Background: ManyUS health organizations are launching convenient care options, includingVirtual Urgent Care (VUC). There is concern VUC will lead to care fragmentationwhen follow-up services are needed after an initial virtual visit. Tounderstand patterns in follow-up care among VUC users, we evaluated differencesin user demographics, virtual visit characteristics, and healthcare spendingdepending on whether follow-up occurs. Methods:We performed a retrospective analysis of data from two Midwestern healthsystems. Dividing our sample into VUC episode types based on whether follow-upcare was recommended at an initial visit, we described VUC user and visitcharacteristics, identified predictors of follow-up, and estimated per personspending, comparing episode cohorts that resulted in follow-up or not. Results: Among 3453 total VUC episodes,1360 received a recommendation for follow-up; 2093 did not. When recommended,follow-up occurred among 15% of episodes. Predictors of follow-up included:patient age and rurality, visit length and modality, and prescriptions forantibiotics/other medications. For follow-up recommended episodes, follow-upwas associated with $128 lower adjusted mean spending per person. Conclusion: Low adherence to recommendedfollow-up may indicate inefficiencies in current VUC follow-up care processes;however, if used when recommended, follow-up can reduce per person spendingamong VUC users.