Smaller primary care practices perform better than other practices in providing ongoing care and care coordination, but are more challenged than larger practices in implementing quality improvement efforts, according to a survey conducted by the Center for Health Care Strategies made possible through the Robert Wood Johnson Foundation.

The survey was designed to be a “reality check” regarding the capacity of practices serving large numbers of Medicaid and racially and ethnically diverse patients to support advanced primary care delivery. The study surveyed 126 practices in four communities that are participating in the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) regional quality improvement effort, as well as in two additional states (Arkansas and Oklahoma). The analysis sought to: (1) assist practices in assessing their own capacity; (2) help local community alliances better target efforts to improve care delivery; and (3) assist state agencies across the country in better preparing the nation’s primary care system to deliver high-quality care to Medicaid beneficiaries.

The findings offer unprecedented “behind closed doors” information on both areas of strength in practices caring for underserved populations and areas of opportunity where primary care offices may need external resources to facilitate care delivery redesign. The findings can inform regional improvement coalitions, like the AF4Q communities, as they attempt to build ambulatory quality improvement infrastructure in their markets and pursue payment reform strategies. Results from the survey also can help guide Medicaid agencies as they pursue strategies to improve primary care for the current 60 million, soon to be as many as 80 million, beneficiaries under the health reform expansion option.