Honk for Bethesda Community Clinic! A Q&A with Executive Director Melissa Belfield

Bookkeeper, accountant and former Walmart associate Melissa Belfield was never a medical services provider herself but joined her nurse practitioner mom at Georgia-based Bethesda Community Clinic and became its director in 2020. In her role, Melissa not only runs the successful program, but handles HR, payroll, drives the mobile unit, and even changes the oil in the generator!

In Driving Health Forward’s latest blog post, she describes the trajectory of the clinic, why it decided to move from brick-and-mortar to all mobile, some of the successes and challenges, and how an initiative like Driving Health Forward can help break down barriers to scaling mobile healthcare.

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Welcome, Melissa! Tell us how Bethesda Community Clinic started.

My mom went back to school and at 55 she became a nurse practitioner. Her first job was at our county health department. She had been under the impression that the public health department would care for people who are uninsured, and she quickly found out that that was not the case. Also, she was surprised by the fact that they offered so few services. Even in our county in North Metro Atlanta, back then there wasn’t even a federally qualified healthcare center (FQHC), so there was no place for the uninsured or underinsured to go to get care.

So, 15 years ago, she assembled a group of people she had met through her school and local churches. They went down to the shelter and housed a clinic for the people who needed care. Many more showed up than expected, and she realized that these people would need follow up. She quickly organized a monthly clinic, and that’s how Bethesda Community Clinic was born. In February 2011, we opened our bricks and mortar for 1-2 days per week. It started out as free and then became a sliding scale for those who could contribute up to $50 per visit. We remained privately funded for the life of our brick-and-mortar clinic.

Why did you decide to transition to mobile?

I took over as director in January 2020, and you’ll recall what happened in March: COVID hit and all the clinics closed. I said, “Why don’t we put a walk-up window at the front door and we’re going to stay open.” So we saw patients in their cars, well before drive-through testing started.

About six months later, we saw an ad in the paper that our county had some extra funding for COVID and they wanted to invest in something for the community that would help people. So, I reached out to the county and said, “I want to have a mobile clinic. We can go right into the neighborhoods and do primary care. This gives people who can’t get to their doctor’s offices an opportunity to remain healthy.”

We found that patients in our original brick-and-mortar clinic would cancel or not show up to their appointments. In 2023, we had 500 no-shows, which equated to a loss of 30 clinic days at a full eight-hour day. But our mobile clinic was booming. We were seeing 30-40 patients over four hours, while we were seeing just 12-15 patients over eight hours in our old original clinic. It just didn’t make sense to continue the brick-and-mortar operation.

In January 2024, I called my mom and medical director and said, “I want to close the brick-and-mortar and go fully mobile.” They both agreed, and I presented to the board of directors my findings regarding the financial aspect, the numbers of patients in mobile vs. brick-and-mortar, the wasted time in the original clinic, and the frustration of volunteers showing up when their patients were not, and they all agreed too.

How did you roll that out?

As our mobile unit became more prominent, we decided that we’d close the brick-and-mortar clinic in November 2024. To prepare for that, we started alternating mobile and clinic days. Finally, we started replacing clinic days with mobile days, and as of November, everything became mobile.

Some of our patients were initially hesitant because they preferred making appointments to a first-come, first-serve approach. I directed those patients to our local FQHC, which still accepted appointments. Approximately 3% of our patients decided to go that route, but most of them came back and told us, “You’re worth the wait. Your providers take the time. You pray with us. You know my name and my kids’ names. I see you in the parade and you wave at me.” They made the change along with us.

My staff was elated, too, because they now have a predictable, set schedule – three days on the mobile unit, two days in our new office.

How do you promote your services? 

Our old clinic was hidden in the back of a condo building, whereas our mobile units themselves are much more visible and identifiable. We also finally have what I call our “Big Beth,” a giant billboard-style sign for our mobile unit. Additionally, I do a bunch of speaking engagements in the community to drive awareness of who we are and what we do.

There’s a lot of cross-promotional value for our partners, too. We offer our services at a church or community center a few days a week, which helps us and becomes a bragging right for them. They can say, “We don’t just have quinceaneras here; we also offer free healthcare!”

I also ask everyone to honk when they see our truck, and we’re getting honks all the time. That’s a reminder to our staff that people care about the work we’re doing and that we belong in this community.

How did this change your financial approach?

Once we decided to transition away from brick-and-mortar, I said that I don’t want this to simply be a low-cost option anymore. I wanted it to be free to everyone.

How did you make this viable?

Donations are critical. In 2022, I was down to like $5,000 and had a lab bill and employees to pay. I went to the mailbox and there was a $50,000 check from a foundation I hadn’t heard of before. They said they just wanted to say thanks for our good work in the community. We needed that check more than anything.

Private donations are our bread and butter. The first year we operated the mobile our individual donations increased 65%. We also have corporate sponsors, church donors and receive county funding.

Also, we reduced our overhead costs significantly when we transitioned to mobile. We don’t need to maintain parking lots, roofs or siding, or any other excessive costs that you need to run a building.

What advice would you have for other mobile program operators?

Know your community and adjust your services to support their individual needs. We have sites in four different counties – some in urban areas around Atlanta and others in the north Georgia mountains. There are different sets of needs at almost every site. In the rural areas, there’s an education gap and a scarcity of providers. Many people don’t understand why they are taking medicine or what they need. We help them sort that out. In our urban areas, we have a high Ukrainian refugee group, as well as a large Hispanic population, and a significant unhoused population. They bring a different set of needs we need to address.

Get to know them personally. We have about 3,000 patients a year. I know many of them by their first name. I’m praying with them, I’m loving on them, and they come back before they even need to be seen just to check in and say hello because they know we care.

What are the greatest challenges facing mobile healthcare right now and how can Driving Health Forward help?

While mobile healthcare is NOT new, there are several misconceptions about it, and Driving Health Forward can help legitimize the industry.

First and foremost, people often mistake mobile health as a screening. Bethesda Community Clinic is a primary care provider–not a screening service. We’re taking your blood pressure, getting your vital signs. You're seeing a doctor. We're drawing your blood and we’re administering medication on site. It’s full service. There’s also a misconception that free care means lower quality. We offer the top standard of care.

We’re excited for Driving Health Forward’s recommendation for an upcoming certification program to establish standards. These standards hold us all accountable, and legitimize us and the industry.

Finally, I’m excited about the national platform and Driving Health Forward’s work with state and local policymakers.

Any final words?

Mobile is the most human-centered type of care. I want this to be a movement that lets people know we are staying. This is not a passing phase. People are seeking something deeper than what traditional healthcare systems have offered them. This is primary care done right, and we are not going away!

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