Objective: To introduce methodology of pay-for-performance program (FFS+P4P) within a private health care plan in southern Brazil where fee-for-service is the main reimbursement system. The objective of FFS+P4P are: increase visits value without compromising relationship between direct health care cost and revenue; to reduce labs exams; to reduce visits average cost; to improve patient satisfaction; to seek doctor's and provider's accountability; and to improve health plan information system. Methods: The FFS+P4P implemented consists in comparing doctors' indicators (i.e. utilization, effectiveness, costs, health care and patientxs satisfaction) with a benchmark and, depending upon their performance, increase their fee in 0%, 10% or 20%. All 138 doctors of this health plan were elected to participate. To monitoring the outcomes of this program I compared patient satisfaction and health plan utilization, costs and effectiveness of one year before (i.e. 2006) to one year after (i.e. 2007) starts FFS+P4P Program. Results: Doctor's visits fee increased 16.3% (R$ 25.00 to R$ 29.15). Patient's satisfaction increased as well, by 13.6%, from 8.37 to 9.51. The diagnosis image exams requested by visit reduced just 1.1%, labs exams increased by 3% (1.32 to 1.36) and the average costs generated by one visit increased 7.8%% (R$ 132.80 to R$ 143.18). In hospitalization by visits reduced 1.4% (4.5% to 4.4%) and average length of stay increased 3.6% (from 2.59 to 2.69 days). Number of mammography requested for women aged more than 40 years old who visited gynecologist increased 1.5% (76.6% in 2006 against 77.9% in 2007) and number of PSA requested for men aged more than 40 years old who visited urologist increased 5.3% (94.5% in 2006 and 99.5% in 2007). Conclusion: Pay-for-performance program shows that it is possible to increase doctor's fee without compromising health care costs and patient satisfaction, as well as improving decision maker information and relationship with doctors' network.