Virtual primary care 101: Usage, benefits and more

Primary care is a cornerstone of the U.S. healthcare system, offering preventive care services, care coordination support, and long-term health management. As with other aspects of healthcare delivery, primary care has gone virtual, spurred by the in-person care constraints of the COVID-19 pandemic.

Following the end of the public health emergency, virtual primary care has remained a popular option, allowing Americans expanded critical access to primary care. Thus, it is important for healthcare stakeholders to gain a comprehensive understanding of virtual primary care, including its benefits and barriers, trends in its adoption and patient perspectives.

What is virtual primary care?

In its simplest terms, virtual primary care refers to conducting primary care appointments and related services through virtual care modalities, such as telehealth, remote patient monitoring and other digital health tools.

According to data analytics firm Definitive Healthcare, virtual primary care includes a wide range of services, such as medication management, disease diagnosis and treatment, chronic disease management, preventive screenings and mental health support.

However, the services included in virtual primary care programs differ by the entity offering them. For instance, ChristianaCare launched a virtual primary care practice in 2023 that includes virtual checkups, secure text messaging, and personalized wellness plans. Meanwhile, in-person and virtual care provider Carbon Health launched a virtual primary care model, also in 2023, that relies on telehealth, remote patient monitoring tools and digital health applications to enhance health outcomes.

Understanding the service's benefits and access barriers

Primary care is essential in enhancing population health. Primary care providers maintain longstanding relationships with their patients, allowing them to catch diseases before they become chronic or deadly, connect patients to specialty care when needed, and offer wellness and lifestyle advice.

However, access to primary care is distressingly inadequate. According to a February 2023 report from the National Association of Community Health Centers, more than 100 million Americans -- nearly one-third of the population -- do not have access to primary care. Rural hospital closures and the primary care provider shortage are the main drivers of this lack of access.

Virtual primary care can help bridge these access gaps. The benefits of virtual primary care are largely the same as those of virtual care in general. Research shows that synchronous video-based visits and asynchronous telehealth -- where patients and providers do not communicate in real time -- increase appointment flexibility, minimize travel-related burdens, and enhance care efficiency.

Similarly, the benefits of remote patient monitoring have been well-documented. RPM models of care are associated with enhanced or similar outcomes as in-hospital care for high-acuity conditions and in-person care for chronic conditions. Not only that, but RPM can help mitigate hospital capacity challenges and create cost savings.

Further, research published in March 2023 indicates that virtual primary care can address health issues without the need for additional in-person follow-up. According to the data from Epic Research, 61% of virtual primary care visits did not require an in-person follow-up within three months in the same primary care subspecialty.

However, like other types of virtual care, virtual primary care utilization can be hindered by social determinants of health (SDOH) and other factors.

Research shows that demographic characteristics, such as race, age and location of residency, socioeconomic factors, such as income and housing, and the digital divide influence telehealth utilization. For instance, one study published in 2023 revealed that U.S. counties with the most significant broadband availability had 47% higher telehealth utilization than counties with the least.

Further, research published in 2022 showed that Black and Hispanic people were 35% and 51% less likely to use telehealth, respectively, than white people.

This points to one of the most trenchant barriers to the broad adoption of virtual care services. The groups that most need access to healthcare are often the ones who are less likely to be able to access it virtually.

This is also true in the case of virtual primary care. Vulnerable groups like racial minorities are not only less likely to use telehealth, but they also are more likely to lack access to primary care. A 2024 report by the Commonwealth Fund shows that Black Medicare beneficiaries are more likely than white beneficiaries to seek and receive care in an emergency department for conditions that are not urgent or can be treated in a primary care setting.

Thus, addressing SDOH barriers is critical to ensure the widespread utilization of virtual primary care, particularly among medically underserved populations.

Trends in adoption and utilization during and after the PHE

Like with other virtual care services, virtual primary care soared during the peak of the COVID-19 pandemic, leveling out after in-person restrictions on healthcare were lifted.

Data from FAIR Health shows that telehealth use increased across various primary care clinicians from 2019 to 2020. Physician assistants represented the most significant increase, with a jump of almost 20,000% in patients treated via telehealth during that period. Nurse practitioners followed, with an increase of nearly 9,000%, and then came pediatricians, with an increase of over 6,000%. The proportion of patients treated via telehealth also increased among family medicine physicians by 1,100% and internal medicine physicians by 2,100%.

However, between 2020 and 2021, the percentage of patients seen via telehealth dropped by 36% each among physician assistants, nurse practitioners, and internal medicine physicians. It declined by 35% among pediatricians and 32% among family medicine physicians.

Despite these drops, primary care physicians support using virtual care modalities. In February 2024, the Centers for Disease Control and Prevention's National Center for Health Statistics released an analysis showing that 77% of primary care physicians said that the quality of care they were able to provide during telehealth and in-person visits was similar. Additionally, 65.5% of primary care physicians were satisfied with telehealth technology.

These perceptions align with those of primary care physicians worldwide. A report released in 2023 by the Commonwealth Fund showed that 77% of primary care physicians based in the U.S. expressed satisfaction with telehealth, following primary care physicians in Australia, Canada, the U.K., the Netherlands, and New Zealand. Not only that, but 72% of U.S.-based primary care physicians also stated that telehealth implementation was easy.

Easy and effective implementation is critical to the success of virtual primary care programs. Research published in April 2024 reveals that on days when primary care providers delivered care via telehealth and in-person, their EHR-based work increased by around 6%. Thus, addressing telehealth workflow challenges early in the deployment process is critical to help ease documentation and other administrative burdens associated with telehealth utilization.

In addition to a well-planned implementation, there is also a need for clearer telehealth visit triage guidelines in the primary care arena. In a study published in May 2023, when the COVID-19 public health emergency (PHE) officially expired, primary care practice leaders noted that not all visit types are appropriate for telehealth. However, triage decision-making was left to individual practices, leading to a patchwork of approaches, the primary care practice leaders said.

Efforts to improve implementation and requests for more explicit guidelines point to the value that healthcare providers see in virtual primary care services. Many organizations have deployed virtual primary care services in recent years -- including in some unusual locations.

In May 2023, Atrium Health announced the implementation of a virtual primary care clinic at an apartment building in Charlotte, North Carolina. The clinic includes an on-site healthcare technician to assist with video visits and virtual examinations. The clinic also provides testing for various conditions, such as the flu, COVID-19 and strep throat.

And it's not just healthcare providers. Healthcare payers, too, are investing in virtual primary care.

For example, in May 2022, CVS Health launched CVS Health Virtual Primary Care. This digital care platform connects healthcare consumers with primary care, on-demand care, chronic condition management and mental health services. Through the platform, eligible Aetna and CVS Caremark members can choose various retail, community-based, virtual, and at-home healthcare options.

Patient perspectives on virtual primary care

Virtual primary care is proving immensely popular not just among healthcare providers and payers, but also among patients.

Elevance Health, a healthcare payer organization, commissioned Harris Poll to survey more than 5,000 U.S. adults in March 2022 about their perceptions of virtual primary care. Survey results revealed an overwhelmingly positive association, with 94% of respondents saying they were satisfied with their virtual primary care experience. Convenience and accessibility were the top-cited reasons for Americans using virtual primary care services, and 71% believe the expansion of virtual primary care is changing the healthcare system for the better.

Another report detailing survey findings from a poll of 1,004 adults in July 2022 revealed that telehealth use remains widely used for certain types of care, including primary care (55%).

These trends underscore the ongoing interest in seeking and receiving primary care through virtual care modalities. Though SDOH barriers and operational challenges must be overcome, virtual primary care services are becoming an integral fixture of the U.S. healthcare system.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.