Funder: Robert Wood Johnson Foundation

Author: Dianne Hasselman, Center for Health Care Strategies

March 2013 | Brief

Small primary care practices play a critical role in caring for low-income individuals with chronic conditions, particularly patients who are racially and ethnically diverse. Reducing Disparities at the Practice Site (RDPS), a three-year Center for Health Care Strategies initiative, was developed to test the leverage that Medicaid agencies, health plans, primary care case management programs, and other community-based organizations have to improve quality of care.

State-led teams in Michigan, North Carolina, Oklahoma, and Pennsylvania participated in the initiative with six to 12 small primary care practices in each state. Each state developed their own practice-based intervention including health information technology, a patient registry, care management resources, practice coaching, a learning collaborative for participating practices, and financial support to practices.

This brief presents key findings from an evaluation of the RDPS initiative and takeaways for Medicaid stakeholders. The initiative confirmed that Medicaid agencies must provide the vision and leadership for quality improvement investment in these critical, but often forgotten practices. Furthermore, health plans, primary care case management programs, external quality review organizations, and other community-based organizations must play a critical role in working directly with these practices to improve chronic care management and reduce disparities in care. Lastly, Medicaid investment in supporting these practices requires a long-term commitment to address the medical, behavioral, and social needs of their patient population.