What Truly Defines High-Quality Healthcare?

When looking at messaging and marketing coming from both healthcare providers and health insurance carriers, we see the term  “high-quality care” a lot. The problem with this phrase is that it doesn’t seem to mean the same thing across all providers, so determining what “high-quality” truly means can be tricky. Thankfully, self-funded health plans have access to tools that help employers analyze objective data to identify the truly highest quality healthcare providers with incredible outcomes. Let’s take a look at how you can determine which physicians will provide superb care for your employees.

How to find high quality

When looking for quality, physician reviews only go so far. But there are two important questions you can ask to uncover more reliable quality indicators:

1. How often does the provider do the procedure?

As the saying goes, “practice makes perfect” (or at least proficient)! One of the best indicators to examine when determining a high-quality provider is how often they perform a procedure. As Mike shares in this video, some physicians perform a procedure much more frequently (say, all day every day) than others who may perform the same procedure only once or twice a month. Just because a patient receives a referral to a provider who can do the procedure, it does not mean that the provider necessarily performs it often enough to have consistently good outcomes.

2. What are the historical outcome scores?

In addition to understanding frequency, you don’t have to guess what the long-term outcomes from a provider look like – the data is public and accessible. We recommend utilizing the Medicare claims database, which reports on the number of times physicians perform a procedure, as well as any outcomes and complications from those cases. While this database accesses an incredible amount of useful information, it can be difficult to interpret the data directly from their platform. Thankfully, third-party platforms have begun to integrate the data into easy-to-understand tools that can help both plan providers and consumers to make more informed decisions about their care.

One such tool is Quantros, a tool created by Healthcare Bluebook that normalizes Medicare data for the risk within each patient treated, allowing us to compare providers more equally. Data from Quantros is readily available on the Sage Transparency dashboard, free to any and all healthcare consumers. 

Note: Sage Transparency is currently undergoing updates and will go live in May of 2024.

Our Innovative Approach

While nearly every health insurance and healthcare provider touts their ability to provide high-quality services at low costs, we know that message simply isn’t ringing true. As Mike puts it in this video:

“We know health insurance and healthcare are not affordable and not always low cost, and that bad things do happen when people interact with the healthcare system. So both things can’t be true.”

Our team believes that healthcare customers deserve the best quality care, and we believe health plans should prioritize this too. That’s why we are committed to investing the time and energy it takes to discern who the truly highest-quality providers are, so that both employers and plan participants can make the most informed choices possible. 


We’d love to chat with you about how we can unlock healthcare cost and quality transparency for your team!  Contact the Total Control Health Plans team today to learn more.

Recent & Related

Reflections on the Recent Johnson & Johnson Lawsuit

For those of us in the employee benefits world, quite a bombshell was dropped on Monday, February 5th when a class action lawsuit was proposed against Johnson and Johnson, and specific executives, for breach of fiduciary duty under the Employee Retirement Income and...

read more
Upcoming Webinar Series – Anatomy of a Self-Funded Plan

Upcoming Webinar Series – Anatomy of a Self-Funded Plan

Anatomy of a Self-Funded Plan: Administration and Data Part 1 of our 5 Part Webinar Series Join us for a Free Webinar on Wednesday, February 28th from 12-12:30pm SHRM Credit Available Register Now As more and more employers consider self-funding as the preferred model...

read more