This primer highlights the results of the Practice Size Exploratory Project (PSEP), an analysis of the size distribution of practices serving Medicaid beneficiaries in Arkansas, Michigan, New York and Pennsylvania, the relationship between practice size and quality of care, and racial/ethnic disparities in access and care.

The guide is designed to help states and plans identify “high-volume/high-opportunity,” small practices — characterized by high Medicaid membership, high volume of racially/ethnically diverse beneficiaries, and low access/quality scores — for quality improvement interventions.

Key findings of PSEP, an initiative funded by the Robert Wood Johnson Foundation, were:

• As many as 50% of Medicaid beneficiaries in select states are served by practices with three or fewer providers.
• Small practices are more challenged by chronic care delivery than by access.
• Persistent racial/ethnic disparities exist for Medicaid beneficiaries across chronic care measures.

PSEP 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.