What Patients Deserve: Turning Provider Data into Decisions

Originally published by HealthCorum

There has been a lot of talk recently about patients’ right to their own data, and efforts have been made in that arena, from wearables and better access to personal health information to integrated EMRs and improved patient portals. On the insurance side, patients also have access to metrics about different plans. Although not always easy to interpret or access, the information is technically available. But one area where patients remain completely in the dark is provider data.

Even those of us in this industry have experienced trying to choose a provider based on a list of names, a vague "Best Provider" badge, or a Yelp review about parking. It’s not exactly a quality search when deciding where to deliver your baby or help your mom find a cardiologist. Meanwhile, behind the scenes, health plans (consumer and state payers), provider groups, and vendors are sitting on mountains of provider data: cost patterns, procedure volumes, prescribing habits, network participation, and performance against quality benchmarks.

To be clear, not all that information belongs on a patient-facing dashboard. But it’s also not enough to offer up reviews that say more about the receptionist’s friendliness than the provider’s actual quality or the outcomes they deliver. Patients deserve meaningful insight into the cost and quality of care they can expect, the kind of data they are used to when shopping for most other services.

There’s a reason this data has been central to the business side of healthcare for years: it’s a major driver of profitability and cost. It influences who gets into networks, how physicians are paid, where care management programs focus, and other critical business operations.

That said, this data isn’t exactly ready for plug-and-play for patient-facing portals and tools. What works for claims processing or internal analytics doesn’t always work for public-facing communication. It’s one thing to build risk models or negotiate contracts; it’s another to help someone figure out whether a provider is more likely to recommend a brand-name drug when a generic will do or to order unnecessary tests. The intelligence behind those insights exists, but we must distill it down and present it in a way people can use and easily interpret.

This is why infrastructure matters. We need to meet patients where they already are- provider directories, plan portals, care navigation tools and make the data understandable. That means fewer acronyms, more plain language, and clear signals about what matters: quality, appropriateness, and cost.

It’s also a win-win for the system. For payers, helping members find high-performing providers reduces total cost of care. For providers, objective performance data gives them a chance to stand out for the right reasons not because of office decor, but because they consistently deliver high-value care. It’s also something providers can use when negotiating contracts or making their case for inclusion in networks.

We’ve made a lot of progress giving patients access to their medical records. Provider data should be next. The industry has had this information for years. Now it’s time to bring patients into the loop by giving them just enough of the right information to make a more informed choice.

At the end of the day, patients deserve more than a friendly front desk and a decent review score. They deserve decisions backed by real data.

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