As consumers, we’ve gotten used to a world that excels at last-mile logistics. Our socks arrive from Amazon the next day. That DoorDashed dinner shows up in 35 minutes. We need a new desk, Wayfair delivers one two days later.
Companies have realized that if you can’t successfully complete those final miles, if the product doesn’t actually make it to your door, the value of the entire system breaks down.
Healthcare has a significant last mile problem. And unlike a late delivery, the consequences aren’t just minor inconvenience.
In America, we have some of the best clinical care in the world. We can perform life changing surgeries. Invent breakthrough drugs. Eradicate diseases we never thought possible.
But the “last mile”, what happens after the appointment, after the discharge, after the diagnosis, is where outcomes quietly fall apart.
What’s falling short
Inside the doctor’s office or hospital, a patient is taken care of. It’s when they walk out that the problem begins.
This is particularly devastating for older adults, who on average see far more doctors than other populations. Scheduling appointments, handling insurance, and ensuring information flows between providers becomes a full-time job, yet there’s no infrastructure to support it.
Here’s what the last mile problem looks like in practice:
Hospital discharge: After a hip replacement, an 81-year-old man is discharged with orders for a hospital bed and a bedside commode to be delivered to his home. His daughter takes the day off work to be there when they arrive.
They don’t come. She spends hours on the phone with the surgeon’s office and insurance company. By the time things have finally gotten sorted out, three days have gone by.
Medication management: A doctor prescribes a new drug for an 88-year-old man who lives alone. The man hasn’t told anyone, but he’s been struggling with his dexterity, and opening pill bottles is a challenge. He picks up the medication, tries to open it once, and then puts it aside and forgets about it.
The clinical part worked. The human part didn’t.
Social determinants: After a stroke, a 78-year-old woman is discharged with a detailed recovery plan that includes physical therapy twice a week. But she lives on the third floor of a walkup and the recommended PT is a bus ride away. She finds herself overwhelmed trying to get there, ultimately deciding it’s easier to just stay at home instead.
No matter how effective a care regimen is, it only works if the patient can actually follow it. In all of these instances, the clinical know-how is there. But the last mile is underfunded, understaffed, and inconsistently supported.
Why hasn’t healthcare solved this?
If the problem is so obvious, why hasn’t anyone fixed it? The answer comes down to incentives and accountability.
No one gets paid for it. Fee-for-service reimburses for visits, procedures, tests. Not for phone calls, coordination, follow-up, or hand-holding.
It’s no one’s job. The hospital’s job ends at discharge. The primary care physician has limited time. The specialist focuses on a specific condition. Everyone assumes someone else is handling it and no single role is accountable for connecting the full picture of care.
It’s hard to measure. A surgical procedure has a clear outcome. Making sure a patient understands and adheres to a care plan is harder to quantify, and therefore under prioritized.
The result is a system optimized for episodes of care rather than continuity of care.
The solution: a dedicated expert for care management
Comprehensive care navigation isn’t just appointment reminders or scheduling. It’s something much deeper.
At its core, it’s a single, trusted expert who actually knows the patient. Their doctors, their history, their living situation, their fears about what comes next. Someone who takes the medical plan and makes sure it works in real life.
This role is especially critical during care transitions such as a hospital discharge, new diagnosis, sudden decline, it’s when families are most vulnerable to gaps and confusion.
Care managers help families understand their options when facing difficult decisions about long-term care. They coordinate between specialists to ensure treatment plans align. They connect families with community resources like meal delivery and caregiver support groups. They catch problems before they become crises.
They also sit at the intersection of a patient’s medical and social needs, understanding that medicine and life circumstances aren’t separate problems. For older adults, an unsafe staircase or an empty refrigerator can undo what a doctor prescribes.
The evidence is clear
This isn’t theoretical. Programs that provide comprehensive care management for high-risk Medicare beneficiaries have demonstrated real reductions in hospitalizations, emergency department visits, and overall healthcare spending. The Program of All-Inclusive Care for the Elderly (PACE) has shown that intensive care coordination allows even frail older adults to remain safely at home.
These models have demonstrated measurable impact. Yet adoption remains uneven due to staffing constraints and fragmented implementation.
Thankfully, we are now living in a world where the reimbursement mechanisms are in place. Chronic Care Management codes allow providers to be reimbursed for the non-face-to-face care coordination that families desperately need. What’s missing is widespread implementation and awareness that this critical benefit exists.
What healthcare systems must do
Healthcare has solved for the hard part. The science, the surgery, the diagnosis: by global standards, we’re exceptional.
What we haven’t solved for is what happens when the patient goes home. Families are quietly absorbing all of it. And as our population ages, that’s not sustainable.
The last mile isn’t a gap at the edges of healthcare. It’s the difference between a system that works and one that only works sometimes. Aging is a universal human experience, and no family should have to navigate the complexity of healthcare alone. Every family deserves someone by their side who can help educate, coordinate, and advocate as they move through the joys and challenges of aging.
Photo: selimaksan, Getty Images
Jenny Lee is the co-founder and CEO of Hera, a company that manages care for aging parents. She has spent her career building technology products in complex systems, from cloud infrastructure at Dropbox to expanding access to mental healthcare as a founding product manager at Headway. She studied computer science and business at the University of California, Berkeley, where she was selected as an Accel Scholar.
Jenny founded Hera after watching her aunt navigate her grandmother’s dementia care largely alone – lost and overwhelmed. That experience made clear that the healthcare system has nothing built for families navigating arguably the most complex industry in the country, even as 11,000 Americans hit retirement age every day. Hera pairs dedicated care managers with an AI platform that ensures expert-level care at every step. The company is backed by Accel, IA Ventures, and BoxGroup.
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