Bridging the Home-Based Primary Care Gap in Rural Areas

Ginny Rogers
Montgomery Smith
Jonathan Gonzalez-Smith
Robert S. Saunders
February 2024
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Interdisciplinary care teams, telehealth, and flexible payment models are included as key recommendations to increase access to home-based primary care (HBPC) in rural communities.


There is a strong evidence base showing that HBPC models can improve outcomes for older adults and other home-limited individuals, as well as reduce overall health care costs. However, HBPC is significantly less likely to be available in rural communities, despite the substantial health care needs and access barriers often experienced by older adults in rural areas. This article offers recommendations on how HBPC programs can be successfully designed, implemented, and scaled in rural communities.


The authors provide insights into tailoring HBPC models to address unique rural challenges, scaling HBPC in rural communities, and using advanced payment models to increase access to rural HBPC programs. Their recommendations include using interdisciplinary care teams, community paramedicine models, and telehealth services, while also amplifying existing community resources such as community-based organizations and area agencies on aging. For policymakers and payers, the authors emphasize the importance of expanding scope of practice laws, addressing regulatory barriers to telehealth services, providing upfront infrastructure investments, and adding flexibility for rural providers within value-based payment models.


This article underscores the unique challenges in delivering home-based care in rural communities and provides actionable recommendations for providers, policymakers, and payers. The need for flexibility in delivering care in rural communities is emphasized through these recommendations, with team-based models, cross-sector partnerships, and flexible scopes of practice all highlighted by the authors as key mechanisms to increase access to care.

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