Rewarding providers not just for the quantity, but also for the quality of the care they provide is something Providence Health Plan has done for years. Now, health care reform advocates are looking at successful regional programs like ours that might serve as models for controlling health care costs.

Our integrated quality and medical management, pharmacy management and provider network teams oversee pay-for-performance programs that combine financial incentives with detailed performance feedback.

Through a secure online portal, primary care providers and specialists access detailed information on how they measure up against medically proven guidelines for treatment and preventive care. Members have access to some of the same data in quality scores for participating primary care providers in our online provider directory.

Today, providers are actively engaged in more than 25 different pay-for-performance incentive programs, including:

• Generic drug utilization
• Glycoslyated hemoglobin and urine screening for members with diabetes
• Women’s health screenings
• General cholesterol management
• Heart and vascular health

An online scorecard sent to primary care providers monitors their performance on 12 quality indicators, including hospitalization rates, screenings and effective disease management. These quality measures include:

• Antidepressant medication compliance
• Appropriate use of antibiotics
• Management of respiratory conditions
• Management of chronic heart failure
• Appropriate treatment of back pain
• Diabetes management
• Mammography rates
• Screenings for coronary artery disease
• Appropriate use of imaging
• Childhood immunizations
• Patient retention

Providers can drill down in their patient data to identify candidates for follow-up care.

Over the last five years, these programs have resulted in higher quality scores on average - with markedly fewer outliers.

Quality scores for Providence Health Plan primary care providers

Many more providers achieved high performance scores after Providence Health Plan launched its pay-for-performance program, as evidenced by this graph. The steepness of the bell curve indicates a consistency of high scores among participating providers.

• y-axis - Number of primary care providers
• x-axis - Quality score
• Blue line - After pay for performance
• Red line - Before pay for performance

In addition, many practices receive incentive pay for meeting accepted quality benchmarks for specialties that include:

• Cardiology
• Ear, nose and throat
• Gastrointestinal medicine
• Obstetrics and gynecology
• Oncology
• Ophthalmology
• Orthopedics

Performance guidelines for incentive pay include quality measures from NCQA, AAFP, ACP, AAP, ABIM, CMS, AHRQ, AHIP and the AMA Physicians Consortium for Performance Improvement.

Yes. In fact, when Providence Health Plan members visit their doctor, they are most often seeing someone who is actively engaged in pay-for-performance programs that reward quality care.

• 75 percent of claims are paid to physicians with pay-for-performance contracts.
• An even higher percentage of claims is paid to specialists with pay-for-performance contracts.
• More than 75 percent of Portland-area primary care providers are participating.

Similar programs reward providers who participate in our national network through Multiplan/PHCS and First Choice Health.

Providers aren't the only ones who benefit from up-to-date performance feedback. Employees can view quality ratings for more than 1,100 primary care providers in Oregon and southwest Washington through our online provider directory.

Employees also can compare providers and facilities based on cost. Our treatment cost estimator generates real-time estimates for out-of-pocket costs for 42 common procedures based on actual member benefits. Employees can access the tool when they register for myProvidence.

Read more about our provider network.