The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care

Objective. Immunizations and other cost-effective preventive services remai n underused by many children, especially those living in poverty. Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns, we designed and tested an intervention combining these s trategies. We studied whether a system of semiannual assessment and feedbac k, coupled with financial incentives, could improve pediatric preventive ca re in a Medicaid health maintenance organization (HMO). Methodology. We randomly assigned primary care sites serving children in a Medicaid HMO to one of three groups: a feedback group (where physicians rec eived written feedback about compliance scores), a feedback and incentive g roup (where physicians received feedback and a financial bonus when complia nce criteria were met), and a control group. We evaluated compliance with p ediatric preventive care guidelines through semiannual chart audits during the years 1993 to 1995. Results. Compliance with pediatric preventive care improved dramatically in the study period. Repeated measures ANOVA demonstrated a significant incre ase in all three study groups throughout the time in total compliance score s (from 56%-73%), as well as scores for immunizations (from 62%-79%) and ot her preventive care (from 54%-71%). However, no significant differences wer e observed between either intervention group and the control group, nor wer e there any interaction (group-by-time) effects. Conclusions. Feedback to physicians, with or without financial incentives, did not improve pediatric preventive care in this Medicaid HMO during a tim e of rapid, secular improvements in care. Possible explanations include the context and timing of the intervention, the magnitude of the financial inc entives, and lack of physician awareness of the intervention.