CLARKSVILLE, Tenn. \u2014 On a hot July morning, customers at the Dollar General along a two-lane highway northwest of Nashville didn\u2019t seem to notice signs of the chain store\u2019s foray into mobile health care, particularly in rural America.<\/p>\n

A woman lifted a child from the back of an SUV and walked into the store. A dog barked from a black pickup truck before its owner returned with cases of soda. Another woman checked her hair in a convertible\u2019s rearview mirror before shopping.<\/p>\n

Each went right by a sign exclaiming \u201cQuick, Easy Health Visits,\u201d with an image of a mobile clinic.<\/p>\n

Just after 10 a.m., registered nurse Kimberly French arrived to work at the DocGo mobile clinic parked in the store\u2019s lot. She checked her schedule.<\/p>\n

\u201cWe don\u2019t have any appointments so far today, but that could change,\u201d French said. \u201cLast night we didn\u2019t have any appointments and three or four people showed up all at one time.\u201d<\/p>\n

Dollar General, the nation\u2019s largest retailer by number of stores, with more than 19,000, partnered with New York-based mobile medical services company DocGo to test whether they could draw more customers and tackle persistent health inequities.<\/p>\n

Deploying mobile clinics to fill care gaps in underserved areas isn\u2019t a new idea. But pairing them with Dollar General\u2019s ubiquitous small-town presence has been heralded by investment analysts and some rural health experts as a way to ease the health care drought in rural America.<\/p>\n

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Dollar General\u2019s latest annual report notes that about 80% of the company\u2019s stores are in towns with populations of fewer than 20,000 \u2014 precisely where medical professionals are scarce.<\/p>\n
Catering to those who want urgent or primary care, the mobile clinics take private insurance as well as Medicaid and Medicare. The company\u2019s website says DocGo\u2019s self-pay rates start at $69<\/a> for patients without insurance or who are out of network. DocGo officials said Tennessee patients may be charged different rates but declined to provide details.<\/p>\n
On the ground in Tennessee, primary care doctors and patients are skeptical.<\/p>\n
\u201cHonestly, they don\u2019t really grasp, I don\u2019t think, what they\u2019re getting into,\u201d said Brent Staton, a family medicine doctor and the leader of the Cumberland Center for Healthcare Innovation, a statewide organization that helps small-town family care doctors coordinate care and negotiate with insurers, including Medicare.<\/p>\n
Michelle Green manages the popular Sweet Charlotte grill about 10 miles south of Dollar General\u2019s most rural test site. Green, who was handing out hamburgers and hand-cut fries during a Saturday rush, said she hadn\u2019t heard of the mobile clinic. She said with a shrug that Dollar General and health care clinics \u201cdon\u2019t go together.\u201d<\/p>\n
\u201cI wouldn\u2019t want to go to a health care clinic in a parking lot; that\u2019s just me,\u201d Green said, adding that someone might go if \u201cyou\u2019re sick and you can\u2019t go anywhere else.\u201d<\/p>\n
Bumps in the Road<\/strong><\/p>\n
The Clarksville-area pilot, which launched last fall, is in a federally designated primary care shortage area<\/a> for low-income residents.<\/p>\n
About 1,000 patients have been seen in the company\u2019s clinics, either at Dollar General sites or community pop-up events, and some became repeat visitors, according to DocGo. Payment is taken outside on a mobile device and, once inside, patients meet with an on-site staff member, like French, and connect via telehealth on an iPad screen with a physician assistant or nurse practitioner.<\/p>\n
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\n\t\t\t\t\t\t\tRegistered nurse Kimberly French works 10-hour shifts at the DocGo mobile clinic partnered with Dollar General. She says the pilot is \u201cjust getting off the ground\u201d and the operation needs to gain the trust of the community.\t\t\t\t\t\t(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n<\/p><\/div>\n
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\n\t\t\t\t\t\t\tOne of DocGo\u2019s mobile clinic vans.\t\t\t\t\t\t(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n
The clinic rotates between three Dollar General pilot sites each week. The stores are in the Clarksville area and, early this summer, the van stopped going to the most rural site, near Cumberland Furnace, because of low utilization, according to company leaders. DocGo moved that location\u2019s time slot to busy Fort Campbell Boulevard in Clarksville.<\/p>\n
\u201cWe do try for months in a given area to see where it makes sense and where it doesn\u2019t,\u201d former DocGo CEO Anthony Capone said in a July interview. \u201cOur goal is to align the supply we have with the demand of the local community.\u201d<\/p>\n
Capone, though, said he thought the pilot would work in rural areas when insurers are signed on to refer their members to the mobile clinic. DocGo recently announced a deal<\/a> with Blue Cross Blue Shield of Tennessee.<\/p>\n
Capone abruptly resigned<\/a> on Sept. 15 after the Albany Times Union reported he lied about having a graduate degree.<\/p>\n
Dollar General stores have a \u201ctremendous opportunity\u201d to have \u201ca major impact on health there and really bond themselves as a member of the community,\u201d said Tom Campanella, the healthcare executive-in-residence at Baldwin Wallace University, who has managed mobile clinics in rural places.<\/p>\n
Near tiny Cumberland Furnace, south of Clarksville, William \u201cBubba\u201d Murphy stopped on his way into a Dollar General, paused to wave and holler hello to friends getting out of their cars, and shared that multiple family members \u2014 his sister-in-law, nephew, and niece\u2019s boyfriend \u2014 used and liked \u201cthe little clinic on wheels.\u201d<\/p>\n
\u201cWe don\u2019t have to go to town and fight all that traffic,\u201d he said. \u201cThey come to us. That\u2019s a wonderful thing. It helps a lot of people.\u201d<\/p>\n
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William \u201cBubba\u201d Murphy says he\u2019s a fan of \u201cthe little clinic on wheels\u201d parked outside of his local Dollar General. \u201cWe don\u2019t have to go to town and fight all that traffic.\u201d(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n
Over on busy Fort Campbell Boulevard in Clarksville, Marina Woolever, a mother of three, said she might use the clinic if she didn\u2019t have insurance. Natural health professional Nichole Clemmer glanced toward the clinic and called it a \u201cploy\u201d to make more money.<\/p>\n
Jefferies lead equity analyst Corey Tarlowe, who follows discount retailers, said the clinics will help \u201cdemocratize\u201d access to health care and simultaneously boost traffic to Dollar General stores.<\/p>\n
With its rapid growth in recent years, Dollar General has faced accusations that its stores kill off<\/a> local grocery stores and other businesses, reduce employment, and contribute to<\/a> the creation of food deserts. More recently, the U.S. Labor Department said the chain \u201ccontinues to discount safety\u201d for employees as it has piled up more than $21 million in federal fines<\/a>.<\/p>\n
Crystal Luce, senior director of public relations for Dollar General, said the company believes each new store provides \u201cpositive economic benefits,\u201d including new jobs, low-cost products, and its literacy foundation. On the federal fines, Luce said Dollar General is \u201ccommitted to providing a safe work environment for its associates and shopping experience for its customers.\u201d The company declined to provide an interview.<\/p>\n
The DocGo pilot, she wrote, is intended to \u201ccomplement\u201d the DG Wellbeing initiative, which is a corporatewide push. Dollar General wants to increase \u201caccess to basic health care products and, ultimately, services over time, particularly in rural America,\u201d Luce wrote.<\/p>\n
States away, DocGo is under fire for a no-bid contract to provide housing, busing, and other services for asylum-seekers in New York. State Attorney General Letitia James is investigating complaints<\/a> levied by migrants under the company\u2019s care. In August, DocGo officials said claims aired by sources in a New York Times article<\/a> that first reported the problems were \u201cnot reflective of the overall scope and quality\u201d of the services the company has provided.<\/p>\n
The company\u2019s pilot with Dollar General is \u201csupported with funding from the state of Tennessee,\u201d DocGo\u2019s Capone said during the company\u2019s first-quarter earnings call<\/a>. The Dollar General partnership is cited in quarterly grant reports<\/a> DocGo\u2019s Rapid Reliable Testing LLC submitted to the state, according to records KFF Health News obtained through public information requests.<\/p>\n
In the grant filing, DocGo listed Dollar General along with other organizations as \u201ctrusted messengers\u201d in building vaccine awareness.<\/p>\n
Dollar General declined to respond to a question about its involvement in the grant. Instead, Luce stated, \u201cWe continue to test and learn through the DocGo pilot.\u201d<\/p>\n
\u2018Relational Care\u2019<\/strong><\/p>\n
The goal of the $2.4 million grant<\/a>, funded by the Centers for Disease Control and Prevention and distributed by the Tennessee Department of Health, is to administer covid-19 vaccines. In a written response provided by DocGo\u2019s marketing director, Amanda Shell Jennings, the company said, \u201cDollar General has no involvement with the TN Department of Health grant funding or allocations.\u201d<\/p>\n
The grant covers storage and maintenance of covid-19 vaccines on the DocGo mobile clinics, Jennings\u2019 statement said, adding that, as of September, DocGo has held 41 vaccine events and provided 66 vaccines to rural Tennesseans.<\/p>\n
Lulu West, 72, was visiting a friend at the Historic Cumberland Furnace Iron Museum when she stopped to consider the mobile clinic. West said she would rather go to her primary care doctor.<\/p>\n
\u201cWhen you say mobile clinic outside a Dollar General it just kind of has a connotation that you may not be comfortable with. You know what I mean?\u201d she said.<\/p>\n
That kind of response doesn\u2019t surprise Carlo Pike, a doctor who for years has practiced family medicine in Clarksville. He said he\u2019s not worried about the competition because providing primary care is about developing relationships.<\/p>\n
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Carlo Pike is a doctor who owns a small practice in Clarksville, Tennessee. He says practicing family medicine is about making sure patients know he cares \u201cabout what happens to them after they leave the clinic.\u201d(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n
\u201cIf I can do this relationship right,\u201d Pike said, \u201cmaybe we can keep you from getting a [blood] sugar of 500 [mg\/dL] or from Grandpa climbing up a ladder and trying to fix something he has no business with and falling off and breaking his leg.\u201d<\/p>\n
Staton said the Cumberland Center for Healthcare Innovation, his accountable care organization, has saved Medicare and Medicare Advantage companies more than $100 million by focusing on preventive care and reducing hospitalizations and emergency visits for patients.<\/p>\n
\u201cWe\u2019re just small rural primary care docs doing our jobs with a process that works,\u201d Staton said. In another interview, Staton called it \u201crelational care.\u201d<\/p>\n
DocGo surveyed its patients and found that 19% of them did not have a primary care physician or hadn\u2019t seen theirs in more than a year. In the written responses Jennings provided, DocGo said it follows up with every patient after the initial visit, offers telemedicine support between visits, and provides ongoing preventive care on a regular schedule.<\/p>\n
But despite its outreach, DocGo struggled to get a foothold in rural Cumberland Furnace.<\/p>\n
Lottie Stokes, the president of the community center in Cumberland Furnace, said DocGo\u2019s team had \u201ccalled and asked to come down here.\u201d Stokes said she would rather use the local emergency medical technicians and firefighters, who she knows are \u201clegit.\u201d<\/p>\n
Her father-in-law, Bobby Stokes, who\u2019s nearly 80 years old, said he used the mobile clinic before it moved locations.<\/p>\n
His wife couldn\u2019t breathe. They pulled into the parking lot and climbed onto the van.<\/p>\n
\u201cWe wasn\u2019t in there five minutes,\u201d he said. \u201cThey done the blood pressure test and what they need to do and put her in the car and said, \u2018Get her to the hospital, to the emergency room.\u2019\u201d<\/p>\n
The DocGo staff, he said, did not ask for payment: \u201cNothing.\u201d<\/p>\n
\u201cThey were more concerned with her than they were with I guess getting their money,\u201d he said, adding that his wife is doing well now. \u201cThey told me to get there, and I took them at their word. My car runs fast.\u201d<\/p>\n
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Bobby Stokes brought his wife to the DocGo mobile clinic parked on a Dollar General lot near Cumberland Furnace, Tennessee, one night when she couldn\u2019t breathe. Stokes says the staff were concerned more about his wife than about \u201cgetting their money.\u201d(Sarah Jane Tribble\/KFF Health News)<\/span><\/figcaption><\/figure>\n
KFF Health News correspondent Brett Kelman contributed to this report.<\/em><\/p>\n
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