Where you live determines how long you’re likely to live. And in South Carolina, more than a quarter of the population risks dying sooner from a preventable death simply because where they live is rural.
With more than 744,000 rural residents statewide, inadequate health care is not just a small-town problem. Rural places represent a health care crisis for all of South Carolina. And a solution is needed.
Clemson University and the Medical University of South Carolina (MUSC) — as two of the state’s primary educators of future health care practitioners — have found themselves on the frontlines of finding answers for improved rural health care. A pilot program that the two universities created called Healthy Me—Healthy SC has been two years in the making, and now it is positioned to activate on an even wider scale statewide.
According to Ron Gimbel, chair of the Clemson University Department of Public Health Sciences and special assistant to the provost, success up to now has been on a relatively small scale. That is all set to change.
“This is an exciting, unprecedented time for rural health outreach in our state,” Gimbel says.
The next step is growing outreach and increasing the number of nurse practitioners, students, clinical staff and partnering physicians serving rural South Carolina with the goal of saving more lives.
Says Gimbel: “It feels like we’re just getting started.”
Covering new ground
Clemson’s Joseph F. Sullivan Center has a 30-year history of providing services to South Carolinians, including deploying mobile health clinics to reach some of the state’s most underserved communities. But that outreach, provided by two SUVs and a mobile van with an exam room, has been primarily limited to only a few Upstate counties. The Healthy Me—Healthy SC pilot program between Clemson University and MUSC is positioned to amplify and expand the Sullivan Center’s work exponentially.
Over the past decade, the Sullivan Center has nearly tripled annual student clinical encounters from around 4,500 to nearly 13,000, covering the Upstate and expanding into the Midlands and Lowcountry. That growth has come from working in conjunction with Clemson Extension, as well as mobile units from the Medical University of South Carolina’s Hollings Cancer Center, Self Regional Healthcare and Servants for Sight. Thanks to the these partnerships and the mobile fleet itself, Healthy Me—Healthy SC programs will serve multiple Upstate counties, providing a more consistent health care presence in each county and growing the clinic from a standalone facility into the state’s first “regional hub.”
The regional hub model consists of
- opening brick-and-mortar outpatient clinics where warranted,
- deploying more mobile health clinics into high-need rural areas,
- focusing on chronic disease management and prevention,
- expanding access to MUSC telehealth networks,
- leveraging the strengths of health extension agents across the state,
- and then tying these programs together so that they provide comprehensive health care aimed at improving health outcomes and equity.
Made possible with funds from the South Carolina General Assembly and the support of Gov. Henry McMaster, Healthy Me—Healthy SC is designed to grow the kind of “health innovations” that result in more preventable care, expanding the availability of clinical services through nurse practitioners and other providers with care documented in a comprehensive electronic health record.
The result is connected clinics and health care partners who provide comprehensive health care services for previously unserved or underserved communities, reducing preventable hospitalization, cancer mortality and premature death.
“The goal is to improve health outcomes for the populations that need it most,” explains Gimbel. And with continued state support, even more rural communities will be able to benefit.
Growing access through new educational opportunities
Piloting the Sullivan Center from a standalone clinic into one of the Healthy Me—Healthy SC regional health care hubs is a study in how to dramatically increase the imprint of health care in a rural area. Using telemedicine, mobile health clinics and clinical partnerships, these regional hubs are emerging as a way to serve multiple counties within a rural area.
“If this Sullivan Center regional hub can work with other clinics and partners to serve so many counties, imagine what other hubs across the state will do,” says Gimbel.
In addition to helping build up rural communities, the partnerships surrounding regional health are also changing the way Clemson delivers its health education programs. It has driven restructuring within the College of Behavioral, Social and Health Sciences, which houses the Sullivan Center. In summer 2019, the center came under the direction of the Department of Public Health Sciences in order to create a unique structure that brings together clinical and public health faculty and staff to foster innovation and bridge gaps in health care at the community, county and regional level.
This new structure within the College is designed to aid existing rural clinics and provide care in areas where people go without, in part due to a lack of reliable transportation. Gimbel said the move will blend the research-based interventions undertaken by public health sciences faculty with practical health outreach and student experiences.
Reaching small towns with care
Nationwide, low-population communities experience the worst health outcomes, according to the Robert Wood Johnson Foundation, the largest public health philanthropy in the United States. Rural residents have the riskiest health factors, including limited housing and substandard transit systems, which result in less access to and diminished quality of health care.
But in South Carolina, where more than a quarter of the population is considered rural, the problem rises to a crisis level. In 2016, of the 2,036 nurse practitioners in South Carolina, only 290 worked in rural areas.
Clemson’s request for continued funding for the Healthy Me—Healthy SC program will go before the 2020 South Carolina General Assembly; it aims to continue leveraging MUSC and Clemson’s collective expertise in education, health and community outreach — as well as the statewide reach of both institutions — to better address the crisis.
Nationally, funding for the deployment of dozens of mobile health clinics has been both lifesaving and cost-saving. For every dollar spent on mobile clinics, an average of $12 is saved — or an average savings of $1,600 in health care-related costs per person served. And, on average, mobile clinics save 65 quality-adjusted years of life during every year of operation and provide accessible care at a cheaper cost to health care systems than emergency departments, according to Mobile Health Map, a national resource for these kinds of clinics.
As an MUSC-affiliated clinic, the Sullivan Center has taken that mobile health service to the next level, soon to benefit from enhanced tools that improve billing efficiency, which allows them to bill more forms of insurance, measure clinical outcomes and gauge the effectiveness of its services. As a next phase, Gimbel says the clinic staff plans to include a telehealth suite on the ground floor of its home in Clemson’s Edwards Hall where staff and patients can connect with physicians and health Extension agents across the state.
This new take on health care access is designed to partner with existing rural clinics and provide care in areas where people go without due to a lack of reliable transportation. The move will also blend the research-based interventions undertaken by public health sciences faculty with practical health outreach and student experiences.
Students pursuing health studies are an integral part of these next-step solutions. Clemson School of Nursing Director Kathleen Valentine says the nurse practitioner students involved in the Healthy Me—Healthy SC partnership will be able to manage the long-term and chronic health care needs of patients while increasing access to primary care in rural, underserved areas.
At the forefront of much of the work with vulnerable patient populations will be Caitlin Moore, a family nurse practitioner and director of outreach and wellness for the Sullivan Center. As a longtime employee of the center, Moore says she is thrilled with the new capabilities that the Healthy Me—Healthy SC initiative provides for outreach efforts.
“The niche areas that aren’t being addressed or aren’t effectively being addressed are where we will thrive,” says Moore. “Medical practices that are stretched thin can refer patients to us and we can serve them in remote areas, or we can find those patients that need to be referred to hospital systems.”
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