2026 Primary Care Scorecard Dashboard
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. Together with the Virginia Primary Care Investment Report, 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 strong primary care system is associated with better population health outcomes, lower costs, and improved access to care.1 The Virginia Primary Care Scorecard monitors key indicators of primary care investment, utilization, workforce, outcomes, and access across the Commonwealth.
Consistent with the Virginia Task Force on Primary Care (VTFPC) framework, measures are presented using both a narrow definition of primary care (i.e., physician-led preventive and office-based services) and a broad definition (i.e., services delivered by primary care physicians, advanced practice providers, community health centers, and other primary care settings).
Additional details and complementary analyses are available in the 2026 Virginia Primary Care Investment Report and noted throughout this report.
Key findings include:
- Primary care continues to represent a small share of healthcare spending in Virginia. In 2024, primary care accounted for approximately 2.4% to 3.9% of total healthcare spending, depending on the definition used, and remained below commonly reported national benchmarks.
- Advanced practice providers are playing an increasingly important role in primary care delivery. Nurse practitioners and physician assistants are helping meet growing demand for services, particularly in rural communities and areas experiencing physician shortages.
- Primary care utilization varies substantially across Virginia. Approximately two-thirds of Virginians received a broadly defined primary care service in 2024, with notable differences across communities, age groups, and payer types.
- Access to care remains uneven across the Commonwealth. Large differences exist across Virginia in primary care investment, utilization, physician supply, behavioral health workforce availability, and provider shortages.
- Workforce challenges continue to threaten access to care. Nearly half of Virginians live in communities experiencing primary care physician shortages, while behavioral health provider availability remains below national averages.
- Health outcomes vary dramatically by geography. Life expectancy, diabetes prevalence, quality of life, and preventable hospitalizations differ substantially across Virginia communities, highlighting persistent disparities in health and healthcare access.
Primary care investment is commonly measured as the percentage of total healthcare spending devoted to primary care services. Changes in this measure may reflect shifts in healthcare prices, utilization patterns, payment rates, or spending on other healthcare services. Although there is no consensus on the optimal level of primary care investment, stronger investment in primary care has been associated with improved health outcomes, lower healthcare costs, and reduced reliance on emergency and specialty care services.2 Note: Maps and figures display both broad and narrow definitions of primary care. The narrow definition includes physician-led preventive and office-based primary care services. The broad definition includes services delivered by primary care physicians, advanced practice providers, community health centers, and other primary care settings. Spending estimates are adjusted to 2024 dollars using the Medical Care Consumer Price Index (CPI) and may differ slightly from prior editions of the scorecard. Primary Care as a Percentage of Total Healthcare Spending In 2024, primary care accounted for approximately 2.4% to 3.9% of total healthcare spending in Virginia, depending on the definition used. Under the broad definition, primary care represented 3.90% of total healthcare spending statewide. Primary care continues to represent a relatively small share of healthcare spending in Virginia, accounting for less than 4% of total healthcare expenditures statewide, regardless of definition.3 Primary Care (Broad Definition) as a Percentage of Total Healthcare Spend Primary care investment varied considerably across Virginia communities. Using the broad definition, spending ranged from 2.33% in Page County to 6.45% in Manassas Park City. Many rural and Southwest Virginia communities exhibited higher levels of primary care investment than other parts of the Commonwealth, reflecting the important role of nurse practitioners, physician assistants, community health centers, and other community-based primary care providers in delivering care. Primary Care (Broad Definition) as a Percentage of Total Healthcare Spend in Rural Localities Across rural counties, primary care accounted for an average of 3.79% of total healthcare spending, compared with 3.90% statewide.3 Primary Care (Broad Definition) Spend Per Insured Member Per Month by Locality Across Virginia counties, the unweighted average broad primary care spending was $29.68 per member per month, ranging from $11.52 to $32.53 among most counties, with several localities exceeding $40 PMPM. Geographic variation was substantial. Using the broad definition, primary care spending ranged from $16.83 per member per month in Highland County to $44.31 in Bristol City. Higher spending levels were generally observed in many rural and Southwest Virginia localities, highlighting the important contribution of advanced practice providers, community health centers, and other community-based primary care settings in these regions.3 Broad primary care spending per member has increased modestly over time, while spending on physician-led primary care services has remained flat or declined after adjusting for inflation. Primary care investment varied across payer groups in 2024. Primary Care as a Percentage of Total Healthcare Spend, 2024 Commercial plans devoted the largest share of healthcare spending to primary care, accounting for approximately 5.27% of total spending under the broad definition. Medicaid, Medicare fee-for-service, and Medicare Advantage plans devoted a smaller share of healthcare spending to primary care. Primary Care Per Insured Member Per Month Spend, 2019-2024 Primary care spending per member per month also differed across payers. In 2024, Medicare Advantage plans spent the most on primary care ($46.43 per member per month under the broad definition), followed by Commercial plans ($30.84), Medicaid ($27.82), and Medicare fee-for-service ($22.01). Differences likely reflect variation in enrollee age, health status, benefit design, and patterns of healthcare utilization. The relatively high Medicaid per member per year spending likely reflects a combination of the unique needs of Medicaid patients and changes associated with Medicaid expansion and continuous enrollment. However, the finding that Medicaid spending exceeds Medicare fee-for-service spending may also indicate incomplete capture of Medicare expenditures, particularly prescription drug spending, in the APCD. As a result, comparisons involving Medicare FFS should be interpreted cautiously.3 Additional Analysis: The 2026 Virginia Primary Care Investment Report includes spending patterns by age group.Spend
Primary Care Spend Trends, 2019-2024
Primary Care as a Percentage of Total Healthcare Spend
Primary Care Spend Per Insured Person Per Month
Primary Care Spend by Payer
Workforce
A strong primary care workforce is essential to ensuring that Virginians can access timely, continuous, and high-quality care. Research has shown that greater access to primary care clinicians is associated with improved health outcomes, lower mortality, and reduced healthcare costs.4
Primary Care Physician Shortages
Primary Care Physicians Per 100,000 Residents, by Locality
Virginia has approximately 75 primary care physicians per 100,000 residents, although access varies considerably across the Commonwealth.
Primary care physician supply ranges from 7 physicians per 100,000 residents in Madison County to 297 physicians per 100,000 residents in Falls Church City. Rural localities average 39 primary care physicians per 100,000 residents, substantially below the statewide average.
Primary Care Physicians Shortage Areas
Workforce shortages remain widespread. Eighty-eight Virginia localities are designated as having a primary care physician shortage, and nearly 47% of Virginians live in communities experiencing primary care physician shortages.5
A locality is defined as experiencing a primary care workforce shortage if it has below 136.8 primary care providers per 100,000 residents.6
Primary Care Physicians Shortages in Rural Localities
Primary care physician shortages remain common across Virginia, particularly in rural communities where physician supply is substantially lower than the statewide average.
Percentage of Clinicians Practicing Primary Care
Primary care represents a relatively small share of the overall clinician workforce.
Approximately 25.8% of physicians in Virginia practice primary care, slightly below the national average of 26.4%. Similarly, 26.1% of nurse practitioners in Virginia practice primary care, compared with 29.6% nationally.
Both Virginia and the nation experienced modest declines in the share of physicians and nurse practitioners practicing primary care in 2023.7
Primary Care Workforce Supply and Demand Projections
Current workforce projections suggest that Virginia’s demand for primary care clinicians will continue to exceed supply over the coming decade.
Virginia currently faces a shortage of approximately 700 family medicine physicians, and workforce adequacy is projected to decline to approximately 79% by 2037. Pediatric workforce projections are similarly concerning, with adequacy projected to fall to 73% as demand continues to outpace supply.
In contrast, primary care nurse practitioners are projected to be the only major primary care profession for which future supply exceeds projected demand. Primary care physician associates (assistants) are expected to approach workforce adequacy, reaching approximately 92% adequacy by 2038.8
Workforce shortages are expected to persist for most primary care physician specialties, while nurse practitioners are projected to play an increasingly important role in meeting future demand.
Primary Care Workforce in Higher-Need Communities
Workforce supply remains lower in communities facing greater social and economic challenges.
Virginia localities with Social Deprivation Index (SDI) scores above the state median had approximately 66 primary care physicians per 100,000 residents, compared with 69 per 100,000 nationally in similarly vulnerable communities. When all primary care clinicians are considered, higher-SDI Virginia communities had approximately 106 primary care clinicians per 100,000 residents.7
Additional Analysis: The 2026 Virginia Primary Care Investment Report includes complementary analyses of Virginia’s primary care workforce using APCD data, including the growing role of nurse practitioners and physician associates (assistants), changes in provider mix over time, and trends in primary care utilization across clinician types.
Use
Primary care use reflects the extent to which Virginians access preventive, routine, and ongoing healthcare services. Utilization patterns changed substantially during the COVID-19 pandemic and continue to evolve as care delivery models, workforce composition, telehealth availability, and patient needs change over time.
Note: Maps and figures display both broad and narrow definitions of primary care. The narrow definition includes physician-led preventive and office-based primary care services. The broad definition includes services delivered by primary care physicians, advanced practice providers, community health centers, and other primary care settings.
Primary Care Use Trend
Primary care utilization has remained relatively stable in recent years. In 2024, approximately 52% to 66% of Virginians received at least one primary care service, depending on the definition used.
Although primary care use increased substantially between 2020 and 2021 following pandemic-related disruptions, utilization has generally remained below pre-pandemic levels. Findings from the Virginia Primary Care Investment Report suggest that declines have been particularly pronounced among older adults, while children continue to exhibit the highest rates of primary care use.3
Primary care utilization recovered following the COVID-19 pandemic but has not fully returned to pre-pandemic levels for many populations.
Percentage of Residents Using Primary Care
Percentage of Residents Using Primary Care (Broad Definition)
Using the broad definition, primary care use ranged from 51% of residents in Williamsburg City to 75% in Poquoson City.
Percentage of Residents Using Primary Care (Narrow Definition) in Rural Localities
Using the narrow definition of primary care, use rates tend to be highest in Northern and Central Virginia. Primary care use in Southwest Virginia varies greatly by definition, as broad primary care use includes services by advanced practice practitioners.
Primary Care Use by Payer
Primary care utilization varied considerably across payer groups in 2024.
Medicare Advantage beneficiaries exhibited the highest rates of primary care use, with 90.5% receiving at least one broadly defined primary care service during the year.
Commercially insured and Medicaid members utilized primary care at somewhat lower rates, with 74.2% and 67.5% of members receiving a primary care service, respectively. Medicare fee-for-service beneficiaries had the lowest rate of primary care use, with 46.8% receiving a broadly defined primary care service.
Compared with 2023, primary care utilization remained relatively stable across payer groups. Utilization increased modestly among Commercial and Medicaid members but declined slightly among Medicare and Medicare Advantage beneficiaries.3
Primary care utilization was highest among Medicare Advantage beneficiaries and lowest among Medicare fee-for-service beneficiaries. Nearly three-quarters of commercially insured Virginians and more than two-thirds of Medicaid members received at least one primary care service in 2024.
Additional Analysis: The 2026 Virginia Primary Care Investment Report includes age-specific analyses of primary care utilization, visit rates, continuity of care, telehealth use, and care delivery settings across the lifespan.
Outcomes
Primary care plays an important role in promoting health, preventing disease, and reducing the need for costly hospital and emergency care. While many factors influence health outcomes, communities with strong primary care systems often experience better health, longer lives, and lower rates of preventable illness. The measures below provide a snapshot of population health and healthcare outcomes across Virginia.
Quality of Life
Virginia’s overall quality of life score was 0.59, similar to the national average. Quality of life declined slightly from the previous year and varied substantially across communities.
Eighty-seven Virginia localities scored below the state average, including 60 rural localities. Falls Church City continued to rank as Virginia’s highest-performing locality, while Danville City had the lowest quality of life score in the Commonwealth.5
Quality of life varies considerably across Virginia, with many rural and economically disadvantaged communities experiencing poorer health outcomes than the state average.
Note: The Quality of Life metric is derived from: 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 in Virginia was 77.8 years, slightly below the national average of 79.0 years.9 Both state and national life expectancy increased modestly from the prior year.
Substantial geographic variation exists across Virginia. Life expectancy ranged from 65.1 years in Petersburg City to 87.3 years in Manassas Park City, a difference of more than two decades between communities.5
Where Virginians live continues to have a profound impact on how long they are expected to live.
Preventable Hospitalizations
Virginia reported 2,649 preventable hospitalizations per 100,000 Medicare beneficiaries, outperforming the national average of 2,769 per 100,000.
Despite Virginia’s relatively favorable ranking, preventable hospitalization rates increased in both Virginia and the nation compared with the prior year. Rates varied widely across communities, with 66 Virginia localities performing worse than the national average.5
Virginia performs better than the nation overall on preventable hospitalizations, but substantial variation persists across communities.
Note: Preventable hospitalization is calculated by discharges following hospitalization for ambulatory care sensitive conditions (PQI 90) per 100,000 fee-for-service (FFS) Medicare beneficiaries.
Diabetes Prevalence
Approximately 12% of Virginia adults have been diagnosed with diabetes, exceeding the national average of 9%.10
Diabetes prevalence increased from the previous year and ranged from 9% in several of Virginia’s highest-performing localities to 17% in Danville City, Emporia City, and Petersburg City.5
Diabetes continues to affect a growing share of Virginians and remains particularly common in several economically challenged communities.
Note: Diabetes prevalence is calculated by the age-adjusted percentage of adults aged 18 and above with diagnosed diabetes.
Multiple Chronic Conditions
Approximately 12.4% of Virginia adults live with multiple chronic conditions, compared with 11.7% nationally.
The prevalence of multiple chronic conditions increased in both Virginia and the nation compared with the previous year. Virginia ranked 33rd nationally on this measure, reflecting ongoing opportunities to improve prevention and chronic disease management.11
Access to timely, high-quality primary and behavioral healthcare is essential for improving health outcomes and ensuring that individuals receive appropriate preventive and ongoing care. Access depends not only on the availability of clinicians, but also on whether providers are actively seeing patients, whether patients have a usual source of care, and whether behavioral health services are available when needed. Access to behavioral healthcare remains an important challenge nationally and in Virginia. Virginia ranks 22nd in the nation for access to mental healthcare and 37th in mental health workforce availability.12 Despite recent improvements in workforce supply, Virginia continues to lag national averages in behavioral health provider availability. Virginia has approximately 295 mental health providers per 100,000 residents, compared with a national average of 363 providers per 100,000 residents. Both state and national provider supply increased relative to the prior year.11 Although Virginia’s behavioral health workforce has grown, provider availability remains below national levels and continues to represent a challenge for access to care. Clinician network directories do not always reflect the clinicians who are actively providing care. Some clinicians listed in health plan networks may not be accepting patients or delivering services, which can overstate the availability of care and make it more difficult for patients to identify providers who are actively serving Medicaid members. An analysis of Virginia Medicaid managed care organization (MCO) clinician networks found that approximately 27% of listed primary care and behavioral health providers were “phantom providers,” meaning they were contracted with a health plan but did not submit claims for Medicaid members during the measurement period. Behavioral health and social service clinicians exhibited the highest rates of phantom participation, with approximately 41% classified as inactive providers.13 The presence of phantom providers may lead network directories to overestimate provider availability, potentially obscuring challenges related to access, continuity of care, and workforce capacity. As a result, patients searching for care may encounter difficulties identifying clinicians who are actively accepting and treating Medicaid members. Among clinicians who actively delivered services, patient volume varied substantially across specialties. Approximately 41% of pediatricians served more than 100 Medicaid members, while only 0.7% of behavioral health and social service providers served panels of that size. In contrast, nearly 19% of behavioral health and social service providers served only one or two Medicaid members, suggesting that many providers maintain very limited Medicaid participation.13 Many behavioral health clinicians participate in Medicaid at very low volumes, potentially limiting meaningful access to behavioral healthcare services. Having a usual source of care is associated with improved preventive care, stronger patient-clinician relationships, better chronic disease management, and lower healthcare costs. In Virginia, approximately 8.6% of children and 22.7% of adults do not have a usual source of care.7 The percentage of children without a usual source of care increased from the previous scorecard, while Virginia continues to fall short of the Healthy People 2030 goal that 84% of adults have a usual source of care.14 Most Virginians report having a usual source of care, but nearly one in four adults still lacks a regular place to receive healthcare.Access
Access to Behavioral Health Providers
Active vs Phantom Clinicians
Members Served by Active Clinicians
Usual Source of Care
Methodology
- 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/data/all-payer-claims-database-data/. 2019-2024.
- Life expectancy grows with supply of primary care doctors. https://pmc.ncbi.nlm.nih.gov/articles/PMC6435370/. March 2019.
- County Health Rankings. https://www.countyhealthrankings.org/health-data/virginia?year=2025. 2025.
- VCU Department of Family Medicine Ambulatory Care Outcomes Research Network (ACORN). https://acorn.squarespace.com/primary-care. 2024.
- Milbank’s 2026 Primary Care Scorecard Data Dashboard. https://www.milbank.org/primary-care-scorecard/. 2026.
- HRSA Workforce Projections. https://data.hrsa.gov/data/download. 2025.
- National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db548.htm. 2024.
- County Health Rankings National Statistics Table. https://www.countyhealthrankings.org/sites/default/files/media/document/2022%20National%20Statistics%20Table_0.pdf. 2022.
- America’s Health Rankings. https://assets.americashealthrankings.org/ahr_2025annualreport-statesummaries_all.pdf. 2025.
- The State of Mental Health in America 2025 Report. https://mhanational.org/wp-content/uploads/2025/09/State-of-Mental-Health-2025.pdf. September 2025.
- Virginia Department of Medical Assistance Services External Quality Review. https://www.dmas.virginia.gov/media/ibjjoec0/2024-cardinal-care-annual-technical-report.pdf. 2024.
- HHS Department Office of Disease Prevention and Health Promotion. https://odphp.health.gov/healthypeople/objectives-and-data. 2019.