The High Cost of Getting It Wrong: Why Provider Choice Matters More Than You Think

Every healthcare journey begins with a few simple questions: What’s wrong with me? Who can help me?  

Answering the first question often leads directly to the second. Once people recognize they need care, the next, and often most overwhelming, step is figuring out where to go. With a lack of guidance, members turn to word of mouth, online reviews, or limited provider directories — tools that rarely reflect the true quality of care. As a result, members end up in the waiting rooms of low-performing providers without knowing it.

When members land in the wrong waiting rooms, the impact goes beyond a poor experience. It drives significant variation in care, one of healthcare’s most persistent and costly challenges.

The High Cost of Care Variation

Unwarranted variation in care is one of healthcare’s most persistent and expensive challenges. Members who choose (or are guided to) providers who don’t practice evidence-based medicine are at a higher risk of:

• Unnecessary procedures that add risk without improving outcomes.

• ER visits that are entirely preventable.

• Higher complication rates that prolong pain.  

These aren’t isolated events; they happen every day. Choices made by providers impact 80% of the healthcare dollar.  And these costly risks quickly compound to increase the overall cost burden for employers, health plans, and the healthcare system as a whole.

Appropriateness: The Missing Link in Provider Choice

Traditional tools — whether they’re provider directories, star ratings, or network “find a doctor” portals — weren’t designed to guide members to the right care, or consider cost and quality. While these tools may highlight convenience, cost, or availability, they often overlook the critical dimension of quality. Cost considerations matter, but without quality, savings are short-lived and outcomes are compromised. These tools don’t answer the most critical question: Is this provider proven to deliver the right care?

This concept,  appropriateness, is the missing link in most definitions of healthcare quality. Appropriateness refers to whether a provider delivers the right care, at the right time, for the right patient. It means avoiding unnecessary or low-value services and instead following evidence-based guidelines that improve outcomes.  

By measuring appropriateness, providers who consistently make high-quality, clinically sound decisions that benefit both patients and employers can be highlighted. Without this measurement, even the most polished tools risk guiding members toward providers who overuse, underuse, or misuse care.

Turning Insight into Action

At Embold, we take a different approach. By using objective, clinically rigorous, and peer reviewed data, we evaluate providers on what matters most: whether the care they deliver is evidence-based and appropriate.

And we don’t stop there. Our solutions put this insight directly in members’ hands, offering real-time guidance before the care decision is made. Tools like Provider Guide, Embold Virtual Assistant, Referral Guide, and more equips members and care teams to choose the right care, the first time. This is where the biggest impact happens — helping members choose high-quality providers quickly and efficiently.

The result? Fewer unnecessary procedures, fewer avoidable complications, and fewer wasted dollars. But most importantly, it means members receive care that helps them get healthier, faster.

Why It Matters More Than Ever

Healthcare costs continue to rise, and organizations are under pressure to deliver smarter, more effective benefits. Getting provider choice right isn’t just a cost-saving measure — it’s a way to protect the well-being of employees, members, and their families.

The most important moment to engage a member? Before they make a care decision. Choosing a provider. Weighing treatment options. Deciding whether to seek help. These are the moments that drive outcomes and costs.

The consequences of missing this moment are significant. When members don’t get the right care from the start, it drives up costs for health plans and employers, delays recovery, and puts their overall health at risk.

When members have confidence they’re seeing a provider who delivers high-quality, evidence-based care, everyone wins because:

• Employers gain a healthier, more productive workforce.

• Health plans achieve stronger engagement and measurable improvements in quality metrics.

• Members avoid costly missteps and experience better health outcomes.

The Right Answer, The First Time

Choosing a provider is one of the most important decisions in healthcare — and one of the easiest to get wrong. With trusted, evidence-based insights, Embold helps ensure member choices are  guided by more than convenience.

Because when members ask “which provider should I see?” and then they have the tools/guidance for choosing the right provider, they don’t just avoid unnecessary costs — they get the care they deserve.