Selecting a Healthcare Provider

In the era of healthcare transparency, a dizzying array of provider quality tools – Amino, Carrum, Clara, Embold, Garner, Healthcare Bluebook, Healthcorum, Healthgrades, Leapfrog, Quantros, RateMDs, Talon, Zocdoc, to name a few – promise to empower payers, patients and concierge teams with data-driven insights. From star ratings on consumer apps to blackbox algorithms, most of these platforms get something right – a piece or two from the overall puzzle.

Yet, for all the bells and whistles, most miss the big picture: true quality isn’t just about patient satisfaction or isolated metrics like readmission rates. It’s about the hard evidence of a provider’s real-world experience — the procedures they perform, the patterns of interventions that signal success vs complications, alignment to medical necessity using evidence-based medicine, outcomes like treatment duration, return to function, and last but far from least: cost.

Without a holistic view, care navigators risk misalignment, perpetuating inefficiency and uneven outcomes in a system already strained by decades of rising costs.

Let’s start with an unconventional view: There’s no such thing as a ‘good doctor’ (if by good we mean ‘good’ at everything). If you need a doctor, the first question is, for what?

Even the generalists – when you unveil what they do most – are oriented: good at some things, less so at others. Need an orthopedic surgeon? Again, for what? The answer is almost always different if you need a hip, knee, ankle or shoulder surgery. How about spine surgery? What level and what kind? Finding the right man or woman for the job has always been key to success in any specialized industry. Why would healthcare be different?

Consider the limitations plaguing many existing solutions. Consumer-facing tools rely on self-reported data or limited surveys, which can be skewed by low response rates or selection bias—think of platforms where only the most engaged (or aggrieved) patients chime in. Also, what do they ‘like’ (or not) about their provider? The waiting time[1], availability of parking, the blond at the front desk… “patient experience is often marginalized in favor of aspects of care that are easier to quantify (i.e., waiting time). Attempts to measure patient experience have been hindered by a proliferation of instruments using various outcome measures with varying degrees of psychometric development and testing”. Plus, getting five-star reviews is now an industry itself. There’s a place for it, but healthcare quality isn’t measured on Yelp.

What about adverse events – mortality, readmission, complications, and reoperation, for example? Surely these tell us which doctors, hospitals, or surgery centers are better. And they do, a little. The problem comes when risk adjusting for patient population. Most differences are explained away by demographics like age, weight, diet, lifestyle, preexisting conditions and confounding factors. They are important – critical – but only a piece of the puzzle. They tell you a lot about the best and worst providers, but little about 80% in the middle.

How about evidence-based practice patterns? Again, critical – companies like MCG Health are the best at this, outlining the criteria by which physicians and hospitals can adhere to and document medical necessity following their appraisal of peer reviewed literature, meta-analyses, randomized controlled trials, and cohort studies. But in a vacuum, it’s also a fraction of the picture, especially without consideration of outcomes. Some doctors and facilities have become expert at documenting medical necessity – obtaining authorizations and reimbursements – but their outcomes do not justify their increased volume.

Enterprise-level systems might crunch claims but overlook procedure-specific frequency, failing to distinguish a specialist who’s mastered a knee replacement from one who’s dabbled sporadically. And while some integrate pricing data post-Transparency in Coverage rules, they rarely tie to longitudinal trends, like how a provider’s practice evolves year-over-year. The result? Fragmented rankings that prioritize form over function, style over substance, or bedside manner over hard data, leaving stakeholders with incomplete intel. Most do 1-2 things well, but don’t round out their rankings with robust, experience-based metrics – who does what, where, how much, and how well compared with peers? Sure, he or she gets an A, but what are they good at, specifically? This is where rubber meets road, and failure to reach this level of detail can amplify rather than resolve disparities in care.

Enter Denniston Data Inc. (DDI), a trailblazer in evidence-based transparency that’s redefining the field with its Provider Ranking System™ (PRS). Founded by veterans of ‘big data’ in healthcare (including creators of ODG, now part of MCG Health, plus Medical Device Register and Physician’s GenRx), DDI doesn’t just measure quality—it quantifies experience at scale.

PRS leverages claims data including commercial health claims, Medicare Fee-for-Service, Medicare Advantage, and workers’ compensation claims to rank over 2 million unique providers nationwide from 2012 through the latest available year. Users can rank individual providers, group practices, hospitals, and ambulatory surgery centers (ASCs) by specialty or better yet, down to the procedure level. Remember the first question when you need a healthcare provider is… for what? PRS takes a holistic view of quality, incorporating practice patterns, outcomes, adverse events, and optionally, cost. PRS reveals a Composite Ranking Score (CRS) on quality alone, while it’s Smart Score incorporates your own network level pricing from the Transparency in Coverage data. Add in billable vs. allowable costs, patient demographics & risk profiles, and multi-year trends visualized in intuitive graphs, and PRS delivers a panoramic view that’s objective, comprehensive, and free from advertising bias (no pay-to-play listings here).

PRS is designed for the full healthcare ecosystem: self-insured employers and their TPAs optimizing utilization in networks, insurers vetting high performers for network development, medical tourism seeking the best US healthcare providers, and concierge, case management, & care navigation applications. Rankings are granular—national, regional, or local, by procedure or specialty — with provider profiles and rankings that show exactly what each provider is best at. Unlike siloed competitors, PRS integrates all this data seamlessly via API for automated workflows. Its subscription model (no software installs) ensures accessibility without the bloat.

In a healthcare landscape where “quality” too often means checking a box or two, DDI zooms both in and out to the metrics that matter most: proven expertise that drives better health and lower costs. As payers and providers grapple with post-pandemic pressures like inflation, telehealth, WFH, and access to care, tools like this aren’t just innovative — they’re essential.

[1] Beattie M, Lauder W, Atherton I, Murphy DJ. Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol. Syst Rev. 2014 Jan 4;3:4. doi: 10.1186/2046-4053-3-4. PMID: 24387141; PMCID: PMC3892022.