Every doctor brings unique training, experience, intuition and perspective to the table. Yet, this human element also contributes to a persistent challenge in healthcare: variations in care.
Even with the proliferation of evidence-based guidelines, there are wide discrepancies in how physicians diagnose and treat similar conditions. This isn’t just a clinical or academic issue—it’s a human one. As physicians, we take an oath to “do no harm.” But harm can come not only from mistakes or errors, but also from inaction, misdiagnosis, overtreatment or unnecessary procedures that increase cost and risk. While practicing as a physician, I witnessed dangerous variations in care first-hand – both as clinician caring for patients and as a patient receiving medical care myself.
To reduce this kind of harmful and costly variation, the path forward isn’t to enforce rigid standardization. Instead, it’s to identify and empower the physicians who consistently deliver appropriate, high-quality care. Doing that requires better provider performance data— data that reflects not only outcomes and satisfaction, but also clinical appropriateness.
The Problem: Inconsistent Care Despite Clear Guidelines
Anyone who has sought a second opinion knows the experience: the patient and their clinical situation is the same, but they often get wildly different recommendations from different doctors. Whether it’s something major like spine surgery for back pain or something more mundane like antibiotics for sinus infections, variation persists and sometimes, dramatically so.
While clinical guidelines offer a framework, they’re not always interpreted the same way. Human judgment plays a role, as does the individual training and local practice culture of a provider. This leads to inconsistency and, at times, to unnecessary care that puts patients at risk and drives up costs.
A Better Way Forward: Start with the Best Doctors
Rather than attempting to reduce variation by force, we have an opportunity to reframe the solution: Couldn’t we identify the top-performing physicians and build around them?
Top doctors don’t just get good results. They make accurate diagnoses, offer appropriate treatments and avoid unnecessary interventions. They know when to act and when to hold back. They stay current on the latest literature and bring that knowledge to the bedside.
Critically, performance data must be shared with physicians— not as a punitive measure, but as a tool for continuous improvement. When providers can see how they compare to their peers and the latest clinical evidence, they can apply new learnings and utilize additional knowledge as an opportunity for professional growth. Most providers aren’t experts in quality improvement; they are experts in delivering care. Providing the tools needed to improve their practices results in lower-performing providers improving their care delivery and giving high-performing providers the opportunity to step into new models such as value-based care.
The Missing Metric: Appropriateness of Care
Too often, provider performance data is measured by proxies like patient satisfaction or intermediate process data. While helpful, these metrics have historically missed a vital piece— appropriateness. Whether the care provided was necessary, evidence-based and timely.
Appropriateness matters because it directly addresses the question, “Was this the right care, at the right time, for this patient?” To answer that, the data has to be both rich and objective: longitudinal so you know what happened to the patient previously, patient-level information that includes comorbidities, demographics and comprehensive so providers know what other physicians and specialists were involved in the patient’s care.
A Case in Point: C-Sections and Obstetric Care
Consider C-sections. They are a common and sometimes lifesaving medical intervention. But in low-risk pregnancies, unnecessary C-sections can cause physical and emotional harm, prolong recovery and drive-up costs.
A recent 2023 JAMA Health Forum study showed that 92–94% of U.S. pregnancies are considered low-risk. Yet rates of C-sections for low-risk pregnancies vary wildly based on the provider. In the top 10th percentile of providers, only 15% of low-risk deliveries involved a C-section, and in the bottom 10th percentile, that same figure is 50%—a staggering 35-point difference. Additionally, unnecessary C-sections put patients at risk for further complications which can lead to longer hospital stays or readmissions.
- Postpartum infection (including endometritis and wound infection)
- Hemorrhage and transfusion requirement
- Venous thromboembolism (VTE)
- Anesthetic complications
- Surgical injury
- Longer recovery time and delayed return to normal function
These aren’t just statistics. They’re real experiences with real patients that carry long-term consequences.
What Better Data Can Unlock
With accurate, appropriateness-focused provider performance data, everyone benefits.
For patients, it means more confidence in choosing the right doctor—someone who’s less likely to over- or under-treat their condition.
For payers and employers, it creates opportunities to design smarter networks that prioritize value over volume.
For the healthcare system at large, it paves the way for reduced waste, more accountability and ultimately, better health outcomes at lower cost.
Building the Path Forward
Achieving a healthcare system that prioritizes appropriate, high-quality care requires a deliberate and data-driven approach. To realize this vision, there are several key steps.
First, build comprehensive performance metrics that explicitly incorporate appropriateness. By assembling a significant multi-payer dataset of comprehensive claims data, the entire care journey can be assessed— capturing not just what was done, but whether it was the right thing to do at the right time – down the individual provider.
Second, provider performance data must be made transparent and actionable. Data on provider performance must be translated into clear, trustworthy insights that both patients and providers can understand and use. Patients need this information to make informed choices about their care, and providers need it to benchmark their performance, identify opportunities for improvement and feel empowered rather than penalized.
Third, support and incentivize top-performing physicians. To drive meaningful change, the healthcare system needs to realign incentives to reward the consistent delivery of high-quality, appropriate care. Recognizing and compensating physicians for making the right decisions will foster a culture that prioritizes value over volume.
Finally, partner with the right organizations to bring this vision to life. From health systems to payers, and from employers to technology and data companies, collaboration is essential to develop and scale platforms that can analyze care precisely and appropriately. Working with innovative partners who have the tools, infrastructure and clinical expertise to operationalize this kind of insight is essential to success.
From Variation to Value
Variation in care is inevitable. Harmful variation is not.
To truly improve outcomes, reduce costs and honor the oath to “do no harm,” the healthcare system must prioritize identifying and supporting the physicians who deliver consistently appropriate care. That starts with better provider performance data.
Let’s give patients, providers and health systems the clarity they need to choose wisely and the tools to build a better healthcare future for all.
Daniel Stein, MD, MBA
Daniel Stein is President and Founder of Embold Health, a data analytics company that is creating a new standard for healthcare quality. Bringing together the largest dataset in healthcare, clinically validated analytics and the expertise of leading physicians and data scientists, Embold shines a light on top-performing doctors, ensuring that people receive better care and all doctors have the opportunity to improve. Prior to founding Embold Health, Stein served as Chief Medical Officer of Walmart Care Clinics, where he led the retailer’s efforts to offer quality, affordable primary health care services. Stein launched his career in healthcare by holding various policy positions in Washington, D.C., while completing his medical degree at Johns Hopkins School of Medicine in Baltimore.
