The Virginia Primary Care Scorecard is developed by the Research Consortium at VCHI on behalf of the Virginia Task Force on Primary Care, funded by the Virginia General Assembly. The scorecard aims to provide an annual tracking tool to monitor the health and well-being of primary care in Virginia through an interactive exploration of data.
A robust primary care infrastructure has been shown to improve the health and well-being of populations.1 VTFPC defines primary care using a narrow definition (preventive services provided by physician specialties) and a broad definition (includes all services provided by primary care physicians and advanced practice practitioners). For more information, see the Virginia Primary Care Investment Report, 2025.
Key findings include:
- Virginia spent 2.1 to 3.9% of total healthcare dollars on primary care, lower than the previous year.
- 13.7 to 45.5% of localities in Virginia lack a sufficient number of primary care physicians.
- 33.1 to 43.7% of insured Virginians utilized primary care services, with variation by payer type and locality.
- Quality of life decreased overall in Virginia and 93 localities are worse than the national average.
Spend
Primary care investment in Virginia can be evaluated through the percentage of total healthcare dollars spent on primary care, which may rise due to prices, rates, use patterns, or reductions in spending on non-primary care services. While there is no consensus on the “right” amount to invest in primary care, increased investment is associated with improved health outcomes and savings related to reductions in emergency and specialty care services.2
Primary Care as a Percentage of Total Healthcare Spend
Primary care spend averages 3.9% of total healthcare spend in Virginia when using the broad definition.
When defining primary care with the narrow definition, primary care spend averages 2.1% of total healthcare spend in Virginia.
Both of these percentages have decreased ↓ since being reported in the 2024 Virginia Primary Care Scorecard.
Using the broad definition of primary care, percent spend ranges from 2.2% in Highland County to 5.7% in Scott County. Using the narrow definition of primary care, percent spend ranges from 0.9% in Galax City to 3.5% in Manassas Park City.
Percent spend increases significantly in Southwest Virginia when using the broad definition of primary care because of the inclusion of Nurse Practitioners.3
Percent spend maps show primary care spend as a percentage of total healthcare spend. PMPM maps show primary care spend per insured resident per month.
Primary Care Spend Per Insured Person Per Month
Virginia spends an average of $17.21 per member per month on primary care when using the broad definition.
When defining primary care with the narrow definition, Virginia spends an average of $9.20 per member per month.
PMPM spending increased ↑ in Virginia with both the broad and narrow definitions of primary care from 2022-2023.
Using the broad definition of primary care, PMPM spend ranges from $9.76 in Highland County to $28.96 in Norton City. Using the narrow definition of primary care, PMPM spend ranges from $4.35 in Highland County to $14.11 in Smyth County.3
Percent spend maps show primary care spend as a percentage of total healthcare spend. PMPM maps show primary care spend per insured resident per month.
Primary Care as a Percentage of Total Healthcare Spend Trend
Virginia spent 2.1-3.9% of total healthcare expenditures
on primary care in 2023.
Primary care as a percentage of total healthcare spend decreased ↓ in Virginia using both the broad and narrow definitions.3
Primary Care Spend Per Insured Person Per Month Trend
Virginia spent $9.20-$17.21 per insured person per month on primary care in 2023.
Using the narrow definition of primary care, PMPM spend has been more consistent from 2019-2023, but factoring in advanced practice practitioners in the broad definition, rates have increased $4.04 in the past five years.3
The narrow definition of primary care spend encompasses preventive physician services only. The broad definition of primary care includes all services provided by primary care physicians and advanced practice practitioners.
Note: Previous years may differ slightly from past scorecards as they are now adjusted for inflation.
Range of Primary Care Spend by Payer
Commercial payers spent a significantly larger percentage of total healthcare spend on primary care, ranging from 2.8% using the narrow definition to 5.4% using the broad definition. Medicaid, Medicare, and Medicare Advantage plans spent between 1.7 to 3.6%.
Primary care as a percentage of total healthcare spend decreased ↓ for commercial and Medicaid payers and increased ↑ for Medicare plans. Between the narrow and broad definitions of primary care, the range of payments grew for Medicare Advantage.
Commercial, Medicaid, and Medicare plans spend between $8.00-$16.79 on primary care per member per month, but Medicare Advantage plans pay significantly more at $19.64-$37.21.
Medicare Advantage plans also have the largest range of PMPM payment between the narrow and broad definitions of primary care, varying by $17.57.
PMPM spending on primary care decreased ↓ for commercial payers and increased ↑ for all other payer types from 2022-2023.
Under the narrow definition of primary care, PMPM payments have been decreasing ↓ for all payers except commercial from 2019-2023.3
The range of primary care spend shows the statewide average for both the narrow and the broad definition of primary care. The narrow definition of primary care spend encompasses preventive physician services only. The broad definition of primary care includes all services provided by primary care physicians and advanced practice practitioners.
Workforce
A healthy primary care workforce is critical to ensure a healthy Virginia. Ten additional primary care physicians (PCPs) per 100,000 residents can increase life expectancy by 51.5 days.4 Burnout remains high amongst clinicians, especially in primary care. Virginia continues to see a decline in primary care providers while demand for services steadily grows. Shortages and changes in primary care physicians affect geographic regions at various levels.
Primary Care Provider Workforce
Virginia has an average of 252 primary care providers per 100,000 residents using the broad definition of primary care.
102 out of 132 localities in Virginia are below the statewide average of broad primary care providers per 100,000 residents.
Caroline County has only 23 broad primary care providers per 100,000 residents, while Winchester City has the highest at 1234.
Using the narrow definition, Virginia has an average of 125 primary care physicians per 100,000 residents. 101 out of 132 localities in Virginia are below this average.
Bland County has 0 primary care physicians under the narrow definition. Pittsylvania County is the next lowest at only 7 narrow primary care physicians per 100,000 residents, while Charlottesville City has the most at 642.5
Primary Care Provider Shortages
Using the broad definition of primary care, 13.7% of localities in Virginia have an insufficient number of primary care providers.
8 localities need at least 5 new primary care providers (broad definition) to have an adequate supply. The locality with the largest shortage, Caroline County, needs 16 new primary care providers to reach a sufficient amount for their population.
Excluding APPs and narrowing physician services, there is an even larger shortage of primary care physicians. 45.5% of localities in Virginia have an insufficient number of narrowly-defined primary care physicians.
10 localities need 10 or more new primary care physicians to have an adequate supply under the narrow definition. Stafford County needs 56 narrowly-defined primary care physicians and Pittsylvania County needs 41.5
Workforce Practicing Primary Care
26.5% of physicians in Virginia are practicing primary care. This is slightly lower than the national average of 26.8%.
The number of physicians practicing primary care increased in the US overall, but decreased ↓ in Virginia.
26.7% of nurse practitioners in Virginia are practicing primary care. They make up a large portion of Virginia primary care providers using the broad definition.
Virginia has a lower percentage of nurse practitioners practicing primary care than the national average of 30.0%. Both of these percentages decreased ↓ in 2022.7
Primary Care Workforce Supply and Demand Projections
Virginia’s demand for family medicine physicians already outpaces supply by 670 physicians. By 2037, this workforce is projected to reach only 75% adequacy.
The supply of pediatricians in Virginia is projected to fall from 1,680 to 1,400 in fifteen years. Meanwhile, demand will continue to grow and workforce adequacy is projected to reach a low of 67%.
Virginia nurse practitioners in primary care are projected to grow faster than the demand, the only primary care specialty predicted to reach 100% adequacy.
The workforce of primary care physician assistants in Virginia is projected to stay between 81-86% percent adequacy.8
Primary Care Physicians in Areas Above the Median Social Deprivation Index (SDI)
Virginia localities considered “vulnerable” based on high Social Deprivation Index (SDI) had 104.7 primary care clinicians per 100,000 residents.
This is slightly lower than the national average rate of primary care clinicians per 100,000 residents of 112.2 in high SDI areas.
The Virginia and national rates in areas with a high SDI both decreased ↓ from 2021 to 2022.
Excluding advanced practice practitioners, Virginia rates become closer to the national rate. Areas above the median SDI have a rate of 67.6 primary care physicians per 100,000 residents in Virginia, and 68.6 in the US. These numbers did not change significantly in the past year.7
Use
Significant disruptions to the use of primary care occurred during the pandemic, and have yet to fully recover. Use trends across localities vary by the narrow and broad definition of primary care, while trend across payers are more consistent. The ways in which care is accessed and delivered are still evolving, driven by increasing demand for telehealth and behavioral health services.
Percentage of Residents Using Primary Care
Primary care services were utilized by 43.7% of Virginians using the broad definition or 33.1% using the narrow definition.
Use rates vary from 33.6% of residents in Williamsburg City to 54.6% in Smyth County, using the broad definition of primary care.
With the narrow definition, use varies from 18.5% in Dickenson County to 41.2% in Greene County.
Use rates tend to be highest in Northern and Central Virginia when using the narrow definition of primary care. When using the broad definition, use rates increase significantly in Southwest Virginia.3
Primary Care Use Trend
Using the broad definition of primary care, 44.0% of Virginia residents utilized primary care.
Without including advanced practice practitioners, 33.2% of Virginians use primary care services under the narrow definition.
Primary care use has remained stagnant in the past year using both the narrow and broad definition.
While primary care use sharply increased from 2020-2021, data have not shown rates to have reached their previous peak yet.3
The narrow definition of primary care use encompasses preventive physician services only. The broad definition of primary care includes all services provided by primary care physicians and advanced practice practitioners.
Note: Previous years may differ slightly from past scorecards as they are now adjusted for inflation.
Range of Primary Care Use by Payer
Medicaid plan members use primary care services at slightly higher rates than commercial plan members: 46.2% versus 41.4% of members under the broad definition of primary care, and 34.3% versus 31.7% using the narrow definition, respectively.
Virginia Medicare enrollees have a significantly lower rate of primary care utilization than commercial or Medicaid at 34.2% under the broad definition and 25.9% under the narrow definition.
Medicare Advantage plans use significantly more primary care, with 75.6% of members utilizing services under the broad definition and 55.4% under the narrow definition.
Virginians with commercial and Medicare plans decreased ↓ their primary care use from 2022-2023 using both the broad and narrow definitions. Virginians with Medicaid insurance plans increased ↑ their primary care use under both definitions.
Medicare Advantage plan users increased primary care utilization under the narrow definition, but decreased under broad.3
The range of primary care use shows the statewide average for both the narrow and the broad definition of primary care. The narrow definition of primary care use encompasses preventive physician services only. The broad definition of primary care includes all services provided by primary care physicians and advanced practice practitioners.
Access to Behavioral Health Providers
Virginia ranks 19th in the nation in state-by-state rankings of access to mental healthcare. Virginia’s mental health workforce ranks 38th in the nation on availability.9 Both of these rankings are an improvement since being reported in the 2024 Virginia Primary Care Scorecard.
There is an average of 265 mental health providers per 100,000 residents in Virginia. This is significantly lower than the national average of 333 mental health providers per 100,000 residents.10 Both of these numbers have increased ↑ since being reported in the 2024 Virginia Primary Care Scorecard.
Outcomes
Primary care enables timely health screenings to avoid serious illness and care in expensive, acute settings, and is especially essential in treating patients with multiple conditions. Virginia’s primary care-related outcomes show that quality of life has decreased in the past year, along with life expectancy. Diabetes prevalence has increased. Preventable hospitalizations and multiple chronic conditions have decreased in both Virginia and the US. All of these measures vary greatly by locality.
Quality of Life
Virginia averages a slightly better quality of life than the US, with a score of 0.61 in Virginia and 0.59 nationally.
Quality of life decreased ↓ both in Virginia and nationally from 2021 to 2022 data.
93 out of 133 localities have a worse quality of life than the national average.
8 localities rank in the national “Top Performers”, or 10th percentile, scoring 0.83 and above.
The highest quality of life is in Falls Church City and the lowest in Hopewell City. Falls Church City was also the top performer in the 2024 Virginia Primary Care Scorecard, while the lowest was Buchanan County. Both the top and bottom performers in Virginia declined in score since 2024. 10
County Health Rankings calculates Quality of Life using: 1) Percentage of live births with Low Birthweight, Percentage of adults in Poor or Fair Health, Poor Physical Health Days within 30 days, and Poor Mental Health Days within 30 days.
Life Expectancy
Life expectancy for a Virginian is 77.6.
Virginia’s average life expectancy is slightly below the national average11 of 78.4.
Virginia’s life expectancy decreased ↓ in 2022, while the national average increased.
Life expectancy varies greatly, from 64.3 in Petersburg City to 88.9 in Manassas Park City.
This variation grew from 2021 when Petersburg City had the statewide low of 64.3 and Manassas Park City the statewide high of 85.3.10
Preventable Hospitalizations
Virginia averages 2,505 preventable hospitalizations per 100,000 Medicare members, slightly lower than the national average of 2,666.
Both the Virginia and national preventable hospitalization rates have decreased ↓ since 2021.
65 Virginia localities are worse than the national average, with rates as high as 4,522 in Franklin County.
5 Virginia localities rank in the national “Top Performers” category of 1,596 or fewer preventable hospitalizations.10
In 2021, 67 Virginia localities were below the national average, while 3 were top performers.
Virginia ranks 21st in the nation in state-by-state rankings of preventable hospitable stays. This is an improvement since Virginia ranked 23rd in the nation in 2023.12
Preventable hospitalization is calculated by discharges following hospitalization for ambulatory care sensitive conditions (PQI 90) per 100,000 fee-for-service (FFS) Medicare beneficiaries.
Note: There is no preventable hospitalization rate data available for Bedford County.
Diabetes Prevalence
Virginia has a diabetes prevalence rate of 11%, higher than the national average of 9%.
Virginia’s diabetes prevalence rate increased ↑ since 2021, while the national rate decreased.
0 Virginia localities rank in the national “Top Performers” category of 8% or less.
Even Virginia’s highest performers (Albemarle, Falls Church City, and Poquoson City) are equal to the national average13 of 9%.
Diabetes prevalence is highest in Emporia City and Petersburg City at 17%.
In 2021, diabetes prevalence in Virginia was as low as 7% in Falls Church City, and as high as 17% in Emporia City and Petersburg City.10
This measure is calculated by the age-adjusted percentage of adults aged 18 and above with diagnosed diabetes.
Multiple Chronic Conditions
11.7% of adults in Virginia have multiple chronic conditions, above the national average of 10.7%. Both of these rates have decreased ↓ in the past year.10
Virginia ranks 31st in the nation in state-by-state rankings of adults with multiple chronic conditions. This is an improvement since ranking 33rd in 2023.12
- Contribution of Primary Care to Health Systems and Health. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-0009.2005.00409.x. October 2005.
- Primary Care Spending: High Stakes, Low Investment. https://thepcc.org/reports/primary-care-spending-high-stakes-low-investment/. December 2020.
- Virginia’s All-Payer Claims Database (APCD). https://www.vhi.org/apcd/. 2019-2023.
- Life expectancy grows with supply of primary care doctors. https://pmc.ncbi.nlm.nih.gov/articles/PMC6435370/. March 2019.
- American Medical Association Health Workforce Mapper. https://www.ama-assn.org/about/research/health-workforce-mapper-app. 2023.
- VCU Department of Family Medicine Ambulatory Care Outcomes Research Network (ACORN). https://acorn.squarespace.com/primary-care. 2024.
- Milbank’s 2025 Primary Care Scorecard Data Dashboard. https://www.milbank.org/primary-care-scorecard/. 2025.
- HRSA Workforce Projections. https://data.hrsa.gov/data/download. 2024.
- The State of Mental Health in America 2024 Report. https://mhanational.org/wp-content/uploads/2024/12/2024-State-of-Mental-Health-in-America-Report.pdf. 2024.
- County Health Rankings. https://www.countyhealthrankings.org/health-data/virginia. 2025.
- CDC National Health Statistics. https://www.cdc.gov/nchs/fastats/life-expectancy.htm. 2025.
- America’s Health Rankings. https://assets.americashealthrankings.org/app/uploads/allstatesummaries-ahr24.pdf. 2024.
- County Health Rankings National Statistics Table. https://www.countyhealthrankings.org/sites/default/files/media/document/2022%20National%20Statistics%20Table_0.pdf. 2022.