The Last Mile in Healthcare Delivery

File under: Healthcare innovation, Multi-Channel Marketing, Patient Engagement, Relationship Marketing

Lately, I’ve been thinking about the impact of the changing healthcare landscape on the people who actually deliver the healthcare – the healthcare professionals -  as millions and millions of more Americans now have health insurance coverage.

There’s been much written about how there won’t be enough primary care physicians available to handle the increase in patients. Some primary care physicians are overloaded, and in some cases are not taking on new patients because their capacity is maxed out, but so far most practices are handling the increase in insured patients.

Nevertheless, the predictions are that the US will have a shortfall of 50,000 primary care physicians in the next decade.

I’ve already written about the primary care physician as an “endangered species.”

This emerging situation highlights the important role of Nurse Practioners (NPs) and Physician Assistants (PAs), those professions that are often lumped under a category called “Healthcare Extenders” or HCEs. Sometimes they’re known as the “Allied Professionals” within healthcare. There are currently 150,000 nurse practitioners in the US.

city on hill 2The Last Mile in Healthcare Delivery
I often consider these HCEs or allied professionals as providing the “last mile” in healthcare delivery.

Physicians have traditionally done the tasks of diagnosing the illness, writing the prescriptions and monitoring the patients, but as primary care physicians are called on to see more patients, they are able to spend less and less time in the exam room. And that’s where the “last mile” comes into play.

For example, some patients may ask, “Now that I have this disease, how do I manage it?” For them, the last mile is patient education. Others may be encountering drug side effects. For them, the last mile is patient support or discussion about an alternate therapy.

Lifestyle changes? Coaching is the last mile.

All of these support requirements will fall more and more squarely on the shoulders of the allied professionals.

What’s more, the HCEs and allied professionals aren’t just doctors’ helpers – they have the education and authority to prescribe medicine and educate patients.

-       79% of NPs and 69% of PAs provide or recommend patient support resources for patients

-       NPs are able to legally prescribe medications in all 50 states

-       PAs can prescribe in 48 of the 50 states

Patient Support & Education
As the focus of healthcare moves from “fee for service” to “fee for outcomes,” there is a great need and demand for patient support and education. Since doctors are swamped, this duty will need to be picked up by allied professionals.

Not surprisingly, PAs and NPs are looking for more support. They are interested in digital and print resources they can give to their patients. They need continuing education contextualized around the enhanced roles they are playing.

Currently, many of these patient and professional development resources are lacking. To meet the needs, many allied professionals have developed their own workarounds. A third of allied professionals develop their own patient education materials. Forty-two percent translate the materials into other languages themselves!

Opportunities Abound
There’s an open door for pharma to step inside and help out on the new front lines of patient care. As I see it, there are three meaningful opportunities:

1. Multi-Channel Patient Education Resources – We need to provide NPs and PAs with multi-channel resources – digital and mobile online, as well as print.

Print is still important. 95% of allied professionals and 55% of doctors use paper materials when talking to their patients. There are a couple of reasons for that. Many patients, particularly older ones, tend to be non-digital and/or just don’t have access to the Internet or mobile apps.

Secondly, it’s easier to customize an information packet for a patient by just pulling 3, 4, 5 or even 10 different sheets of paper, rather than trying to edit together some kind of digital information packet.

Another interesting reason why paper is still an important tool in patient education (despite the fact that 92% of Americans have access to the web) is that only 12% of patients are considered “health literate,” according to a recent study. The allied professionals play a very important role as curators of information. Instead of just saying, “Go look it up on the web,” they often tell patients, “These are the kinds of websites you should visit,” or “Here’s a printed summary of your disease and the ways that you can better manage your recovery.”

Allied professionals serve the last mile by helping patients better understand their condition and how to manage it.

2. Multilingual Patient Resources – Allied professionals are faced with a palpable, desperate need for multilingual resources. According to a number of studies, translation into three principal languages is needed: Chinese, Spanish and Spanish Creole.

3. Train the Trainer Resources – A third important need is for Trainer the Trainer programs. As allied professionals step up their roles in managing patients and patient care, they will take continuing education courses and go to conferences. But training them in how to manage patients and how to use resources to help manage their patients presents a real opportunity for outside resources such as pharma to help.

Stepping Up & Creating Value
So how do we as pharma marketers increase our value proposition to healthcare professionals? By providing an integrated “last mile” content solution for allied professionals.

Traditionally, pharma hasn’t shown allied professionals much love – our primary focus has been on doctors. But as the healthcare environment shifts, there’s more interest in reaching out to NPs and PAs. They’re playing an increasingly sophisticated role in healthcare and have needs that aren’t being fulfilled. Pharma has the financial resources and the content resources to help.

It’s time to bridge the last mile.

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