The Last-Mile Healthcare Delivery Platform

The US spends over $4 trillion on healthcare every year, and that number is growing. This isn’t sustainable, and it’s nothing new to say that change is needed.

DispatchHealth was founded in 2013 for exactly that reason. Over the past two years, we have built our new Last-Mile Healthcare Delivery Platform to accelerate that change. Alongside this technology platform, we’ve built an incredible team of engineers, data scientists, data analysts, product managers, designers, and more – all in a remote-first environment. Today, we are talking a little about what we have built and why we are excited about the impact it will have on reshaping healthcare.

Who is DispatchHealth

DispatchHealth is at the forefront of solving some of the biggest challenges in healthcare. We are transforming how healthcare is delivered by bringing the full spectrum of healthcare into the home, including high-acuity care for patients with complex needs.

Imagine: You or a loved one are sick. You are feeling your worst. Instead of dragging yourself out of bed, hauling yourself to the closest urgent care or emergency room, and sitting in a waiting room for hours – we come to you, wherever you are, when you need us. Once you’ve received care and your DispatchHealth provider waves a fond farewell, you are already at home ready to start resting and feeling better. No travel. No waiting rooms. No hassle.

This is who we are. We are transforming how patients experience healthcare by making it more accessible, approachable, and convenient. At the same time, we are radically reducing healthcare costs, achieving better outcomes, and improving the provider experience. We are doing all this by using the combination of technology, operations, and clinical prowess to bring healthcare into the home and build the nation’s largest distributed healthcare system.

And this isn’t just some dream or lofty vision. It’s already becoming reality. Today, DispatchHealth...

• Operates in over 30 states and is available to more than 200 million people
• Has served more than 1 million patients in their homes!
• Has prevented hundreds of thousands of costly trips to the hospital
• Has reduced healthcare costs by nearly $1.5 billion
• Has achieved an 8.5% 30-day hospital readmission and 58% ER avoidance rate
• Has achieved overall patient satisfaction of 98%

While providers are ultimately the ones who deliver care and are the true heroes, our technology platform enables our providers to deliver this care at scale and bring our shared vision for the future of healthcare to life.

Healthcare & Technology

Getting here has been tricky. Technology in healthcare can be a challenging space, and the problems are different than what most pure technology companies face.

For example, while technology is playing a key role in transforming healthcare, technology on its own is not enough. We have found that the key to real change is to partner with clinicians and operators to leverage technology to evolve the clinical and operational models themselves. While building tools to help providers in the traditional hospital setting is unquestionably valuable, building the technology platform that has enabled providers to work out of patients’ homes in a distributed fashion across the entire country – that changes the game. It’s not about building a product to replace providers or do their job for them. That’s not possible or even desirable. It’s about building technology that positions providers to have the biggest impact and then get out of the way.

Another key challenge is that you can’t build it all yourself. This isn’t unique to healthcare, but it’s especially pronounced. We would never get off the ground if we blocked ourselves on building an entire in-house electronic health record (EHR). That is a whole company on its own. At the same time, it is still early days for modern, highly interoperable, and API-rich technology in healthcare. There are few off-the-shelf solutions, and where they exist, they tend to be point solutions that are not easy to integrate as a part of what you are building. We have found that the industry gold standard solution for a given problem often would not provide the flexibility we need or be able to integrate with our platform. This is common when you are building on the bleeding edge, and it has required a very thoughtful approach in terms of what we build, what we buy, and how we integrate the two.

Despite these challenges, the opportunities in healthcare are perfectly aligned with what technology is best at – and that’s what makes this so exciting.

• Complex Logistics – Having all the right resources together at the right time to provide the care a patient needs can be a challenge. Solving that challenge is one of the reasons why the brick-and-mortar hospital has traditionally made sense. Technology can allow us to solve the problem in the home.
• Rich Data – With the advent of EHRs and health data exchanges, healthcare has among the richest data sets in existence. This data can be appropriately leveraged using machine learning (ML) and AI algorithms to provide actionable insights.
• Rising Costs – With an ever-growing need for healthcare, the traditional solution has been to add more people, leading to increased costs and staffing shortages. Technology can help providers and operators scale themselves exponentially.

The unique combination of challenges, opportunities, and the sheer size of the market involved make healthcare a ripe target for tech-driven innovation, potentially the ripest in existence today. The most impactful companies of this decade are likely to be those that bring that innovation to life.

The Problem Solved by DispatchHealth Technology

At DispatchHealth, we are solving the problem of last-mile health delivery by bringing healthcare into the home and building the nation’s largest distributed healthcare system.

This is a fun, albeit extremely complicated problem to tackle.

Delivering high acuity health care in the home is not as simple as fielding a phone call, handing the address to any available provider, and saying go. At scale, there are 1,000s of simultaneous matches to make and manage between patients, providers, and partners – not just within a single building or even on a single medical campus, but across entire cities and beyond. And all of this must be done in real time.

These matches are not simple to make or manage either.

Matches cannot be made in isolation. Our services are physically distributed, and providers can only be in one place at a time. They need to drive from one visit to the next. This means we need to create a plan for their entire day, not just the next visit. Otherwise, providers might waste hours inefficiently crisscrossing the city instead of seeing patients.

This challenge is compounded by the need to react in real-time to 1000s of updates coming in every minute – from visits running long or short to new requests coming in, traffic building up, changes in needs, and more.

No two patients are alike. No two providers are alike. And we must balance logistical efficiency with safety, which is especially important because we are seeing high acuity patients, many of whom have time sensitive needs. No team of operators, no matter how talented, could manage this logistical problem by hand. This is why technology is so vital to delivering our vision of distributed healthcare out of the home.

While there are many more aspects of the problem we can’t cover in a single post, this provides a glimpse into some of the challenges our platform has had to grapple with.

The Last-Mile Healthcare Delivery Platform

The overall platform consists of five parts. Our Patient, Provider, and Partner Platforms equip each set of users with the products they need to engage with DispatchHealth, and our Knowledge & Decision-Making Engine connects them together. These four platforms are all set atop a foundational layer of Data & Machine Learning (ML) Infrastructure that enables them to function at scale and allows us to continuously improve them in partnership with clinicians and healthcare operators.

Data & ML Infrastructure

The foundation of our platform is data and the infrastructure to use it.

Our platform aggregates data from the more than 1 million visits we have completed and third-party sources to power our user experiences and ML algorithms, which in turn power several of our most critical use cases.

One of the advantages of the distributed model is that scale is not spatially limited. A hospital can only be so big, limiting the number of patients that can be seen. DispatchHealth can be everywhere and scale indefinitely. As we continue scaling, we will build our data sets at an accelerating rate, continuously improving our ML performance.

Separately, we have invested heavily into experimentation to support our data-driven product development culture. Whenever possible, product changes are evaluated via rigorous A/B testing and market-level experimentation frameworks such as paired-market difference-in-differences analysis.

This foundation is what allows us to build and continuously improve upon all other areas of the platform.

The Patient Platform

Part of the problem of bringing healthcare into the home is facilitating the entire patient journey – from requesting care, through triage, waiting, receiving care, and after care – entirely remotely.

Every patient and request are different, with distinct needs to be discerned and catered to, all before we have seen the patient in person. And this all must be done in an almost fully automated fashion to enable meeting the scale potential of a distributed model and to break traditional cost curves. Elements of the platform we have developed to meet these needs include:

• A range of remote-first onboarding pathways for patients – from fully self-serve web request experiences to assisted onboarding over the phone where patients can receive help from dedicated onboarding specialists.
• Triaging workflows which collect the information we need for our platform to determine that a patient is safe to be seen at home and what levels of care are suitable.
• Companion experiences for the patient which enable them to complete preparatory steps after they have requested care and while they are waiting for their providers to arrive.

The Patient Platform is patients’ gateway to feeling better. As a result of these products working in concert, patients never need to step foot outside of their home to request or receive care, and DispatchHealth still knows everything it needs to take care of them.

The Provider Platform

Enabling providers to work effectively in a distributed system is similarly complex.

Providers must know when and where to go and have the right tools to provide care on-scene in patients’ homes. Our clinical teams must also have the right data and insights available to observe and improve upon their performance over time despite working in a fully decentralized fashion. Elements of the platform we have developed to meet these needs include:

• An internal clinical dashboard that provides the visit, episode, and patient-level information needed by providers to conduct each visit as well as to schedule follow up visits as part of multi-visit episodes of care which may serve as alternatives to inpatient hospitalizations.
• Bi-directional integrations between our in-house platform and the EHRs used by our providers to administer care.
• Third-party tools to enhance and support in-person care, such as remote patient monitoring.
• Performance data tools for individual providers to see how they are doing and for clinical leaders to keep an eye on big picture performance.
• Profile building tools to designate key provider attributes that our Logistics Engine leverages to ensure the best matches. These are augmented by integrations with third-party databases which serve as a source of truth for things like provider licenses and credentials.

Our focus is on getting the right providers in front of the right patients at the right time and with the right context, giving them the right tools to work on-scene, and then getting out of the way to let them work their magic.

The Partner Platform

DispatchHealth engages with a vast array of partners across the healthcare landscape – from healthcare systems to payer groups, senior living facilities, and beyond. Nothing in healthcare happens without deep partner relationships and integrations.

Our partners need confidence that they can rely on us to see their patients, to keep them informed about patients’ progress, and to understand the impact that we have had on their clinical and business goals. Elements of the platform we have developed to meet these needs include:

• A range of ways to request care from DispatchHealth for their patients – from deep integrations directly into partners’ EHRs and native workflows, to an easy-to-use partner specific portal (DispatchExpress), and even assisted onboarding over the phone.
• Features within DispatchExpress that enable partners to follow along with the care of individual patients we have seen, along with a clinical notes exchange to keep them up to date, even in instances where the patient requested care from us directly versus through the partner.
• Way for partners to manage their population with us and reporting to close the loop and provide a clear picture of the impact that we are having.

Our goal is for our partners to think of us exactly as that – partners. We are collaborators in the care of their patients and committed to providing and demonstrating true value creation through reduced costs, an improved patient experience, and superior outcomes.

The Knowledge & Decision-Making Engine

While our Patient, Provider, and Partner Platforms are what enable each of these groups to engage with DispatchHealth, it’s our Knowledge & Decision-Making Engine that connects them all together and allows the distributed model to work at scale and in real-time.

Like other two-sided marketplace platforms such as ridesharing or delivery, we must connect multiple parties, in real time, at scale. That said, the number of additional factors that must be considered in healthcare is enormous – patient acuity, urgency, provider-specific licenses, patient availability, visit-to-visit drive times, the list goes on. This complexity grows exponentially as we expand the range of services we provide, from high-acuity single-visit care to in-home hospitalizations, coordinating imaging services, facilitating care coordination with external organizations.

To manage this all, we have built products like our Logistics Engine that can combine to:

• Intake information we learn while fielding a request for care and combines that data with third party data and data from prior interactions.
• Perform complex triaging as whether a patient is safe to see and how urgently we must see them.
• Determine what appointment slots to offer each patient, balancing the needs of each request against the needs of every other appointment on the schedule.
• All within seconds of receiving that initial information and reacting dynamically to new or changing information we receive in the next moment.

The ability to derive these types of insights and make these types of decisions at scale is what allows the whole model to work. This is how we can get the right providers in front of the right patients at the right time and with the right context to provide world-class care, right there in patients’ homes.

Looking Forward

Building this team and bringing the last-mile healthcare delivery platform to life these past two plus years has been extremely gratifying.

As a business, we are moving beyond our roots as an alternative to the urgent care and emergency room to deliver the full spectrum of care in the home, including care models like transitional care to get you home from the hospital sooner, an alternative to inpatient hospitalization, and wellness capabilities to keep you out of the hospital in the first place. Our technology platform is helping to drive that future forward.

And the future beyond that is even more exciting. Our platform may one day enable the healthcare marketplace of the future. Or it may provide the basis for making at-home healthcare an industry standard practice.

Again, healthcare IS complex. It is intimidating. It is filled with challenges both tech and otherwise. Yet that is what makes it so exciting and why there are such tremendous opportunities to make such a lasting impact.