Home Care

Improving Rural Health Access

A pilot study

BY Lisa Lavin

When a pharmacy closes or the nearest clinic is 30 miles away, the effects add up quickly. Patients skip refills, stretch doses or delay care until a problem becomes an emergency. Emergency departments are the most expensive place to receive care, so the cost falls on patients, families, rural hospitals and payers alike. Rural residents are older on average and have higher rates of diabetes, hypertension and obesity, which means those who need consistent care the most often have the least access to it.

Managing medication is hard work. Sorting pills, remembering what to take when and tracking changes after a hospital visit can challenge even sharp, independent seniors, and vision changes, arthritis or mild memory loss make a schedule harder to follow. Caregivers are stretched, too. The ratio of caregivers to seniors is falling from about seven to one toward four to one, and rural families often live far from the people they help. Doing more of the same will not close the gap. There are not enough caregivers, and pharmacies and clinics keep closing in rural communities, so care has to be delivered differently. Technology can help bridge the gap.

Managing medication is hard work.

A Six-month Pilot Study

The Rural Health Innovation Initiative is a six-month pilot designed to test a simple idea — bring the pharmacy and care management into the home allowing rural residents to stay healthier where they live. The study is collaboration among local leaders, researchers, a national pharmacy and a home health technology company.

The University of Minnesota Center for Healthy Aging and Innovation leads the research and will track and measure the results. Ōmcare provides in-home services through its pharmacy-integrated Ōmcare Home Health hub®. ExactCare Pharmacy, a national pharmacy partner, delivers pharmacy services through the hub. Two mayors have lent their support as community champions — Wade LeBlanc of Silver Bay and Alicia Pearson of Lanesboro.

The study is observational and retrospective. Participants are Medicare members who are 65 or older and take five or more medications a day. They live in or near Lanesboro and Silver Bay, and the initial group is about 25 people. During the six months, each participant transfers prescriptions to ExactCare, uses the hub at home and completes four surveys. Researchers will track medication adherence, health care use, emergency department visits and hospitalizations, patient-reported health and wellness and patient satisfaction.

Making Care Easier to Reach

The goal is to show that a virtual-first care model, built on pharmacy home delivery and medication support, works in a rural setting and can be repeated in other communities. If it does, rural residents get the benefit of a nearby pharmacist and a connected caregiver without having to drive for either.

The Ōmcare Home Health Hub® is the last mile of the pharmacy in the home, meaning the final step between the pharmacy and the moment the patient actually takes a dose. Each month, ExactCare sends the participant a roll of medication pouches, pre-sorted and labeled by day and time. The roll goes into the hub, which follows a schedule synchronized with the pharmacy and dispenses the right pouch at the right time. Three cameras verify that the dose was taken, and the information flows to a caregiver dashboard so family members or care staff can see adherence at a glance and respond to missed doses.

One touch connects the participant to pharmacy staff at any hour. Another connects them by video to family, friends or caregivers. A daily check-in feature invites conversation instead of surveillance. If a participant needs more help, a caregiver can assist remotely and watch the dose taken on camera. The same audiovisual platform is also the foundation for a longer-term goal —adding telehealth services, so a patient could see a clinician or pharmacist through the hub without leaving home.

Assessing Outcomes

The university will compare adherence, emergency visits, hospitalizations and patient-reported measures over the six months. Participants will also report how satisfied they are with the service. The aim is also to learn whether the model is practical enough to expand. For patients, the benefit is less work and more confidence — no pill sorting, no trips to the pharmacy and a way to see a familiar face on screen. For caregivers, it is reach, because one person can keep an eye on more households without adding drive time. For clinics and payers, it is earlier warning when a patient falls behind, which can mean fewer avoidable emergency visits. In other settings, the same approach has produced dose-level adherence of about 98%.

Potential Obsticles

A pilot is also a way to find the problems. Several barriers to participation are already clear.

The first is trust and timing. Older adults are understandably cautious about a new device in the home and about switching pharmacies. Moving prescriptions is a real decision, and it has to be explained by someone they know, so recruitment is happening in person and through familiar community channels.

The second is insurance. Participants need Medicare with coverage for their medication, and the fall open enrollment period is a stressful time for many beneficiaries. Some are losing coverage they had counted on, and joining a study while sorting out a new plan is a lot to ask. The teams have to be clear about what the study requires, and the hub is provided at no charge, with no added fees for the pharmacy services.

Three in four adults 65 and older take five or more medications.

The third is connectivity. The hub is designed to run on little bandwidth, but some rural homes have no home internet at all. Cellular hotspots can fill that gap, and the study is planning for the cost. National data suggests about 22% of Medicare beneficiaries also qualify for Medicaid lack internet access, so this is not a small issue.

Beyond participation, the larger challenge is building a model that works at scale. A pilot of about 25 people can succeed because the team knows every participant. A model for thousands of rural residents has to work without that level of attention. That means a pharmacy partner that can serve patients across many states, a technology platform that integrates with the pharmacy's systems, recruitment methods that can be repeated and a payment approach that makes the service sustainable.

Early Findings

The study is still young, and the results are not in. The first weeks, however, have already shown what matters to participants and communities. The video screen is where the hub is most visibly different from a conventional pill organizer. One touch connects a participant to a family member, a friend or a caregiver, and the large, bright display makes faces easy to see. The same screen shows the schedule, so the participant can see at a glance what to take and when.

The study would not be moving without local people. The mayors of Silver Bay and Lanesboro have championed the project. Home-delivered meal volunteers have carried study fliers to older neighbors. A local pharmacy and a veterans home have posted information. A community radio interview is scheduled for after the election.

Community members have also made clear where the work is hardest. Recruiting is slower than expected where insurance changes are underway, and it takes repeat visits to explain the study to some residents. The research team has responded with home visits, plain-language materials and a willingness to talk through insurance questions before anyone signs up.

From Pilot to Practice

If the pilot shows that a pharmacy-connected device in the home improves adherence and reduces avoidable emergency visits, the model could extend well beyond Silver Bay and Lanesboro. Rural residents everywhere face the same pharmacy deserts, the same stretched caregivers and the same difficulty following a medication schedule. Our vision goes a step further. Because the hub already connects patients by video, we plan to add telehealth services through that audiovisual platform, so the device that delivers medication can also bring a visit with a clinician into the home.

Health and Cost

Better adherence is the first benefit, and better health follows. When people take the right medication at the right time, chronic conditions are easier to control and complications are less likely. Fewer emergency visits and hospitalizations mean fewer disruptions for patients and families, and lower costs for the system. In value-based care programs, estimates suggest that every dollar spent on adherence can save $3 to $10 in avoidable care. Whether that holds in rural Minnesota is exactly what the study will help answer.

There are also gains that are harder to measure. Older adults who stay in their own homes longer keep their independence and their connections to the community. Caregivers can use their limited time more effectively.

Defining Success

Success will depend on several groups. Health systems and clinics must be willing to refer patients and use adherence data in care planning, and as telehealth is added, to see patients through the hub. Someone has to pay for the technology and the services that go with it, including the hub, the pharmacy services, the remote monitoring and eventually telehealth. Payers, health systems and employers need to see the results and decide whether to fund the service, whether as a covered benefit or a value-based arrangement that shares the savings from fewer emergency visits and hospitalizations. Pharmacy partners must be able to deliver pouch-packaged medication to rural homes reliably. Local governments, senior services and community organizations need to help residents learn about the option and trust it. Researchers will need to keep asking hard questions about what works and for whom.

How You Can Help

Physicians have a particular role. If you care for older adults in rural Minnesota who take five or more medications, tell them about the study and encourage them to call the University of Minnesota at 612-626-4816, email HealthStudy@umn.edu or visit redcap.link/ruralhealth. If you lead a clinic, health system or plan and want to understand how this model could fit your patients, we would welcome a conversation. One pilot will not fix rural health, but a well-studied one can show others the way. 

Lisa Lavin is the founder & CEO, Ōmcare.