Sunnyvale Primary Care (SPC) is considering a P4P program to increase preventative care for its diabetic patients. HbA1c is a blood test used to determine how well diabetes is being controlled. The state medical association recommends that diabetic patients have this test a minimum of two times per year. In addition, because patients regularly enter and leave primary care practices, the association considers that a level of 90 percent of diabetic patients having a HbA1c test two times per year is a reasonable goal for most primary care practices. In the state where SPC is located, currently only 80 percent of diabetic patients actually have a HbA1c test two or more times per year.

SPC decided on HbA1c as a process measure for its P4P program and is now considering three methods of allocating rewards. For each of the measures below, a physician receives a $5,000 bonus if:

The percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state average of 80 percent (relative performance).

The percent of their diabetic patients that had at least two HbA1c tests in the past year is greater than the state goal of 90 percent (benchmark performance).

The difference in the percent of their diabetic patients that had at least two HbA1c tests in the past year compared to the previous year is greater than 10 percent (improvement performance).

The percent of diabetic patients that had at least two HbA1c tests in the past year for each SPC

Physician is shown below:

Physician        Jan-Jun            Jul-Dec

A          60%                 76%

B          70%                 81%

C          80%                 81%

D          90%                 91%

For the Jul-Dec period, what would be each physician's P4P if rewards were allocated based on relative, benchmark, and improvement performance?

Which method(s) of allocating rewards would you recommend?