How Amino identifies high quality physicians

Overview

As consumers of healthcare, we recognize that one of the most important factors when choosing a physician is the quality of care they provide. We define high-quality care as safe, effective, and responsive to individual patient preferences. Amino’s data-driven approach to identifying high-quality physicians, or Smart Matches,  includes the analysis and modeling of over 200 quality of care measures from a wide range of datasets—representing over 1 million providers spanning all 50 states.

Smart Match: Physician Quality

At Amino, we make the search for a high-quality doctor as easy as possible by leveraging our data science models to identify top-performing, in-network physicians, also known as Smart Matches. A Smart Match physician must meet three essential criteria:

1. In-network for your insurance plan
2. High-quality (earning an Amino Quality Score of B or better)
3. Cost-effective compared to similar in-network options

If you participate in a Reference Based Pricing (RBP) plan, a Smart Match physician must meet the following criteria:

• Are "more likely to be RBP-friendly" for your plan
• High-quality (earning an Amino Quality Score of B or better)

Amino Quality Score

A physician’s Amino Quality Score is created by leveraging a variety of data sources to model and develop a single composite score. This score accounts for both physician experience and performance on relevant overall quality measures. 

Amino’s approach to modeling physician quality is unique. Not only do we identify physicians who are experienced in medicine—but we also determine their experience providing specific procedure or condition-related care. For example, if you search for “food allergies” in Amino, we’ll give you a list of Smart Match physicians who both (1) have specific experience treating patients with food allergies, and (2) score highly on key quality measures (see Table 1 for examples).

Scores on key quality measures are part of a physician’s composite quality score and are also displayed by category on provider profiles so you can compare physician performance based on the criteria that matter most to you. 

Data Source and Measures

The quality component of our Smart Match algorithm is created based on our massive database of over 19 billion claims, as well as our third-party quality measure sets. In total, we have access to data for about 200 quality-of-care measures, including metrics created by The Leapfrog Group, the Centers for Medicare and Medicaid Services (CMS), the National Quality Forum (NQF), and the Agency for Healthcare Research and Quality (AHRQ). The table below provides a snapshot of the measures we use to identify high-quality facilities.

Table 1. Examples of Physician-Level Quality-of-Care Measures