The landscape of primary care in the United States has undergone significant transformation following the COVID-19 pandemic, with practices showing improved capabilities but diminished accessibility, according to a new study published in JAMA Health Forum.
The research, comparing national survey data from 2017-2018 and 2022-2023, reveals a complex picture of how the pandemic has reshaped primary care delivery systems and organizational structures.
Shifting Ownership Patterns and Organizational Changes
The study documents a clear trend toward consolidation in the healthcare sector. Hospital and health system ownership of primary care practices increased substantially from 40% to 49%, while independent ownership decreased from 37% to 31%. Physician group ownership also saw a decline, dropping from 13% to 10%.
Participation in Accountable Care Organizations (ACOs) showed modest growth, with practices averaging 1.6 payer contracts in 2022-2023, up from 1.2 in the pre-pandemic period. However, 43% of practices maintained minimal ACO involvement, reporting one or no payer types.
Enhanced Practice Capabilities and Clinical Tools
Despite challenges, practices demonstrated improved capabilities across several key metrics:
- Overall capability scores increased from 51 to 54 on a 100-point scale
- Depression care processes improved from 67 to 72 points
- Electronic health record integration advanced from 59 to 67 points
- Patient-reported outcome measures rose from 63 to 70 points
- Social needs screening showed modest improvement from 37 to 43 points
Notably, practices serving patients with complex or high needs showed the most significant improvement, with a 15-point increase in capability scores.
Declining Accessibility Trends
While capabilities improved, patient access to care saw concerning declines:
- Weekend hours availability decreased dramatically from 44% to 26%
- Advanced access scheduling dropped significantly from 60% to 26%
Organizational Impact on Performance
The study revealed that practice ownership and ACO participation significantly influenced performance metrics. Practices owned by physician groups and hospital/health systems maintained higher capability scores, averaging 12 points above independently owned practices both before and after the pandemic.
ACO-participating practices demonstrated superior performance in several areas:
- Higher rates of extended-hours access compared to non-participants (55% vs 34%)
- Highest overall capability scores among all practice types
- Better adaptation to post-pandemic challenges
Implications for Healthcare Delivery
These findings suggest that while the healthcare system has enhanced its technical and clinical capabilities, the decrease in accessibility could pose significant challenges for patient care. The trend toward consolidated ownership and ACO participation appears to support better practice capabilities, though questions remain about the optimal balance between system integration and maintaining accessible care.
The research team notes that while the study cannot definitively attribute these changes solely to the COVID-19 pandemic, the findings highlight the crucial role of payment reform and primary care ownership structures in shaping the future of healthcare delivery.
