Efficiency Where It's Needed Most: What the Payor Mix Shift Means for Hospitals and Health Centers, Alike
New Epic Research data (Cosmos network, 550M+ encounters, 2022–2026) shows self-pay share rose and Medicaid share fell across every care setting studied, most sharply in the emergency department (self-pay 5.5% → 7.6%; Medicaid 18.2% → 16.1%).
Primary care, though, barely moved (self-pay 1.8% → 1.9%). At first glance that looks reassuring, but Epic's Cosmos network doesn't see everywhere patients go for care. It largely reflects hospital-affiliated systems, academic medical centers, and pediatric hospitals, which leaves out most FQHCs and community health centers, as well as truly independent primary care/pediatric practices, the very places built to keep people connected to primary care when their coverage changes.
Other data suggests that's exactly what happened. HRSA-funded health centers reached record volume every year through this window — 31M patients in 2023, 32.4M in 2024, 32.7M in 2025. Over that same span, KFF's analysis of federal UDS data shows the number of uninsured patients at health centers grew from 5.6M to nearly 5.9M between 2023 and 2024, while Medicaid patients dipped for the first time in years — right in step with the unwinding.
Taken together, this points to something more encouraging than it might first appear: many people who lost Medicaid coverage may not have fallen out of primary care altogether. They may have found their way to community health centers built to serve exactly this need. One thing worth watching is that health center growth slowed in 2025 — up only 350,000 patients, versus 1.4 million the year before. It's too early to say whether that means the disruption from the unwinding is settling down, or whether community health centers are starting to feel the strain of serving more people with the same resources.
Why this is worth paying attention to:
A shrinking Medicaid panel doesn't necessarily mean patients have lost access to care. It may mean they've moved to a setting better equipped to serve them. Worth understanding where exactly within your market.
If community health centers are approaching capacity, that safety net may not stretch as far going forward. Health systems shouldn't assume they will keep catching everyone who needs it.
The patients most worth worrying about are the ones who don't show up anywhere until they're in the emergency department — because for them, it's quite possible that neither system caught them in time.
The Vantage Viewpoint
This data points to two very different operational challenges, and we work on both sides of it.
On the inpatient and ED side, the message is straightforward: self-pay volume is rising, and it isn't going away. Every avoidable delay, every unnecessary day, every inefficiency in how inpatient teams are staffed and coordinated – all these become harder to absorb when a growing share of that volume comes with no reimbursement. We help Mospital Medicine programs fine-tune and optimize these levers.
On the other side of this data is a growth story. FQHCs and community health centers are living out their mission. Yet, growth without operational readiness has its own risks, and can show up as longer wait times, provider burnout, and patients who technically have a medical home but can't get a timely or coordinated appointment. We work with FQHCs on exactly this: right-sizing care teams to volume, refining scheduling and care-team workflows to protect access as panels grow, and building the operational muscle to scale without the quality of care or the patient experience slippage.
Connect with us at www.vantageclinicalpartners.com/contact .
Beth Papetti MBA FHM
Principal & Chief Operating Officer
References
Epic Research (Aug. 31, 2026); HRSA/HHS National Health Center Week data (Aug. 3, 2026)
KFF, "Community Health Center Patients, Financing, and Services."