Funder: Robert Wood Johnson Foundation

Author: JeanHee Moon, Rivka Weiser, Nikki Highsmith, Stephen A. Somers, Center for Health Care Strategies

July 2009 | Resource Paper


Little has been documented about the size of physician practices serving racially and ethnically diverse Medicaid populations. Uncovering this information and understanding the relationship between practice size and quality of care for Medicaid beneficiaries can help state purchasers and health plans drive efforts to improve quality and reduce disparities.

This resource paper presents the findings of CHCS’ Practice Size Exploratory Project, which examined the quality of care that Medicaid managed care beneficiaries receive in different practice settings in Arkansas; Michigan; Erie County, and Bronx, New York; and Southwest Pennsylvania. Goals of the study, funded by the Robert Wood Johnson Foundation, were to: (1) gain a clearer picture of the distribution of the size of practices serving Medicaid managed care beneficiaries in these five regions; and (2) explore whether practice size may be related to variations in quality of care.

Overall findings were:

  • Small practices serve a large share of Medicaid patients: in select states, as many as 50% of Medicaid beneficiaries are served by practices with three or fewer providers.
  • Disparities in care for racially and ethnically diverse populations are pervasive, but the reasons for these gaps are unclear.
  • High access to care and quality of care do not necessarily go hand in hand, and each may be more or less achievable in different-sized settings.

Findings informed the creation of CHCS’ Reducing Disparities at the Practice Site initiative, launched in October 2008 to support quality improvements in small practices serving racially and ethnically diverse Medicaid populations.