Overview
As consumers of healthcare, we recognize that one of the most important factors when choosing a facility is the quality of care provided. We define high-quality care as safe, effective, and responsive to individual patient preferences. Amino’s data-driven approach to identifying high-quality facilities includes the analysis and modeling of over 200 quality of care measures from a wide range of datasets—representing over 10,000 facilities spanning all 50 states.
Top Provider: Facility Quality
At Amino, we make the search for a high-quality facility as easy as possible by leveraging our data science models to identify top-performing, in-network facilities, designated in our platform as Top Providers. A Top Provider facility must meet four essential criteria:
- In-network for your insurance plan
- High-quality (earning an Amino Quality Score of B or better)
- Affiliated with top physicians for the topic you search
- Cost-effective compared to similar in-network options
If you participate in a Reference Based Pricing (RBP) plan, facilities with the Top Provider label satisfy all of the following criteria:
- Are "more likely to be RBP-friendly" for your plan
- High-quality (earning an Amino Quality Score of B or better)
- Affiliated with top physicians for the topic you search
Amino Quality Score
A facility’s Amino Quality Score is created by leveraging a variety of data sources to model and develop a single composite score. This composite score combines a measure for top performing providers at a facility and a wide range of relevant overall quality measures (see Table 1 for examples). In addition, the measures included in our composite scores are customized by facility type—for example, we use different measures to develop quality scores for Ambulatory Surgical Centers than we do for Hospitals.
Scores on key quality measures are combined to create a facility’s composite quality score, and are also displayed by category on facility profiles so you can compare facility performance based on the criteria that matter most to you.
Data Source and Measures
The quality component of our Top Provider 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. Sample of Facility Level Quality of Care Measures
|
Quality Category |
Example of Measures |
|
Affiliated with High Performing Physicians |
- Count of top-performing physicians practicing at a facility |
|
Safety |
- Central line-associated bloodstream infections (CLABSI) - Rate of complications for hip/knee replacement patients |
|
Readmission |
- Rate of unplanned readmission for coronary artery bypass graft (CABG) surgery patients - Rate of unplanned readmission after hip/knee surgery |
|
Care Coordination |
- Appropriate colonoscopy follow-up - Management of chronic conditions |
|
Effectiveness of Care |
- Percentage of patients who received appropriate care for severe sepsis and septic shock - Percentage of patients who received appropriate radiation therapy for cancer that has spread to the bone |