As a healthcare financial wellness benefit designed for employees on high-deductible commercial insurance plans, Amino guides members through the process of choosing health care providers and using health benefits. Amino's guidance is delivered through product features that surface the access, relevance, affordability, safety, and humanity of the member's provider options.
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One of the key aspects of care quality that’s critical to our members — but often completely unaddressed in first generation transparency tools — is access to care providers. Access to care has multiple dimensions, but most importantly it combines:
- The current location of the member
- The current location of the care provider
- The current status of the provider as in-network or out-of-network given the individual member’s insurance plan
- The current availability of the provider within the timeframe that the member requires care
Determining accessibility of care is deceptively difficult. Provider network definitions evolve rapidly from plan year to plan year, sometimes even within a single year. Individual professional providers move between practice locations at unpredictable intervals or practice part-time at many different locations with different network affiliations. The basic directories provided by insurance plans are riddled with inaccuracies that can lead to accidental out-of-network charges and balance billing despite careful planning by a member.
So even the most basic questions about what providers a user has access to at a given moment can be surprisingly difficult to answer. This is why the foundation of the Amino guidance experience is an award-winning map-based search experience, a comprehensive MD/DO provider database that combines multiple data feeds that help us to track current provider practice locations, direct data feeds of network definitions from the member’s plan, and a high-touch concierge booking experience that serves as a backstop when even the freshest data does not capture the on-the-ground reality of which provider is in network today. These features combine to ensure that each member is able to find an available in-network provider at the time they need care.
After answering members' foundational questions about access, Amino guides members using a best in class search relevance algorithm for providers.
Our search relevance algorithm draws from our patient de-identified database comprising nearly 10 billion commercial insurance claims. Our claims reflect the rendering provider, location, diagnostic codes, services codes, and de-identified patient tokens for encounters experienced by over 220 million patients across the United States since 2014. Our claims reflect the care rendered by over 1 million providers and charges billed and adjudicated amounts under nearly all major national and regional commercial insurance carriers.
We use this unprecedented commercial claims database to assess, rank, and report provider’s recent clinical experience — experience treating specific health conditions, performing specific surgical procedures, and rendering other care services within the last 4 years. Our search relevance algorithm allows us to start with a member’s search for a user-friendly term (e.g. “annual exam,” “asthma,” “knee surgery”, “MRI”), combine that with the member’s age and sex when applicable, and map that search to the relevant groups of ICD9/10, CPT, HCPCS, DRG, and other claims codes that represent care for these needs in our database. For each user’s search, we scan the 1M+ providers in our database for the relevant experience and return the list of most experienced providers for the member’s need, filtered through the lens of accessibility for that individual member’s plan.
Using experience ranking to determine which providers are most relevant to a member’s search allows us to quickly answer the question “Who are the most experienced and currently accessible providers for my needs?”
Amino supports condition- and procedure-specific search for about 1000 common health needs, and we add new topics frequently based on member or customer requests, provided the condition or procedure is frequent enough to support nationwide search results. In addition, we support individual doctor name search for MD/DO providers and facility type search for hospitals, urgent care centers, ambulatory surgery centers, and imaging centers.
The unfortunate reality of American healthcare is that many people live in fear of an unforeseen medical expense, which can result in dramatically negative financial outcomes. Amino believes that ensuring a good financial outcome for our members is as important as ensuring a good clinical outcome.
For this reason, Amino’s search algorithms incorporate information about the affordability of care providers under the member’s plan. For each provider in our database for whom we see sufficient in-network adjudicated claims data for the service a member needs, Amino offers an easy to use cost rating to assess the relative cost of providers. Our rating mimics familiar consumer product features like a $-$$$$ expensiveness rating, simplifying the complex question of “how much will this cost” into the more straightforward question of “under my plan, for this service I need, which of these providers will be most affordable?”
The vast majority of our member searches are for broad topics like “primary care” and “dermatology” where there is no obvious single clinical quality rating that will provide user-interpretable information when the member is comparing providers, especially before the user has any specific treatment plan or service in mind. For this reason, clinical quality measurements are not factored into our search algorithms for many of our most common specialty-specific or condition-specific searches.
However, there are many procedure topics within Amino for which facility safety is an important consideration, especially when a user is seeking care for a surgical procedure. For search topics where facility safety is important for surgery outcomes, we have partnered with the Leapfrog Hospital Safety Grade nonprofit to display their hospital safety grade for all hospitals who choose to report. Leapfrog’s methodology produces a single letter grade composite score that combines 28 measures from the Leapfrog Hospital Survey, AHA IT Supplement, and CMS. You can read more about Leapfrog at http://www.hospitalsafetygrade.org/about-us/about-the-leapfrog-group. Leapfrog scores are updated twice per year, in the spring and the fall. We typically have about a one month lag between the time new scores become available and when they are reflected in our product.
Using our physician-hospital affiliation data, so we can match members with highly experienced physicians who are able to admit patients to A or B-rated hospitals, if the member search topic involves a procedure that is commonly performed inpatient.
In the absence of domain expertise about how to make health care choices, most people value social signals of quality more than data-derived signals when choosing health care providers. Information such as provider headshots, provider gender, patient reviews, personal recommendations, and “name brand” medical education — information that most people are conditioned to value and use in consumer shopping contexts — often outweighs information that should be considered more critical in the health care decision context.
For this reason, Amino uses data relevant to the member's search (like “Dr. A has performed 10x the number of knee replacements as Dr. B in the last four years” or “Dr. A performs surgery at a D-rated hospital whereas Dr. B performs surgery at an A-rated hospital”) to serve as a counterbalance to social cues that might otherwise dictate the member's choice (like a smattering of anonymous patient reviews or the provider's appearance in a headshot).
Amino's data-driven framework to guide the member through their provider search is called “Smart Match” in our product user experience.
Smart Match is how we create simple, repetitive education and clear visual signals in our user interface to train our members how to make objective assessments about their available health care options. Depending on the search topic the user has selected, Smart Match incorporates all or a subset of the following factors and reminds the user to focus on these things:
- Is the provider in network?
- Is the provider highly experienced for your specific health condition or procedure?
- Is the provider cost effective given your insurance plan?
- Is the provider at a safe facility for the care you need?
By providing the Smart Match framework in our search experience, we aim to help our members understand what signals to weigh more heavily when choosing providers, while still allowing them to see patient reviews complaining about an office receptionist or to guess which physician is likely to be kinder based on a headshot — information that adds color but that should not be the deciding factor for most health needs.