Patient outcomes and evidence-based medicine in a preferred provider organization setting: a six-year evaluation of a physician pay-for-performance program

Health Serv Res. 2007 Dec;42(6 Pt 1):2140-59; discussion 2294-323. doi: 10.1111/j.1475-6773.2007.00725.x.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blue Cross Blue Shield Insurance Plans
  • Evidence-Based Medicine*
  • Female
  • Hawaii
  • Health Services Research
  • Humans
  • Male
  • Organizational Case Studies
  • Outcome Assessment, Health Care*
  • Physician Incentive Plans* / economics
  • Preferred Provider Organizations / economics
  • Preferred Provider Organizations / standards*
  • Quality Assurance, Health Care
  • Quality Indicators, Health Care*
  • Reimbursement, Incentive*
  • Time Factors