The Orchestra Needs a Conductor: Why Health Care Doesn’t Need More Point Solutions

My doctor said something to me recently that I haven’t been able to shake: “Whenever I have a patient who gets colon cancer, I feel like a failure. This is preventable if the whole system just worked together.”

He was right to feel frustrated. I’ve watched it play out over and over, most painfully with my own brother-in-law. Nearly two years before my brother-in-law was finally able to get a colonoscopy, he first went to his doctor with gastrointestinal symptoms. The prior authorization for his colonoscopy didn’t go through. The procedure was delayed. Then the pandemic hit, and the backlog grew. By the time he was screened, he was handed the devastating diagnosis of stage 4 colon cancer.

What followed was surgery, sepsis, chemo and months in the intensive care unit. He had an internist, an oncologist, a surgeon and a hospitalist. But their systems didn’t talk to each other. After a long fight, my brother-in-law passed away.

I’m not saying a better system could have saved him. But I am saying the experience could have been better.

Every year, out of more than 100 million specialist referrals¹ in the U.S., only half are completed because the handoff failed.²

This is not a medical failure. It’s a coordination failure. We don’t need more instruments in this orchestra. The orchestration of care is what is missing. We need a conductor.

The point solution trap

The health care industry has invested heavily in point solutions ($100 billion). We have one tool for scheduling, another for prior authorization, another for analytics and another for patient engagement. No-shows cost the U.S. health systems $150 billion annually³ as patients slip through the cracks of fragmented care.

Adding another electronic medical record (EMR) module or building another integration optimizes one corner of the system, but it can’t move work across organizational boundaries. It can’t coordinate. Sixty-eight percent of specialists⁴ report receiving no preliminary information before patient referral visits. The systems exist, but they don’t talk to each other. The solution to this problem is not another point solution, but rather orchestration. An operating spine that sits above the fragmented systems and enables true coordination across them.

This realization crystallized for me across my career. In pharma, I learned that the best drugs in the world are just hope in a bottle until they actually reach patients. When I led the private health care company Thirty Madison, I saw that removing friction from care delivery can make a difference. But consumer-driven models can only go so far in a system built on payers and providers.

The challenge is applying these lessons at the systems level. We now have the right tools, so how can we get them to work together?

Building the execution layer

Having led complex health care operations, I’ve learned that the framework requires three components in order for a conductor to work across different organizations and serve as an execution layer:

First, a unified record. Everyone has to work from the same record. You can’t coordinate care if the payer and provider are looking at different versions of the truth. This means creating a longitudinal view of the patient’s record that unifies clinical, financial and policy data. Not just what’s in the EMR, but insurance coverage, prior authorization requirements and payment policies.

Second, clear action.Using the record, a system needs to clearly identify and take the next best action so that recommended care actually becomes completed care. Ambiguity in handoffs is one of the most expensive problems in U.S. health care, and at scale, if there is not absolute clarity on the path to completion, the system defaults to individuals trying to bypass broken processes. Whether the action needed is scheduling appointments, completing a prior authorization or closing a gap in care, the system should make the action visible to the appropriate stakeholders and drive it to completion. This ensures a patient moves toward a finished clinical outcome rather than a stalled recommendation.

Third, aligned incentives. We have to reward coordination, not just activity. If my incentive is to clear my queue or deny claims, patients lose. If we align everyone to the next best action, patients win.

Health care artificial intelligence (AI) spending reportedly hit $1.4 billion in 2025, nearly tripling 2024’s investment. There’s tremendous excitement about AI in health care, and rightly so. But too often, AI is being deployed as another point solution.

AI deployed as an execution layer becomes the connective tissue that enables systems to work together. When these capabilities work together as infrastructure rather than isolated tools, organizations can move from flagging problems to preventing them. From optimizing individual workflows to orchestrating entire care journeys.

The stakes are clear

The toll of fragmentation extends beyond the staggering financial cost. Behind every coordination failure is a patient whose care was delayed, whose outcomes may have suffered.

And behind every administrative burden is a clinician pulled away from patient care. Physicians spend more than a third of their time on paperwork, over a day and a half each week. That doesn’t include what is referred to as “pajama time,” the excessive, often unpaid hours doctors spend at home finishing EMR documentation after their clinical day ends. Nearly 35% of physicians spend over six hours per week on these tasks, a major contributor to burnout.

Time that could be spent healing instead of navigating broken handoffs and fragmented systems.

As health care leaders, we must evaluate solutions to fragmentation by asking the right questions: Does this coordinate with my system? Or does it add another layer they have to manage?

This is a choice point for the industry. An industry that is showing tremendous interest in AI and making investments that will bring value to our health care system. We can either continue adding instruments to an already crowded stage, or we can think beyond points in time and build the execution layer the future of our system needs.

Michelle Carnahan is co-founder and CEO of Arbiter

References

1. Weiner M, Perkins AJ, Callahan CM. Errors in completion of referrals among older urban adults in ambulatory care. J Eval Clin Pract. 2010;16(1):76-81. doi:10.1097/JAC.0000000000000219

2. Vimalananda V, Dvorin K, Fincke BG, Tardiff N, Bokhour BG. Patient, PCP, and specialist perspectives on specialty care coordination in an integrated health care system. J Ambul Care Manage. 2018;41(1):15-24. doi:10.1097/JAC.0000000000000219

3. Pappas P. The $150 billion cost of poor patient communication. Digital Health Insights. February 16, 2026. Accessed August 28, 2026. https://dhinsights.org/news/the-150-billion-cost-of-poor-patient-communication

4. Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15(9):626-631. doi:10.1046/j.1525-1497.2000.91119.x