By Sarah Jane Tribble
KFF Health News
CLARKSVILLE, Tenn. 鈥� On a hot July morning, customers at the Dollar General along a two-lane highway northwest of Nashville didn鈥檛 seem to notice signs of the chain store鈥檚 foray into mobile health care, particularly in rural America.
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鈥檚 rearview mirror before shopping.
Each went right by a sign exclaiming 鈥淨uick, Easy Health Visits,鈥� with an image of a mobile clinic.
Just after 10 a.m., registered nurse Kimberly French arrived to work at the DocGo mobile clinic parked in the store鈥檚 lot. She checked her schedule.
鈥淲e don鈥檛 have any appointments so far today, but that could change,鈥� French said. 鈥淟ast night we didn鈥檛 have any appointments and three or four people showed up all at one time.鈥�
Dollar General, the nation鈥檚 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.
Deploying mobile clinics to fill care gaps in underserved areas isn鈥檛 a new idea. But pairing them with Dollar General鈥檚 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.
Dollar General鈥檚 latest annual report notes that about 80% of the company鈥檚 stores are in towns with populations of fewer than 20,000 鈥� precisely where medical professionals are scarce.
Catering to those who want urgent or primary care, the mobile clinics take private insurance as well as Medicaid and Medicare. The company鈥檚 website says DocGo鈥檚 self-pay rates start at $69 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.
On the ground in Tennessee, primary care doctors and patients are skeptical.
鈥淗onestly, they don鈥檛 really grasp, I don鈥檛 think, what they鈥檙e getting into,鈥� 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.
Michelle Green manages the popular Sweet Charlotte grill about 10 miles south of Dollar General鈥檚 most rural test site. Green, who was handing out hamburgers and hand-cut fries during a Saturday rush, said she hadn鈥檛 heard of the mobile clinic. She said with a shrug that Dollar General and health care clinics 鈥渄on鈥檛 go together.鈥�
鈥淚 wouldn鈥檛 want to go to a health care clinic in a parking lot; that鈥檚 just me,鈥� Green said, adding that someone might go if 鈥測ou鈥檙e sick and you can鈥檛 go anywhere else.鈥�
Bumps in the Road
The Clarksville-area pilot, which launched last fall, is in a federally designated primary care shortage area for low-income residents.
About 1,000 patients have been seen in the company鈥檚 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.
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鈥檚 time slot to busy Fort Campbell Boulevard in Clarksville.
鈥淲e do try for months in a given area to see where it makes sense and where it doesn鈥檛,鈥� former DocGo CEO Anthony Capone said in a July interview. 鈥淥ur goal is to align the supply we have with the demand of the local community.鈥�
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 with Blue Cross Blue Shield of Tennessee.
Capone abruptly resigned on Sept. 15 after the Albany Times Union reported he lied about having a graduate degree.
Dollar General stores have a 鈥渢remendous opportunity鈥� to have 鈥渁 major impact on health there and really bond themselves as a member of the community,鈥� said Tom Campanella, the healthcare executive-in-residence at Baldwin Wallace University, who has managed mobile clinics in rural places.
Near tiny Cumberland Furnace, south of Clarksville, William 鈥淏ubba鈥� 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 鈥� his sister-in-law, nephew, and niece鈥檚 boyfriend 鈥� used and liked 鈥渢he little clinic on wheels.鈥�
鈥淲e don鈥檛 have to go to town and fight all that traffic,鈥� he said. 鈥淭hey come to us. That鈥檚 a wonderful thing. It helps a lot of people.鈥�
Over on busy Fort Campbell Boulevard in Clarksville, Marina Woolever, a mother of three, said she might use the clinic if she didn鈥檛 have insurance. Natural health professional Nichole Clemmer glanced toward the clinic and called it a 鈥減loy鈥� to make more money.
Jefferies lead equity analyst Corey Tarlowe, who follows discount retailers, said the clinics will help 鈥渄emocratize鈥� access to health care and simultaneously boost traffic to Dollar General stores.
With its rapid growth in recent years, Dollar General has faced accusations that its stores kill off local grocery stores and other businesses, reduce employment, and contribute to the creation of food deserts. More recently, the U.S. Labor Department said the chain 鈥渃ontinues to discount safety鈥� for employees as it has piled up more than $21 million in federal fines.
Crystal Luce, senior director of public relations for Dollar General, said the company believes each new store provides 鈥減ositive economic benefits,鈥� including new jobs, low-cost products, and its literacy foundation. On the federal fines, Luce said Dollar General is 鈥渃ommitted to providing a safe work environment for its associates and shopping experience for its customers.鈥� The company declined to provide an interview.
The DocGo pilot, she wrote, is intended to 鈥渃omplement鈥� the DG Wellbeing initiative, which is a corporatewide push. Dollar General wants to increase 鈥渁ccess to basic health care products and, ultimately, services over time, particularly in rural America,鈥� Luce wrote.
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 levied by migrants under the company鈥檚 care. In August, DocGo officials said claims aired by sources in a New York Times article that first reported the problems were 鈥渘ot reflective of the overall scope and quality鈥� of the services the company has provided.
The company鈥檚 pilot with Dollar General is 鈥渟upported with funding from the state of Tennessee,鈥� DocGo鈥檚 Capone said during the company鈥檚 first-quarter earnings call. The Dollar General partnership is cited in quarterly grant reports DocGo鈥檚 Rapid Reliable Testing LLC submitted to the state, according to records KFF Health News obtained through public information requests.
In the grant filing, DocGo listed Dollar General along with other organizations as 鈥渢rusted messengers鈥� in building vaccine awareness.
Dollar General declined to respond to a question about its involvement in the grant. Instead, Luce stated, 鈥淲e continue to test and learn through the DocGo pilot.鈥�
鈥楻elational Care鈥�
The goal of the $2.4 million grant, 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鈥檚 marketing director, Amanda Shell Jennings, the company said, 鈥淒ollar General has no involvement with the TN Department of Health grant funding or allocations.鈥�
The grant covers storage and maintenance of COVID-19 vaccines on the DocGo mobile clinics, Jennings鈥� statement said, adding that, as of September, DocGo has held 41 vaccine events and provided 66 vaccines to rural Tennesseans.
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.
鈥淲hen 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?鈥� she said.
That kind of response doesn鈥檛 surprise Carlo Pike, a doctor who for years has practiced family medicine in Clarksville. He said he鈥檚 not worried about the competition because providing primary care is about developing relationships.
鈥淚f I can do this relationship right,鈥� Pike said, 鈥渕aybe 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.鈥�
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.
鈥淲e鈥檙e just small rural primary care docs doing our jobs with a process that works,鈥� Staton said. In another interview, Staton called it 鈥渞elational care.鈥�
DocGo surveyed its patients and found that 19% of them did not have a primary care physician or hadn鈥檛 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.
But despite its outreach, DocGo struggled to get a foothold in rural Cumberland Furnace.
Lottie Stokes, the president of the community center in Cumberland Furnace, said DocGo鈥檚 team had 鈥渃alled and asked to come down here.鈥� Stokes said she would rather use the local emergency medical technicians and firefighters, who she knows are 鈥渓egit.鈥�
Her father-in-law, Bobby Stokes, who鈥檚 nearly 80 years old, said he used the mobile clinic before it moved locations.
His wife couldn鈥檛 breathe. They pulled into the parking lot and climbed onto the van.
鈥淲e wasn鈥檛 in there five minutes,鈥� he said. 鈥淭hey done the blood pressure test and what they need to do and put her in the car and said, 鈥楪et her to the hospital, to the emergency room.鈥欌��
The DocGo staff, he said, did not ask for payment: 鈥淣othing.鈥�
鈥淭hey were more concerned with her than they were with I guess getting their money,鈥� he said, adding that his wife is doing well now. 鈥淭hey told me to get there, and I took them at their word. My car runs fast.鈥�
KFF Health News correspondent Brett Kelman contributed to this report.
(, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of 鈥� the independent source for health policy research, polling and journalism.)
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