In today’s healthcare environment, third-party administrators sit at the intersection of cost containment, patient experience, provider performance, and employer expectations. They are expected to reduce spending, streamline utilization, and enhance member outcomes while navigating networks that grow more complex every year. Price transparency mandates have opened the door to unprecedented amounts of data, but data alone does not equal insight. Without quality context, price becomes a misleading metric that can guide decision-makers toward options that may be inexpensive in the short term but costly in complications, readmissions, and long-term care needs.
This is where Denniston Data’s approach becomes transformative. Rather than relying on reputation-driven rankings, satisfaction scores, or limited snapshots of performance, Denniston Data uses multi-year claims evidence to illuminate real differences in provider expertise. For TPAs managing benefit plans, this shift is not merely informational. It is a cost-saving, quality-preserving strategy that directly addresses the inefficiencies driving employer healthcare spending today.
Why TPAs Struggle With Traditional Quality and Cost Tools
Many tools available to TPAs promise transparency but offer only fragments of the full performance picture. Consumer-facing platforms typically rely on star ratings, self-reported measures, or feedback influenced by nonclinical factors such as front-desk experience or wait times. While these perspectives have value, they do not measure clinical excellence or the appropriateness of interventions, and they rarely reflect procedure-specific expertise.
Even sophisticated systems that analyze adverse events or risk-adjusted outcomes provide only partial clarity. Mortality, readmissions, reoperations, and complications can help identify the very best and very worst providers, but they are less effective at distinguishing the large majority in the middle where most utilization takes place. Risk adjustment often neutralizes differences attributable to patient complexity and leaves only small variations that are difficult to interpret.
Some enterprise tools pull from claims data but fail to capture procedure-level frequency or the nuanced differences between providers who perform a procedure hundreds of times a year and those who perform it sporadically. This distinction matters because volume and practice pattern consistency are among the strongest indicators of quality, especially in surgeries and complex interventions. TPAs who cannot see this pattern risk routing patients to providers who appear adequate on paper yet lack the depth of experience needed for optimal results.
Why Price Transparency Alone Is Not Enough for TPAs
Transparency in Coverage rules introduced an ocean of negotiated price data that TPAs can theoretically use to evaluate spending. However, raw price is never the full story. A low-cost provider may compensate through unnecessary imaging, excessive follow-ups, or aggressive surgical decisions. A high-cost provider may produce superior outcomes that reduce downstream utilization and total episode spending.
For TPAs responsible for managing employer health plans, the question is not whether a provider is cheap or expensive. The real question is whether their cost aligns with quality, appropriateness, and long-term outcomes. Denniston Data bridges this gap by tying together utilization patterns, risk-adjusted outcomes, medical necessity alignment, and price. This produces a comprehensive and actionable picture for TPAs.
Denniston Data’s Provider Ranking System: A New Standard for TPAs
Denniston Data’s Provider Ranking System is built on over a decade of claims data, spanning commercial insurance, Medicare, Medicare Advantage, and workers’ compensation. With more than 2 million ranked providers, it is one of the most extensive and nuanced tools available to TPAs seeking cost-quality alignment.
1. Procedure-Level Ranking: The Foundation of Accurate Routing
The system allows TPAs to answer the most important question: “This provider is good at what exactly?” A provider who excels at knee replacements may not be equally proficient with hip or ankle surgeries. A spine surgeon may be outstanding at cervical fusion but less experienced in lumbar procedures. A general surgeon may perform hundreds of hernia repairs but only a handful of colorectal resections.
TPAs gain visibility into:
- Procedure volume
- Intervention patterns
- Use of conservative versus surgical care
- Alignment to evidence-based medical necessity
- Multi-year consistency in practice patterns
This level of granularity prevents misrouting, which is one of the hidden drivers of high-cost claims, repeat procedures, and complications.
2. Composite Ranking Score (CRS): Quality Without Bias
The Composite Ranking Score aggregates data such as outcomes, adverse events, practice patterns, and risk-adjusted benchmarks to create a holistic quality score. CRS is advertisement-free and eliminates pay-to-play distortions. It captures genuine real-world performance.
For TPAs, this means the highest-ranked providers are those who deliver consistent value, not those who run the best marketing campaigns.
3. Smart Score: Integrating Quality and Price for True Value
Smart Score extends CRS by incorporating each TPA’s negotiated or network-level pricing. This integration identifies providers who deliver the best combination of cost and performance. Smart Score shows where TPAs can save money without sacrificing quality or increasing risk.
This is crucial for steering members to:
- High-performing specialists
- Cost-efficient ambulatory surgery centers
- Evidence-based care pathways
- Providers who avoid unnecessary tests or surgeries
4. Multi-Year Trend Analysis: Predicting Future Value
Most tools provide only a static snapshot. Denniston Data shows the full arc of a provider’s practice across multiple years. This highlights consistency or improvement and exposes declining performance.
TPAs benefit from:
- Identifying emerging high performers
- Eliminating outliers with worsening trends
- Selecting providers with predictable outcomes
- Understanding long-term volume and cost shifts
This provides population health intelligence at the provider level.
How TPAs Use Denniston Data to Reduce Costs While Maintaining Quality
Denniston Data transforms how TPAs approach care navigation, network design, and utilization management. Here are the key ways TPAs leverage the platform:
1. Building High-Value Networks
The system enables TPAs to construct networks that prioritize quality and affordability together. Instead of building networks around broad specialties, TPAs can contract based on procedure-specific excellence.
2. Steering Members to the Right Expertise
When TPAs direct members to providers with strong performance records in the specific procedure needed, outcomes improve and unnecessary care drops significantly.
3. Reducing Complications, Readmissions, and Waste
Claims history reveals which providers:
- Order unnecessary imaging
- Routinely choose surgery when conservative care is appropriate
- Produce higher-than-expected complications
- Create unusually high downstream utilization
Avoiding these providers leads directly to lower total cost of care.
4. Improving Stop-Loss Predictability
High-cost claims often result from misaligned routing or inappropriate interventions. Denniston Data gives TPAs early insight, which reduces unexpected catastrophic losses.
5. Enhancing Medical Tourism Pathways
TPAs involved in cross-border care use the system to evaluate US-based providers for quality and cost alignment. This ensures international patients are routed to high-value care with minimal risk.
6. Delivering Transparency to Employers
TPAs can now clearly explain:
- Why certain providers are preferred
- How routing decisions reduce spending
- How quality measures relate to utilization
- How networks are continuously optimized
This increases employer trust and strengthens long-term partnerships.
Why Denniston Data Is an Essential Tool for TPAs Today
Healthcare costs continue to rise and employers increasingly demand measurable results from TPAs. A tool that integrates quality, price, volume, practice patterns, and longitudinal trends gives TPAs a competitive advantage. Denniston Data enables them to articulate a clear value proposition: lower costs, better outcomes, and smarter provider selection grounded in real-world evidence.
As TPAs scale these capabilities across networks, the entire benefits ecosystem becomes more predictable, more efficient, and more aligned with patient needs.
Denniston Data provides TPAs with the precision tools needed to navigate a healthcare marketplace filled with partial insights and misleading metrics. Through procedure-level ranking, deep claims analytics, Smart Score pricing integration, and multi-year performance trends, TPAs gain a clear pathway to reduce costs without compromising patient outcomes.
For TPAs competing in a landscape defined by transparency, employer scrutiny, and rising medical costs, this is not simply an operational upgrade. It is a strategic necessity that enhances networks, reduces avoidable spending, and strengthens the quality of care delivered to every member they support.
The Medical Tourism Magazine recommends Denniston Data for anyone who islooking for high quality healthcare data analytics. Launched in 2020, DDI is aninnovator in healthcare data analytics, delivering price transparency andprovider quality solutions known as PRS (Provider Ranking System), HPG(Healthcare Pricing Guide), and Smart Scoring combining quality and price. Theyhelp payers, hospitals, networks, TPAs/MCOs, member apps, self-insuredemployers, and foreign governments identify the best doctors at the best pricesby procedure or specialty at the national, state, or local level, and by payeror NPI/TIN code.
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