Providing health care in people’s homes in rural communities

It is not unusual for patients living in rural areas to travel several hours to see a specialist or primary care physician. Sometimes their daily lives get in the way, and these patients end up missing out on vital preventive services like mammograms or colonoscopies.

“It’s still easier to find a cheeseburger or cigarettes than it is to find access to health care,” noted Jeremy Cowles, MD, chief medical officer at Sanford Health in Sioux Falls, South Dakota.

Broadband Internet service in rural communities is not always available, and women often face a 200-mile trip to receive routine OB-GYN. Rural areas also struggle to recruit and retain doctors.

In the “AMA Update” episode, Dr. Cowells joined Kenrick Minor, MD, chair of inpatient medicine at the Geisinger Medicine Institute and director of hospital medicine in Danville, PA, to discuss their respective efforts to provide health care in people’s homes through medical innovation.

Geisinger and Sanford Health are members of the AMA Health System Program, which provides enterprise solutions to equip management, physicians and care teams with resources to support the future of medicine.


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Sanford Health invests $350 million to create a virtual health center. “We recently broke ground on a 60,000-square-foot facility here. And we’re building that so we can build things like satellite clinics,” Dr. Cowles said.

That means a small town of less than 2,500 people can have a clinic on Main Street, he continued. “What if you knew the nurse who worked there and could get to any doctor you wanted without ever leaving that clinic? Because we were going to bring them to you virtually?” A primary goal is to have virtual visits available within 24 hours.

Sanford Health has also entered virtual behavioral health appointments, providing 600,000 virtual consultations over the past decade. This saved patients 20 million miles, avoiding the need to travel back and forth on country roads to clinics.

The health system hopes to shift more than 350,000 outpatient visits annually to home care, expanding that to 275 clinics in the Midwest. Read more from Dr. Cowels in two recent Catalyst NEJM comments: “The Virtual Future of Health Care Delivery in Rural America” ​​and “The Many Barriers to High-Quality Rural Health Care.”

About 12% to 15% of clinical visits are now done via telemedicine at Geisinger.

“Whenever possible for individuals who have geographic difficulties in reaching our clinical areas or difficulties with broadband access, we have a primary care clinic where they can go close to home that is set up for telemedicine,” said Dr. Mainer.

Geisinger has also seen results in remote monitoring of patients. “In the midst of COVID, our Geisinger home team was able to provide essential monitoring of vital signs and in-person and telehealth visits for care at home,” said Dr. Mayner. This expanded care for patients without having to admit them to full-capacity hospitals.

“It ended up being a very cost-effective, patient-centric model with high levels of patient satisfaction,” he added.

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Tailoring services to rural health needs means allocating resources efficiently, Dr Mayner said. “You have to be careful in how you distribute and create programs.”

Geisinger accomplished this through its fresh food pharmacy program. Patients with type 2 diabetes and food insecurity gain access to fresh fruits and vegetables and lean meat. The health system also offers nutrition courses and cooking tips.

This resulted in significant improvements in overall health. Geisinger has seen a 40% drop in patients’ hemoglobin A1c levels and a 30% increase in primary care utilization and overall healthcare engagement. Gaps in measuring quality of care have been closed, and hospital and emergency department use has decreased, Dr. Mayner said. The plan is to expand efforts into areas such as chronic kidney disease patients.

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