in the future and one foot in the past, we still are struggling to gain the velocity we know is possible. While speeds have certainly improved, the potential opportunity can’t be realized until we figure out how to solve the last mile problem. The last mile problem in healthcare has eerie similarities.
Let’s define the players here at a high level:
Health plans are like the telecom companies. They are a regulated bunch that control a tremendous flow of information between parties. Their motivation to solve the last mile is a function of (i) regulations; (ii) changing reimbursement models; and (iii) the growing influence of consumer demands.
Providers/physicians are the backhaul companies. In telecom speak, the backhaul is the middleman. As we move to value based pricing this is like the provider getting paid by the health plan some value “X” and then layering on their value to provide services at some cost of “Y”. X-Y = Margin. (Yes, of course it’s more complicated than this but let’s keep working with my metaphor).
The consumer here is, well….the consumer. They have the last mile issue. But not all consumers are alike which makes last mile more complicated. Access, demographics, socioeconomics all need to be factored into defining what last mile needs to look like for each individual.
So what’s the situation?
The last mile in healthcare is both a performance (speed) and relevance issue. Speed is about getting information promptly into the hands of the individual for action. Relevance is about making sure that the information provided is in fact actionable. For example, if data from your health record is easily accessible but it’s not clear what to do with it or what it means then it’s not useful. If I receive notifications from my health plan to get a screening but the recommendation is not informed by my health status then it’s a waste of time.
The last mile in telecom was about connecting powerful consumer machines (desktops and laptops) to data. It’s no different in healthcare when we talk about connecting our mobile and Internet of Things devices to data sources that can help us better manage our health. There are so many (so, so many) consumer apps that are designed to help people live a healthier life. Unless these apps get connected to an individual’s healthcare it’s hard for me to see how they become relevant and sustain over time. My recommended actions from the consumer apps I use to improve my health should be informed by clinical data points. Hello last mile!
Unless consumer apps get connected to an individual’s healthcare it’s hard for me to see how they become relevant and sustain over time.
Health plans and providers have invested heavily in technology to address both speed and relevance (electronic health records and population health management systems). They are getting much smarter in identifying who should receive what communication outreach, intervention and incentive to improve quality and lower cost (i.e. close care gaps). The problem remains that this information isn’t liberated enough to flow the last mile to motivate the consumer to take action.
The last mile is a big problem to solve in healthcare. Liberating data to flow into the new consumer technology pipes being laid by digital health entrepreneurs will be a critical link to unlocking the potential in each of us.
Russell Benaroya is the Chief Executive Officer at EveryMove, Inc. of Seattle, WA. Prior to that, he was the CEO at REM Medical. Mr. Benaroya has his MBA from the UCLA Anderson School of Management. Russell previously served as Chairman of the Board at Treeswing, a non-profit organization that brings innovative programs to schools that will impact childhood obesity. Follow him on Twitter and LinkedIn.