Question it answers
A network can measure utilization and cost and still leave patients to assemble their own path from directories, portals, and phone numbers. Who is doing that work, and what would the network need to take it on?
The essay calls the answer orchestration, in which the network interprets the need, recommends the pathway, finds usable capacity, makes the connection while preserving clinical judgment and patient preference, and stays accountable until the need is resolved.
How to use it
Walk one common way into care, such as a new symptom or a specialist referral, from the patient's side. At each step, ask who decides what happens next. Then check four capabilities:
- Understand demand. At the point of entry, can we identify the patient's clinical need, urgency, and appropriate level of care?
- See usable capacity. Can we see the appointments a patient could actually get in time, across every practice and setting?
- Route deliberately. Do we direct each patient by clinical need, access, performance, continuity, and cost?
- Own resolution. Can we tell whether the intended care happened, and does someone intervene when it did not?
Any step the patient, family, or referring physician still owns is work the network has yet to take on. The five capabilities in the Leaders' Build Sheet fold into these four as the build list.
In practice
A patient who leaves a visit with a list of cardiologists and a number to call is carrying the complexity. To pass the test, the network has to know which cardiologist is clinically appropriate, takes the patient's coverage, meets its performance expectations, and has usable capacity in time, then help arrange the visit and confirm it happened.
One clinically integrated network built its virtual-first care model around a single point of entry, so the network does the routing from the first contact.
Where it breaks
- The network sees only the doors it owns.
- A patient who starts at a retail clinic or a competitor's urgent care never reaches the network, so the test starts where the network first sees the need.
- Usable capacity is hard to see.
- Across independent practices on separate scheduling systems, this capability usually takes longest to build, and routing without it sends patients to schedules with no room.
- Owning resolution costs money first.
- On fee-for-service revenue, the network pays for the staff and data that close each loop while a payer keeps much of the saving, which is where the Attribute-Steer-Pay test comes in.
- The patient still chooses.
- A patient who prefers another physician or setting keeps that choice, so the network earns its routing through access and trust.
What it borrows
- Patient navigation, which Harold Freeman began in Harlem in 1990 to eliminate barriers to timely cancer care (Freeman and Rodriguez, Cancer, 2011). Orchestration builds that aim into the network's own data and scheduling.
- Burden of treatment. Carl May, Victor Montori, and Frances Mair argued that the ways we manage chronic disease have created a growing burden for patients, and called for minimally disruptive medicine (BMJ, 2009). The test applies that idea to getting to care.
- Referral breakdowns. Ateev Mehrotra and colleagues found that primary care physicians often do not know whether a patient reached the specialist or what the specialist recommended ("Dropping the Baton," Milbank Quarterly, 2011).