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 limes per car. In addition, because patients regularly enter and lease primary care practices, the association considers that a level of 90 percent of diabetic patients base 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 base a HbA1e test two or more times per year. SPC decided on HbAlc as a process measure for its P4P program and is now considering three methods of allocating rewards. A physician receives a bonus of $5000 if: the percent of their diabetic patients that had at least two HbA1c tests in the past six months in greater than the state average of 80 percent (relative performance). The difference in the percent of their diabetic patients that had at least two HbA1c tests in the past six to the previous six months is greater than 10 percent