How much does the School of Medicine Columbia’s Kevin Bennett think about the future of rural health care?
Ask him about a certain list he’s been compiling.
“It's something I've been noodling on for several years,” says the director of USC’s Center for Rural & Primary Healthcare. “I have an annotated bibliography I've been collecting that speaks to that. It's about 40 pages long.”
That’s not 40 pages of notes and spelled-out ideas. His enthusiasm starts with a list of titles of his favorite research source materials that’s 40 pages long.
And because Jan. 1, 2024, was the first day of his term as president of the National Rural Health Association, he’ll be working to turn those starting points into policy and action.
“I can now pull all that stuff together and turn them into guiding documents,” says Bennett, who has been a University of South Carolina professor since 2005 and director of USC’s Center for Rural & Primary Healthcare since 2020. “And to me, that's exciting. A philosophical policy document is fun for me. I can't wait to work on that.”
He envisions crafting thought pieces with the help of national workgroups he assembles that will tackle the Future of Rural Health initiative, a priority of the association that will help shape rural health policy for years to come.
Bennett spent a few December days in Washington to undergo his national association presidential onboarding. He learned about the collaborations he’ll have with federal policy makers, agencies and even the White House. He feels encouraged that he can put forward a positive agenda during an election year, and it’s a strategy he’s talked about for years with the association’s CEO, Alan Morgan.
“Instead of talking about all the doom and gloom with rural health, which is really easy to do, we want to talk about all the good things rural people are doing,” Bennett says.
Across the country, rural communities are building innovative programs that serve their communities in meaningful ways. Bennett sees the work accomplished via South Carolina’s Center for Rural & Primary Healthcare as providing models that can be adopted nationally. The center receives funding for 63 programs, and nearly 22,000 patients were served in 2023.
“I don't know of any other center in the country like ours, with the funding and charge that we have, and the flexibility we have,” he says.
Bennett believes that the national association’s priorities align well with work being done in South Carolina. He plans to engage with other federal agencies to begin the cycle of finding money for pilot programs that take after South Carolina programs.
“And then they could say, ‘Hey, we're going to put out a call for proposals for people to do the South Carolina model,’ which is exciting,” Bennett says.
Bringing care closer
Bennett’s path to being elected National Rural Health Association president began in 2002 as a USC grad student. That was a time when not many medical students or Ph.D. candidates participated in the group, so he helped co-found its student organization. Now, students make up one of the organization’s largest constituency groups.
“Over the years, you keep showing up and you keep saying, ‘Hey, I could help with that,’ ” Bennett says. He has been chair of its policy congress, which helps set the policy agenda and writes briefs that go to Capitol Hill and legislators. “I feel like I've been on every single NRHA committee, which might be why I got their volunteer of the year award.”
Bennett will oversee these national initiatives while balancing his responsibilities home in South Carolina, where disparities continue.
In May, a hospital in Laurens closed its maternity ward. It was just one more sign of the decline rural areas are seeing in obstetrics services.
“It's a burden on the population,” Bennett says. “We have certain pockets of the state that have really poor infant mortality, maternal mortality rates and access rates, especially for women of color.”
Among areas where the state has made progress in narrowing gaps is in preventive services such as mammography rates, as well as prostate and colorectal screenings.
Bennett says a key to improving rural health care is introducing access to specialty services.
“How do you bring care closer to them so they can actually get connected,” Bennett says. “Our center funds pediatric subspecialists to go to the community to deliver care there, which is huge.”
He points to the expansion of telehealth as an important boost to maintaining continuity of care. “Telehealth might not be great for initiating care, but for follow-ups and check-ins, telehealth is a great option,” Bennett says. “For some mental health care, it can be really good.”
Trusted locations, stronger connections
A positive step Bennett and his colleagues have seen is an acceptance of alternative provider types and locations. Examples include pharmacies conducting telehealth and providing immunizations.
A newer strategy is identifying trusted locations where health care can happen. Examples include health liaisons or telehealth services in public libraries or other nontraditional settings.
“We have a partner that's putting a telehealth room in a housing complex,” Bennett says. “With these alternative access points, you don't have to go to a doctor to get physician care, and not everybody has broadband or a smartphone or a tablet.”
So far, nearly 1,400 people have been connected to health care or resources to address their social needs in eight rural library systems.
“What's that ‘easy button’ that’s lower cost, higher value, much better outcomes? That's what we're trying to get to,” Bennett says.
He also notes that the stress of environmental problems in rural communities such as housing, diet, exercise, safety and resources for personal violence become exacerbated when they are not addressed as health problems.
“That's the story of rural America,” Bennett says. “On one hand, we're not doing so great. On the other hand, we've got a lot of folks who are energized and excited to try to make a difference and make a change.”
Bennett sees his national platform as an extension of the large role USC plays in answering rural health care problems.
“We have a lot of national rural health leaders here at our university,” he says. “When people nationally think of South Carolina, it's well respected in that area.”
Part of Bennett’s role is to make a presentation to the South Carolina Legislature every year as a review of the funding provided for USC’s Center for Rural & Primary Healthcare.
“We have to give them a report on what we did and what we want to do next year,” Bennett says. “It’s going to be nice to let them know there's a potential for national impact because of the work they are funding.”