What does usual source of care mean in healthcare?

Defining usual source of care

According to the Agency for Healthcare Research and Quality (AHRQ), a usual source of care is "the particular medical professional, doctor's office, clinic, health center or other place where a person would usually go if sick or in need of advice about his or her health."

PCPs are typically an individual's usual source of care, but as indicated by AHRQ, they don't have to be. A usual source of care can refer to a practice instead of an individual physician, nurse practitioner (NP) or physician assistant (PA).

Having a usual source of care is integral to better health outcomes, especially for an aging population, according to a Milbank Memorial Fund report.

"Having a routine and reliable care source can be particularly important in middle-age to older adulthood when the risk of illness and complexity of health care needs tend to increase," the report authors wrote.

Benefits of having a usual source of care include better patient experience, better access to preventive care, fewer high-risk health measures and overall better patient satisfaction ratings.

The Milbank authors also indicated that usual sources of care can play a role in addressing racial health disparities. People of color and with lower incomes are more likely to report overall poor health and have lower preventive care utilization.

"However, health outcomes and preventive care usage improve when these individuals have a USC," the authors explained. "In addition, having a USC significantly diminishes the association between being a person of color and/or a person of lower wealth and reporting that your care preferences are not being taken into account."

Having a usual source of care is critical for middle- and older-aged adults as their risk of chronic illness continues to increase, but experts also say usual sources of care are important for kids. Pediatric healthcare is characterized by the tracking of child development, wellness checks and key services, especially vaccinations.

Without a usual source of care, kids might not receive the development checks and vaccinations they need to thrive into adulthood.

Decline in usual source of care

Despite the benefits of having a usual source of care, the number of individuals reporting one is seriously declining, the data shows.

Per the Peterson-KFF Health System tracker, only 10.7% of adults in the U.S. reported having a usual source of care in 2022. That's down from 16.7% who said the same in 2010.

Lacking a usual source of care was significantly more likely for uninsured people, 38% of whom did not have a usual source of care in 2022. That's compared to 8% of insured adults who also did not have a usual source of care that year.

Race, too, factors into whether an individual has a usual source of care. In 2022, just under a fifth (17%) of Hispanic people did not have a usual source of care, compared to 9% of white people, 10% of Black people and 11% of Asian people.

Finally, access to a usual source of care depended on age, with younger people being far less likely to report one compared to the over-65 crowd. While only 3% of those over age 65 lacked a usual source of care in 2022, that number surged to 19% when looking at people ages 18 to 34. The percentage of adults who reported no usual source of care continued to decline when looking at increasingly older population segments.

It's not just adults who lack a usual source of care. Despite the importance of having a usual caregiver for developing kids and adolescents, the data -- although less up-to-date -- shows poor care access among the pediatric population.

An AHRQ report published in 2017 using 2014 data showed that 5.8 million children, or 7.9%, did not have a usual source of care. Kids without health insurance coverage were more likely to lack a usual source of care compared to their insured counterparts.

Reasons for decline and how to fix it

The reasons for the decline in access to a usual source of care are varied and therefore require multifaceted solutions.

Some data indicates that the primary care provider shortage keeps patients from securing a usual source of care. Meanwhile, issues with insurance coverage and design could bar some from accessing care.

By examining policy solutions that support both the medical workforce and the insurance system, healthcare experts might move the needle on care access.

Strengthening the PCP workforce

The decline in a usual source of care could be credited to the U.S.'s faltering primary care network. According to 2023 figures from the National Association of Community Health Centers, 100 million Americans are considered medically disenfranchised because they do not have a usual source of care and face some kind of primary care access barrier.

Top PCP barriers include rural hospital closures and the PCP shortage.

There have been some policy-driven efforts to support the primary care workforce. Notably, CMS has increased the number of residency slots for primary care with a special focus on traditionally underserved communities. Better compensation and other benefits might also attract more medical students to the understaffed specialty, experts have indicated.

Additionally, tapping advanced practice providers (APPs) like NPs and PAs has helped move the needle on care access. White people are more likely to meet with an NP or PA as a usual source of care than Black people, according to a 2024 report from the Employee Benefit Research Institute, and doctors are still the most common provider type.

But APPs are proving to be viable alternatives for patients unable to meet with a primary care physician due to shortages or other access barriers. As more states consider scope of practice laws for NPs and PAs, these clinicians could continue to fill in the gap in usual sources of care.

Reexamining managed care plans

Health insurance plan type could also have something to do with usual source of care access.

According to the Milbank report, people in managed care plans were less likely to lose their usual source of care compared to people with other plan types. In fact, people enrolled in a managed care plan became more likely to get a usual source of care during the 2014-2020 study period, although that increase was slight.

"Managed care not only has higher and increasing percentages of those with a USC than fee-for-service over time, but prior research has shown that managed care is also serving a more diverse population with fewer financial resources than fee-for-service," the researchers said.

"Therefore, managed care may represent a promising pathway for increasing the share of people with a USC and serve an important role in helping to reduce racial/ethnic and wealth disparities in health care satisfaction, person-centeredness, and utilization."

However, it should be noted that managed care plans need to improve beneficiary choice and access to a range of providers, as well as boost standards and performance measures to improve clinical quality, the Milbank researchers said.

Supporting continuity of coverage, support

Certain life changes like getting or losing a job were also linked with access to a usual source of care. This is likely because employment is linked with insurance access. Patients without insurance coverage are less likely to have a usual source of care compared to those with coverage, the Milbank researchers said.

Health insurance providers and other healthcare organizations need to play a more supportive role in guiding patients during these types of life changes, which can also include marriage or changes in physical and mental health. In doing so, payers and providers might prevent patients from losing their usual source of care.

Supportive actions might include patient outreach from an existing USC to support during negative life changes and providing patient navigation for individuals experiencing changes in insurance coverage.

Engaging younger patients in care

Finally, the Milbank researchers suggested improving patient engagement with younger populations who are less likely to have a usual source of care.

Most people need to secure a usual source of care when they get older and develop chronic illnesses. Creating incentive structures that compel younger patients to get a usual source of care to provide preventive guidance will be key, the researchers said.

"This could include providing incentives such as reductions in copays or deductibles when longitudinal relationships are established and maintained, providing a bonus payment when a USC is gained and maintained, or waiving pre-authorization requirements for certain services," they offered as examples.

As medical experts continue to eye better outcomes and patient experiences, care access will be paramount. Reconsidering the barriers to having a usual source of care and the policy changes needed to overcome them will be key to ensuring better access to care and population health management.

Sara Heath has covered news related to patient engagement and health equity since 2015.