Objective. To determine whether health plan members who saw physicians participating in a quality-based incentive program in a preferred provider organization (PPO) setting received recommended care over time compared with patients who saw physicians who did not participate in the incentive program, as per 11 evidence-based quality indicators. Data Sources/Study Setting. Administrative claims data for PPO members of a large nonprofit health plan in Hawaii collected over a 6-year period after the program was first implemented. Study Design. An observational study allowing for multiple member records within and across years. Levels of recommended care received by members who visited physicians who did or did not participate in a quality incentive program were compared, after controlling for other member characteristics and the member's total number of annual office visits. Data Collection. Data for all PPO enrollees eligible for at least one of the 11 quality indicators in at least 1 year were collected. Principal Findings. We found a consistent, positive association between having seen only program-participating providers and receiving recommended care for all 6 years with odds ratios ranging from 1.06 to 1.27 (95 percent confidence interval: 1.03-1.08, 1.09-1.40). Conclusions. Physician reimbursement models built upon evidence-based quality of care metrics may positively affect whether or not a patient receives high quality, recommended care.Key Words. Physician incentive plans, quality indicators, evidence-based medicine
2140Within the past decade, several Institute of Medicine (IOM) reports have recommended quality-based incentive programs as effective tools to improve quality of care (Kohn, Corrigan, and Donaldson 2000; IOM 2001;Corrigan, Eden, and Smith 2002). In response, many health plans, as well as the Centers for Medicare and Medicaid Services (CMS), have turned their focus to measures that evaluate physician performance in various aspects of care quality such as patient satisfaction and processes of care (CMS 2003;Casalino et al. 2003;Webber 2005). While the programs have produced an abundance of anecdotal evidence suggesting that performance-based reimbursement can affect physician behavior (Morrow, Gooding, and Clark 1995;Fairbrother et al. 1999;Forsberg, Axelsson, and Arnetz 2001;Amundson et al. 2003;Roski et al. 2003), the majority of the programs were implemented in a health maintenance organization (HMO) setting (Levin-Scherz, DeVita, and Timbie 2005; Rosenthal et al. 2005), where evaluation of physician adherence to clinical guidelines is easier to make (Sommers and Wholey 2003), compared with a preferred provider organization (PPO) setting, where responsibility for patient care is more likely to be shared between multiple physicians because patients have freedom to see providers without referral. In addition, HMO plans are more likely to have systematic interventions to improve care processes and outcomes, such as reminders, benefit coverage for screenings, and disease management programs (Cas...
