The Strategic Power of Quality Care: Why Member Guidance Matters

When members need to choose a provider, they're often scrolling through in-network directories, asking friends for recommendations, or simply booking whoever has the first available appointment.

Here's what they don't know: the provider they choose will shape everything that follows including recovery time, complication risk, or how much they'll pay over the course of treatment. Because provider decisions drive 80% of healthcare spending, that initial choice determines whether members get the right care or just more care.

The challenge isn't that members don't care about quality. It's that most haven’t recognized the importance of quality care or understood why it matters to their lives. Because no one has ever clearly explained how dramatically provider performance varies, even within the same specialty, same network, or same city, members are left to assume all in-network care is essentially equal.

Plans and employers that bridge this gap, that educate on quality differences and why they matter, position themselves as true partners in health.  

What Quality Care Means (And What It Looks Like)

Quality care is not defined solely by credentials, convenience, or bedside manner. Quality care means the right treatment, at the right time, based on evidence-based medicine that works.

Here's what quality looks like: One orthopedic surgeon exhausts conservative treatment before recommending surgery and achieves excellent outcomes. Another operates on most patients who walk through the door, with higher complication rates. Both are in-network and have comparable online reviews, but only one practices evidence-based medicine.  

Communicating this variation in quality is a strategic advantage for plans and employers working to curb rising healthcare costs. When members land with low-performing providers, the consequences compound quickly: from avoidable ER visits to prolonged recovery times that keep them out of work and drive additional spend.  

For health plans: Better care choices mean stronger member engagement, improved outcomes,  and lower medical costs.  

For employers: Quality care translates directly to a healthier, more productive workforce with fewer missed workdays, lower disability costs, and higher employee satisfaction. It significantly reduces avoidable medical spend by steering employees to providers who deliver appropriate, evidence-based care.

Ultimately, plans and employers that educate their members on quality differences position themselves as trusted allies in better member health.  

Turning Data Into Meaningful Guidance

The challenge isn't a lack of quality data. It's that most tools don't measure what matters: appropriateness of care.

Appropriateness means delivering the right care at the right time, avoiding unnecessary procedures and following evidence-based guidelines that improve outcomes. Traditional tools like provider directories and star ratings weren't built to measure appropriateness. Without it, even sophisticated point solutions risk steering members toward providers who overtreat, undertreat, or take the wrong clinical approach.

Embold uses objective, clinically rigorous, peer-reviewed data to evaluate providers on evidence-based appropriateness. Intelligent tools like Provider Guide don't just list in-network providers; they show which ones consistently deliver high-quality, appropriate care.

When members can see clear, objective ratings based on clinical performance (not popularity or convenience) they can make confident, informed decisions about their health.  

Communicating Quality In Moments That Matter

Provider Guide meets members across multiple touchpoints where care decisions happen:

For health plans: Clear provider ratings accessible through online portals or integrated health plan platforms show which providers follow evidence-based practices, helping members choose with confidence.

For employers: Provider Guide integrates into benefits platforms and wellness communications, making quality information available during open enrollment and throughout the year when employees actively search for care.

The point isn't to limit choice, it's to inform it. When members understand why one provider is better than another, they’re engaged in their own care journey and feel ownership over their decisions.  

Three Ways Guidance Changes Outcomes

Provider Guide helps members in three ways:

1. Avoid low-value care and unnecessary procedures. Evidence-based providers are less likely to recommend treatments that don't improve outcomes, protecting members from unnecessary risk while reducing costs.

2. Empower confident decision making. The most critical moment to engage a member is before they choose a provider. The understanding of quality care helps empower better, more confident decision-making with guidance to the right provider.  

3. Build trust through guidance, not more options: Members don’t need more choices; they need better ones, and clear guidance based on quality establishes a benefit program that truly benefits the overall health of the members they serve.  

Making Quality Impossible to Ignore

The most effective way to communicate quality is to make it impossible to ignore. Not buried in a benefits guide, but visible when members are actively choosing providers. Not abstract scores, but clear evidence of which doctors consistently deliver the right care.

Better care choices lead to fewer complications, lower costs, and a healthier, more engaged workforce. But those outcomes only happen when you've done the harder work: educating members on what quality means and why it matters.  

Plans and employers that get this right don't just talk about quality—they make it actionable. Because when members ask, "which provider should I see?" and you can point them to the right answer based on evidence, not popularity contests, you're not just cutting costs. You're keeping your promise to help them get the care they deserve.  

Discover how Embold Health is transforming care. Download the Transforming Healthcare by Measuring What Matters e-book today.