Building primary care that works for busy families and lowers costs

Seeing a primary care provider (PCP) sounds simple. In reality, women call practices that aren't taking new patients until they find one, wait weeks for an opening, and then fit the visit around work and family schedules. For many, having a primary care provider (PCP) doesn't mean being able to see one.

This is more than a convenience issue for employers and health plans. When primary care isn't accessible, families may end up in the ED for concerns primary care could handle: the same headache that costs $140 at a primary care office costs $2,111 in the emergency department (ED).

The ED default costs 11 to 19 times more

U.S. emergency departments (ED) see an estimated 144 million visits a year at a cost of $76 billion, and 1 in 5 adults visits the ED at least once annually. Many of those visits involve nonurgent concerns a primary care office could treat.

A 2025 Blue Cross Blue Shield of Kansas analysis compared the two across six common conditions. The ED cost roughly 11 to 19 times more than an office visit. Gastrointestinal issues showed the widest gap: $137 for in-office care versus $2,662 for ED care.

Your plan pays that difference. So do your employees, in out-of-pocket costs and lost workdays.

Finding primary care is harder than it should be

Coverage isn’t the only barrier. The Affordable Care Act (ACA) covers preventive services without cost sharing. Availability is. The number of PCPs available for new visits fell 23% between 2013 and 2021, and by 2021, fewer than half were taking new patients. Women feel that shortage. In a 2022 national survey, 29.2% of women reported no usual source of care, and 20.3% had no medical visits at all that year.

When a PCP is nowhere to be found or weeks away, problems a primary care office could handle end up in the ED.

When women do find a provider, the appointment lands in the middle of the workday, and their own care moves to the bottom of the list. Only 7.8% of women receive all recommended preventive services. The downstream cost is steep: chronic conditions like diabetes and heart disease account for roughly 90% of U.S. healthcare spending, and many could be preventable through early intervention and preventive screenings.

The problem compounds when kids get sick

Kids get sick on their own schedule, and clinic hours don't flex around their needs. Every earache, rash, or fever means a parent has to make an appointment, leave work, and take the child in.

That parent is usually the mother. Mothers are twice as likely as fathers to take their children to doctor visits, which pulls them away from work or uses paid time off (PTO). The cost compounds: lost hours, depleted PTO, missed deadlines, and for some women, a step back from their careers. Care that fits around the workday keeps both the child and the employee on track.

When care is reactive, costs go up

Most primary care is built around annual appointments, leaving the time between visits as a blind spot. Blood pressure creeps up. A symptom keeps coming back. If nothing gets addressed, it could become a high-cost claim and unplanned time off work.

With total U.S. health spending expected to pass $6 trillion in 2026, health plans and employers can't settle for a model that waits for problems to escalate. Closing the gap takes a dedicated care team that stays connected between visits, identifies concerns early, and takes action.

How Pomelo builds primary care into real life

Pomelo is a virtual medical practice for women and children, built to anchor long-term health, not just respond to emergencies.

• One virtual team for mom and child. Same-day care for both, through the Pomelo app. When a child wakes up with a rash or a fever, a parent can book a virtual visit without missing work. Women don't have to choose between their children's care and their own, and employers see fewer hours lost to scheduling, travel, and unplanned time off.
• Care between visits. Our care team tracks what’s changing between appointments, flags what needs attention, and steps in before a small issue becomes an ED visit or a trend becomes a chronic illness.
• Closing gaps across preventive, complex, and urgent care. One care team • helps coordinate preventive screenings and handles ongoing management of complex conditions and same-day sick visits for kids, so nothing falls through the cracks between providers.

The takeaway for benefits leaders

Look at where your employees' families go when they need care today. If the answer is the ED, the cost is already in your claims. Continuous, proactive primary care for women and their children helps bend the cost curve back down.

Want to see how Pomelo's whole-family care model fits your population? Download our Primary Care and Pediatrics Brief, or book a deep-dive with our team.