Quality improvement and utilization management performance indicators: Does individualized feedback affect provider behavior?

California's Department of Public Health, Office of Family Planning, which administers the State's publicly-funded family planning reproductive health program, Family PACT (Planning, Access, Care and Treatment), initiated in 2005 an innovative quality improvement activity using claims and client enrollment data. The sixth semi-annual individualized Family PACT Provider Profiles were sent to more than 2,000 providers in January 2008. We assessed whether regular feedback and peer-group comparison on performance indicators induces behavior change and thus, improves clinical outcome. The quality improvement and utilization management indicators and average peer-group performance indicators are clinically relevant, objectively measurable, and influenced by provider behavior. Providers that made a behavior change after receiving their first and/or second profiles will now see evidence of that change. Data trends show that private providers demonstrate the greatest change in aligning more closely with their peers in the following indicators: improving annual chlamydia screening rates in women under age 26 by 2% (from 68% in 2003 to 70% in 2007); reducing pregnancy testing per 100 encounters by 40% (from 52 to 21, respectively); and, reducing the percentage of E&M visits coded the highest level (99214) by 68% (from 25% to 13%, respectively). Histograms show that outliers move toward the peer median. Trends of public providers, historically aligning more closely with their peers, remain relatively stable. We will also discuss how these data guide technical assistance and provider support activities to improve quality of care and appropriate utilization of services.