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How primary care physicians can use home-based care models to reach rural populations


Success requires using home care team as extension of physician’s practice

doctor holding medical chart with farm in background ©


Let’s start with some statistics that won’t surprise anyone who provides primary care. As a country, we are experiencing a massive shortage of health care professionals across the board. Nurses, doctors, you name it. A recent report from the Association of American Medical Colleges projected a shortage of between 37,800 and 124,000 physicians within roughly the next decade. The report suggests that we could be short almost 50,000 primary care physicians in this time span.

The study also said that if we wanted to ensure rural residents had the same access to care as urban populations, we would need to find an additional 180,000 doctors. In total, three out of five federally designated health professional shortage areas are rural. Approximately 80 percent of rural America is medically underserved.

But wait, it gets worse. Nearly 30 percent of rural hospitals across the US are at risk of closing. Almost 200 rural hospitals have already shuttered since 2005.

Rural Americans are paying a steep price for these shortages. They are more likely to die prematurely from heart disease, cancer, lung disease and stroke. They also have higher rates of obesity and diabetes, and are even more likely to die from car crashes, suicide and drug overdoses.

Meanwhile, primary care physicians (PCPs) are also feeling the weight of these shortages. With fewer physicians practicing in rural areas, and more hospitals closing their doors, the clinicians who are available carry an increasing burden as they try to care for their communities. This is leading to historical levels of burnout. Research from George Mason University estimates that one-third of primary care physicians are experiencing burnout. This study was conducted before COVID-19. It’s safe to say burnout rates have increased since the start of the pandemic.

It’s obvious we can’t wave a magic wand and make thousands of extra physicians appear, or hundreds of hospitals reappear. So, how do we improve our ability to reach rural Americans and create better access to quality health care?

The problematic part of moving forward is that we must ask over-burdened providers to navigate a changing ecosystem, which includes engaging with numerous regulatory and payer requirements, adopting new technologies and transitioning to new reimbursement models. As we move forward, we have to ensure we keep this reality front and center.

The promising part of moving forward is that meaningful innovations are available to help clinicians support patients and extend care beyond the four walls of their offices. Telemedicine use has been growing rapidly in recent years, as an example. Additional technologies such as remote monitoring also help keep chronically ill patients under consistent observation.

Although virtual care can be effective in bridging some access gaps, not all patient needs can be addressed via technology, particularly those of an older, more vulnerable population. As a result, many health plans and health systems have invested in home-based care initiatives, using multidisciplinary teams to bring care to patients and reinforce existing care plans. They keep close watch on individuals between office visits and keep PCPs better informed and equipped to quarterback care.

These teams include not only traditional clinical resources such as physicians and nurses, but also behavioral health specialists and pharmacists. The anchor of the team model for home-based care is the community health worker, who serves as a trusted liaison with the patient and a connector to community resources.

This all sounds good in theory, but PCPs are key to making this model work. As such, this type of approach requires cooperation from physicians. They must be willing to collaborate differently in care delivery and commit to value-based reimbursement models.

Collaborate differently in care delivery

A home-based care model brings with it the necessity for physicians, hospitals, payers and third-party vendors to work together more collaboratively than ever before. This includes partnering to operationalize new technologies and use advanced data capabilities to enable population health management activities across patient panels. Home-based models must be integrated into practice workflows to ensure patients are receiving highly coordinated care.

An effective way to approach home-based models is to embrace the remote care team as an extension of the provider’s practice and to interact with home-based care in the same manner as other specialties. Ultimately, this is no different from collaborating with a cardiologist or an endocrinologist. Home-based care is a specialty as well. Viewing these models through this lens will help PCPs take the right steps forward with collaboration and fully maximize the impact the team can have on their population.

Commit to value-based reimbursement models

The transition to value-based care has been long discussed. Recently, the concept has picked up momentum and is being leveraged much more frequently. When you align incentives around the quality of outcomes via a value-based model, everyone wins. Patients get better care; physicians are compensated for quality and overall health care costs go down.

Primary care physicians who have not yet engaged with value-based care can experiment by participating in home-based care initiatives, which typically involve rewards for quality outcomes. For physicians who are already in value-based arrangements with payers, leveraging the availably of home-based resources can dramatically increase their success because these resources are specifically engaging the most costly and complex segment of the provider’s panel.

Bringing Primary Care Home

PCPs are critical to improving health care outcomes in this country. We need more primary care, not less. We need to help those delivering care do more with less in the process.

Home-based models offer great promise for improving the effectiveness of community physicians, lowering rates of burnout, extending their impact and providing additional revenue streams for practices while improving the health of the patients they serve. This is particularly true for rural patients, who are finding care harder to come by in today’s environment.

It requires a new level of collaboration and a different method of compensation, but at the end of the day, it introduces a new kind of care that serves even the hardest to reach patients.

Christopher Dodd, M.D, is chief medical officer, PopHealthCare and Emcara Health

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