Amino, a San Francisco-based startup that uses claims data to help consumers choose a doctor, announced today that it now has access to Medicare claims data and has been certified by the Centers for Medicare and Medicaid Services to create new healthcare quality measures focused on the healthcare consumer experience.
The company uses a database of billions of patient-doctor interactions to match patients with the doctor who has best served patients who share their demographic and treatment profile. They can also filter results to find the best local doctor who takes their insurance. Then patients can book an appointment right from inside the platform.
Amino is the first private company to become a qualified entity under Medicare Data Sharing, which gives it the access to all of Medicare’s claims data back to 2009. It's also the first private company to become a Medicare “consensus-based entity” which gives the company CMS’s support in creating new healthcare quality measures that will then be available to other CBEs.
“[Consensus-based entity] is a very technical term to describe a very basic idea, which is Medicare wants to make sure that if you’re going to profile physicians the way that we do, that you take a rigorous approach designing the measures you use,” David Vivero, CEO of Amino, told MobiHealthNews. “So you can use measures from bodies they’ve already approved in this way. So for example, the National Quality Forum produces a set of measures they designed through their process. And if you are a qualified entity, someone who has access to this data, then you can use these approved measures.”
As part of the CMS certification requirements, Amino had to appoint a board of diverse healthcare stakeholders to weigh in on the fairness and rigor of their quality measures. The board consists of Dr. Arnold Milstein, a professor of medicine at Stanford University; Elizabeth Gilbertson, chief of strategy for Unite Here Health, a Taft-Hartley labor management trust fund that provides health benefits to its participants; Dr. Mark Rattray is an OB/GYN physician and president of CareVariance; Lawrence Becker, director of strategic partnerships and alliances for Xerox Corporation; Jennie Chin Hansen, former CEO of the American Geriatrics Society and past President of AARP; and David Joyner, CEO of PriMed Management Services Inc., a management services company that serves the Hill Physicians Medical Group, one of the country’s largest independent practice associations.
“We decided it was important for us to design measures that were focused on the decisions that consumers make, whereas NQF measures are much more broadly applied,” Vivero said. “We wanted to stick to an approach that would allow us to mimic the speed of our product, so we wanted to design our own product. Having said that, we also believe it’s super important to be rigorous in our methodologies, so it was great to be able to go through this process, and put all our ducks in a row, and recruit all the right people, so we can control that destiny and build the quality measures that are meaningful to consumers.”
The Medicare Data Sharing initiative is fairly recent, as it was created by a provision of the Affordable Care Act.
"Before the ACA, it was impossible, based on a judge’s ruling at the time, to profile individual physicians using Medicare claims data," Vivero explained. "And then, through the ACA that was changed so that organziations who met a certain bar could have access to it. For five years or so, most of the qualified entity behavior was from regional nonprofits, and only one had actually published measures."