Two prescriptions for closing healthcare’s ‘last mile’ gap

In the healthcare industry, there is currently a gap between poor and vulnerable populations and community health resources.

Many of the people who could benefit from these services are either unaware or unable to access them, while providers are left wondering what else they can be doing to improve outcomes for these groups.

This is having a direct impact on outcomes. According to research by the U.S. Department of Health and Human Services, low-income adults tend to be less healthy than those with higher incomes, with nearly 25 percent of adults living below the poverty line reporting fair or poor health. For those earning twice the poverty threshold for income and above that figure is just 8 percent.

A large part of the problem is related to so-called “last mile” concerns, getting health services to the people who need them most.

This isn’t exclusively a problem for underserved populations -- the healthcare industry has long struggled to bridge the gap between clinical services and patients’ daily lives -- but it presents one of the biggest risks to those on the lower end of the economic spectrum.

It is time for a more strategic, innovative approach to getting these patients the care they need.

Because the truth is, it is often the non-clinical aspects of a person’s life -- poor access to housing, transportation, and other basic needs, or simply because they live far away from existing providers -- that are the true barriers to care. Community health providers that address some of these non-clinical obstacles can make a greater dent in their patients’ overall care, whether it is by opening new locations in underserved areas or implementing technologies that allow for in-home diagnosis.

Leveraging technology

But we’re not going to get there with the tools the industry has access to now. We need to embrace innovation in all its forms in order to enable this collaboration.

Take a chronic asthma patient. He or she can be treated by a community health provider and learn about asthma triggers to avoid at home, but what about the rest of their quality of life? How can they connect with the network of other providers to ensure the best outcomes? The systems in these networks are old, siloed and unable to talk to each other.

Technology tools can make this happen.

For example, with a digital directory platform, a nurse could discharge the patient, referring them to an allergist and then follow-up on the case. Perhaps a case worker checks in from time to time to ensure that individual is controlling symptoms.

But it wouldn’t have to stop there. Perhaps the allergy report finds that patient is highly allergic to mold, and the patient says that her rented apartment has had a leak for some time. At that point a social worker might be brought in to help the patient advocate with the landlord for a mold test and remediation.

The insurers can get involved too, ensuring seamless billing and reimbursement. Bringing all of these organizations together on one platform can create a network effect that allows for better collaboration and more streamlined communications, enabling a more holistic approach to care.

Startups are currently leading the way, with software packages that improve patient-doctor communication, digitized referral platforms, online community resource directories and more. With the advent of mobility and an increased acceptance of digital tools, keeping an updated digital registry of these community resources is a first step.

This approach to community health is based on understanding the physical, social, and financial needs of the patient, and bringing the right providers together to meet those needs.

Fostering partnerships

Health providers so far have not necessarily embraced collaboration because they run a business based on reimbursements. In general, the provider has focused largely on the clinical care perspective, but a strict focus on healthcare alone is not going to make a dent in these last mile concerns.

A meaningful collaboration between insurance companies and healthcare providers would go a long way toward closing that gap, since both have economic and social incentives to try a holistic approach to community health. After all, as the Baby Boomer generation continues to age, getting sicker, we’re seeing an increasing population of chronic patients who are not getting better and remain vulnerable.

These are patients who will be better served with an integrated access to health, beginning with a new focus on industry partnerships.

If a few forward-thinking insurers and health providers get together in a particular market, test out a viable economic model led by insurers, all of a sudden that creates the right incentives for other participants to jump in, further expanding access to services.

In a world where community providers are actively competing for market share, a holistic approach to health and wellness toward the poor and vulnerable is not only the right thing to do but also makes economic sense. Given the increasing competition for patients and market share – now and in the future – the time is now for a credible revenue model to support this approach to community health care.

Victor Kats is the Managing Director of Ascension Ventures, a strategic healthcare venture firm that invests on behalf of 13 nonprofit health system limited partners that collaborate to identify, invest in, and grow transformative healthcare companies. The limited partners combined operate nearly 500 hospitals that serve the poor and vulnerable, have close to 600,000 employees and generate almost $90 billion in annual revenue.

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