Senior-focused primary care programs are located mostly in urban and suburban geographies as opposed to rural ones. This is because they need a geographically dense group of eligible seniors to build a sustainable program.
Often, it's difficult to scale to rural areas due to geographic spread, lack of infrastructure, and shortage of health care workers—and it's particularly challenging to scale in-home services since these models need a higher-density area to be efficient on a per-encounter basis.
However, there's an opportunity for senior-focused primary care organizations to increase access to underserved, remote areas. A sizable portion of the older adult population resides there. Of the 46.2 million people 65 years and older, 22.9% lived in rural areas between 2012 to 2016.
Also, the rural population is poorer and sicker compared to their urban counterparts. This provides an opportunity for senior-focused primary care models since they are designed to serve high-need senior populations. Longer appointments, lower physician panels, and the use of interdisciplinary teams can improve access to care for rural patients.
Senior-focused primary care should consider the below strategies to reach seniors in rural areas:
1. Partner with MA plans to identify eligible patients
Senior-focused primary care payment models often rely on having large enough pools of patients to effectively manage medical risk.
To identify and engage more of the rural population, providers of senior-focused primary care will need to coordinate with Medicare Advantage plans to identify eligible patients. They can help leverage clinical data, collect more robust patient information, and identify high and rising-risk patients.
2. Utilize technology appropriately, and keep in mind digital inequities
Rural geographies face heightened disparities and often lack access to quality broadband internet, which can make it difficult for local providers to successfully implement technology solutions. However, technology has tremendous potential benefits. It can extend the reach of care and allow team members to communicate with each other and patients.
To overcome challenges with technology implementation, providers can partner with local institutions who have existing infrastructure. Broadband is only one piece of digital inequity puzzle. It will also be important for organizations to assess patients' digital literacy and financial situation to understand what additional support or education patients might need, and to adapt telemedicine solutions to their level of comfortability.
3. Get creative about workforce solutions
It's difficult to sustain high-touch, team-based care for patient populations dispersed across large geographic areas. To reach these patients, senior-focused primary care providers can train members of the community, often peers, to increase care teams' ability to address social determinants of health and provide navigation support.
Community health aides and navigators don't need formal healthcare training and can help fill care gaps. Similarly, paramedics and other health care workers can extend the primary care team's reach into the community. They can help schedule appointments, review medications, conduct routine health screenings, and assess social risk factors in a patient's home.
However, existing staff in rural areas are often volunteers, overworked, undertrained, and understaffed. Some level of investment in training and compensation will be necessary for staff to manage higher volumes. Lastly, creating a dedicated, traveling team is useful in situations where you can't permanently staff certain locations.
4. Use community-based resources
Often, rural communities are tightly knit and share a strong identity. They rely on family, neighbors, and a trusted set of leaders for support. Senior-focused primary care can leverage existing relationships in the community, such as civic or faith-based groups to expand their scope of care.
These partnerships can promote better access to nutrition, transportation, and personal services. Other existing community resources may include local pharmacies and workplaces, which can serve as locations for off-site or mobile primary care clinics. By discovering what already exists, organizations can leverage these resources to better serve their patient populations.
