The Hawaii Medical Service Association spent $20.7 million this year on incentive programs that reward hospitals, health maintenance organization health centers and physicians who deliver high levels of care, patient safety and satisfaction.

HMSA said it awarded physicians and practitioners $9.9 million under its Practitioner Quality and Service Recognition Program, while another $6.2 million was awarded under its Hospital Quality and Service Recognition Program to hospitals. Still another program focused on rewarding quality care paid $4.6 million to HMO health centers.

HMSA considers the program an investment in improving the quality of healthcare in the community, something it says helps keep healthcare cost down. The incentives are paid out of HMSA's operating budget, and are above what HMSA, the state's dominant health insurer, pays in reimbursements and fee adjustments to health providers.

HMSA was one of the first health plans in the country to start a pay-for-performance program. In making the awards, HMSA seeks out physicians and hospitals that adhere to nationally recognized practice guidelines and standards of care. Such practitioners check for drug interactions and follow up on preventive screenings with patients.