CLARKSVILLE, Tenn. — On a scorching July morning, prospects on the Dollar General alongside a two-lane freeway northwest of Nashville didn’t appear to note indicators of the chain retailer’s foray into cellular well being care, significantly in rural America.
A lady lifted a baby from the again of an SUV and walked into the shop. A canine barked from a black pickup truck earlier than its proprietor returned with instances of soda. Another girl checked her hair in a convertible’s rearview mirror earlier than procuring.
Each went proper by an indication exclaiming “Quick, Easy Health Visits,” with a picture of a cellular clinic.
Just after 10 a.m., registered nurse Kimberly French arrived to work on the DocGo cellular clinic parked within the retailer’s lot. She checked her schedule.
“We don’t have any appointments so far today, but that could change,” French mentioned. “Last night we didn’t have any appointments and three or four people showed up all at one time.”
Dollar General, the nation’s largest retailer by variety of shops, with greater than 19,000, partnered with New York-based cellular medical providers firm DocGo to check whether or not they might draw extra prospects and deal with persistent well being inequities.
Deploying cellular clinics to fill care gaps in underserved areas isn’t a brand new thought. But pairing them with Dollar General’s ubiquitous small-town presence has been heralded by funding analysts and a few rural well being specialists as a technique to ease the well being care drought in rural America.
Dollar General’s newest annual report notes that about 80% of the corporate’s shops are in cities with populations of fewer than 20,000 — exactly the place medical professionals are scarce.
Catering to those that need pressing or major care, the cellular clinics take non-public insurance coverage in addition to Medicaid and Medicare. The firm’s web site says DocGo’s self-pay charges begin at $69 for sufferers with out insurance coverage or who’re out of community. DocGo officers mentioned Tennessee sufferers could also be charged totally different charges however declined to offer particulars.
On the bottom in Tennessee, major care medical doctors and sufferers are skeptical.
“Honestly, they don’t really grasp, I don’t think, what they’re getting into,” mentioned Brent Staton, a household drugs physician and the chief of the Cumberland Center for Healthcare Innovation, a statewide group that helps small-town household care medical doctors coordinate care and negotiate with insurers, together with Medicare.
Michelle Green manages the favored Sweet Charlotte grill about 10 miles south of Dollar General’s most rural check web site. Green, who was handing out hamburgers and hand-cut fries throughout a Saturday rush, mentioned she hadn’t heard of the cellular clinic. She mentioned with a shrug that Dollar General and well being care clinics “don’t go together.”
“I wouldn’t want to go to a health care clinic in a parking lot; that’s just me,” Green mentioned, including that somebody would possibly go if “you’re sick and you can’t go anywhere else.”
Bumps within the Road
The Clarksville-area pilot, which launched final fall, is in a federally designated major care scarcity space for low-income residents.
About 1,000 sufferers have been seen within the firm’s clinics, both at Dollar General websites or group pop-up occasions, and a few turned repeat guests, in line with DocGo. Payment is taken exterior on a cellular machine and, as soon as inside, sufferers meet with an on-site workers member, like French, and join by way of telehealth on an iPad display screen with a doctor assistant or nurse practitioner.
The clinic rotates between three Dollar General pilot websites every week. The shops are within the Clarksville space and, early this summer season, the van stopped going to probably the most rural web site, close to Cumberland Furnace, due to low utilization, in line with firm leaders. DocGo moved that location’s time slot to busy Fort Campbell Boulevard in Clarksville.
“We do try for months in a given area to see where it makes sense and where it doesn’t,” former DocGo CEO Anthony Capone mentioned in a July interview. “Our goal is to align the supply we have with the demand of the local community.”
Capone, although, mentioned he thought the pilot would work in rural areas when insurers are signed on to refer their members to the cellular clinic. DocGo lately introduced a take care of Blue Cross Blue Shield of Tennessee.
Capone abruptly resigned on Sept. 15 after the Albany Times Union reported he lied about having a graduate diploma.
Dollar General shops have a “tremendous opportunity” to have “a major impact on health there and really bond themselves as a member of the community,” mentioned Tom Campanella, the healthcare executive-in-residence at Baldwin Wallace University, who has managed cellular clinics in rural locations.
Near tiny Cumberland Furnace, south of Clarksville, William “Bubba” Murphy stopped on his approach right into a Dollar General, paused to wave and holler whats up to associates getting out of their vehicles, and shared that a number of members of the family — his sister-in-law, nephew, and niece’s boyfriend — used and preferred “the little clinic on wheels.”
“We don’t have to go to town and fight all that traffic,” he mentioned. “They come to us. That’s a wonderful thing. It helps a lot of people.”
Over on busy Fort Campbell Boulevard in Clarksville, Marina Woolever, a mom of three, mentioned she would possibly use the clinic if she didn’t have insurance coverage. Natural well being skilled Nichole Clemmer glanced towards the clinic and known as it a “ploy” to earn more money.
Jefferies lead fairness analyst Corey Tarlowe, who follows low cost retailers, mentioned the clinics will assist “democratize” entry to well being care and concurrently increase site visitors to Dollar General shops.
With its fast development lately, Dollar General has confronted accusations that its shops kill off native grocery shops and different companies, scale back employment, and contribute to the creation of meals deserts. More lately, the U.S. Labor Department mentioned the chain “continues to discount safety” for workers because it has piled up greater than $21 million in federal fines.
Crystal Luce, senior director of public relations for Dollar General, mentioned the corporate believes every new retailer supplies “positive economic benefits,” together with new jobs, low-cost merchandise, and its literacy basis. On the federal fines, Luce mentioned Dollar General is “committed to providing a safe work environment for its associates and shopping experience for its customers.” The firm declined to offer an interview.
The DocGo pilot, she wrote, is meant to “complement” the DG Wellbeing initiative, which is a corporatewide push. Dollar General desires to extend “access to basic health care products and, ultimately, services over time, particularly in rural America,” Luce wrote.
States away, DocGo is beneath fireplace for a no-bid contract to offer housing, busing, and different providers for asylum-seekers in New York. State Attorney General Letitia James is investigating complaints levied by migrants beneath the corporate’s care. In August, DocGo officers mentioned claims aired by sources in a New York Times article that first reported the issues had been “not reflective of the overall scope and quality” of the providers the corporate has supplied.
The firm’s pilot with Dollar General is “supported with funding from the state of Tennessee,” DocGo’s Capone mentioned through the firm’s first-quarter earnings name. The Dollar General partnership is cited in quarterly grant reviews DocGo’s Rapid Reliable Testing LLC submitted to the state, in line with data KFF Health News obtained by public data requests.
In the grant submitting, DocGo listed Dollar General together with different organizations as “trusted messengers” in constructing vaccine consciousness.
Dollar General declined to reply to a query about its involvement within the grant. Instead, Luce acknowledged, “We continue to test and learn through the DocGo pilot.”
‘Relational Care’
The purpose 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 manage COVID-19 vaccines. In a written response supplied by DocGo’s advertising and marketing director, Amanda Shell Jennings, the corporate mentioned, “Dollar General has no involvement with the TN Department of Health grant funding or allocations.”
The grant covers storage and upkeep of COVID-19 vaccines on the DocGo cellular clinics, Jennings’ assertion mentioned, including that, as of September, DocGo has held 41 vaccine occasions and supplied 66 vaccines to rural Tennesseans.
Lulu West, 72, was visiting a buddy on the Historic Cumberland Furnace Iron Museum when she stopped to think about the cellular clinic. West mentioned she would quite go to her major care physician.
“When 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?” she mentioned.
That sort of response doesn’t shock Carlo Pike, a physician who for years has practiced household drugs in Clarksville. He mentioned he’s not anxious in regards to the competitors as a result of offering major care is about creating relationships.
“If I can do this relationship right,” Pike mentioned, “maybe 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.”
Staton mentioned the Cumberland Center for Healthcare Innovation, his accountable care group, has saved Medicare and Medicare Advantage firms greater than $100 million by specializing in preventive care and lowering hospitalizations and emergency visits for sufferers.
“We’re just small rural primary care docs doing our jobs with a process that works,” Staton mentioned. In one other interview, Staton known as it “relational care.”
DocGo surveyed its sufferers and located that 19% of them didn’t have a major care doctor or hadn’t seen theirs in additional than a 12 months. In the written responses Jennings supplied, DocGo mentioned it follows up with each affected person after the preliminary go to, presents telemedicine help between visits, and supplies ongoing preventive care on an everyday schedule.
But regardless of its outreach, DocGo struggled to get a foothold in rural Cumberland Furnace.
Lottie Stokes, the president of the group middle in Cumberland Furnace, mentioned DocGo’s crew had “called and asked to come down here.” Stokes mentioned she would quite use the native emergency medical technicians and firefighters, who she is aware of are “legit.”
Her father-in-law, Bobby Stokes, who’s practically 80 years previous, mentioned he used the cellular clinic earlier than it moved places.
His spouse couldn’t breathe. They pulled into the parking zone and climbed onto the van.
“We wasn’t in there five minutes,” he mentioned. “They done the blood pressure test and what they need to do and put her in the car and said, ‘Get her to the hospital, to the emergency room.’”
The DocGo workers, he mentioned, didn’t ask for fee: “Nothing.”
“They were more concerned with her than they were with I guess getting their money,” he mentioned, including that his spouse is doing effectively now. “They told me to get there, and I took them at their word. My car runs fast.”
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KFF Health News correspondent Brett Kelman contributed to this report.
(KFF Health News, previously often known as Kaiser Health News (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications of KFF — the impartial supply for well being coverage analysis, polling and journalism.)
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