For years, policymakers, employers, insurers, and care navigators have championed the idea of “healthcare shopping” as if consumers could simply compare options the way they might evaluate hotels or flights. In theory, transparency tools and public reporting would arm people with the clarity they need. In practice, most solutions still fall short because they fail to answer the most important question in healthcare: Which provider is the right provider for this specific procedure, for this specific patient, right now?
Despite the explosion of rating platforms and transparency dashboards, many suffer from the same fundamental flaw. They focus on fragments of quality instead of the full picture. They measure satisfaction but not expertise. They evaluate outcomes without accounting for what providers actually do most often. They offer price lists without context, creating the illusion of clarity while leaving decision makers under-informed.
Denniston Data changes this reality by providing a system built on the principles healthcare shopping has always needed but rarely achieved: granular experience, evidence-based practice patterns, objective outcomes, and price alignment at the procedure level.
This article explores why traditional healthcare shopping falls short and how Denniston Data’s methodology finally makes meaningful comparison possible for global care coordinators, employers, insurers, and medical tourism professionals.
The Broken Promise of Healthcare Shopping
Many tools in the market claim to measure healthcare quality through composite ratings, stars, or basic metrics. Some lean on patient reviews. Others surface complication rates. Others highlight accreditation, bedside manner, or hospital amenities. While all of these elements add some value, they do not answer the core question of clinical performance.
Why Reviews Don’t Measure Quality
Many consumer-facing platforms rely on opinions rather than evidence. Reviews tend to reflect interpersonal interactions, wait times, parking convenience, staff friendliness, or administrative efficiency. They measure patient satisfaction, not clinical expertise. While valuable, they cannot be used as a substitute for evaluating real-world outcomes or procedural proficiency.
Moreover, reviews are often influenced by selection bias. Those who feel strongly are the ones who respond. A small but vocal group can skew ratings dramatically. This makes reviews useful for customer service insights but inadequate for life-impacting surgical or medical decisions.
Why Adverse Events Alone Are Not Enough
Mortality, readmissions, reoperations, hospital-acquired conditions, and complication rates are legitimate quality indicators. However, when taken alone, they have serious limitations:
- They often apply only at the extremes.
- With appropriate risk adjustment, differences between most providers become statistically small.
- They struggle to differentiate 80 percent of providers who perform within acceptable ranges.
Adverse events help identify the worst performers and occasionally highlight the best, but they do not define the majority in between.
Why Evidence-Based Practice Patterns Matter but Still Fall Short
Practice guidelines reveal whether a provider follows appropriate pathways of care. This includes adopting conservative management before surgery, ordering appropriate diagnostics, and documenting medical necessity. Yet, even this is incomplete without context. Providers who rigidly follow documentation rules may appear strong on paper but still produce inconsistent outcomes.
Without combining evidence-based patterns, outcomes, and procedure-level experience, a picture of quality remains partial.
Why Price Transparency Alone Misleads
Price transparency rules have surfaced negotiated rates across the country. While this is a major milestone, price without quality context can be harmful. A low-cost provider may have higher complication rates that generate downstream expenses. A high-cost provider may offer no additional value compared with peers.
Price only acquires meaning when fused with risk-adjusted quality indicators.
The Missing Element: Procedure-Level Experience
One of the biggest misconceptions in healthcare is the idea of a universally “good doctor.” But quality is specific. A physician may excel at hip replacements but have modest experience in shoulders. A surgeon strong in lumbar fusions may do little cervical work. Even generalists demonstrate patterns that reveal strengths and limitations.
Procedure-level insights answer questions essential for care navigation:
- What does this provider actually do most often?
- How do their outcomes compare with peers performing the same procedures?
- How do their practice patterns align with evidence-based medicine?
- How has their performance trended over the past decade?
- How does cost integrate with quality for each procedure?
This type of intelligence is what the industry has lacked, and what Denniston Data delivers.
How Denniston Data Fixes Healthcare Shopping
Denniston Data’s Provider Ranking System (PRS) brings together multiple dimensions of real-world performance in a model designed specifically for accurate provider comparison. Instead of relying on opinions or generic quality labels, PRS evaluates what providers actually do and how well they do it across millions of claims.
1. Multi-Year Claims Data That Reveals True Expertise
PRS analyzes large-scale claims across commercial, Medicare, Medicare Advantage, and workers’ compensation systems. This enables visibility into real clinical behavior over more than a decade.
This longitudinal analysis answers critical questions:
- Which procedures does each provider perform most frequently?
- How has their practice evolved?
- Are their outcomes steady, improving, or declining?
Procedural volume and experience are among the strongest predictors of outcomes. PRS incorporates this truth into every ranking.
2. Evidence-Based Practice Patterns That Identify Appropriateness
Not all providers follow care pathways consistently. PRS evaluates:
- How often conservative management is attempted before surgery
- Whether tests and imaging align with guidelines
- How providers sequence treatments
- Whether patterns suggest efficiency or overutilization
These patterns reveal whether care is medically necessary and aligned with best practice.
3. Outcomes and Adverse Events Integrated with Context
PRS combines complication rates, readmissions, and downstream events with:
- Patient demographics
- Risk profiles
- Procedure complexity
- Volume thresholds
This ensures that comparisons reflect real differences in performance rather than differences in patient populations.
4. Cost Integration That Creates Real Value Metrics
The Smart Score incorporates pricing from the user’s own network through Transparency in Coverage data. This reveals where cost and quality align to create high-value care. Instead of shopping by price alone, employers and care navigators can shop by value, which is the only metric that genuinely matters.
5. Composite Ranking Score (CRS) and Smart Score for Complete Clarity
PRS offers:
- Composite Ranking Score (CRS): A pure quality score based on outcomes, practice patterns, and experience.
- Smart Score: A value-driven score combining CRS with local negotiated pricing and cost dynamics.
Together, these scores provide the clearest view of performance in the market.
6. Granular, Procedure-Level and Specialty-Level Insights
PRS rankings can be viewed at:
- National level
- Regional level
- Local market level
- Specialty level
- Procedure level
This allows decision makers to identify the exact strengths of each provider rather than relying on general specialties.
7. API-Driven Integration for Real Workflow Use
PRS is built for:
- Employers
- Insurers
- TPAs
- Medical tourism facilitators
- Care navigators
- Concierge medicine platforms
- Digital health applications
With API-driven architecture, PRS integrates seamlessly into existing systems, powering automated referrals, care routing, and provider selection.
Why This Matters for Medical Tourism Professionals
International patient managers must consider safety, outcomes, and cost more carefully than domestic patients. Currency differences, travel risk, accommodation costs, and follow-up care add layers of complexity. Selecting the wrong provider, even if they appear reputable, can lead to complications that require expensive return trips or long-term care.
PRS solves these challenges by:
- Identifying providers with the best experience in specific procedures
- Highlighting those who follow evidence-based guidelines
- Revealing the cost-value relationship for each intervention
- Reducing uncertainty and risk for international patients
It transforms medical tourism from an intuition-based industry into a data-driven discipline.
A Better Future for Healthcare Navigation
The future of global healthcare hinges on accurate provider selection. With rising costs, fragmented data, and increasingly complex health needs, decision makers need tools that reflect reality, not partial metrics or marketing narratives.
Denniston Data delivers this through:
- Transparent methodology
- Evidence-based scoring
- Multi-year claims that reveal true expertise
- Integration of cost and quality at the procedure level
Healthcare shopping can only work when the data reflects what truly matters: the right provider, for the right procedure, at the right time, at the right price.
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.
Join an intro to PRS Webinar:
https://zoom.us/webinar/register/7117646163323/WN_2ELqNeDSS2W-fMPb4lOsRA
Or schedule a discovery call with Denniston Data:
