Method: This analysis utilized administrative claims data for 2008-2011 representing 2.7 million member-years and 1,461 primary care practice locations in southeastern Pennsylvania. Health care quality scores were defined as the proportion of eligible members who received cancer screenings, immunizations, and chronic-disease care. To risk-adjust proportions, we fitted generalized linear models with a logit link function and a binomial probability distribution. All multivariable models adjusted for both practice-level and member-level covariates.
Result: The incentive program was established in 2008 and rewarded practices for relative quality scores (percentile rank) within their peer group. Doubling the incentives for quality in 2010 was associated with a significant increase in the proportion of patients receiving recommended preventive care and disease management by 1.6 percentage points. Practices in the bottom 10% increased their quality scores by 1.9 percentage points – nearly 50% percent faster than practices in the top 90%, which increased their quality scores by 1.3 percentage points. These quality improvements were sustained into the second year after implementation, the last year for which data are available.
Conclusion: Performance-based monetary incentives can serve as an effective tool to increase health care quality, especially for practices with historically weaker performance records. These quality improvements appear to be sustained beyond the initial year of strengthening the rewards.