Primary Care Access Ecosystem Remains in Flux

The following is an excerpt from Low-Acuity Sites of the Future: Reconfiguring the Primary Care Puzzle. Sg2 members can read the full publication and view other facility planning resources in the Facility Planning Resource Kit on

Provider systems working to optimize their primary care offerings confront a complex market unlikely to take final shape anytime soon. The industry should expect heated competition and market consolidation as large insurers and private equity–funded enterprises expand their brands, especially in higher-margin options like urgent care and in markets with elevated Medicare Advantage penetration.

Sg2’s demand forecast across primary care sites gives a glimpse into the likely future state as market players make their moves and increasingly savvy consumers make their choices.

Sg2 Site of Care Forecast, 2018-2028 showing by 2028 17% E&M visits will be virtual and primary care access will decrease by 10%

Current Activity Already Is Beginning to Radically Reshape the Landscape

Payers as providers: Health plans are morphing into hybrid payer/provider roles and organically steering patients toward lower-cost sites of care, many of which are now payer owned. What started as payers dabbling in telehealth has evolved into a full-on move into comprehensive primary care.

For example, with its addition of DaVita Medical Group, UnitedHealth’s Optum will employ more than 47,000 physicians, becoming the largest physician employer in the US. Already the owner of MedExpress urgent care and ambulatory surgery centers, this data analytics firm has rapidly transformed into a care provider behemoth targeting 75 markets across the country.

Retail partnerships: Major retail chains increasingly are looking to join forces with health sector players to extend their care offerings.

For instance, the completed CVS and Aetna merger could create consumer-focused “health hubs” across the chain’s retail pharmacy sites. The vision includes expanding the existing 1,100 MinuteClinics to more closely resemble urgent care centers, offering consumers durable medical equipment, pharmacy and health care services, and health education under 1 roof.

New market entrants: Big business and small venture capital–funded efforts also are getting in the game. Some are investing in niche offerings targeted to patient populations that may have gotten short shrift in traditional models of care. Others seek to completely upend health care’s longstanding value chain.

In one example, Oak Street Health, a Medicare Advantage provider in the Chicago, IL, area, created a consumer-friendly 1-stop shop for its managed care population. The clinics are mostly located in traditionally underserved areas, increasing the short-term earning potential for providers eligible for value-based performance bonuses.

Employer clinics: On-site and near-site clinics are back in vogue among the nation’s large employers. Nearly 30% of companies with more than 5,000 employees have near-site or on-site employer clinics to meet the primary care needs of their employee populations and their families. The clinics often compete with local health systems for volume, prompting some progressive health systems to launch new branches of business.

Advocate Health Care, the largest health system in the Chicago area, has a division called Advocate at Work that operates on-site clinics at more than 120 companies.

How to Move Forward

Even thoughtfully planned suites of low-acuity assets may fail to achieve system goals if logistics get short shrift. Beyond the ideal configuration, equal thought must be given to issues that impact how well disparate sites unify into a true low-acuity ecosystem: location, scheduling convenience, potential cultural barriers and metrics for success.

Are you an Sg2 member? Go to to access the full publication Low-Acuity Sites of the Future: Reconfiguring the Primary Care Puzzle, which provides guidance on how to tailor a low-acuity care network to specific market conditions through strategic profiles of key low-acuity sites of care and scenarios on how to configure them for strategic advantage. Also included are case studies on how other organizations are leveraging their primary care access points. Reach out to your account team or for help with your primary care access strategy!

Not an Sg2 member yet? Sg2 has helped countless organizations identify and prioritize opportunities across their markets’ primary care landscape. Let us know how we can help you fully leverage your primary care network for strategic advantage by contacting us today at

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