Cosmos Study

Telehealth Use for Primary Care Visits Has Stabilized, with Higher Use in Metropolitan Areas and Among Non-English Speakers

February 17, 2026

Team A:Kersten Bartelt, RNEmily Higgs

Team B:Louis Kazaglis, MDEric Barkley

Key Findings

Telehealth use in primary care decreased from pandemic-era highs through mid-2023 and has remained relatively stable at around 6 to 7% of encounters since then.
Telehealth has consistently remained more common among patients from metropolitan areas compared to those from more rural areas.
Telehealth use varied substantially by preferred language; many non-English groups had much higher rates than the rates among English-speaking patients.

Telehealth use in the United States expanded rapidly during the COVID-19 pandemic, supported by temporary federal and commercial coverage flexibilities that allowed virtual care to substitute for in-person visits across primary care and many specialties.¹ Since then, telehealth use has declined across all specialties,² with mental health care retaining the highest proportion of visits conducted by telehealth.³ Policy discussions now focus on which flexibilities should be made permanent and how telehealth affects access and equity, particularly across different populations.⁴ Understanding how telehealth has trended in the post-acute pandemic period and how patterns differ by geography, age, and preferred language can inform operational planning, interpreter services, and policy decisions.

We studied 411 million primary care visits between July 2022 and October 2025. For each encounter, we identified the patient’s rurality based on their most recent ZIP Code, their age at the time of the encounter, and their preferred language. We evaluated each subgroup for the proportion of primary care they had conducted by telehealth.

Across all primary care encounters, telehealth use declined from mid-2022 to mid-2023 and then stabilized at around 6% of visits. Telehealth accounted for just over 8% of encounters in July 2022 and just under 6% by October 2025, representing a roughly 30% reduction by the end of the study period. Since 2023, the overall telehealth share has remained around 6–7%, suggesting a new steady state in the balance between virtual and in-person care.

Telehealth remained more common for patients from metropolitan areas than for those from less urban settings throughout the study period, as seen in Figure 1. While the telehealth proportion fell in all rurality categories, the relative urban–rural gradient persisted: metropolitan patients consistently had about twice the telehealth rate of patients in rural or small-town areas, with micropolitan areas in between.

Figure 1

Primary Care Visits Conducted Using Telehealth by Rurality (12-Month Rolling Average Rate)

Figure 1. The 12-month rolling average percent of primary care visits that were conducted using telehealth by patient’s rurality.

Age patterns were stable over time, with telehealth concentrated among working-age adults and less frequently used for very young children and the oldest adults. Children aged 0–2 years consistently had telehealth shares below 2%, while adults aged 25–39 years had rates above 10% across the study window.

Figure 2

Primary Care Visits Conducted Using Telehealth by Patient Age (12-Month Rolling Average Rate)

Figure 2. The 12-month rolling average percent of visits in primary care that were conducted using telehealth by patient’s age.

Telehealth use was consistently higher among patients whose preferred language was not English, and this pattern persisted despite overall declines, as seen in Figure 3. Chinese-, Portuguese-, Russian-, Persian-, and Spanish-speaking patients started from substantially higher baseline telehealth rates, and those rates remained substantially higher than those of English speakers by the end of the study period.

Figure 3

Primary Care Visits Conducted Using Telehealth by Preferred Language (12-Month Rolling Average Rate)

Figure 3. The 12-month rolling average percent of primary care visits that were conducted using telehealth by patient’s preferred language.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 300 million patient records from 1,800 hospitals and more than 42,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

Shaver J. The State of Telehealth Before and After the COVID-19 Pandemic. Prim Care. 2022;49(4):517-530. doi:10.1016/j.pop.2022.04.002
Bartelt K, Piff A, Allen S, Barkley E. Telehealth Utilization Higher Than Pre-Pandemic Levels, but Down from Pandemic Highs. Epic Research. https://epicresearch.org/articles/telehealth-utilization-higher-than-pre-pandemic-levels-but-down-from-pandemic-highs. Accessed on December 17, 2025.
Telehealth Utilization. Epic Research. https://www.epicresearch.org/data-tracker/telehealth-trending. Accessed December 17, 2025.
Telehealth policy updates. Health Resources & Services Administration. November 21, 2025. https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates. Accessed on December 17, 2025.

Data Definitions

Study period: July 2022 to October 2025

Study population: inclusion: A primary care encounter with a type of “Telemedicine,” “Office Visit,” “Well Child,” “Walk-in,” “Urgent Care,” “Follow-up,” “Telephone” (with any CPT billing code), or “Telephone Visit” (with any CPT billing code) for patients with a U.S. residence.

Exposures: RUCA based on most recently documented ZIP Code: metropolitan, micropolitan, small town, or rural
Patient’s age at time of the encounter: 0-2, 3-11, 12-17, 18-24, 25-39, 40-64, 65-79, 80+
Patient’s preferred language: Arabic, Chinese, English, Haitian, Persian, Portuguese, Russian, Sign Language, Spanish, or Vietnamese

Outcomes: Percentage of visits that were telehealth

Primary care: An encounter performed in a department with a specialty of “Primary Care” or “Primary Care – Peds”

Telehealth

An encounter with one of the following:

A type of “Telemedicine”
A type of “Office Visit,” “Well Child,” “Walk-in,” “Urgent Care,” or “Follow-up” and CPT code 99441-99443
A type of “Telephone” or “Telephone Visit” and any CPT code

Model specifications: Percentage rates over time

Limitations: Whether clinics and organizations offered telehealth, insurance coverage, and patient preference were not accounted for.
Telehealth visits that occurred outside of Cosmos organizations was not captured.