Research – Cantor co-authors study examining Medicaid-Serving Primary Care Teams

January 6, 2023


Primary care factors related to Medicaid enrollees’ receipt of guideline concordant cancer treatment is understudied; however, team structure and processes likely affect care disparities. We explore Medicaid-serving primary care teams functioning within multiteam systems to understand performance variations in quality of breast and colorectal cancer care.

We conducted a comparative case study, using critical case sampling of primary care clinics in New Jersey, to provide maximum variation on clinic-level care performance rates (Medicaid enrollees’ receipt of guideline-concordant treatment). Site evaluations, conducted from 2019 to 2020, included observation (2-3 days) and interviews. Using a multistep analytic process, we explored contextual factors within primary care that may contribute to cancer care performance variations.

We identified performance variations stemming from adaptations of multiteam system inputs and processes on the basis of contextual factors (ie, business model, clinic culture). Team 1 (average performer), part of a multisite safety-net clinic system, mainly teamed outside their organization, relying on designated roles, protocol-based care, and quality improvement informed by within-team metrics. Team 2 (high performer), part of a for-profit health system, remained mission-driven to improve urban health, teamed exclusively with internal teams through electronically enabled information exchange and health system–wide quality improvement efforts. Team 3 (low performer), a physician-owned private practice with minimal teaming, accepted Medicaid enrollees to diversify their payer mix and relied on referral-based care with limited consideration of social barriers.

Primary care team structures and processes variations may (in part) explain performance variations. Future research aiming to improve care quality for Medicaid populations should consider primary care teams’ capacity and context in relation to composite teams to support care quality improvements in subsequent prospective trials.

Denalee M. O’Malley, Michelle Doose, Jenna Howard, Joel C. Cantor, Benjamin F. Crabtree, and Jennifer Tsui. 2022. Understanding the Impact of Medicaid-Serving Primary Care Team Functioning and Clinical Context on Cancer Care Treatment Quality: Implications for Addressing Structural Inequities. JCO Oncology Practice 0 0:0

Joel Cantor is Distinguished Professor of Public Policy at the Bloustein School and Director, Center for State Health Policy at Rutgers University

Recent Posts

Voorhees Transportation Center seeks new Executive Director

The Alan M. Voorhees Transportation Center (VTC) seeks a new Executive Director who will oversee the center’s research program, technical services and other initiatives, including external relations, communications, business development, and fundraising. The Executive...

How the heat will continue to affect your commute

Clinton J. Andrews, director of the Center for Urban Policy Research at Rutgers University, joins Drive Time with Michael Wallace to discuss how the heat affects transit infrastructure in and around the city.    WCBS AM-NY, July 11, 2024

Chen et al. Leverage GPS Data for HIV Prevention

Using GPS-defined venue-based affiliation networks among Black sexually minoritized men and transgender women to identify locations for HIV prevention interventions Purpose HIV biomedical intervention uptake is suboptimal among Black sexually minoritized men (SMM) and...

Report Release: R/ECON Forecast Summer 2024

By Will Irving READ REPORT R/ECON’s economic forecast for New Jersey as of June 2024 continues to show a slowing trajectory, though the decline in annual GDP growth is not as pronounced as in the prior forecast. The anticipated slowdown has also been deferred from...

Dean Shapiro: Reflections on the Chevron Decision

With Chevron overturned, Americans’ faith in government will sink even further On Friday, the Supreme Court overturned the 1984 decision Chevron v. NRDC, critical in American regulatory policy. Under Chevron, courts were to defer to federal agency interpretations of...

Upcoming Events

Event Series CAREERS

Virtual Career Drop-ins


Stop by virtually on Mondays (except for holidays) beginning September 9th through December 16th between 11 am and 1 pm to ask a quick (15 min) career-related question of Bloustein […]