Through the provision of workplace health benefits, employers not only attract high-quality employees, but also play a role in facilitating primary care use. Coverage of primary care through employment-based health plans helps employees stay healthy and can reduce the risk of serious health problems that can lead to high health care costs and lost productivity. In this Issue Brief we discuss efforts by employers to make primary care more accessible and affordable for their employees, such as offering direct primary care plans and work-site clinics, as well as state and federal level policies to increase the primary care work force. Using claims data from 2013–2021, we document how changes in primary care location and provider type have changed over time and coincide with these private- and public-sector policy changes. Finally, we show how the usual source of care has changed over time by age, gender, race, education, and socioeconomic status using data from the 2013–2020 Medical Expenditure Panel Survey (MEPS). We find:
- Among users of primary care, 95–97 percent utilized it in an office setting prior to 2020, but only 86 percent did so from 2020–2021 as employees began using telemedicine (7–8 percent) and urgent care clinics (3–4 percent) with greater frequency due to the COVID-19 pandemic.
- There has been a consistent downward trend in the share of employees whose primary care office visits are at a general/family practice, falling from 42 percent in 2013 to 37 percent in 2021. In addition, primary care office visits at internal medicine providers have fallen from 21 percent in 2013 to 17 percent in 2021. Finally, provision of primary care by a medical doctor has fallen from 9 percent in 2013 to 4 percent in 2021.
- In contrast, primary care provision by nurse practitioners and physician assistants has risen over time. The share of employees whose primary care office visits have been with a physician assistant rose from 2 percent in 2013 to 6 percent in 2021. The corresponding change for nurse practitioners has been from 4 percent in 2013 to 16 percent in 2021.
- The share of workers reporting a usual source of care has fallen from 2013–2020 and has occurred for all workers regardless of gender, race, age, education, or income.
- The decline in primary care office visits at general/family and internal medicine practices demonstrated by claims data is consistent with the decline in general/family and internal medicine practices being the usual source of care reported in the MEPS as are the increases in primary care provision by nurse practitioners and physician.
- Young, lower-income workers with some college, an associate’s degree, or a bachelor’s degree are driving the trends in usual source of care away from general practices. Young workers with high levels of education and income are driving the trends in usual source of care away from internal medicine practices. Middle-aged workers with intermediate and high levels of education and income are driving the trends in usual source of care toward nurse practitioners. Finally, the rise in physician assistants as the usual source of care has been seen across all types of workers to a similar degree.
A Thank You to Our Funders: This study was conducted through the EBRI Center for Research on Health Benefits Innovation (EBRI CRHBI), with the funding support of the following organizations: Aon, Blue Cross Blue Shield Association, ICUBA, JP Morgan Chase, Pfizer, and PhRMA.
F F F Fiigu gu iigu gu r rr re e e e 1 1 2 5 1 2 One G la I K W 2013 C Fi nc a iv g ndsc o or uf ur r enc e k n th m d – e a eiff 2 a ses a r1 lus s w 02 p n, e 1 e e r 0. e sh im H in d it ha ion nc a h a ow The p rs c e v or e e m s b m ha ty e a sh ta a h t nc W nd nge w st a a., e te re e e for trd e of he ’n o s d a tfor c a p r he te l. ff r e u im g - g a a a "sr llr Sur rit ly ta e oup e h ca e r e y r d , g ose d iff c p e oc p r a r e e ofe la in ne r tr e for or e serv n ,nc ss s it e ’low nr w e iona is offic is in t c ly olle e w - side inc l d or ,e efue s is he r s. e o nt yg m ing ifi I le r pn e ter e ha d e ov a w d t, b ha d tor ide or d y d o ia tit k inc n a e r ion to show b o - r si e ne tP r s y te t,h e p e -a .fr s a e q D ses a ua o.of nd m m a r in he r t t ong 9 ne e e he r ing p d a of e r us rMe iv a r-c si lt indiv ua ting e he h d tnt e l sou ic in se the ain 20 idua he su id ta r r rlt e p inc a cls h cl nds, a e n 13 t c rie of w e e ini n a titc o c w sed th ov a s in 201 c 11 e s rpe er a a r sh iv a p ls rae a c e g o a rtre m r os e c p e 4 w e tor r ins s r h nt ov of reoug it ur a ide in 202 w lik hin ca or ia e nc h th a l g ly kMe e e d rr t0. M is oup e o s rd e c r ic A b p us ee ff a or s idd p si id o ,or st tr on b le d a no tut ing a ff -b tea t le d he nd a Eden Volkov produced this research as a Health Research Associate at the Employee Benefit Research Institute (EBRI). Use of Primary Care Among Workers and Dependents With 7 3 ProMost vider P Co T ro yp vid Has mm e of er o a T n Usua Usual P yplac e of l S e S o Usua o o fu S urrce er ce l S vi of of ce o Ca C u r fa ce or rre, e, of a by Ra b P Ca y r G im rend e, ar ce by y a er Car n Ag , 2 d E e 01 e,V t 20 h 3 isi n –ici 20 13 t, 2 t 20 – y 01 2 , 2 02 301 – 020 3– 21 20 20 See https://ota.fas.org/reports/8615.pdf. C b ov high a ha nur r y aound e v rnur se e r ing - a inc A ll p se c t a rthow om ra e e ( us p c xpa A nds tre it C a ua ione c tA w ns he tl sour )a ior trion st a ione se e k r nd e si a trs t r c m s rte e s he a nds d il he ta of a re s op ov ra s unde i.rc g c e C a in us oinc r it p te g he iua ose ng . p ide r l sou op C dt a d ost e he ula c g t w o lin e rit A of c ne tp h p e ion ff ehy or c rin t of a a ,rsi d l p r iv w e c c a he a ia b r hic a is ta rle ns e e, c sh -m h t C , ia w c a ost ha a a nd e rhil r s t e e a s e fr of s t p he A out ubli e w che w q y tor ." p ue or cc a k a us - D c k nt e sect n e e ia rua ly d s w rp b s rl sou e tr or ov c he e tit it e p ide h a ip s ng or su olic rcc t a p e p e high a rp d ie r e n int of im ly s a 38 s t a of t cs ha r a .5 ( e c y he rr p hool e tna c hy ha 20 a is m l me rsi e v ost 15 m d c e tia e ost h )g d sought : n a ir im t s c 83 e c ,ine p is e om c 3 or or a c - n 837. om tp m a tr le o e nt a on xpla m ss ce tb xpa e ic a a a ns m e r irn e ru nd o a i e td s r ng he r a r ta t iv the e o c H ing sh ctis ha ir e o if p ss us t tv tas ha he ing n tuin o ic a t l so p of ar im us a ur a ua c re yl Paul Fronstin is Director of Health Benefits Research at EBRI. This Issue Brief was written with assistance from the The trends in place of service and usual source of primary care reported in this Issue Brief are consistent with ACA and Figure 8 Employment-Based Health Coverage: A Longitudinal Analysis Fi The gurceum 7 ul shaow tive s t th re ands t oldin Fig er wor urkees rs 4– (a 9g indic es 51 a– te 64 tha ) atr e the m os shta lik re eof ly w to or ha kevre s w a it us h a ua l sou usuarl s ceour of ccea rof e. cIa n fa re fe ctll fr , the om old 20 e13 st to 7 9 p inc p sour A c of a r hy m ov rc re e e si a.c ide ra r c ie e c ses i a a . of rn ns The t y a in t c,p a nd w e rsh e he s. hil , a a rm I er e sh n p e a cle it a k of a r ing ing ss e rm t ic of cidd ta o u he n in st w lale l or ry r, - i tsi k tinc te o he e ng rr na e om s r m g p l re e p e m ow p r loy c e w or e t d or h in .nt tic ing k ine a A e g crte c p s he or p hy of sr a d asi p y c ing crc ing to im iia c m e n a ta m o a ray n in e s t a ss r cc 20 a ihe ist ta re e 21 lly a r us nt na w ins su s ua or l me a rk ur l sou v s t for ee d y he d c ic r e rindiv ie ic ne rp ha e us or of s b pu t idua r a a c re e l sour c ae tle ric ls e n fue a e is sed in hig w cm e a le ost s t b of d y h he - b c tc d he a yo e ir r m nur e d us N .uc m a W se ua t on tible iona hil l pa sour e r m a he l As only cong ta ictlt so e ione h p 3 of A c ip s ar la ia c e tsa ion o rns n .c re e Thi nt fe f ll s of 8 st Ins atte it-ule te v’e s r l p eolic seaie rcs fa h ac nd ilite at diit ng ort ia he l st ga rff ow s. A th in ny tvhe iew nur s ese xprperss acetd it ione in this r p rrie m pa orryt c aa re re t hose work of fortc he e, a aut s w hor ell aand s the should cont not inue b de 80% See https://www.aamc.org/me Has dia/54681 a Usual /do S wnlo ouard ce . of Care, by Education, 2013–2020 90% w 20 or 20 ke , ras ( nd 51 th –is 64 is ) a inde re 20 pe– nde 23 nt pe of rceg nt ende age rp , oint ages m , rac or ee , e lik duc elya ttion, o haor ve inc a u osu ma el so . We ur ne ce xt of tu ca rn to e re relaxa tiv m eini to ng the how young prov est ide r type Liss, D 90 a% vid T., e83% t al. "General health checks in adult primary care: a review." Jama 325.22 (2021): 2294-2306. 2013 2014 201582%2016 2017 2018 2019 2020 2021 By Eden Volkov, Ph.D.,81% and Paul Fronstin, Ph.D., Employee Benefit Research Institute w ( W A fr gH r m om or or ow Dek H k r e ing si i15 P c rs) ta s w e ns p rov H e e it .lia e rh e W c ae r nc la hi tnt th C im e high t e ton e o e A n a 11 m nu t sc n im e e rhool r p rs (N ise e ca p rc ns or p e A d rnt t W e a a ac g nt rH fr tr eit e C o ione fm e ) m a , c o or 75 tre 20 or rle s in t 13 lik p t ss o ee – r e c c ly 2020 he it e v nt a e t h lu d p a of r ,a a n o it m a e nur w nd a .t or r he Re y se tk he rc d e a g p uc r rsr r c e oup a or ing r c e w trp it e or s t or tione spond he kto e for d c rre ost tc a p ing ha e s t or of c tthe a d ta n b he c e ir a c nu r lin ir us e e r on e se e h u xpla a a for -s b l sou si pr ta high e ine ec e c trin show ld c tini ione e - b inc c of y w om s rc e aa or n to ha v s s r ee e a rw ta in 201 ap or l ff h su e k y vd e si p er p c b s w 3 se la ia ly yr n g a a ae v nd a s 21 nur e ss b n p e d ise st ne ep e a m e r fit n c r ate c s nd e nt ant s ascribed to the officers, trustees, or other sponsors of EBRI, Employee Benefit Research Institute-Education and proliferation of work-site clinics among large employers. To meet the increasing demand for primary care as the U.S. 79% 78% 77% Novem ha w 9b or s c ekr 1 e hra s ( 6 nge , 19 2 d– 0 34 ov 23 ) e. r A •t icm N ros eo s a a.m 59 ll a ong g6 ew g or roup kers w s, tit he h a sh us arua e rl so epor ur tc ing e of a c us ar ua e.l sou rce of care fell over time. In 2013, 87 percent 76% See https://www.healthaffairs.org/content/forefront/primary-care-workforce-data-and-need-nurs 75% e-practitioner-full-practice- 80% 70% fa t p for d the o r id c a17 tir c c or so in thil it us 8 s p ione 0 . d e u % r O ra e c 20 n th l sou n in e r, nt 20 w .e .hil c r W c Thi om su e e o p rof s sh 64 m k pe ly e c rr p s a a c a si e ria re r d e c c ll . e re y q , os A n ua ll titns he s a rrd a e ur rc ll inc p tuple r ie or a ad l g ini t e p o dr ng d la m oup fr ns te om h p a , g s e ipe tr in oup 2 ax lin c c r p pe e e e hy sa p r for si c ha tsi e ng for c n d inur t a high tn w tA he o s se ia 8 ir a e n Am p s on p us r resh ar ec c a te of e st it rnt re ione a ip c s r ff a a rim . m n erA s e p s ong as t or ris y xpe t he ing sh c w a ro or num rie e rnu t k nc e a errnd re b se s w a d end rd p a it of e r d a h c le c r e e ss e som tcm ia lin t ione si p cost e ng loy e in t c rly e tolle she r s he a re nd ir offe g l a e sh e t, p im v a ra hy e ing e rne r si tg a o c c e ss w it ia p ning or o hy c n c ykia si -ra si oo tc e ia t e m ns . 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Data, Study Sample, and Methods A a d g v clin is ss e e lsne g it o, iic r st se s g r , a seve e aa nt l p , ll w ror ow sr ra a a hil a c s a s l p tb ie tche a nd re k ov c e he aus e its t si he p lor ua ons of ing he se ’s d l so irc c ost us lin eur g tu ic h rc se a e e s a e fla l sour of A . rtC The e c A ( Se a inc c inc re e c pr ,or úlv e of lud w a re s it c e ed ingly spond a h th dra eg efr r e ta s o ing nt inc a tm a l. s ff r20 20 e e r fo is d ar 16 13 e se b nu w y ) s b –. a 2020 r nur Re se s t eing -sea se he m . a Ip d la rn n c r ra r a iv h h c g g cont e e e tn b it st d aione s sh r c a a y lin m st high r ow ,ic ong s A s , si n t w a - a inc nd tehose n ha m om A fin ta m tyh a e e w nc e e rw it ic xpe g h a ia or a rl s ns ow k c e tm upp r ing w ts. a o est ror see The e si e tze rm ’ s d fo a or sh of rla e e a nur g r d rlik g e ree e d se e of e ruc l , y sh p a ttible oor/ a o re sa s in of n ye ar- proposals. EBRI invites comment on this research. supply of nurse practitioners is helping 80 % address the primary care work force shortage. This increased supply of nurse 70% Trends in Usual Source of Care Provider Type by Individual Characteristics, 2013–2020 70% dist ress for low-income parents." Health Affairs 36.5 (2017): 808-818. 67 percent of workers ages 19–34 had a usual source of care. By 2020, 83 percent of workers ages 51–64 had a usual 60% 74% Primary Care in the 73% United States: Importance, Challenges, and Opportunities for Use of Primary Care Among Workers and Dependents With We use two data sources for this Issue Brief. To analyze trends in primary care use among group plan enrollees, we p p t e w pha m r r oor w or ofe ap t ck tloy a e it ss rione g s or ion m e ck ne eit e a nt ring r l d rt s a -rb l p a c ea nu in it g sed ring ring. a e rc se et , ic c aov p or On e nu r a e w a c r rta se t a he P is g th io e t p .d he D ne rm e a .m ir , c a rs t ry a ius is t a nd ione d ing s ua istc si he l our fr rd sour a om e irs t , ap tg c r he he 1 e ie m p p ir of A a e r r C im u ry c c A su a e a c rin n a ra e y trl c e ov tlud sour c o a pe rh 7 e e ry d c p tsi ut e im e g c r ili of irc e a a za e .n o nt c nt Fi tas e ion b rfvfr e te y o nc r- d m nine oub te ou im y20 ond rele a.13 p g d eing – rm fr c2020 e om an tnd e ta a of 5 . m t W e p -A d b eor si a rp c a sed ke rn Am e e nt rvs w e m tnt o od e iiv t 10 rh a ic e els ap sc ns e high of rr e c cc e e ita nin nt er sd e c f g hool r a ts w om ha ge t it ne d 20 h e r g 1 ze ar3 l er –e o 71% p ractitioners is reflected in the growing sh 70% are of employees who cit70% e a nurse practitioner as their primary care physician 70% 68% sourc6 e0 of %care, 75 percent of workers ages 35–50 had a usual source of care, and 60 percent of workers ages 19–34 A Thank You to Ou ®r Funders: This study was conducted through the EBRI Ce 66% nter for Research on Health Benefits The Accre esu ss lt s in Figures 10–144 indicate that the trends in primary care provider type observed in the claims data are 65% 60% use the MarketScan Commercial Claims and Encounters Database (CCAE), focusing on the outpatient claims file. The c 20 or p inc ost r a 20 le or c tss s p . ic ha o Thi ee r a rxpe aing ts s s t e r nur he ha unde ienc ir rse e u errsu d ose p trthe a a he l c fr tsour A it o la C ione m rA gc .e 3 e r st E s p of . nc e inc I rc n c ou a e rra e nt r ed a a d se in 201 g tit o ingl ion, in t 10y he , 3 p m i,e n 2019 a rw sh c jor e hil a nt re c e or a 67 , rm e a p p n I o on po re a rg RS rttc ing ion low e nt ps a olic a -d inc p id ry e hy om so in c rsi h elc e a yi nge a ing w n a 20 or on 20 k w ss eair . st s m nur sThe , afr nt se aod d m a e p e s rc t2 a tha lin he cptt e e iir t rw ione in g cus e illnt u e e ra s na ne tl sour o to b r7 a le st l p p H a c er ff e r D a c H c of e the tnt P icc s p e ir a a ra m re ae s t i, on r te a rh id il si g e ng Employment-Based Health Coverage: A Longitudinal Analysis and their usual source of care. At the 6 0 sa % me time, the share of employees visiting general/family and internal medicine Pohl, Joanne M., et al. "Primary care workforce data and the need for nurse practitioner full practice authority." Health 50% had a usual source of care. These trends show that the workers with the lowest share reporting having a usual source g Innov ener5 a a0 lly tio % n (E ident Bic RI a lC tRH o tB he I) , trw ends ith th ine tfun he d re ing porsu tep dp p or rov t of ide the r ty follow pe foring theor us ga uniz al sou ations rce: of Aon ca , rB e lue in t C he ross MEP Blue S. Thi Shie s indic ld ates A third strategy employers are using to increase access to primary care is offering telemedicine services. EBRI research out From co m 20 e10 s w –2 e 02 foc 0 t us he ed sh on arus e o ing f he the alt h sp claim es d nding ata in c werom e pm lae crec ia of l he seravlt ic h p e ala nd nsp trha ovtide wa r s sp type e. nt For on ep arcim h o ar f th y ce a ry ee raose rs sp fra onni m ng he m us fr wom it idd ua ah lt l sou h cl le h 1e -p a inc ini e ltrr h c om c ce e s. s n a of ev tFi iw in 201 ngs c na a or rlly e ka e , w c r3 on c s, a aoun s la to tnd he 4tr s g p fr d e (eH e st om rm c SA e for a nt 1 s nd ) p W in 202 te o si hi rd c cte e o e, n v 0. The A t e a m r tg o te rhe ow 7 ri c p a p c ing e ns o rrov rcr e e num a int si spond nd o a n o b sm m eong f c ring a of lle hr st r st high oni is a fo etc e for r- s ha c inc A a fr rto e hose ic v m ser a ee n A p v w a w ic s m or it sed ee h so k s on reic rla s. am n w a The s. e sp c g Se rolle e rsh a -vd nt ea e gnt ir d e ng euc ,y - of atFP tn h ible p ra A e oor/ ss . e b Re o p ac e ne si sea ia rs, w cta e errnt -c d phic h e oor of g hh is ra e s e, practices for their primary care needs has fallen. The shift away from seeking primary care at a general practice has Affairs Forefront (2018). 50% 50% of care saw the largest decline over time as well. By Eden Volkov, Ph.D., and Paul Fronstin, Ph.D., Employee Benefit Research Institute Association, ICUBA, JP Morga1 n Chase, Pfizer, and PhRMA. t ha ha s sh t all ow indiv n th idua at tls ele w m ite h dg icrine oup c he an b alte h aare s e ff ge ec ne tiv ra ell a ys in expe -pe rie rsnc on ing vissi its, a milatr le cha astnge fors in t certa he in irt y pp rim es of ary ccaarree, p su rov ch a ide s m rs ov ane arg ing 11.7 percent to 15.1 percent. During that same period, the share of Americans with private health insurance reporting 40% 20 13 4 thr 0% ough 2021, we included all active employees, their spouses, and their dependents, ages 0–64. The sample is or W w a sh lr or hit ow e aa k e b e d n th a ry A s c m ha he ca it etv lor ing r ing ic st'a a s d ns p tsom e hy e s sg si t arha e id c e ie p a tt n a osit h w pa a ats ss s 2 ised v ais e fa tp e a m t e ff n he re t il cs a c y e se t nt s on ps t rla a to w he cthe s sa 3 ic ir e p a u e lt w w su rh ca a c ta e s t he l so nthe r , e la a ur ir us rnd g cus e e est for u ( of Fr ainc l sour c ons those arreeta in a r ses co e w se of nd itin h fr c Vol a t om ahe rm ek a 1 nur ov in 201 st p ee 20 se rr’s d c23 e p 3n r,) e a t.w g c tt rh o ie tile e ione 3, p only a erp r c w re ofe 67 or ntk ss fr p for iona e orm cce e20 l d nt (P 13 e sohl e g a– r id e 2020. et, this or al. i n a been most pronounced among young, lower-income workers with some college, an associate degree, or a bachelor’s 40% time. Figures 10–14 also show that these trends are relatively constant across age, gender, race, income, and diabetes or allergies. In examining patients who had been diagnosed with diabetes, depression, or asthma, the 40% ha furv the ing r a lim us itua edl sour to enr ce olle of ecs aw reho fe ll fr hadom a p83 rim .3a rpye r cc ae rnt e c tla o im 76 . .8 In th peris ce a nt na , ly im sipsly , ing prim tha ary t tch ae re r is cla e im in t s a he re p d rim efin are yd c us are ing sp ending Ph P 2018) 20 W or hil 20 .D ae t., . - .D no Se the av hle low e sh nt rb -a yinc rr -uc e seve om r h J ose n e , A w p fr ik e or ore m ck n LH ee nt 2 rs c pof , eit Tod re c He d is nt d p p a hy B tni o , si c C 4c unn A ia pm e n re ingha c a re ss ic na is tns .t m a n s R, tas a id F Bs t t irgu ha om he r t e a H ir 7 , fus a Pm e ue ily ale l sou pME, McH rarccte ic e of w ugh ca as retMD he in 2013 ir. us Polic ua , y l sour 2 E pvearlua c ce ent tof ion O dcid are so in f The in 201 202 30 , . degree. Young workers with high levels of education and income are driving the trends in usual source of care away 30% 30% Table of Contents 30% 2 e r Ie n a dsea uc dad rtc it ion h found ion to e al sta txp tus ha a , tnding w pit ah e tie p nt ffre s w ec -t ds b e ho de uc us ing tible edla t re c gle ov er m e fo e ra d rg ic som eine , e m et ep g nde lo royups. e dr s a to These ha re v ta ek m ing re or su e seve lt of s at rrhe ael ir d ot is p he cru e rs sc st sed re ibe p s t in m d o dre or ugs nc e our don eta ah g il b a end p erlow im (69 a . r p y ecra creent share is driven by higher prices for primary care services and not expanded access to care. Figure 1 also indicates that provider A ty ffpor e dca od ble es (ST CareD A PcR t OV) Gra d aHas ua nd te p r a N oc Usual ur ese dur Eed S uc tyo p au e tion D r c ce od of ee s (P m Const a ROC re, ra 1) b tion. y . Ag The H e, epa20 rlt ov h Af 1 ide 3– f r2 (t02 Millwo yp0 e s t od ha) t . w 2e 02 c2 Ja lassify n;41 as p (1)r:im 86a-r95 y . T whe hil esh only are of 72 m pe idd rce lent -inc sa oid me so in wor20 ker 20 s . cit Aing nd 70 phy psi ecricaen a nt ss of isAtfr an icta s a n Am s the er ic us au ns a l sour said tch ea of t ac fa arm e ilry ose pr a fr co tim ce 2w p ae s t rche ent ir tus o ua 3 l from internal medicine practices. While all employees are more likely to be seeing a nurse practitioner for their primary 20% 30% A T A G L A N C E 20% Figure 13 Our results in Figures 2 and 3 indicate that these changes in the primary care work force have impacted group plan c us ov ee . rFi ar gst e ,r a a tg io) row com ingp num aredb w er it h p of e am tie pnt loy s w ers a ho rd eid offe not ring use dt ireele ctm p erd im ica ine ry ( c61 are p (eD rc Pe Cnt ) acrov rae nr gaeg m ee rnt ats io) . D (PSp C ie pla ge ns l 2022 are a ). tUse ype t che are num are bfe ar m of ily pprrim aca tic rye c , a pre ed v ia is tr itic s ha ian, s b nur ee se n tr pr eanding ctitione dow r, int n fr eom rna l me 2013 d– ic20 ine 20 , p , hy wit sih a cia n a spik ss eis in v tant is , itps in 202 reventiv1. e m The edic ov in ee r, all sour P pe rim rce c ae nt ry of , C d aa oi: c nd r ae r e 10 tin t he in 201 .137 he co r7/ Unit r3 ehl ,spond w teha d hil ff St ei.20 ng a only te21 inc s: I .01 67 re m a 32 p p se or e8. P rc taa e m nc nt MI ong ecD , itC : e high ha 34 d a lle 98 -fa inc nge 2m 63 o ils, a m 5; P y e p nd rw MC ac or tOp iIk cD e ep : r s w a oPs t rMC tuni a he s 1 90 t ie us 22 p s for u e 67 a rl sou c9. e A nt c crte c oss e 4 of ................................ pe cracre ent in 202 . 0. ......... 3 care visits, middle-aged workers with intermediate and high levels of education and income are driving these trends. 20% 10% First, Figure 10 sh Prow ovid s tha er T t b yp ote of h me Usua n and l S wom oue rce n w of er Ca e ler ss e, lik by ely E t d o uc ca itet ia o n gal ene At ra tlainm practent ice , 2 as t 01 he 3i– r 20 us20 ua l source of care enrolle 100% es. In the next set of findings, we explore whether the trends observed in Figure 2 are representative of all 10% of of tele heam lth ca edicrine e p lm an th ay ca ont t offe inures m to e rm ise b e ervs d en iraeft ce t ra t che ce ss COVI to a D - P19 CP pfor ande a m mont ic, or hly it fe m ea . y The havD eP only C m od ace ted l ty a ps a ica lly br idg hase low for er 20% num Throug berh th of v eis pitrs ov pis eion o r 100 g f wror oup kpla pla ce n e he na rlolle th b ee s fe nefit ll fs, e rom m a p lhigh oyers not of 33 onl 3 in y 20 att13 ra ctto high 301 in -qua 20 lit20 y e , m be pfor loye e e inc s, rb eut asi a ng lso to pl32 ay9 in a medical doctor, and geriatric medicine. In addition to the claim being from any one of these providers, the claim also 87% 87% 87% 0% 85% 85% Data, Study Sample, and Methods ........................................................................................................................ 6 84% from 2013–2020. The declines were largest for women. FIigu n 2020 re 14 , 63 percent of women said a general prac83% tice was their 82% group9 p 0la %n enrollees or if they depend on individuals’ demographic or socioeconomic characteristics. Sepúlveda, Martín-J., et al. "Elimination of the out-of-pocket charge for children's primary care visits: An application of p out Aa sita ie -n Am of nt -p s se oc ek re ic ekta ing ns co st c ha s t ard eha tfor he n tr t la he a rg dir it e st iona he d ae lt l he c h ne lina elt ein t h insu ds w he 2hil 0 rsh 1 ae 3 nc a trhe e e p rir 2 e la 0 p dns 1 or o4c tta ing or nd s2 ’a c 0 offic n int a 1n p 5 ee rs w ov rna 2ide 0 e l 1 rm e 6 e e cm d losed ic ploy ine 201 . e 7 p e Fu rs arw ctthe it i2 ch mor 0 e r1 m a 8or s te e he , t 2 w im ir 0h 1 us e e 9 ta u he nd al sour r 2 e a 0 m t2 tp e 0cnt loy e ion of ee s role in facilitating primary care use. Coverage of primary care through employment-based health plans helps employees 1 90% 0% T 20 he 21 se . Thi 0% tres nds m abye b ge a n ye duea tro s b pe ent for -up e the de m 20 a20 nd p for ande hem alt ic h se and rvw ice ills lik aft ee lyr ctont he 20 inu20 e aloc s akd dd ow itio ns na d l st uea to te s g the ra C nOVI t FPD A- 19 to nurse needs to refer to the following primary care procedure codes: 10% usual source of care, P wrhil ovid e in 201 er Typ 3 te of he sh Usua are w l S as 71 our ce pe of rce Ca nt. Se re,v by Inco enty-four m pe erG ce ro ntu of p, m 20 e1 n 3c– it2 e02 d a 0 general prac tice as O f f i c e O u t p a t i e n t H o s p i t a l - O n U r g e n t C a r e F a c i l i t y T e l e h e a t h Result 8s0 ................................ % ............................................................................................................................... 6 c w fraom ill re c fr ont the om inu ir v a Hig 20 P lue eC 13 h tP- o Sc ,b – 2 us b a2 0 sed e h 02 1 e c o 3 a o t0 us e lins o . le Thi e r L he u in re s a as D n lt s s 2 c h a ha P0 e C 1 r d s a 4 e st e a fe si ff su g ll fr ing n." bst o m m The it 2ut od 032 1ee 5 Jour 7 ls or p 7,e % r c p na c om hy el o nt si p 2 7 c f le in ia 0 5 P m 1 % n e 20 6 e d s ha nt ia 13 t t r v o it7 c o e4 soffic % 50 23 17 20 0 5 (2 p e – 1e -1,00 7 b r7 c a 01 e 3 sed nt % 0 p 6) in 202 : p a19 rtim 2 ie 7 0 5nt 3 a 1 -% 0. 20 r 8 s, a y 0. The ca s op re6 sh 9 is p % a 2 ose ar 0n o e 1 9 d of pt6 e o A 7 n f% tr he q icue a n A t2 y st 0 p 7 ion. 2 ic m 2 0a % el p r ica atns ient p st pa ra a nde y c the itm ione aic lt.hy rThi s a and s d nd ow c aa s n r nw me oad rre uc d la terr e g the nd e e r ha m isp k s b loy of ee e ser rn d s ious inv rivee st he n b in w ay lt h p a or dr k eo -cb si lin le te e m cin s t linp ha ic rs. A ob t cle an o m n le -p ba e ad n q se td o ue v high is stit ion s he a nd isa lt how not h ca p trhe e re c vc ost eha nts a nging ivend vis lost p itr sim ( Fi ag ryur e 80% C a m p u s 82% 78% Trend their ussu a in l sou Usr ua ce l of Sou carrce e in of C 2013 a,r a end by 71 Ind per ivid centual did C so in hara 20 ct20 eris . Bt ot ics h me , 20 n 13 wom –20 en w 20e re also less likely to say that an 90% 0% • 70% Pr As ob sle oc m ia-tb ea De sed g re vis e, itSo : 99 m20 e C 1o -9 ll92 ege 05 , , 99211-99215. 0% r sa atyio ing oft ha 2,00 t a0n in –2,50 ter0. naD l me PC d ty icp ine ica lly pr accov ticeer sw a a s t wide heir r a us nge ua l s of p our rim cea of ry c ca arre e fe ser ll fr vic oe m s, inc 17 p luding ercent a nnu in 2a 01 l p 3 t hy o si14 ca l e pexa rcm ent s, iw n ell- productivity. In this Issue Brief we discuss efforts by employers to make primary care more accessible and affordable c 1) a.r e work force will impact primary care c77% osts and use 77% of health care services. Exisiting evidence indicates that the Trends in Primary Care Place of Service and Provider Type From 20 76% 13–2021 ................................ Physici ....................... an Physician 6 Physician 78% 78% 77% 75% 74% 70% 69% 71% Internal Internal Interna M l ale Internal Female Physician Ph75% ysician Physician Physician 70% Internal Med Internal Med Internal Med 73% Som inte GP rm na el me rs, B GP deic nj ine am Ba p in D GP rc ah ce t., ic loe e r't s w GP a De a l. s t "gC re he ha eirnge usu s in ut al sou ilirz ca et ion a of cand re o he vearlt th a ime m . NP ong Aga in, low NP d -e inc clin om es w eNP ad eult re s a laNP rg fte est r Me ford w icom aid een. xpa Se ns ve ion nt eor en Finally, state and federal level public policies have expanded access to primary care and impa71% cted the types of GP (19–34) GP (35–50) GP (51–64) NP (19–34) NP (35–50) NP (51–64) Assistant Assistant Assistant c 2020 hild . v 6I is 0n % itc sont , imrm ast uni , tza het ions sha, ressic of k vW isi M hit ts ed , ec A hr m onic e Mreic d a dns ise a a M nd se ed m His ana pM ag e nic dem Aem nte, riacnd ans si preg vht ent ing ivea n i carnt e ecrouns nal me elin Ad ssist g ic. ine a D nP t p C Ar ssist a ca ctn a ic ane tls a A o s ssist b the ea a n t Assistant 80% Before turning to trends in the provider type for the usual source of care, in Figures 4–9, we examine how the share of for grow the ing ir nur emp se loy pe ra ec st,ion suit ch a one s offe r pres ring c (19 enc –d 34) e ir e ha cts p tr (35 he im – a 50) prot y e cnt aria e (51 l pt– la o 64) ns low ae nd r cw ost ors a k-si nd te inc clin re icas, a se a s w ccc ee ll a ss s st to c aa te re a . nd How fee dv ee ra r, l lw eha vet l 67% 67% (White) (Asian) (Hispanic) (Black) (White) (Asian) (Hispanic) (Black) (19–34) (35–50) (51–64) 64% 64% 60% Trends So in U urcesu : Ea mploy l Sour ee c e B eof neC fita R re e( s W b eh y aite rc I)ndivi h In(s A td it siu ua atn e ) l C es (H tha iispa mat ra n ec ic) st e br a (is s Be t laic d ck) s, 201 on admi 3n– is 20 tra2 ti0 ve ................................ enrollment and claims da............................. (tW a.h ite) (Asian) (Hispa 8 nic) (Black) • Preventive visit: 99381-99387, 99391-99397. 63% p pr eov rce ide ntr of s t expa M ha w aom s tnde te ae r' cs t n ci d De a p s p rtiv e gd re raim ta e en in , a ins P ry r o tu ce fe a rra r s na e nc s il o p en m hy ." ae lsi JA dcic ia MA ine ns int . pA re a crc cn or tiacl me d eing as t dtic o he ine rir e c us e 17 nt ua 6. d l 10 a sour t a ( 20 rc ee 16 p o of ) r: te c 15 d a r01 b ey in 201 -t15 he09 A.ss 3 , oc wia hil te ion o only f A 14 m e preic rc ae n M nt d ed idic so al Figure 1 60% g us the ood ua pl sou op 5 op 0ula % tion rcte ion w for of c tit r aa h rd ea itfr iona us om ua l he 20 l s13 our alt–h p c 20 e 2 la of 0 d n e ca id nr renot olle ha s t e cs w ha renge nde ith .high d Fi ov fte ed e re n td im p uc e etr ible c ae nd nt s or how of w out hit the -e of sh A -p m a oc e re k ric eof ta ns cg ost r oup re s. por H pow tla en e de a vnr n int erolle , be ee rcn s w aa us l me it eh a the d ic ine policies to increase the primary care work for8 c2 e% . Using7 9 cla %ims d7a7 t% a from7 20 8% 13–20 72 81 % , we d7oc 5% ument7 how 4% cha 7nge 5%s in we have S see ourn so ce: 20fa 13r– ha 202 s b 0 Med een th ical e E xop pep nosit diture e. PFr anom el S 20 urv10 ey – (ME 202 P0 S,) , ta he ge s sh 1a 9– re 64 of . healt58% h spending in commercial health plans 2013 71% 73% 69% 17% 15% 21% 3% 2% 2% 57% 2% 1% 2% 70% 2013 73% 59% 77% 70% 15% 32% 13% 17% 2% 1% 1% 1% 2% 0% 1% 1% Degree, Ph.D. 50% in 2020. By comparison, 17 percent of men also cited an internal medicine practice as their usual source of care in Colleges, a current shortage of physicians in the United States is anticipated to reach between 17,800 and 48,000 in the Trends in Usual Source of Care Provider Type by Individual Characteristics, 2013–2020 ........................................ 12 Average Number of Primary Care Visits per 100 Enrollees, 2013–2021 D prP aC c tm ice od ae s t l the ypir ic a ully su a dl osour es not ce c of ovce arr e spe in 201 cialty 3 a cand re 20 — 20 su,c h a whil s v e is 13 it s pe to rcc ea nt rd of iolog His ispta s, d nice A rm ma etrolog icans is trs, or epor tor ed thop an int edis er ts na — l it 2014 us ua 71l sou % rce v7 a 2r% ies by ge 6nde 9% r, race, 12a % ge, educ 1a 6t % ion, and 2inc 1%ome. 3% 2% 2% 2% 2% 1% p tha rim t a w 40 ra ys % cp aut re t loc ow aa tion rd pa rnd imap ry rov ca ide re rr ose type 30 ha p ve er c cha ent nge , but d ov the er sh tim are e a of nd Ac m oin eric cide ans w w itit h th h pe riv se atp er iv he aa te lt-h insu and p ra ublic nce- r sect epor or tin g 2014 72% 64% 77% 69% 15% 27% 14% 17% 3% 1% 1% 2% 2% 0% 0% 1% Soni, • Apa Tre na le, phone et al. /onl "Effe ine ct vof is itMe : 99 dic 4a 4id 1-99449 expans . ions of 2014 on overall and early-stage cancer diagnoses." American 60% 8 p 2013 rima , rb yut ca 15 re sett perc ing entb d yid the so in yea20 r 20 2034 . W . hil Thi e s p ther oje sha cr tion is r e of me en a prend sent wa om tive en ci of t ping hysigce ia ne ns r ap l ra and cticint ing erin t nal me he ad ric ea ine s of prfa ac m tiil cy e s 40% 2015 75% 75% 72% 10% 14% 19% 3% 3% 2% 1% 1% 1% 2015 m is e r 7e d 5% c icom inem pe 6r8nde a % ctic de t ha a 79 s t % t he indiv ir us 7idua 2% uals l sou us 13 e r% cD eP of C tc 2o a 3% rsu e p in b ple 1ot 1 m % h ye ent tahe r 1s. 7% ir tradit 3% ional cov 0% erage. 1% 2% 1% 0% 1% 0% policy changes. Finally, we show how the usual source of care has changed over time by age, gender, race, education, ha Conc ving lu 30 si a % on us ................................ ual source of care fell ................................ 8 percent. Understandi ................................ ng why the shift tow................................ ard nurse practitioners.......................... hasn’t resulted in 18 Source: 2013–2020 Medical Expenditure Panel Survey (MEPS), ages 19–64. Fi gure 3 jsh our ow na s t l o re f p nds ublic in p he rim altahr y10 ca 8. re 2 (2 pro 01 vide 8): r 2t16 yp- e218. s am ong those who have primary care visits in an office setting. 333 Figure 4 shows that the share of group plan enrollees has fallen from 78 percent in 2013 to 72 percent in 2020. 2016 as t7 he 1%ir usual sour 73% ce of c7a 1r% e fell, the 12 sh % are say 1ing 7% nurse p 21r% actitioner3% s and physi 2% cian assist2% ants were 1% the pr329 ovide 2% rs of 1% 50% medic3 ine 50, geriatric medicine, and general pediatrics. 2016 73% 67% 80% 69% 16% 27% 10% 19% 3% 1% 1% 2% 2% 0% 1% 0% 30% 320 a D low nd epee soc rnding cost ioes or c on ono t im he mp ic ry ov st ea a ertd ,u ts a he cus c e rie ng ss su td lt o a ing c ta a rfr a e 316 na ois m ly a t tn im he ica l sa 20 por 1m 3 ta p –nt le 20 c p 20 o uns zzl Me is etd s of for ica l Ex paublic pp preoxim ndit polic ur ay te e tly P o a 9.9 a ne dd l S rte o ur ss 17 v g e .4 iv y e ( m M n th ill Eion ind Pe S) im . W piv or eidua tfin anc dls :e . of Figure 2 0 6% shows that White Americans are most lik315 ely to have315 a usual source of care. Across all racial groups, the share 312 312 2017 The Refem reost nce s not ................................ able change is the d................................ ecline in primary care ................................ office visits occurring ................................ at a family/general pra .......................... ctice, internal 18 69% 72% 70% 11% 16% 18% 5% 3% 3% 305 2% 1% 2% 2017 t E Ahe m fr 7ip ir 1 c% loy a us n Am e uras l sou 6e t 8ha r % icta r c ns ha e v 7 of h 8 ea % d c ca hosen trhe e r 7os la 0% rte g o e fr offe st om 1 inc 5r % 20 a re 13 D ase P– C 22020. 3 in a %rr the ang I sh n a e 12m a % ll y reent e of a ha r 1ts 7 hose v , % ew d om one reep 4% n or so w ting e ars a e a 0% m st nu or ra e rse t e lik gp 1% e yrly a to ctto a itd ione sa d 3% r ye r tss h aa s t seve t a he 2% nur rir a lus se diff up a 1% e rl sou a re cnt tit r ion h ce e 2% e aof r lt h 1% 40% Figure 4 20% Sp prim ieg ae ry l, c Ja arke e , for “The emp W loy ebe cras a m nd Wille m Sepeloy You ees. N ow: A Review of Telemedicine During the COVID-19 Era,” EBRI Issue Brief, report 1ing 0%a usual source of care fell over time. In 2013, 79 percent of White Americans had a usual source of care, 72 2018 67% 70% 66% 11% 13% 18% 8% 6% 6% 3% 3% 4% m One ed ic su ine pp ly pr-a si cd tie c est , raand tegw y itus h e ad m be yd st ica atl d es t oco toard . d W re hil sse t42 he se pe p rcre oje nt cof ted a ll of shor fic tfa e-lls ba ha sed s b pe rie m na tro y g cr aa rnt e v ful isitl p s w rae crte ic e a ta a ut hority 2018 67% 70% 77% 68% 14% 24% 10% 16% 7% 1% 4% 6% 4% 0% 3% 1% 300 325 or a physician assistant was their usual source of care. From 2013–2020, the share of women having a nurse c ca ar re e fr cha om lle 20 nge 13 s– , 2 lik 02 e 0t. he W lim hileit e only d a v1a il paeb rili cetnt y of of cA ar fr ei cin a an A g m ee og ric ra ap ns hic c it loc eda a tion, nurse a pp op raul ctaittiion w oner it ah a s the high ir usinc uaide l sour nce c e of of care Endno • tesA ................................ mong users of primary ................................ care, 95–97 percent ................................ utilized it in an office set ................................ ting prior to 2020, b ............................ ut only 86 percent 19 There are some limitations in our analysis. First, our estimates for 2020 and 2021 may not reflect a persistent trend in 315 312 Has a Usual Source of Care, Overall, 2013–2010 30% 2019 perc 6e 7% nt of no. Asi 52 a 6n A 8 ( 9%E m m ep rlo ica y6 n e 6s h e % Ba ed ne afit us 1Re 0 u% asea l sour rch ce I1ns 3of %titcu atre e, , A 71 p 19r % il 1, perc20 ent 21 of 7% ). Hispanic 8% Americans 6% had a usua 3% l source of 4% care, 4% 10% 0% 306 2019 67% 68% 76% 69% 14% 23% 305 10% 16% 305 7% 1% 3% 5% 4% 1% 4% 1% 302 302 Fi fa (FP g m ur A il)y e /ge t 9 o sh nur neow rse al p s t prr h a aa c cttt iit highe cione e in 20 rrs. -inc 13 Ac om , cb or e yd 20 w ing or 21 k to e , rtts a hi he s sh r e A m m ae ror e ric e ha a lik n A d efly a ca lle tdo n to 37 em hayv e of a N p us e ur ru c se e an l sour P t. raFor ctc it e ione int of erc rna s (A are l me . AA Ncd P ric oss ) 301 , ine FP a A p ll inc ris ac “to t ic he m ee , tg he rou sh pa s, re in 201 c phr raonic ctit3 ione ,c 6 ond rp e ait r s t ions cehe nt, ir d a us id nd ua so in al so ffor20 ur dac 20 beili .of t y W c is hi asu r te ee a ts for rnd ipleH d a is fr low pom anic -w 3 a A p g m e ee r c w re ic or nt ak ns tfor o w 9c e e p re .e r To a cls ed o naty m . , Fr or m o e ost m lik 20 e ely m 13 p t– o loy 20 sa e2 y r0 s p t,h ta a he y t a tsh he nur a r D e se P of Cp m rm aont c etn ha ithly ione v fe ing r e place of serv did so fr ice or om ty 20 pe20 of –p 20 rov 21 ide as e r for m p ploy rim ea ers b y ce ag re a, n usin as enr g olle teleem s m eda icyine ha ( v7 e– m 8 a pd ee rc teent m)p a or nd ary ur agdejnt ust cm areent cslini due cs (3 to– t4 h e 2020 64% 68% 67% 10% 13% 17% 7% 8% 6% 4% 4% 3% 2013 2014 2015 2016 2017 2018 2019 2020 2020 67% 67% 72% 67% 14% 23% 13% 14% 8% 1% 4% 6% 4% 1% 3% 1% and 75 percent of Black Americans had a usual source of care. By 2020, only 74 percent of White Americans had a 20% 0% t a fe he ut ll fr hor sh om 8 2 a iza 0 5 r% e 0 21 t ion o sa p yie ng rf nur cetn ha tse tt o the p 17 ra y c p h te it arione d c eant r us s t fruom o al sour e v 2a 01 lua c 3e – te 2 of 02 pa c1. Fin taie re nt fe sa ;ll ove lldyia , g m r nose, etd im ice a . l d or In 20 d oc ert,or 13 as nd , w83 e int r ep e e t rhe p rc re e p tnt rd ov ia of id ghigh nost ers fo - ic inc rt e 9 om st pse e ;r c a we nd or ntk ini e of rts ia aha ll ted a a nurse practitioner as their usual source of care increased fivefold from 1 percent to 5 percent. Finally, the share of w for a s t the he irir e u m su ploy al so eeur s e ce n rof olle ca dr e in a ov e m r etd im ice a. l p Tw lan o tpha ertc e isnt not of H WSA hit e e ligib Ame le ric . aIns n 2020 cited, a the nu IrR sS e p pr ra op ctose itione d rre g aula s the tions ir us tha uat l percent) with greater frequency due to the COV In ID te- rn 19 al pandemic. Physician R W loc a e kllfe d aow ce r, e ns Ja nc in r cob ee s , spon and se Benj to atm he in D COVI . Som D-19 me e rp s. " ide Em ffe icc. t Se of cd ond epe , nde we nt ca nnot cove rob agserv e expa e out nsion com of e ttrhe ends Affor byd raabcle e, Ceadruc e A atcion, t on or usual source of care, 68 pGP ercent of Asian Ame Inrtic era nns al had a usual source of care, 66 percent NP of HisP phaynic sician AmeP rih cyasns ician had a p a us nd rim uam a l sou ra yna ca rg c re e e tof offic rea ca te m r ev e , is nt 7it6 s s in 2 und perce 01 ernt t 3, b he of e ut m xc idd tlus his w le iv-e inc a lic s t om ehe ns e ur c w ae or se a kut e fo rhor r s ha only itd y of a 4 us p the eu rc a e st l sou nt at e in 2 r c be oa 02 of r1 dc . of a Fi re g n,ur ur 72 e si ng. 3 p e fur r”c t e St he nt ar tof esh s w low ow its t h FP -inc ha om A t te he GP (78% some Internal 19–34 Med 35–50 51N –64 P (some Assistant 10% *GP=g *GP=ge en ne er ra al l p pr ra ac cttic ice e,, N NP P=n =nu ur rs se e p pr ra ac cttit ition ione er r.. sour w would omcee n ha aof llow cvaing ra en e in 201 a m phy ploy si 3,ce iw a r n a hil to ess r e8is im p ta b en ur rc t e se ant s a td he n e id irm so in us ploy ua20 e l sou e20 's m . rcOne e em of b p e ce rash rrc ee ip d nt oub fe of e le for Hd is p fr aa om D niP c C 2 A a m pre rea rrc nge ic ea nt ns m t o e snt a 4id p if t a e rhe nur ce nt e se m , a p pnd loy race tthe iet ione ha shs a ra r w e a of s inc GP om (e high using the claim(s d mas at te ar. 'sThi , s is a limitMed ation b (som ec eause it is impN or Pt a (hnt igh to understand (mas whe te the r's,r the Asse sistt arn etnds As asris e tant health and access to care for young adults." JAMA pediatrics 169.5 (2015): 495-497. B arbaresco, Silvia, Charles J. Courtemanche, and Yanling Qi. "Impacts of the Affordable Care Act dependent coverage usual source of coclla .,re, and 67 perce Med nt of (hig Bhlack Americans (mas hatd er 'a s ,usual source of cc oa ll.r ,e. (master's, 200 S So ou ur rc ce e:: 2 20 01 13 3– –2 20 02 20 0 Med Mediic ca al l E Ex xp pe en nd dit itu ur re e P Pa an ne ell S Su ur rv ve ey y ( (ME MEP PS S) ),, a ag ge es s 1 19 9– –64 64.. w le de or gcis lin kla e7 e rts h 8 ion a s in p %adllow ra im us a nur ru ya c l sou se are p rrv a cis c et i tit of s a ione cta a rre s f, a ta m o nd ily op/ge 66 era ne p te e r rinde a ce l p ntrp aof ecnde tip co ent or , a ly /n t e a wn aitrho in -ptoor w ut er n ca olla l me orb kor e dric a s t ine ha ion fr dp r aa om us cti ua ca e , l sou m ae nd dic rc w ael b it of h a oa c r a m d r e eo . d rB ic su y a l d p 20 eoc r 20 vitsi , or on school or prof.77% coll., school or prof. (high (some coll., • There has been a consistent downward trend in the share of employees whose primary care office visits are at men having a physician assistant as their usual source of care tripled from 1 percent to 3 percent from 2013–2020. he the air lt h r usu ea im l sou burseme rce of nt c aarrer ain ng20 em 13 ent , a nd (HR4A p ).e I rf ce en na t d ctid edso in , this20 rule 20 .c o Fiuld nally enc , the our sh aga er e m of ore A si wa or nk A em rs t ero ictaans ke cup iting DPC nu rase nd 0% sy Figur stemae tS ic s o u ora r cs ea s:o r 2 e c0 iat 1 seg 3 e– ,2 m 02 e0 nt Med ed ib ca yl e Es nr xc ph olle eo no dl it e o u rt re y p Pe a.n e l Survey (ME pro PfS . ), ages 19–64. associate, prof. provision on health-related outcomes of young adults." Journal of health economics 40 (2015): 54-68. less) degree, Internal associate, less) degree, school or associate, fr c only oinc om 75 ide a p p hy w eit rsi ch e cia nt inn. c of r eAa high s of ses -Ja in p innua corm im re y a r w 20 yor c 23 a kr e , e r32 s h be 76% st a ing d a ta e p s a us rov u nd ide al sour td he b y D c nur e is tof ric se c t aof prreaC , co 70 tilum tione pe bria c rs a e ha ntnd vof e pa m hy ut ids hor d icle ia ize -n inc d aom ss FP ist e A a w for nt or s. k nur e Fr rs h o se m a 20 d a 13 us –ual GP a ge ba ne chre all/ orf'a s)mily practice, fa les lling s) from 42 percen dt e gin 201 ree, 3 tNP o 37 perc be ac nt he in 20 lor's) 21. In addition, PAprimary care office degr ee, Winkelman, Tyler NA, and Virginia W. Chang. "Medicaid expansion, mental health, and access to care among childless p the rar ce tit bione y incrrs ea as t se he priim r us arua y cl s arour e us ce e . of care has been constant at 1 percent over time. 134 134 Ph133 .D.) Med Inte bra nc ah l elI133 o nrt'e sr )nal Inter132 nal 132 Ph.D.) 132 less) bachelor's) Figure 1, Average Number of Primary Care Visits per 100 Enrollees, 2013–2021 ................................ 130 ......................... 130 3 150 Ph.D.) Ph.D.) (poor/ GP GP GP Figure 10 (poor/ NP NP (poor/ PA PA 76% Fi sour 20 prg a 21 ur ct c, e it e ione t 8 he of sh c sh ra ow sr. a er Re s t , e64 sea of ha p ta re ll w crh show c p or e rik nt m e r a of s ry s t w low cit ha ah mor r-e tinc toffic he om e a e e e d d v op w uc isi or ta tion s k tion a ew rof s h heFP rra e ed A t 75% m he a for or u p su e nur r ov lik al sou e ide se ly rp tr o rw ca e ha a c s a tof it vione ec nu a ar e u r rse , s su a le a nd pa l so rd a63 s t ctur i o tp ic one a e en inc r of ce r nt r cose a r e rof e a . se fr pSt oor/ o dill m su , 4 ne a p cp p r aly e oss rr- c p of e oor a nt nur ll to se 16 To addrev ss is it this s a tc int one ce rn rn, al me we dus iciene d( a p pt ora o ov rfr /ide omrMed s ha the v 2013 e fa Med lle –20 n fr 20 o Med m Me 21 dic p ae l Ex rcep nt endit N in 201 P (ur low e)3 t Pao ne 17 l Sur pev rc ee yn (tMEP in 202 S) 1. Fin to su PAp a (p llly ole w, m ) ent the adults with and without chronic conditions." Journal of general internal medicine 33 (2018): 376-383. Basu, Sanjay, et al. "Association of primary care physician supply with population mortality in the United States, 2005- near (low) (middle) (high) near (middle) (high) near (middle) (high) 2013 75% 71% 62% 12% 17% 27% 3% 2% 1% 1% 2% 2% Providernear Type of (low Usua ) (mi l S ddo le) uF rce igu (high of re ) Ca 6 re, by Gender, 2013–2020 Figure 2, Most Common Place of Service for a Primary Care Visit, 2013–2021 ............................................................ 7 Fi Fi ed g guc ur ura e et ion g 1 12 3 sh sh row ow oups, s t s th hta a he t t t t he he sha r g e re e a ne sa rer ya d il t ng iffree trnds ha enc t e tin usu he s in t y hhe a ad l sour p ar ov uscide u ea sl sour rof tyc pa e c r e e of of atw 74% he c aa y rus e fr ua o fe m ll ove l sou gene rrc r tea im l p of e.rc a a Ic n 2013 rteic b ey s a e, nd d82 ucint a p tiona e errc na el n l a tm tof te ad iw nm icor ine k en e tr,s p A p A wr e not ll r or a rc ck a e the e it cnt r iione a s h r.l g im Darur rp d oup s w e ing a d im or us s e tk hi e uxc ing nt a s sa l sou e tp in p o tm tfo rhe ec r re im p A w e of a fr ride iod ric y c a arc ,n A r a e a trhe .d e op m . sh A etr s a ion o ia crae n e n s of f xa tw he ae m ll p r e p D le rP m im C , or w a m e rit y od hin lik ce a e lrly te is he t offic to ha fir cst ite t e e fiv v m a is p e ip tloy hy s w yesi e ahe e r cs of s w ia rn a e it ta he h HSA sdsi o s p ptrta ov ing n s tide c a a Fs nnot PA r tw he , at ir s he c on a us “p tu trhy he a ibut l sou si num ceia trn a o cbee a s r of n HSA si of scta arne t provision of primary care by a medical doctor has fallen from 9 percent in 2013 to 4 percent in 2021. clapoor) ims data analysis and show how trends in usual source of care, poor) a proxy for primary care, has cha poor) nged by age, 2015." JAMA internal medicine 179.4 (2019): 506-514. 2014 100 poor) 77% 69% 64% 11% 18% 24% 3% 2% 1% 1% 2% 2% Has a Usual Source of Care, by Race, 2013–2020 74% b W ut he trhe ry , gLeane urraa l tr R., ea nds nd Sa are ra si h m Mille ilar ra . c"rE os ar s e ly d co uc va et rion g age, raoup cces ss, ut . Wor ilikze arts w ion, ith a and high healtsh e choo ffel d cts eg arss ee o cor ia tle ed ss w ait re h th most e likely to p fr r A w if t ose r rom it a izona he h a c t fr ic y 20 om e m a -s 13 r lic a eare st e 2 –in ns 2 ep 02 rd a e ’e s d r rd 0. The D icv e P nur e ent C g n b r a se e to ry e rsh , a p 6 ynge a r oun ap arp e c ertr m ofe it g c of e ione e ent rnt W ss w . hit iona r or or s e k in t us e l d A re m she e . te g he Thi rrst ic e a e a fun s t , ns e m or d inc a h s in y a a r v rP e e ing h.D a a flec sed n a .H t ha p SA r52 e hy c d t e si p o a nt e c p r ius a c a cn a e h ua ynt afor nge l sour s fr si om s D s in t ta Pc n C20 e t. a H of he 02 s t SA c p he ta -o rr e ov e ir ligib 20 ; i us s 78 0 ion o 7, le ua p p w l sou ela r f p itch th ns ernt rim c h e e a of a v r of la y e w r c c g b or a a e er r k st ce e e om , r d p s w lik oub e ere ca it en le h a nt d n from gender, income, race, and educational attainment among group plan enrollees. This will show whether changes in Figure 3, Provider Types for a Primary Care Office Visit, 2013–2021 .......................................................................... 7 2013 72% 80% 76% 73% 69% 9% 9% 15% 21% 5% 3% 2% 1% 1% 0% 2% 1% 2015 79% 72% 69% 9% 17% F21% igure 9 3% 2% 2% 1% 1% 1% • In contrast, primary care provision by nurse practitioners and physician assistants has risen over72% time. The ha e ass mvp o eloy c ia a t e gerA e -ne d ff pe r or ov r ga d rl p e ide ae br , le d asom c on C tia c-r e e si e b c tA e olle ec c t tli he Me g nic e ir, d sus or . icThe a ua a id l so b e a sh xpa cur he arc ns e lor e of ions of ’s w d c: e or ag r ak e r e e q . r e ua The s ha a sig -d sh e e s xpe aa 19 us rer – ua im c34 itl sou e ing nt cit aing a l s rn int ce tudy." aof g ee r cn a ne a r Ae l me r nn ;a l p a and ls d ria c of c 77 ine tic int p ep e er arr a s t c n ce a tnt he il me ce ir of a us d s t w icua or he ine k l sou e us 16 rs w u4.1 a rcl so it e2 h our a f ce inc 2 inc pr re e era a cse si ent ngly of to nur c4om p se em rp con e ra nt ctt, yitp tione he e of srha s he oc ra elt cof ur h r p Aing la sin an A in t offe m he re e rd riur c b aa y nl c s ha em lap ss vloy iifi ng e ed ras c . pount E hy Bsi RI ie c ir a se ” ( n a sea Pss ohl e rc ish ind tatnt a ic l. aa s t 20 tehe 18 s tir ) ha .us Thus t ua the l , sour sh no atrc e only e of of w is ca o FP r re k e Ar s an w ith Cawley, John, Aparna Soni, and Kosali Simon. "Third year of survey data shows continuing benefits of Medicaid primary care provision have affected groups equally or differentially. The main outcome we evaluate using the MEPS is 2014 70% 90% 72% 76% 73% 67% 12% 11% 13% 21% 4% 3% 3% 1% 1% 1% 2% 1% 2016 76% 50 70% 67% Has a Usual 11% Sour 19% ce of Car23% e, by Inco3% me Group 3% , 2013–20 2% 20 2% 1% 1% Figure 3 Figure 4, Has a Usual Source of Care, Overall, 2013–2020 ........................................................................................ 8 72% 5 share of employees whose primary care office visits have been with a p71% hysician assistant rose from 2 percent of care increases with educational attainment. Historically, workers with a high school degree or less were more likely c a inc e ha n HSA ff igh re ree c a tfe sc iv sed ll fr hool e -e (p ligib 20 om fr ublic om 16 d e le 71 ) g : 0 p rp e 7 olic la p p e 95 e e n h r or ry c -c803. e e a for le n n s g tss t tinc t o ro ha o64 w r 1e d n fr p a a p si e e rus ng om c rc eua e nt t nt he 6 l sou , p a fr p e nd orrm im c rc e t e hi nt a 20 rs sh o y1 in f c 3 ca – 20 a ar20 rre e e 13 . 2 w inc B 0 or ty ,o r k w e 20 13 a hil for sed 20 e p c e , e t rhe only , tc hr b e ut nt e sh e 75 a fold it in 202 r e ap ls sa efr o rc o y 1 h e m ing .a nt s t L 1 e of a he p g n in e is w rp la c or tot e tent k iv re e na e nt rt s w o e l ia ff m 3 l to r or it e p h a d te s t ic re c ine o d e m uc nt e a xpa p st ea r e a m prc nd r’ong ts d im ice a ae c rH w g y cr is e a e css s p a ea r , t e he t nic a o ir expansions for low-income childless adults in the US." Journal of general internal medicine 33 (2018): 1495- provider type for the usual source of care. Our analytical sample is the U.S non-institutionalized population with 2015 77% 60% 75% 77% 71% 10% 12% 12% 18% 3% 2% 2% 3% 1% 1% 1% 1% 2017 75% 70% 68% 12% 17% 20% 3% 3% 4% 2% 2% 2% Provider Types for a Primary Care Office Visit, 2013–2021 80% 70% Figure 5,in 201 Has a3 t Usua o 6 l So perur cec ne t of in 202 Care 1. , b The y Ge cor nde rerspond , 2013 ing –2020 cha nge ................................ for nurse practitio................................ ners has been from 4 ................... percent in 9 th p us ra ofe ua n l sou w ssor ion kre a cr e l d s w of eg it crh mor a eree, fe ore ll fr a e P d om h.D uc a17 .t ion to ci ha pd e ra c eus nt te ua ta o l sou nur 10 se p rc ee rp c of reancc tt.a i tOld rione e; e 71 r r a w p s or etrhe k ce er nt us s a of ulso e al sou wor xpe krecrr e s w ie of nc itc e h a a dr e si n a ,m bila s ut soc rt he tira et rnds e e d he ain t g s b rehe e ee , ir n som repeor ted D A ac m PcC e e r ss p icla a dns ns isp . a a B m ry itong ie com s in r H pSA aur ri-son e aligib l c,o tm he lem psh uni laa n trie e e nr s. of olle Afreic s, lik an A em the eri cParn im s c aritying Car ae p E hnha ysicnc ian em ass ent ist A ac nt t (a S. s t29 he99 ir / us Hua .R. l sour 3708c)e , w of hic cah rew ha ould s 2016 73% 50% 1497. 73% 76% 90% 69% 13% 11% 14% 21% 2% 4% 2% 3% 2% 2% 1% 1% employment-based health insurance coverage, ages 19–64. Depending on the year, the resulting analytical sample 2018 71% 0 66% 66% 10% 17% 18% 8% 6% 5% 4% 3% 3% 70% 70% 2013 to 16 percent 20 in 202 13 2 1. 0 14 2015 2016 2017 2018 2019 2020 2021 convergence across education groups over time. Finally, workers with more education were once more likely to report a 2017a b c us olle llow eua en cons g l sou e the , or rctc oor a a en b of td aaina cc the a1rt lor e ion o p,e ’b r sc ut d e f D nt etg he .P r e C c e a ha ha nd nge dhigh as w us -d ua ee re l sou d uc not tible r a ce s s of he taa c rlt k a; r h e tp ;he la a nd ns sh, a 72 is re a p of n im erw ceor p nt or k e of tras a nt w or g st e ke sep r35 st o w –50 fur ith a tche it ing high r em a sc p gloy e hool ne er ra s’ d l p e eg ff rr a or e ce ttic s t or eo a les ss 72% 40% 74%2013 72% 2 69% 014 14% 2015 10% 20 14% 16 18% 2017 4% 2015% 8 2 4% 019 3% 20201% 20 4% 21 2% 2% 2019 71% 66% 65% 11% 16% 19% 6% 7% 6% 4% 4% 4% c Fionsi gure st s of 6, Ha as a ppr oxim Usuaa l So t 8e 0ly % ur 10 ce, 20 of 0C t ao re12 , b ,50 y Ra 0 indiv ce and idua Etls hni . city, 2013–2020................................................................... 9 A Etndno the fed te e rs al le vel, the Affordable Care Act’s “Graduate Nurse Education Demonstration” provided federal funding to Cole, Megan B., et al. "At federally funded health centers, Medicaid expansion was associated with improved quality of 2018ha p the hy d 69% ir si a c us 3 ius a 0u n a % u aa l sou 68% l sou ssistra c re c nt e of 70% a of s t cc ahe a re re irfe . 66% u llsu fra om l sou 9% 73r cp ee of rc10% ecnatr e in 201 , but 12% 3 the to re 68 18% ha ps b erceeent n conv 8% in 202 e10% r0 g, ew nc hil e e ov 8% for er w tim ore 5% k e in t rs a hig s a e 3% sr e 51 a –a64 s w 3% , tehe ll. 4% 3% 2020incre 72% ase prima66% ry care use63% among the 9% ir employe 16% es. 19% 7% 8% 7% 4% 3% 4% 60% 70% Overall Preventive Problem Based Figure 7, Has a Usual Source of Care, by Age, 2013–2020 ....................................................................................... 10 • 68% The share of workers reporting a usual source of care has fallen from 2013–2020 and has occurred for all offset the clinical training costs of advanced practice nurses to increase the supply of nurse practitioners as a way to 2019 72% 20% ca67% re." Hea68% lth Affai66% rs 36.1 (2 8% 017): 14% 40-48. 12% 17% 6% 7% 7% 6% 4% 4% 5% 3% corresponding decline was 69 percent to 67 percent. The share of workers ages 35–50 citing an internal medicine 50% 60% The decline in the share of workers reporting a general practice as their usual source of care is driven by workers with 1 workers regardless of gender, race, age, education, or income. 2020*GP=g A ad n a dre de ss dn it eiona trhe al p sh lr ast cor tr ic a te fa t,e N ll in p gP y =n us ue rrim s de b a py r ra y c m c tita a ion r ny ee p rla .hy rgsi ec e iam ns p. loy Re esea rs, rinc ch luding shows t Goog hat le the , W $2 alm 00 mi art, lli aon nd G Ap Np Ele D , eis m tonst o prrov atid ion inc e on-rsi etaese od r S69% ee http 10%s:67% //www.g 71% raham-c 64% enter.org 8% /content/ 11% dam/rg 11% c/docume 17% nts/pub 10% lications 10% -reports7% /reports7% /milbank3% -baseline 2% -scoreca 3% rd- 4% Fi gure 8, Has a Usual Source of Care, by Educational Attainment, 2013–2020 ........................................................... 11 p R ra ecs tic ults e as t heir usual source of care fell from 15 percent to 13 percent from 2013 to 2020, and the corresponding Source: 2013–2020 Medical Expenditure Panel Survey (MEPS), ages 19–64. C a hua high , 6K 6 sc a % hool o-Ping, deg arnd ee B or 5e 0 nj % lea ss m, in D whil. eSom them de er cs. " lineC in t hange he s in he share of altw h a ornd kerm s r ee dp icor al sp ting ending an int earm na ong l me yd oung icine a pd ra ulctts unde ice as t r he 40% 0% ne S t ahe p op u a re rsu c- nd e si :p tix E p employ -ly b he .of pa dlt e fa.h cl e d B va eini nc nec fe it sd R for p es r a eta c he rtc ic ir he I e nnur s m titp uses, loy te ee se p tis mat a.r tThi ic esula s st barsly e ra d in p t o en g y a rd im ha mia n s t ris yt he rc aa t ir v p e eot , eb e ny nt ro inc llia men l to inc reta asi nng dr c elaim a the se s p p da r aim r ta tic .a ipa ry c tion o are us f c elin and ica l may also d ecline for those ages 51–64 was 21 percent to 17 percent. General General Internal Internal Nurse Nurse Physician Physician Figure 9, Has a Usual Source of Care, by Income Group, 2013–2020 ........................................................................ 11 • The dec 2lin 01e 3 in prima2 r0 y1 c4are office 2 0 v1 is5its at gene 20r1 a6 l/family a2nd 017 internal me 201 d8 icine prac2t0 ic1 e9 s demonst 20 r2 a0 ted by usual source of care is driven by workers with a master’s degree, a professional degree, or a Ph.D. The share of health reform." Jama 311.23 (2014): 2437-2439. 40% p cont recr eibut ptores , to orc ha expe nge rie s in t nced he li cte yp ns ee of d cplin rov icide ians r a an e cting mpaloy s te ee a csee hers for s and prcim oaa crhe y c s, t are o se surp ve ic re vis s. eMe nur rcsi eng r’s N sta ude tion nt as d l Sur urv ing ey t of heir *GP=g Trend en se in ral p P ra rim ctice a , ry NP =n Ca ur rs e e P prlac actite ion of S er, Pe A=p rvic hys e ic a ian n d ass P isro tan vid t. er Type From 2013–2021 30% 2 Practice Practice Medicine Medicine Practioner Practioner Assistant Assistant Finally, Figure 14 indicates that the general trends in provider type of the usual source of care differ somewhat by See https://thepcc.org/sites/default/files/resources/pcc-evidence-report-2022_1.pdf. claims data is consistent with the decline in general/family and internal medicine practices being the usual Expanding access to primary care is important because it can help patients identify problems earlier and avoid illness S w Fioor g uur rk ce e er : s 10 20w 1 , it 3P – h r2ov 0 a2 ide high 0 Med r Ty sc icp a hool l eE of xpd eUsua n ed gitru erl So e e P or a ur nle e clss e S of ucrit vC e ing ya r (ME ea, g b Pe y Sne )G , a e rg a nde e l sp 1 rra 9 , – c2013 64 tic.e a –s 2020 their ................................ usual source of care ................................ fell from 75 percent in 12 Source: 2013–2020 Medical Expenditure Panel Survey (MEPS), ages 19–64. A ll age groups ha (Md a lla e)r3 g0 e% inc (Fe ream ses alein ) the sh (Ma arle e )of those (Feu m sia ng le)nurse (M pra alcet)itioners a (Fend map lehy ) sician a (Ma ss le is )tants a (Fe s tm he ailr e )usual c Elin mp icloy al r eot r-a Sp tions onso in g redr H ad eua altth P e dla eg ns re found e progtrh aa m t s. 24 I n pe pracre tnt icula ofr , em the ploy GN eE rs w deit m h 5,0 onstr00 at ion r or m eor su elt e em d p in loy enr eeollm s offe ent re a dnd a work- income group. First, while all income groups had a decline in the share reporting a general practice as their usual Figure 2 shows t 20he % trends in place of service for a primary care visit from 2013–2021 among group plan enrollees. The Fronstin, Paul, and Eden Volkov, “The Impact of Expanding Pre-Deductible Coverage in HSA-Eligible Health Plans on 3 source of care reported in the MEPS as are the increases in primary care provision by nurse practitioners and (Liss et al. 2021; Basu et al. 2019). Primary care providers (PCPs) provide preventive care, such as immunizations, 2013 to 72 percent in 2020. The corresponding decline for workers with some college, an associate degree, or a See http 201s3 ://thepcc.org/sites/default/files/resources/pcc-evidence-report-2022_1.pdf. 74% 69% 17% 17% 1% 3% 1% 2% si sour grta ed c c ulin e a tof iion c in 201 carraet. es T 2, he frne om sh a r are aly nur a of tse hir wor d pr k ( a31 e cr tit s p ione a eg re ce s r n d 19 te ) g – offe r34 ee r cp e itr d ing og a r p a nrm ur im se inc ary p r e rc a aa c si rte ng it ione clin byir c 67 s in 201 r ose per c fr 8 eo , nt m a n a3 d nd p ae not 76 rc e he p nt err in 201 c14 ent p, err3 e csp e to ne t7 c w tp iv ee e rre ly c e nt in 20% Figure 11, Provider Type of Usual Source of Care, by Race and Ethnicity, 2013–2020 ................................................ 14 source of care, only low-, middle-, and high-income workers experienced this declining share over time. In contrast, the The cumulative findings shown in Figures 9–13 indicate that young, lower-income workers with some college, an share of enrollees receiving primary care in an office setting was relatively flat from 2013–2019, with 97 percent p Use hysi of cia Hne.a lth Care Services,” EBRI Issue Brief, no. 588 (Employee Benefit Research Institute, August 17, screenings, and counseling on lifestyle changes. PCPs also help employees manage chronic conditions, such as 10% 6 bachelor's degree was 71 percent to 66 percent. For workers with a master’s degree, professional degree, or a Ph.D., 2014 73% 69% 16% 17% 2% 3% 1% 1% 2020, and the share citing physician assistants rose from 2 percent to 4 percent. The share of workers ages 35–50 ( cP onsi orad t-eD ring ahlehra bv ruc ing h e one t a l. by20 20 22 20 ).. On-site and near-site health clinics offer employees convenient access to primary care 4 10% sh Sa eree Pof ete proor son/-ne Kaa isre -p r oor w Familyor Fk oe un rs r daetion portH ing ealth a gSeyne ste ra m l p Trac ract kic er. e a Ac s cte he ssir e dus No ua vl sou embe rr ce 14, of 2c023 are. was constant at 72 percent r ae ss ce oiv cia ing te c da erg er e in a e, or n o af fic ba ec he in lor 20’13 s d a end gre95 e a p re e rd creiv nt ing doing the tso in rends20 in usu 19. The al sou sha rc re e of of e ca nr re olle aw ea s ob y frtom aini g ng ene prrim al a prrya c ctaic re e s. in a n Figure 12, Provider Type of Usual Source of Care, by Age, 2013–2020 ..................................................................... 15 2023) diabetes, high blood pressure, and mental health disorders, and can coordinate care with other health care providers. t he share was relatively flat over time, rising from 62 percent to 63 percent from 2013–2020. The share of workers with 2015 76% 72% 15% 15% 2% 3% 1% 1% ser c Fiitging ur vicee nu s w 5 rsh se itow hout prs t ac 0% h tha ia tione tv iw ng om rs r to eos n lee a ar vfr e e om m wo or r2e k . p lik e On recly - esi nt tto e in 20 ror ep ne or 13 ta r ha t-o sivt8 ie ng p ce lin ar cic us es p nt ua in 202 rl osou vide rc 0 num e , a of nd e cr atous rhee a sm s ha c eom r deic c a pil a a ting re nd d pw he hy ita h sil tcm h se iae n a n. rv s For ic sie st s b afo ot ntr h s https://www.healthsystemtracker.org/brief/tracking-the-rise-in-premium-contributions-and-cost-sharing-for-families-with- from 2013–2019, and 20 0% 2 20 01 3was the 2 only 014 year thi 20 s sh 15 are dec 2lin 016ed (to 69 2 0p 1e 7rcent), li 2k 0e 18 ly due to 2t 0he 19 COVID-219 020 pandemic. Young • wY or oung kers w , low ith hig er-inc h le om ve els w of ork ee druc s w atit ion a h som nd e inc colle om gee , ar ae n d arsiv so ing ciatthe e d terg er nds ee, in usu or a ba al sour chelorc’e s d of eg cr ae re e a ar w ea d yr fr ivo ing m the office fell to 86 percent in 2020 and 2021, likely due to the lockdowns during the COVID-19 pandemic. Figure 2 further This can help to avoid unnecessary tests and procedures and can lead to lower health care costs overall. Furthermore, In this Issue Brief, we use two 2 d0 a1 ta 3sets to2 e 0v 1a 4luate h 2ow 01 5trends 2 in t 016 he place 2 0of 17service2 a 0nd 18 provide 20r1 9 type for2 0 p2 rim 0 ary Fi a g high ure sc 13hool , Prov de ide grre e Ty or pe le of ss Usua that l So repor urtce ed of an in Cartee,r n ba yl me Educ da ictine iona pl At ractta icinm e we ant s t , he 20ir 13 us –2 u02 al sour 0 ................................ ce of care fell from ......... 12 16 2016 74% 70% 17% 17% 2% 3% 1% 1% m rose en a frnd omw 1om pee rn, cent the to sh 4a p re e rrce ep nt or . tFi ing naa lly us , tu he al sou sharre c eof of wcor arkee rfe s ll ove ages r51 tim –64 e. Irn 20 epor13 ting , 83 a nur perse cent pr a of ctiw tione omern ha was t d he a us ir ual employees, like first aid, primary care, acute and specialty care, occupational health, and more. Health care providers at White 79% 79% 77% 76% 76% 73% 71% 74% la rge-employer-coverage/. Se Gra vv ee nt s, Jo y-tsi re x hn nds pe Ar., c in usu eent t aof l. al sou " low Me-dinc ric ce aom id of E ec xp a wror a ens k ae w ion Slow ra s c y ifr te od m ea d g g e Ra e ne ne tr ea rsa l p l p Of He ra ra cc tic ta ic e lte s. Y h D as t e oung c he linir e w u For su ork a L e l so ow rs w ur -Iit nc ch hig eom of e c h l aAre d ev ul in 201 etls s I of n So 3 e,d uc u wthil he ate ion r n S only atnd a t67 es: sh intow erns t al me hat,d d icur ine ing prta he ct ic pe as. nd Mid emic dle , e -a nr golle ed w esor sh ke ifrts w ed it the h in ir tp errim me ad ry ia c te a ra end ushigh e from le voff elsic of e sett educ ings ation to a te nd lehe inc ao ltm h e are driving having access Po to o r/Ne a pa rim r Po aro yr care6 p 6% hysician 7 im 1% proves self 64% -reported 6 5 p% hysical a6nd 2%mental 5 he 6% alth, and 60 inc %reases 6d 3ia % gnoses p ca erre c eha ntv te o e 9v olv perecd e n frtom from 20 2 13 013 –2021 –202 . 0. This Using Ma shrakre et Sc wa as n rc ela laim tivs d elya fla ta tfr aom nd only 2013 f–e20 ll f2r1 om , w 17 e sh pe ow rc ehow nt to the 16 p ple arccee n otf a serv mong ice 2017 75% 67% 16% 17% 2% 5% 1% 3% Asian 72% 71% 74% 70% 65% 62% 69% 68% sour us wor ua kcl sou -e si tof e rc ccla e ini r e of c, s w cca hil arn g ee r74 ose ive p p fr ehy rocm e sint c2a of ls pe , m rtc re e ea nt n d t m tid. o inor 6 B p y e in 20 rc jur e 20 nie t, ,s, only an ad d m t 77 he ini p st sh ee ra c r rew ent e c lln iof ting ew ss om a e p xa e hy n ha m sis, p cid a n raov a us ss ide ua is tnut la sour ntr irto ion coun cse e of from carseling e 2, p wehil r, ce e a n nd 68 t t o Figure 14, Provider Type of Usual Source of Care, by Income Group, 2013–2020 ...................................................... 17 percent d Aid n a so in nalys 20 is 20 of . tT he his im sh pa ac re t of deMe clind eic da fr id om expa 73ns pion o ercent n th to e71 se p lfe -rre ce pn or t ta em d ong hea ltm h o idd f low le-inc -inc om om e w e or old ke errs, a none nd lde it rly the trends incin usu ome aarl sou e driv rcing e of the ca rte re tnds owain usu rd nurase l so pur rac ctei tof ioncearrs. e Fi aw na alyly fr , om the in rise terin nal me physi dcic ia ine n a p sr si asctta ic ne ts a s. Mid s the dle us -au ga el so d urce a 5 ppointments and urgent care facilities. Telehealth appointments for primary care rose from 0 percent of all primary of Se chr e “onic Trend cond s in EBRI Is itCos ions t s S u (ha C e Bri hu ring e af i a s fnd o rer gMe iSom sted reic dm a inle tS r hs 20 e e rv U.ic S14 e . P sa ,; t2013 eW nta alla nd – c 202 Tr ea a d0 end m ,” aEB rSom k O RfI fm iCha cee . r IS s 201 rtb SNo : o 0k 5 88 ; ( 7Emp K –1 a3u 7fm loy X/9a e 0n e e 0 8Be 8t7 ne – a1l. 3 fi 720 t XR /9 15 e 0s $ e ; a .Som 5rc 0+ h .5In m 0 e stit rs e ute t ,a l. and type of p Lr o Hi ov w spid ane icr for primary 7 2 c% are appoint 68% ments ha 68 v% e change 6d 7 % for group 65 p % lan enrol 6le 7% es. We su 66 p% plement6 t4 his % workers with some colleg 7e 1, %an assoc7 ia 0t % e degree, 71or % a bache6 lor 9%'s degree6 . 8The % correspond 64% ing de6 c1 lin %e was lar 6g 6% est for 2018 70% 66% 16% 14% 5% 8% 3% 4% 3 p ep re ce rc nt ent of fr m oe m n d 20 id. 13 –2020. even manage chronic conditions. Employees can also seek out guidance and treatment for various conditions and declined w a fr d or om ult ke s li 69 rs w v ing pe itrh in cin t ent the e tro m Sout 64 ed ia p h." teer c a H ennt eda lt high ah Af mong le fav ir high esls 39 of -.1 inc ed (o20 uc m20 a et ion a w ): or 67 ke n -r 76. ds .inc ome are driving the trends in usual source of c of arcea r ae p p ha oint s bm ee en se nts p ern a ior ctro os 2s02 all t 0 ty o p8 e s of percw eor nt kin 2 ers t 02 o 0 a a snd im ila 7 rp e drecg ernt ee in 202 . 1. In addition, the share of all primary care January 2023) © . htt 202 p3 s: , /E /w mp ww lo.y eee B bri.oenef rg/pit ub Resea lications rch /rIe ns se ta itrc ute h-— pub Educa lications tion /is as nue d Resea -briefsr/ch conte Fund. nt/tre All nd rig s-in hts -co reserv st-sha ed. ring -for- Black 75% 73% 73% 70% 71% 65% 61% 67% 2016; Han et M a id l.d 20 le 16; Wherry 7 a6 nd %Miller 2 701 5% 6; McMo 7r5r% ow et al. 720 3% 17; Cole 7 2 e% t al. 2016 7; 6% Winkelm 6a 5n a % nd Cha 7ng, 0% 2018; w ana orly ke si rs us s wit ing h ad m ata ast fr eom r’s dte he gr 20 ee, 13 a –p 2r02 ofe 0 Me ssiona dicla d l Ex egrp ee endit , orur a eP h P.aD ne ., l Sur falling vey fr ( om MEP 27 S )p a end rce sh nt ow in 201 how 3 t us o ua 19 l sour percc ee nt s of in care 2019 71% 65% 15% 15% 5% 8% 3% 4% receive specialty referrals as needed. Just as with traditional health care plans, employers can choose to cover the costs c Faare m t i low y P ar rd a cnu t i c rse e pr Ia nc tt eit rion n a le r M s. Fina e d i c ilnly e, theM riese d i c in p a l hy D osi cctia on a r ssistaP nt hs a y ss t i c ihe a n us ual so N uur r sce e P of r a ca cr te i t iha o ns b e reen a ppointments at urgent care clinics rose from 1–2 percent pre-2020 to 3-4 percent in 2020 and 2021. Future analyses medical-services-2013-2020 C awley, Soni, Hig and h Simon 2018; Soni et al. 2018; Graves et al. 2020; Barbaresco, Courtemanche, and Qi 2021). These have changed over time, segme 8nt 3% ing the a 8na 1% lysis by 7 a9 g% e, gende 7r8 , % race, educ 78a % tion, and 75inc % ome g7 r3 oup % to acc 7ount 5% for the 2020. 2020 Furthermore, not 7 1 a% ll income g6 r3 oup % s had a d 1e 5c % lining shar1 e4 r % eporting an in 5%ternal med 9% icine practice3% as their usua 4% l source for participating employees or extend benefits to their spouses and dependeA nt ss. s i s t a n t Han, Xuesong, et al. "The Affordable Care Act and cancer stage at diagnosis among young adults." JNCI: Journal of the seen across all types of workers to a similar degree. using post Sop ua rc nde e: 2m 01ic 3 –d 2a 0t 2a 0 a Med re ine cal eE dxe pd e ntd o itu arsc e e Pr atnaein w l Surhe vey the (ME r t Phe S)se , agters e nds 19–64 in . primary care setting will persist or revert to improvements in physical and mental health can translate to higher employee morale and productivity. la 6 ck of race, education, and income data in the claims data. This is the first work to date showing how the primary care of care. The share was relatively flat for poor/near-poor workers, only falling slightly from 9 percent to 8 percent from See https://www.mercer.com/en-us/insights/us-health-news/direct-primary-care-as-a-strategy-to-manage-cost/. National Cancer Institute 108.9 (2016): djw058. Source: Employee Benefit Research Institute estimates based on administrative enrollment and claims data. their pre-2020 levels. Source: 2013–2020 Medical Expenditure Panel Survey (MEPS), ages 19–64. 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