The Question: Is my health care provider relatively low cost or expensive?
When choosing a care provider, there are a handful of factors that we all consider:
- Insurance: Does the provider accept my insurance?
- Location: Is the provider located close to where I live or work?
- Quality: Will I receive high-quality care from this care center?
- Cost: Is this care center relatively low cost or are they expensive?
The historic lack of transparency in health care cost has been a source of frustration for many. In addition, there is an overwhelming amount of evidence that higher cost does not consistently equate to higher quality care. In order to help our users make more informed choices about their care providers and derive value from their care, we have developed a tool to provide more clarity when it comes to the cost of healthcare.
The Question: Amino Specialist Cost Ratings
Amino has developed specialist cost ratings to help users compare the cost of different specialty care providers. Although built on a complex set of data assets and modeling approaches, the specialist cost ratings themselves are displayed intuitively - with a system of dollar signs ranging from one dollar sign indicating “low cost” to four dollar signs indicating “high cost.”
When you log in to your Amino account and search for and select a specialist, you can see that specialist’s cost rating. The rating is customized to be specific to your health insurance carrier.
Specialist cost ratings are used to identify your Smart Match recommendations.
In your search for a specialist, you may notice that the providers who are ranked at the top of the list have a Smart Match badge. Smart Match providers must meet three criteria:
- In-network for your insurance plan
- High-quality (earning an Amino Quality Score of B or better)
- Cost-effective compared to similar in-network options
Specialist cost ratings both allow you to compare cost and highlight cost-effective providers - these are providers who are less expensive than at least 50% of other specialists with your insurance carrier.
The Approach: Data and Methodology
Step 1: Data Aggregation and Cleaning
Amino provides cost ratings for ~40 different specialties. Each cost rating is customized to take into consideration the specialty, the specific provider, and the insurance carrier.
We begin by aggregating multiple sources of claims and remits data. Using our data models for providers, insurance carriers, and facilities, we identify records that may have errors or not represent typical experiences and remove these outliers.
Step 2: Calculate cost estimates
We then calculate the median cost for each procedure associated with that specialty. We link specific providers to their claims using the provider’s NPI (National Provider Identifier).
We integrate insurance carrier data to estimate the approximate prices a provider charges for a variety of services for your insurance network - ensuring that your cost rating is specific to your insurance. To normalize the data, we compare our initial cost estimates to the Medicare fee schedule.
Step 3: Take geography into account
Cost estimate calculations are adjusted by geography using Hospital Referral Regions - geographic units of analysis that were developed by the Dartmouth Atlas of Health Care to delineate regional health care markets in the U.S. This ensures that we account for cost variation by geography. For example, the same specialty procedure is often more expensive in Oakland, California compared to Richmond, Indiana - we account for that.
Step 4: LAMP “Location-Based Augmentation Model for Prediction”
To account for missing data (i.e. when we don’t have raw data from a provider), we use supporting signals from the providers that they work with to estimate their cost of care. This allows us to confidently provide cost ratings for a wider range of providers - making it easier for you to find a “cost effective” provider.