Harnessing the power of machine learning and billions of commercial and government claims covering more than 215 million lives and over 2.6 million providers, ConsumerMedical introduces SmartSelect|MD. Using a data-driven approach to identify top-performing physicians, the proprietary solution was developed for employers, health plans, and other sponsors of care. The complementary personalized support by a dedicated nurse ensures that members searching for a physician are matched with high-quality, in-network specialists and providers tailored to their preferences, and who have been objectively ranked based on risk-adjusted quality and patient experience scores.
ConsumerMedical is a leading clinical advocacy, decision support and expert medical opinion (EMO) company marking 25 years of service in April. The company, which serves more than six million people through hundreds of commercial relationships, helps reduce the complexities of navigating any healthcare journey so the highest quality care and outcomes are achieved.
Top-Performing MDs Impact Patient Experience and Outcomes
“Medical errors lead to complications, unnecessary procedures, poor patient experiences, and billions in avoidable healthcare costs each year,” says Randy Hawkins, MD, FACHE, chief medical officer for ConsumerMedical. “Physician quality is a key driver of measurable improvements in healthcare delivery, yet no standardized definition of quality exists. ConsumerMedical has taken a data-centric approach to define and score physician quality. SmartSelect|MD analyzes billions of data elements to match patients with the highest-quality, in-network providers who have the greatest relevant experience in treating a condition they have or performing a procedure they need. When patients are matched to physicians with specific clinical expertise, documented quality outcomes, and who are also convenient and accessible, they are in the best position to receive optimal care.”
Personalizing Physician Guidance: Why it Matters to Employers
“When our members are diagnosed with a serious illness or condition, SmartSelect|MD provides compassionate, personalized support and guidance,” said Michael Ventrone, Vice President of Global Benefits for Honeywell. “SmartSelect|MD offers them clarity in navigating to high-quality healthcare providers, which ultimately leads to better outcomes. At the same time, it supports our benefits strategy as we strive to meet our members’ needs and business challenges.”
Powered by Machine Learning, But Delivered with a Human Touch
SmartSelect|MD was built by clinicians, data scientists, engineers, and user experience experts. The algorithms developed account for the volume of conditions treated and procedure-level experience, with a risk adjustment made for the severity and complexity of the patient panel. Qualitative experience from patients is also factored into ratings, based on socially determined data sources such as verified reviews and patient-reported outcomes.
ConsumerMedical’s nurses and physicians work closely with SmartSelect|MD users to understand their priorities and preferences, allowing them to “curate” the Physician Performance Reports accordingly. The reports use simple star ratings to highlight the top 40% of providers across three tiers with the designations of Elite, Excellent, and Good. Detailed practice information, including QR codes to quickly link locations and directions, are also shown.
Patients can review side-by-side reports of providers by themselves or talk through options with their dedicated nurse. This consumer-centric approach maintains their momentum to take the next step in their healthcare journey.
ConsumerMedical is a leading clinical advocacy, decision support and expert medical opinion company serving over six million individuals through some of the nation’s largest employers, health plans and private exchanges. The company has been serving patients and payers for 25 years. ConsumerMedical offers a fully integrated suite of solutions, including Medical Decision Support®, Surgery Decision Support®, Expert Medical Opinion, Claims Advocacy and more, helping individuals and families navigate the healthcare system while improving outcomes and reducing costs. ConsumerMedical’s results have been validated continuously by independent actuaries. www.consumermedical.com