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Getting care.

We make it easy to get care, so you can focus on being healthy. And you have many options, including in-person care, telehealth care, and urgent and emergency care.

Convenient ways to get care

In-person appointments

Our state-of-the-art medical centers offer many services under one roof, so you can get care in less trips.

Video and phone appointments

Schedule a face-to-face video visit or phone appointment with a Kaiser Permanente clinician.

Get on-demand support with 24/7 care advice by phone or chat with a clinician 24/7.

E-visit questionnaires

Use our online symptom checker for certain conditions and get personalized care advice within a few hours.

Prescription delivery

Fill most prescriptions for delivery to your home, or same-day pickup at our facilities.

Message your doctor’s office with nonurgent questions and usually get a response within 48 hours.

Managing your care

Urgent care saves time, money, and stress, when is urgent care right for you, emergency care, not sure which care is right for you, care while traveling.

• If you get hurt or sick while traveling, you’re covered for emergency and urgent care anywhere in the world.
• Get urgent care at a MinuteClinic (in select CVS and Target stores) or Concentra urgent care center when you’re traveling outside a Kaiser Permanente area. 2
• We can also help you before you leave town by checking to see if you need a vaccination, refilling eligible prescriptions, and more.

Just call us or go online:

24/7 Away from Home Travel Line: 951-268-3900. 3

Or visit us online at  kp.org/travel .

1 An emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that you reasonably believed that the absence of immediate medical attention would result in any of the following: (1) placing the person’s health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to bodily functions; or (3) serious dysfunction of any bodily organ or part.

2 MinuteClinic and Concentra payment experiences vary by plan.

3 This number can be dialed inside and outside the United States. Before the phone number, dial “001” for landlines and “+1” for mobile lines if you’re outside the United States. Long-distance charges may apply, and we can’t accept collect calls. The phone line is closed on major holidays (New Year’s Day, Easter, Memorial Day, July Fourth, Labor Day, Thanksgiving, and Christmas). It closes early the day before a holiday at 10 p.m. Pacific time (PT), and it reopens the day after a holiday at 4 a.m. PT.

Find out how convenient it is to switch.

Connect with a Kaiser Permanente advisor to learn more: 800-777-7902 (TTY 711 ), Monday through Friday, 7:30 a.m. to 9 p.m.

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After-Hours and Urgent Care Services

Day or night, mauka to makai

When you’re healthy, you usually don’t think about the doctor — until you need one. If you have a minor illness or injury, you have convenient ways to get care that won’t slow you down. Talk to a clinician virtually by video or phone 24/7 or visit one of our urgent care centers.  Plus, call us anytime for treatment advice, help finding our nearest urgent care center, or scheduling an appointment.

24/7 Virtual Care

• In-Person Care

Connected Care

Talk to a clinician by video or phone from your home or work.¹ With telehealth, you get convenient, quality care. And, there is no additional cost for most plans.

In-Person Urgent Care

You can go to an urgent care center to get non-emergency, non-routine care during weekdays, as well as nights, weekends, and most holidays. We’re here for you at more convenient times, with expanded urgent care services on Oahu and Maui plus access to additional affiliated urgent care centers on Maui, Hawaii Island, and Kauai. The cost of an urgent care visit is generally the same as a routine doctor’s appointment.²

How to schedule appointments

We recommend you call us before going to an urgent care center:

• Statewide: 833-833-3333

24/7 Advice by Phone

Talk with a licensed clinician day or night for medical care and advice at no additional cost.

Call us 24/7

At Kaiser Permanente, your care team is connected. We're different because we provide care and coverage together in one package. That means your personal doctor, specialists, imaging, lab, and pharmacy, and your health plan all come bundled together for you. Even better, your health care team can access your medical record in real-time – helping you get the coordinated, quality care you need in a way that works for you.

Frequently Asked Questions

What symptoms or situations should i use urgent care visits for.

Urgent Care is appropriate for medical conditions that require prompt medical attention, usually within 24 or 48 hours, but are not an emergency. Examples include, but are not limited to:

• abdominal/stomach pain (mild or moderate)
• back or muscle aches (mild)
• breathing difficulties (mild or moderate)
• broken bones or sprains (minor breaks on a limb or appendage such as an arm, hand, finger, leg, foot, or toe – with no large wounds)
• burns (superficial only)
• colds or flu
• cuts and lacerations with minimal bleeding (may require a few stitches)
• dizziness and/or lightheadedness
• eye irritation and redness/conjunctivitis (pink eye)
• foreign body removal (small objects stuck in the eye, ear, or skin)
• migraine symptoms that you’ve had before
• skin rashes and hives
• sinus infections
• sore throat
• swollen or painful joints (moderate)
• urinary tract infections or kidney stones, frequent urination, burning sensation when urinating
• vomiting or diarrhea (moderate)

What if I’m having an emergency?

If you think you or someone you care for is having a medical or mental health emergency, call 911 or go to the nearest emergency department. Do not attempt to access emergency care through an urgent care center, kp.org, or a video/phone visit.

Issues that should be seen in an emergency department include:

• abdominal/stomach pain (severe)
• allergic reactions
• breathing difficulties including shortness of breath (severe)
• broken bones (with open wounds, multiple broken bones, parts of the body that are not limbs or appendages – e.g., head/face, neck, ribs)
• burns (moderate or severe)
• car or other motor vehicle accident
• chest pain or chest pressure
• coughing or vomiting blood
• facial drooping or sudden weakness/numbness in an arm or leg, slurred speech, confusion, vision loss
• fever in a newborn
• head trauma
• headache that starts very suddenly and is very painful
• heavy, uncontrollable bleeding
• injuries to the head, neck, or back that appear to be serious in nature
• insect bite reaction (severe)
• loss of consciousness
• vomiting or diarrhea that persists
• pregnancy-related issues including bleeding
• suicidal or homicidal feelings

Will an urgent care visit be with my primary care physician?

In-person urgent care or on-demand video or phone visits will connect you to a clinician who will likely not be your primary care physician. However, the result of your visit will be documented in your medical record and your primary care physician will have access to that information.

Will the clinician have access to my medical history?

Yes. Whether you access care in-person or virtually by video or phone, the clinicians you see will have access to your medical history and prescription information through your Kaiser Permanente electronic medical record. The relevant medical details of your visit will be added to your medical record.

Can the clinician I talk to prescribe medications and/or refer me to a specialist, order labs, and provide other care during a virtual care or in-person urgent care visit?

Yes, when appropriate, the physicians and providers in these settings can prescribe medications, make referrals, and order tests just like in a routine primary care office visit.

How much do urgent care visits cost?

Generally, in-person urgent care visits are subject to the same copay, coinsurance, or deductible you pay for regular primary care office visits. Medicare members may have an urgent care office visit copay that is different than the primary care office visit copay, as described in their Evidence of Coverage.²

Costs for virtual care visits by phone or video depend on your plan. For most Kaiser Permanente members there is no charge. HSA-qualified high deductible health plan (HDHP) members must first meet their deductible before phone and video visits are provided at no charge. For benefit information, review your Evidence of Coverage, Membership Agreement or Certificate of Insurance.

Have additional questions?

¹When appropriate and available. If you travel out of state, phone appointments and video visits may not be available due to state laws that may prevent doctors from providing care across state lines. Laws differ by state.

² Please note that as a Medicare member, if you are seen in an urgent care department, you may have an urgent care office visit copay that is different than the primary care office visit copay, as described in your Kaiser Permanente Senior Advantage Plan (HMO) Evidence of Coverage.

If you believe you have an emergency medical condition, call 911 or go to the nearest hospital. For the complete definition of an emergency medical condition, please refer to your Evidence of Coverage or other coverage documents.

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Urgent Care Options

When you want to see a doctor quickly (but it’s not an emergency), you have access to about 90 urgent care locations and many other convenient care options.

• Learn the difference between urgent care and emergency care and how we can help you get the right care at the right place.
• View your many options for getting care quickly and conveniently, and even at no cost right from home.

In-Person Urgent Care

Kaiser Permanente 24/7 Advanced Care Centers

Get quality, coordinated care and under-one-roof convenience 24 hours a day, 7 days a week. When you visit a Kaiser Permanente 24/7 Advanced Care Center, you’ll get care from our own, highly-trained physicians and nurses. They’ll have access to your medical record to help personalize your care. You’ll even be supported by advanced technology like MRI and CT scans, plus X-ray, lab and pharmacy services—all under one roof!

More than Urgent Care. Not quite an Emergency Room. 1

In addition to typical urgent care issues like fever, severe sore throat, sprains, minor cuts, and earaches, you can now also get help with more serious (but non-life-threatening) issues such as:

• deeper cuts
• broken bones
• severe abdominal pain
• dehydration

If your doctor decides you need additional treatment or observation, you’ll have the peace of mind knowing we can monitor your condition in our on-site “Clinical Decision Unit” for nearly a full day — or transfer you to a hospital if needed.

24/7 Advanced Care Center locations:

Gwinnett Comprehensive Medical Center 3650 Steve Reynolds Blvd. Duluth, GA 30096

Southwood Comprehensive Medical Center 2470 Mt. Zion Parkway Jonesboro, GA 30236

TownPark Comprehensive Medical Center 750 Townpark Lane Kennesaw, GA 30144

Save time and money

Why spend hours and pay more at the ER when it’s not an emergency? 1 With Kaiser Permanente Advanced Care Centers, you can enjoy:

• Shorter wait times: You’ll often get care more quickly than at the hospital ER.
• Lower out-of-pocket costs: Your cost for a visit to an urgent care location will usually be lower than for the ER.
• Coordinated care: You’ll get care from our own doctors who have instant access to your electronic medical records.
• Pharmacy Convenience: You’ll be prescribed drugs that are covered by your plan, 2 and can pick them up without leaving the building.

Affiliated Urgent Care Centers

To make getting care easier, you also have access to about 90 affiliated urgent care centers including certain locations from:

• Children’s Healthcare of Atlanta
• Northside Family Medicine & Urgent Care
• Peachtree Immediate Care

Some locations offer evening and weekend hours. For a searchable directory, click here .

Need help deciding where to go for care?

Our Health Line advice nurses are available 24 hours a day, every day at 404-365-0966 . You have many convenient options for getting care quickly.

1. In an emergency — a condition that requires immediate attention to prevent serious jeopardy to your health — call 911 or go to the nearest hospital emergency room.  2. For plans with a pharmacy benefit, you’ll be prescribed drugs that we cover, when available.

©2023 Kaiser Foundation Health Plan of Georgia, Inc. Nine Piedmont Center • 3495 Piedmont Road • Atlanta, GA

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Americans' Primary Care Experiences and Preferences: 2024 Survey Report

U.S. News & World Report surveyed 2,000 U.S. adults about health care issues, including why and how often they go to the doctor, how they choose their doctors and why they choose to (or don't) follow the advice of their doctors.

Americans' Primary Care Experiences

People don’t typically think about their health until they get sick. At that point, they might visit an urgent care center or emergency room rather than seeing a primary care provider , or PCP. However, a trip to the ER for a common ailment is, on average, 12 times more expensive than getting care at a physician’s office, according to an analysis from UnitedHealth Group.

In addition to vast cost savings, having a consistent primary care provider for health ailments and regular screenings can improve a patient's experience and help prevent medical issues from becoming critical emergencies. Most health insurance companies and Medicare plans will cover an annual preventative wellness visit to a PCP.

Health care costs have been on the rise for years; and for many Americans, it’s an obstacle to getting timely and dependable health care. According to the Kaiser Family Foundation, one in four American adults say they have skipped or postponed getting medical care because of costs, and 41% of adults report having medical or dental care debt.

To better understand Americans’ health care preferences and attitudes, U.S. News & World Report surveyed 2,000 U.S. adults about a number of health care issues, including why and how often they go to the doctor, how they choose their doctors and why they choose to follow the advice of their doctors – or not.

Here are the top insights from that survey.

How Often Americans Go to the Doctor

Nearly three in four (73%) of respondents had their last annual physical in either 2023 or 2024.

It seems the COVID pandemic has shifted many Americans’ attitudes on wellness and preventative health. Of the respondents who had gone in recently for an annual physical, 29% said that since the COVID pandemic, they now visit their PCP more regularly. And more than two in three (68%) surveyed adults said they plan to have an annual physical this year.

Why Some Americans Won’t Go to the Doctor

While a majority of adults surveyed have recently seen a primary care provider, many people aren’t getting the preventative health screenings and checkups they need. In fact, 12% of the surveyed adults said they were unsure of when they would go in for their next annual physical.

Of those who haven’t had an annual physical recently, people had different reasons for not visiting a doctor or other health care provider:

• 32% said they can’t fit an appointment into their schedule or keep forgetting to make an appointment. 
• 25% said they don’t like going to the doctor. 
• 12% said they just haven’t found a PCP they like. 
• 10% said they have felt shamed or judged by doctors in the past. 
• 10% said they’re afraid of getting sick from others during a PCP visit.

Scheduling issues and poor experiences can be difficult obstacles to overcome. The relationship with a primary care physician is an important one, and some patients might be seeing a PCP who simply isn’t a good fit for them.

Finding the right primary care provider is the first step a patient can take. And it’s easier than ever to find a doctor by using U.S. News & World Report’s doctor finder tool , which allows patients to search for a doctor by specialty and areas of expertise, location, insurance accepted and many more details to ensure patients choose a doctor that will be a good fit for them. The doctor finder tool also shows patient ratings of individual doctors.

How Americans Choose Their Primary Care Providers

Establishing care with a PCP seems to make people more likely to have regular visits: 81% of people who had a recent annual physical visited a PCP that they’d seen previously. Seeing the same PCP year after year and creating that continuity of care (vs. a one-off urgent care visit) can improve the quality of care a patient receives because that PCP will be more familiar with them and their medical history.

How people find their PCPs varies. About one quarter (24%) found their PCP through their insurance provider’s directory of providers that are in-network.

Types of Doctors

Adults in the U.S. can choose to see different types of doctors :

• Family medicine specialists treat people from childhood through adulthood.
• Internal medicine doctors , or internists, only treat adults. 
• Children may see pediatricians through the age of 18 to 21, depending on the practice.
• Older adults may choose to see a geriatrician .
• Doctors for women, including OB/GYNs, provide important additional preventative care, including mammograms and PAP smears.
• Gastroenterologists also provide important preventative screenings, like colonoscopies .
• Some men may see a urologist for conditions such as an enlarged prostrate or prostate cancer.

What to Look For in a Doctor

Aside from the type of doctor, people surveyed considered the following characteristics when choosing a doctor:

• Nearly 30% (28%) of U.S. adults are looking for their doctor to have experience and expertise in a specific area of care, possibly one related to a health condition they have. 
• 24% are looking for providers with positive patient reviews.
• 13% look for a PCP who is the same sex, gender or race as them. 
• 13% look for a PCP who is associated with a highly-rated hospital . 
• Only 9% look for whether the PCP went to a top medical school or residency program. 

COVID precautions

It's been four years since the beginning of the COVID pandemic, and most Americans still value providers who follow COVID-related precautions: 66% are more likely to make an appointment if masks are required, and three quarters of those surveyed (75%) would be more likely to make an appointment if the office offers COVID vaccines and boosters.

What Americans Think Makes a Great Doctor

People may want to consider certain c haracteristics when looking for a doctor that is a good fit for them. For example, they may think about whether the doctor communicates with an open and empathetic dialogue, shows compassion and fosters trust.

The good news is that of the respondents who had their last annual physical in 2023 or 2024, an overwhelming majority feel comfortable with and trust their doctor, at 96% and 95%, respectively.

Additionally, of the 2,000 survey respondents:

• 35% felt heard and understood by their PCP during their last annual physical exam.
• 26% said their PCP eased their nerves during their last annual physical exam. 

Of those who felt heard and understood by their PCP:

• 56% said their PCP asked questions in a nonjudgmental way. 
• 38% reported that their PCP said they would follow up with next steps or answers to their questions . 

Of those who felt that their PCP eased their nerves:

• 50% said their PCP was compassionate.
• 48% said their PCP asked questions in a nonjudgmental way.
• 22% said their PCP clearly explained next steps in their care. 

Online Patient Portals

Respondents were also asked to select up to three choices from a set of options about what features they’d like to be able to use with an online patient portal for their PCP.

The most popular options chosen:

• Ability to review test results within the online portal. More than half (57%) of adults want this option.
• Request medication refills. 47% would prioritize being able to request medication refills.
• Schedule an appointment. 47% of respondents chose this option. 
• Message with their PCP or staff. 42% want the ability to communicate with their PCP via an online portal.

What Americans Do – And Don’t – Want to Know About Their Doctor

When people visit their doctor, they aren’t just looking for answers about their health. There are things that they do - and don’t - want to know about their doctor.

For this question, respondents were able to select up to three options that they’d like to know about their doctor. These were the most common things patients want to know about their doctor:

• Beliefs about alternative medicine. 46% of respondents said they would like to know their provider’s beliefs about alternative medicine.
• Stance on vaccination. 42% of respondents wanted to know their provider’s stance on COVID vaccines, and 22% wanted to know their PCP’s stance on vaccinations for infants and children.
• Opinion on cannabis. 20% of respondents said they would like to know their PCP’s opinion on cannabis. 
• Perspective on ethnic disparities in healthcare. 20% of respondents said they’d like to know more about their PCP’s perspective on ethnic disparities in healthcare. 

What patients are less interested in knowing about their doctor:

• Stance on abortion. Only 13% of U.S. adults surveyed want to know their PCP’s stance on abortion.
• Political affiliation. Additionally, most respondents (73%) said they would prefer not to know their PCP’s political affiliation. 

When Americans Don’t Follow Their Doctor’s Advice – and Why

When Americans visit their PCP, they generally follow the advice that the PCP gives them. Four in five (81%) say they usually or always follow their PCP’s health advice.

When people don’t follow their PCP’s advice, they say it’s because:

• The advice is difficult to implement in daily life (43% of the time).
• They cannot afford what their PCP recommends (34% of the time). 

While treatments are often covered by a person’s medical insurance, doctors may sometimes recommend things like vitamins and supplements, over-the-counter medications , ongoing physical therapy or new medical equipment that insurers don’t always cover.

Bottom Line

PCPs can be a valuable part of a person’s medical journey – both to prevent health emergencies as well as to effectively manage ongoing health conditions. These health professionals can see and treat a person throughout their life, tracking medical issues over the course of years or decades, and puzzling together pieces of medical information to understand a full picture of a patient’s health.

While many Americans have a PCP whom they see regularly and report positive experiences with, there are still millions of people who do not see a PCP on a regular basis for a variety of reasons, from time constraints to trust issues and poor prior experiences.

Methodology

In February of 2024, 2,000 U.S. adults were surveyed about their experiences with primary care. 44% identified as male and 56% identified as female at the time of the survey. After collecting responses through a third-party survey platform, responses were weighted to reflect the current U.S. population by achieving equal distribution with known population characteristics. According to Census.gov , as of July 2023, the population of those 18 years of age and older in the United States was 262,083,034 and thus the margin of error for this survey is 3% at a 95% confidence level.

Citation Guidelines

Should you reference any data from this report elsewhere, please include a source link to https://health.usnews.com/health-care/top-doctors/articles/primary-care-experiences-survey-report .

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• Ten Things to Know About Consolidation in Health Care Provider Markets

Zachary Levinson , Jamie Godwin , Scott Hulver , and Tricia Neuman Published: Apr 19, 2024

National health spending totaled $4.5 trillion in 2022 —17% of gross domestic product (GDP)—and is projected to grow faster than GDP through 2031, contributing to higher costs for families, employers, states, and the federal government. As policymakers consider a variety of strategies to make health care more affordable, they have been increasingly attentive to consolidation in health care markets—including mergers and acquisitions of health care providers—and the potential effects of consolidation on the cost and quality of care and other outcomes. Consolidation may allow providers to operate more efficiently, and could help struggling providers keep their doors open in underserved areas, but also often reduces competition. A substantial body of evidence has found that consolidation has led to higher prices, but the evidence on quality is unclear.

In response to concerns about the effects of consolidation and reduced competition on prices and quality, the Federal Trade Commission (FTC) recently authorized a lawsuit to block a hospital acquisition in North Carolina. And, just last month, the FTC, Department of Justice, and Department of Health and Human Services issued a request for information (RFI) seeking input on the effects of consolidation involving health care providers and related products and services as part of a broader effort to clamp down on anticompetitive practices.

This issue brief identifies ten things to know about consolidation in health care provider markets, touching on topics such as the different types of consolidation, trends, ways in which consolidation can be beneficial or harmful for patients and other consumers, some key findings from existing research, and policy options for increasing competition. This brief focuses on consolidation among health care providers, rather than health insurers, and builds on a 2020 KFF issue brief on provider consolidation. More recent research has not altered the key takeaways pulled from that brief.

Efforts to promote more competitive provider markets could help address health spending and affordability issues, but also entail a number of challenges, given that many markets are already highly concentrated and that some regions cannot support competitive markets. Some have considered more direct regulation of prices and spending, and the two approaches could play complimentary roles when address rising health care costs, such as by encouraging providers to compete on quality when prices are regulated.

1. Consolidation in health care markets can take many forms and involve various types of providers

Health care consolidation often refers to scenarios where hospitals and other health care entities join together under common ownership through either a merger or acquisition (referred to as “mergers” in this brief). There are three main types of mergers:

• Horizontal mergers occur when there is consolidation between entities that offer the same or similar services, such as when a health system acquires a hospital or when two physician practices that provide overlapping services merge. For instance, in August 2023 , Oregon Health & Science University and Legacy Health—two of the largest health systems in the Portland area—announced plans to merge.
• Vertical mergers occur when there is consolidation between entities that offer different services along the same supply chain, such as when a hospital or health plan acquires a physician practice. For instance, in May 2023 , the health system HCA Healthcare announced a deal to acquire 41 urgent care centers in Texas, where HCA already had a large presence. Some mergers may entail both vertical and horizontal consolidation (e.g., if a health system acquires a physician practice that provides services offered by the system’s existing physician group).
• Cross-market mergers occur when there is consolidation between two providers that operate in different geographic markets for patient care. For example, in March 2024 , Kaiser Permanente closed its merger with Geisinger Health through a new organization called Risant. These systems operate in different regions of the United States, with Kaiser Permanente operating in five states in the West (including California) and Georgia, Maryland, Virginia, and DC and Geisinger operating in Pennsylvania.

Aside from merging, health care entities can form other types of affiliations without necessarily changing ownership, which may also have implications for patient care. Examples include the creation of accountable care organizations (i.e., groups of doctors, hospitals, and other providers who form partnerships to collaborate and share accountability for the cost and quality of care delivered to their patients) and joint ventures (i.e., agreements to collaborate on a particular goal, such as a health system and group practice that work together to create a new ambulatory surgery center). These affiliations can raise similar issues as mergers and are sometimes referred to as “soft” forms of consolidation.

2. There has been a large amount of consolidation in provider markets over the past 30 years

Provider markets have become increasingly consolidated over the past 30 years. Following a wave of consolidation in the early- and mid-1990s, there were 1,573 hospital mergers from 1998 to 2017 and another 428 hospital and health system mergers announced from 2018 to 2023. The share of community hospitals that are part of a larger health system also increased from 53% in 2005 to 68% in 2022 (see Figure 1). Relatedly, the share of physicians working for a hospital or in a practice owned at least partially by a hospital or health system increased from 29% in 2012 to 41% in 2022.

Consolidation has also contributed to the emergence of large health systems . For example, the ten largest health systems (see Table 1) accounted for about one in five (22%) of nonfederal general acute care hospital beds in 2022. These systems are the size of large corporations. For example, HCA Healthcare, which operates the largest number of nonfederal general acute care hospital beds in the country, had greater operating revenues than each of Netflix, Uber, and Starbucks in 2023. AdventHealth, the smallest of the ten largest health systems in terms of beds, had greater operating revenues than Zoom and Lyft combined in 2023 (as did Community Health Systems, the smallest of the ten largest systems in terms of operating revenues). Consolidation, which often occurs between providers based in the same region, has also contributed to highly concentrated markets where patients have limited options among large provider organizations.

Today, many provider markets are highly concentrated, particularly markets for hospital care. One study estimated that the vast majority (90%) of metropolitan statistical areas (MSAs) had highly concentrated hospital markets in 2016, while another estimated that the share of metro areas with highly concentrated hospital markets increased from 71% to 77% over the period from 2017 to 2021 (differences in magnitudes across these studies likely reflect their distinct methods, including market definitions). The former also found that most MSAs (65%) had highly concentrated specialist physician markets in 2016, and nearly two in five (39%) had highly concentrated markets for primary care physicians. Physician markets may have become more concentrated in recent years due to the ongoing trends in consolidation described above.

3. Corporations such as CVS, Amazon, and UnitedHealth and private equity firms have recently acquired many physician practices

In addition to hospitals and health systems, other types of entities have also been involved in a large number of acquisitions in recent years:

• Corporate buyers. Corporations that have not traditionally specialized in the provision of health care services—including large national companies such as CVS, Amazon, and UnitedHealth—have acquired many physician practices in recent years. The share of physicians employed by corporate entities increased over a three-year period from 15% in January 2019 to 22% in January 2022. Optum, a division of the insurer UnitedHealth, now employs or is affiliated with about 10% of all practicing physicians . Some policymakers have expressed concern about the role that large corporate buyers could have in increasing consolidation and reducing competition, which could lead to higher costs and reduced quality, although evidence is not yet available on this trend.
• Private equity firms. Private equity is a form of corporate ownership that often entails relying on loans to acquire a business, taking it private (if not so already), and attempting to increase its value with the goal of selling it at a profit in three to seven years. One common strategy is to consolidate providers through a series of mergers and acquisitions. Private equity provider acquisitions have increased by a large amount since 2010 —e.g., with physician practice deals increasing more than six-fold from 2012 to 2021—though deals have slowed somewhat since a peak in 2021. Some policymakers have expressed concern about the role of private equity in consolidation and the effect of the short-term profit motive of private equity firms on the prices, quality, and financial standing of acquired providers.  

4. A substantial body of evidence shows that consolidation has led to higher prices, but the evidence on quality is unclear

Consolidation could in principle benefit consumers in some instances and be harmful in others. On the one hand, consolidation could allow providers to operate more efficiently, such as by obtaining supplies at steeper discounts (by purchasing them in greater volume); sharing resources (such as medical imaging equipment); and achieving the scale necessary to participate in value-based payment programs. These potential efficiencies could in turn benefit patients, for example, if they lead to higher quality care or reduced costs (e.g., if providers share savings through lower prices), and the latter could benefit health plan enrollees more generally to the extent that it leads to lower plan spending and premiums. On the other hand, consolidation often reduces market competition and therefore the pressure on providers to lower prices or invest in quality improvement. Critics have also questioned the extent to which mergers allow providers to operate more efficiently. Efficiencies may depend , in part, on the degree to which providers integrate their operations, which can be complex and may or may not be a priority.

The following discussion describes key findings from the research.

A substantial body of research shows that consolidation has led to higher health care prices , as noted in a 2020 KFF issue brief on provider consolidation. The evidence that consolidation leads to higher prices is strongest for hospitals, though studies that have evaluated physician and hospital-physician consolidation have also tended to find that they are associated with higher prices. Studies that have looked specifically at consolidation among nonprofit hospitals—which account for 58% of all community hospitals—have found price increases as well. A RAND Corporation review from 2022 (which also informs other sections of this brief) found that estimated price increases associated with hospital mergers have ranged from 3 to 65 percent. The large variation in estimated price increases may reflect differences in the types of mergers that were evaluated (e.g., the extent to which they reduced competition), the context of these mergers (e.g., the competitiveness of local insurance markets), and methodology. In addition to increases in the prices that commercial insurers pay providers, consolidation can also lead to higher Medicare reimbursement rates, as the program often provides greater reimbursement for a given service when provided in a hospital outpatient department versus a freestanding physician office (see discussion of site-neutral payment reforms below).

Relatedly, studies have typically found that consolidation leads to higher health care spending, which could increase costs for families, employers, states, and public programs, like Medicare and Medicaid . Several studies have found that consolidation leads to higher spending, which reflects both the price and volume of care. This includes studies evaluating hospital consolidation and hospital-physician consolidation. Only a small number of studies have evaluated physician consolidation, with mixed results. Increases in health care spending can be passed onto health plan enrollees through higher premiums and workers with employer-sponsored insurance through lower wages. Notably, a couple of studies have found an association between consolidation and premium increases, and one study found that hospital mergers led to decreases in wages among non-health care workers with employer health plans.

The evidence on the effect of provider consolidation on the quality of patient care is unclear . The evidence on the impact of horizontal and vertical consolidation on quality has been mixed, as described in a 2020 KFF issue brief and 2022 RAND Corporation review . For example, most of the research on horizontal hospital consolidation has found no difference 1 in or a negative impact on quality. Among other analyses, one study found that increased market concentration was associated with higher risk-adjusted one-year mortality rates for heart attacks and another found that hospital mergers were associated with a small decrease in patient experience measures and no changes in 30-day readmission and mortality rates (with inconclusive findings regarding clinical process measures). However, some studies have included mixed or positive findings relating to hospital consolidation. For example, a study funded by the American Hospital Association found that mergers were associated with decreases in 30-day readmission rates but no change in 30-day mortality rates (though an earlier version of the study found decreases in mortality rates as well).

The evidence is also mixed on the effects of vertical hospital-physician consolidation on quality. For example, one fairly recent study found that clinical process and patient experience measures were “marginally” higher for patients when their primary care physician was part of a system, another study found no difference in patients’ 30-day readmission rates when their primary care physician was part of a large system, and a third study found that complications following colonoscopies were higher for patients when their gastroenterologist was part of a system (though the evidence was less clear for clinical process measures).

Interpreting the evidence on quality is further complicated by the fact that there are many dimensions and measures of quality that have been or could be used to assess the effects of consolidation and that it could take time for changes in quality to materialize. Additionally, it is likely that the effects of consolidation vary based on the extent to which providers have integrated their operations and across different patient populations.

5. Mergers between hospitals and health systems can lead to higher prices even when entities operate in different markets

While policymakers and regulators have historically focused on consolidation within the same region, many mergers have occurred between hospitals and health systems that operate in different regions, as discussed in a KFF issue brief , including several multi-billion dollar deals over just the past couple of years. The small number of studies that have focused on cross-market mergers have estimated price increases ranging from 6% to 17%, even though these deals entail hospitals and health systems that are not competing against each other in the same area. There are a few reasons why cross-market mergers might lead to price increases. For instance, a combined health system with providers in, say, different areas of a state may be able to use its dominant position in one market to negotiate higher prices in another when contracting with a given health plan (e.g., a state employee plan with enrollees that reside in several markets). As another example, a large system that, say, acquires a small hospital may have more expertise in bargaining with insurers, which it could use to negotiate for higher prices.

6. The impact of consolidation on the availability of health care services for rural and other underserved patients is unclear

Consolidation could in principle have mixed implications for access to care. For example, it is conceivable that the acquisition of a small, financially struggling, rural hospital by a large health system based in another region could increase the availability of services in the community in some instances and reduce it in others. On the one hand, being acquired could benefit the hospital financially—such as by providing access to a wide range of resources, managerial expertise, and capital—which could help the hospital keep its doors open and maintain or expand the services it offers. On the other hand, the system that acquires the rural hospital may be less responsive to the needs of the local community, such as when deciding whether to close the hospital or to stop offering certain services, such as maternity care (an outcome supported by some research, as described below).

A small number of studies have evaluated the association between consolidation with rural hospital closures and service eliminations, with mixed results . Two studies found that rural hospitals that merged with other hospitals or health systems were more likely to eliminate certain service lines, such as obstetrics care, and another study found that independent hospitals (urban and rural) that joined a health system were more likely to stop offering inpatient pediatric services. One study found that system affiliation was associated with a lower likelihood of closing among rural hospitals with weaker finances but a higher likelihood among those with stronger finances.

A small number of studies have evaluated the association between consolidation and access to care among Medicaid patients, also with mixed results . On the one hand, two studies found that physician practices were more likely to accept Medicaid patients after becoming affiliated with a health system. This may be because the broader system has a commitment or obligation to treat patients regardless of their ability to pay (e.g., for emergency care) or because efficiencies allow providers to treat more patients. On the other hand, one study found that increases in hospital market concentration were associated with fewer Medicaid admissions and a shift in care from nonprofit to public hospitals. This could be because increases in commercial prices resulting from greater market concentration may lead private hospitals to focus more on commercial versus Medicaid patients. Another study found that system affiliation was associated with a decrease in Medicaid as a percentage of all hospital discharges, although that study also found that the number of beds in a hospital or health system was associated with an increase in Medicaid discharges as a share of the total.

A small number of studies have evaluated the effect of consolidation on hospital charity care and total community benefits, with mixed results . For example, one study found no association between the acquisition of independent hospitals and charity care or total community benefit spending overall but a decrease in the latter when focusing on hospitals acquired by an out-of-state system. Another study found that the association of higher market concentration with hospital charity care varied depending on the method used, with an increase under one approach and no difference under another. One study found that higher market concentration was associated with higher income thresholds for charity care eligibility, which effectively increases the number of patients who could qualify for charity care in a hospital.

7. Hospital consolidation can lead to lower wages for some skilled workers, such as nurses, but the broader evidence on employment and compensation effects is limited

Consolidation could in principle have both benefits and drawbacks for health care workers. On the one hand, consolidation could increase the negotiating leverage of hospitals and their ability to extract concessions from workers. For example, in 2023, a coalition of labor unions filed a complaint with the DOJ that UPMC, a large health system in Pennsylvania, had used its market power to suppress the wages of nurses and other health care workers, increase workloads, and restrict the ability of health care workers to seek better employment elsewhere. Mergers could also lead to layoffs, for example, to the extent that providers consolidate their staff and operations. On the other hand, health care workers could benefit from hospital mergers in some scenarios where consolidation allows hospitals to remain open and operate more efficiently. For example, the acquisition of a struggling rural hospital by a health system could help the facility sustain its operations in certain circumstances, which could protect jobs and possibly bolster wages.

A couple of studies have found that hospital consolidation has led to lower wages for some skilled workers, such as nurses, though the implications of other studies on health care worker wages are less clear . For example, one study found that hospital mergers were associated with lower wages for nurses and pharmacy workers and for skilled nonmedical mergers following mergers that caused large increases in market concentration (but not for unskilled workers). Research from the Center for Economic and Policy Research also found that increases in hospital market concentration were associated with lower wages for nurses in small metropolitan statistical areas. An earlier study did not find consistent evidence when evaluating nurses’ wages but did find that hospital mergers in California were associated with greater work effort (as measured by patient caseload). A small number of studies that looked more broadly at the financial impact of consolidation, including average compensation across all hospital workers, have produced mixed results .

Some studies find that hospital consolidation has led to reductions in staffing, though others have not, and the evidence is unclear on whether mergers avert closures, which could preserve jobs . A small number of studies have analyzed the effects of hospital consolidation on employment, with some finding an association with reduced staffing levels. For example, one study evaluating independent hospitals in New York found an association between joining a system and a reduction in employment, especially among employees with overhead and support functions. However, other studies have found no differences or inconsistent or unclear results. Additionally, as noted above, there is no clear evidence regarding the effect of mergers on hospital closures. If mergers lead to efficiencies that prevent closures, they may help preserve jobs.

8. The FTC, the DOJ, and state antitrust agencies each play a role in challenging consolidation and other potentially anticompetitive practices

Federal and state antitrust agencies each play a role in challenging consolidation and other potentially anticompetitive practices of health care providers and other businesses, as described in a KFF issue brief . At the federal level, the Federal Trade Commission (FTC) and the Department of Justice (DOJ) share responsibility for enforcing federal antitrust laws, including the Sherman Act, the Clayton Act, and the FTC Act. State attorneys general (AG) offices also have the authority to bring action under federal antitrust law, as well as under state statutes, which sometimes expand upon federal law. Antitrust agencies challenge mergers, acquisitions, and other practices that may hinder competition (such as the use of anticompetitive contract clauses). They do so to promote competitive markets, often for the benefit of consumers (such as patients and health plan enrollees).

There are at least a few challenges that may limit the ability of the federal government and states to foster competitive provider markets through antitrust enforcement:

• It is difficult to break up mergers after they have already occurred, and many provider markets are already highly concentrated . Breaking up a merger after providers have already consolidated can be difficult. At the same time, regulating the behavior of merged providers—such as through restrictions on the prices they charge—may be difficult to monitor and enforce on an ongoing basis.
• Some regions cannot support competitive provider markets . For instance, rural communities may not have enough residents to support several providers that offer the same service.
• Antitrust litigation can be complex and expensive . Without adequate funding, it may be impractical to challenge a large number of provider business practices that raise anticompetitive concerns.
• Antitrust agencies may have difficulty staying ahead of market trends . For example, it could take time for the government to develop strong guidelines for challenging vertical or cross-market mergers and to accumulate enough evidence to convince courts that these practices harm competition. In the meantime, these mergers will likely continue.
• The benefits of competitive provider markets for individuals with health insurance will depend in part on the competitiveness of health insurance markets . One study estimated that most MSAs (57%) had highly concentrated insurance markets in 2016. When insurance markets are not competitive, cost savings from competitive provider markets might not be fully passed along to consumers.

The FTC and DOJ have recently signaled an interest in expanding their scrutiny of different types of mergers. For example, in December 2023, the agencies released updated merger guidelines that indicate that they may challenge a broader range of deals. Among other changes, the guidelines expand the definition of highly concentrated markets, rely on a lower threshold for identifying large changes in market concentration, consider the combined effect of a series of acquisitions (e.g., of a health system acquiring several small physician practices over time), add an explicit discussion of the agencies’ views on how workers may be negatively impacted when their employers merge, and touch on cross-market mergers.

The FTC and DOJ have also indicated an interest in challenging provider acquisitions by private equity firms and private payers. For instance, the agencies, along with HHS, specifically mentioned these types of entities in a March 2024 request for information on the effects of transactions involving health care providers and related products and services. Further, in September 2023 , for the first time, the FTC challenged a common strategy of private equity firms that entails amassing market power through a series of physician practice acquisitions.

9. Site-neutral payment reforms, if enacted, could reduce incentives for vertical consolidation by lowering the rates at which acquired providers bill Medicare

Policymakers have expressed interest in aligning Medicare reimbursement rates for outpatient services across care settings through “site-neutral payment reforms,” which could directly lower program costs and reduce the incentive for hospitals to buy up physician practices. Under current payment rules, Medicare reimbursement is often higher for a given outpatient service when provided in a hospital outpatient department versus a freestanding physician office or ambulatory surgical center. Two studies have found that these payment differences are associated with an increase in hospital-physician consolidation, which can allow providers to bill Medicare at higher rates.

Through legislation and rulemaking, Medicare has aligned payments for office visits across freestanding physician offices and off-campus hospital outpatient departments—which often resemble physician offices—as well as for other services for relatively new off-campus facilities. Policymakers have considered other site-neutral reforms with varying scope that would extend to additional sites of care and services. Proponents of these reforms assert there are no grounds to pay different amounts for the same service based on site of care (physician office or outpatient hospital department) while hospitals and other opponents counter that patients treated in hospital outpatient settings have greater needs than patients in physician settings and that their cost structure justifies higher payment rates.

10. Policymakers have considered a number of options to increase the competitiveness of provider markets

Several policies have been proposed to rein in provider consolidation or increase the competitiveness of provider markets in other ways:

• Strengthen antitrust enforcement . This approach would make it easier for the FTC and DOJ to enforce antitrust law. Specific policies include: requiring more providers to report planned mergers, lowering the legal standards by which mergers are deemed anticompetitive, and mandating that providers receive approval from the government before merging. Other proposals to strengthen antitrust enforcement include: eliminating state Certificate of Public Advantage (COPA) laws (which some states use to shield mergers from federal antitrust challenges in exchange for state regulation), increasing the scope of antitrust law (such as by giving the FTC full authority to regulate nonprofit providers and outlawing anticompetitive contracting clauses), and providing greater resources to agencies that enforce antitrust law.
• Reduce incentives for health care providers to consolidate . This could include site-neutral payment reforms (as described above), changes to the 340B program (which currently allows certain providers acquired by a 340B entity to purchase drugs at a substantial discount), and efforts to reduce the administrative burden of government regulations on providers (which may incentivize small practices that have difficulty shouldering these requirements to merge with other providers).
• Increase price transparency . Greater price transparency could help patients, plans, and employers shop for health care providers (e.g., to receive care from or include in provider networks) and may in turn encourage greater competition among providers. As discussed in a KFF issue brief , information about hospital and other health care prices remains elusive, despite recent federal transparency rules.
• Allow more providers to enter the market . This could include reforming state Certificate of Need (CON) statues (which can be used to limit, for example, the construction of new health care facilities) and scope of practice laws (which regulate what work various health care professionals, such as nurse practitioners, are allowed to perform).

Each of these proposals would involve tradeoffs that would be important to consider.

This work was supported in part by Arnold Ventures. KFF maintains full editorial control over all of its policy analysis, polling, and journalism activities.

References to no differences, no changes, or no associations in this issue brief indicate that there were no statistically significant differences.

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• Health Costs
• Quality Measures
• Access to Care
• Affordability
• Health System Performance

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Also of interest.

• Understanding the Role of the FTC, DOJ, and States in Challenging Anticompetitive Practices Of Hospitals and Other Health Care Providers
• Understanding Mergers Between Hospitals and Health Systems in Different Markets
• Gaps in Data About Hospital and Health System Finances Limit Transparency for Policymakers and Patients

Updates to your health plan’s coverage for COVID-19 testing and treatment

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While the Federal Public Health Emergency (PHE) ended on May 11, 2023, some medical plans are mandated to cover COVID-19 tests, vaccines, and therapeutics for six additional months, through Nov. 11, 2023, in accordance with the State of California’s Senate Bill (SB) 1473. Self-funded and Medicare plans are not required to comply.

At-home over-the-counter antigen tests

UC Medicare Choice, Kaiser Senior Advantage HMO and UC Medicare PPO plans do not cover antigen tests as of May 12, 2023.

Kaiser HMO will continue to cover antigen tests through Nov. 11, 2023.

UC’s non-Medicare PPO and UC Blue and Gold plans will continue to cover antigen tests through Dec. 31, 2023.

Please note that the Navitus and Anthem public websites, which serve all Navitus and Anthem members, list the end date of coverage for antigen tests as May 15, 2023. This information does not apply to members of UC non-Medicare PPO plans.

UC Medicare and non-Medicare PPO plans will continue to waive the cost share for PCR tests that are ordered by physicians through Dec. 31, 2023.

UC Blue & Gold HMO will continue to waive the cost-share for diagnostic PCR tests if ordered by an in-network or out-of-network physician through Dec. 31, 2023. UC Blue & Gold HMO will waive the cost-share for antibody PCR tests by out-of-network physicians through Nov. 11, 2023

After Dec. 31, 2023, UC Blue & Gold HMO will no longer cover diagnostic or antibody PCR tests by out-of-network providers or labs. 

Kaiser HMO and Kaiser Senior Advantage HMO will continue to waive the cost-share for PCR tests through Nov. 11, 2023.

UC Medicare Choice will continue to waive the cost-share for PCR tests ordered by physicians until further notice.

COVID-related treatment and care

For the most part, treatment and care related to COVID-19 are now covered as regular plan benefits, with the same cost-sharing rules as would otherwise apply.

UC Blue & Gold HMO waives the usual cost-share for medical visits (to an office, urgent care facility or emergency room) for the purpose of screening for COVID testing.

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