Finding the RIGHT Doctor: Leveraging Responsible AI to Assess Provider Quality and Simplify Navigation

The following is a guest article by Daniel Stein, MD, Founder and CEO at Embold Health

Finding a doctor should be simple, but it rarely is. Search engines return hundreds of results. Online reviews tell conflicting stories. A friend or family recommendation, though provided with good intentions, might not be the best fit. The process for finding a good healthcare provider is often overwhelming, unclear, and can lead to the wrong care. This, in turn, leads to poor health outcomes and unnecessary costs.

Every minute, people make more than 70,000 health-related searches. But information overload doesn’t lead to better care, it leads to confusion. There’s a better way forward: guiding patients to high-quality care without the noise.

The State of Healthcare Navigation

How do you know who’s qualified to treat your condition? Most people don’t. 

In fact, 75% turn to online reviews as the first step when searching for a new provider. Reviews and star scores don’t reflect clinical outcomes or expertise, and the consequences are real. Choosing the wrong provider can lead to poor health outcomes, misdiagnoses, and unnecessary costs. The connection between how better care lowers medical costs is well established. In fact, providers determine 80% of healthcare spending; therefore, guiding members to the right providers directly impacts the total cost of care. Yet the tools to guide patients to better care are still underutilized.

Healthcare has improved in many ways. But there remains the opportunity to adopt AI tools that can make navigating care easier for patients and more aligned with clinical quality for better results.

Understanding AI’s Role in Healthcare Navigation and Provider Selection

The Potential of AI to Simplify Healthcare Navigation

AI is transforming how people make healthcare decisions. Instead of searching and hoping for the best, patients can seamlessly receive the necessary guidance to make informed healthcare decisions about high-quality providers. Intelligent AI can assess symptoms, understand personal health details, and provide context-aware guidance and recommendations for providers who are best suited to help. 

This is a major shift — from passive searching and outdated symptom checkers to active, informed healthcare decision-making.

The Benefits of AI-Powered Healthcare Navigation

Provider quality data is the engine behind better recommendations. When AI tools use this data, they can match patients with doctors who have a strong track record in treating specific conditions.

It doesn’t stop at specialties. Conversational AI can consider personal preferences — like location or language — and use conversational interfaces to answer questions in plain language. A simple question about symptoms can lead to a recommendation for what type of specialist to see and a targeted list of high-performing providers nearby. 

This level of personalization helps patients avoid poor quality care and unnecessary steps. It also gives them a clearer path forward for optimal care — one that’s based on data, not guesswork.

The Role of Provider Quality Data

Not all providers deliver care the same way. That’s why quality data matters.

Quality data should evaluate provider performance across key metrics like patient outcomes, cost-effectiveness, and adherence to clinical best practices. When used responsibly, AI enables reliable, data-driven assessments of healthcare quality, empowering employers and patients to make informed decisions. 

Going even further, sharing this information openly between patients and healthcare providers builds long-lasting trust. Patients are more confident when they understand how a doctor actually performs and don’t have to rely on opinion-driven information based on what others say about them.

Prioritizing Responsible AI

AI models are only as good as the data they’re built on. If the data isn’t representative, the results won’t be fair or accurate.

That’s why training AI on diverse and representative datasets matters. Additionally, regular audits and testing are necessary to make sure the algorithms work across different patient populations. Without this, AI can miss important context or worse, reinforce disparities.

Ensuring the accuracy, fairness, and robustness of AI algorithms is critical for effective healthcare provider selection, while continuous learning and refinement of these models will drive ongoing improvements in healthcare quality and patient outcomes.

The Importance of Collaboration and Continuous Improvement

Developing effective AI solutions in healthcare doesn’t happen in isolation. It takes ongoing partnerships between healthcare organizations, technology teams, and healthcare solution providers.

Because ultimately, the experience must work for the patient. If tools aren’t easy to access or use, they won’t help. AI solutions need to be integrated into the platforms people already use, like employer portals or health plan apps, so that the right guidance feels natural and seamless.

Empowering Patients with AI-Driven Insights and Support

The goal of responsible AI in healthcare navigation is to empower patients to make the best decisions for their health. 

When AI tools can explain provider performance clearly — and back it up with quality data — patients feel more prepared and more engaged in their healthcare. They’re not left wondering if they made the right choice. They know they made the right choice.

Solutions built with responsible AI give people the confidence to act, the information to move forward, and an easy-to-use experience that helps patients find the right doctor. As AI evolves, ongoing evaluation and refinement will be key to keeping it accurate, fair, and effective.

Finding a quality healthcare provider doesn’t have to be a guessing game. With responsible AI paired with provider quality data, the path to better health is simple.

About Daniel Stein

Daniel Stein is the Founder and CEO at 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.