How we got here — a quick scene-setter

• Who are you and what’s the single most important outcome you’ve been asked to deliver this year related to physician networks?
• Which title best describes your role in decisions about physician alignment and network strategy? Options: Chief Strategy Officer/CSO, VP/Director, Physician Enterprise, President, Physician Enterprise, ACO Executive/Leader, CMO/Clinical Leader, Other
• Roughly how many employed or closely affiliated physicians are in scope for this effort? Options: Under 100, 100–299, 300–999, 1000+, Unsure
• Tell us about one recent moment — a meeting, a report, a conversation — that made this initiative feel urgent.
• Which of these is your primary driver for change right now? Options: Protect referral volume from competitors, Reduce physician employment cost growth, Close specialty/geography network gaps, Prepare for value-based contracts, Improve physician engagement and governance, Other

Are we comfortable letting referrals slip away?

• How many referral relationships do you estimate have moved to competitor systems in the last 12 months? Options: None / minimal, Some visible losses (1–5%), Moderate losses (5–15%), Significant losses (15–30%), Severe losses (30%+), Don't know
• Give one or two concrete examples of referral shifts you've watched happen — which specialties, what triggered the move, and how leaders reacted.
• How do those losses feel inside the organization — embarrassment, denial, urgency, or something else? Options: Urgency to act, Frustration/Blame, Denial/minimization, Confusion, Resignation, Other
• What short-term and long-term business consequences are you most worried about if this trend continues?
• Which data sources currently tell you about leakage and retained referrals? Options: Claims/admit data, EMR referral logs, Payer reports, Third-party analytics, Anecdotal/physician feedback only, Other

What’s quietly driving your employment and alignment costs?

• Are you confident the current physician compensation and employment model is sustainable — or is it quietly fueling the problem? Options: Sustainable, Some unsustainable elements, Clearly unsustainable, Unsure
• Which of the following cost drivers are most material for you right now? Options: Guarantees/guaranteed income, High PTO/benefits burden, Malpractice/subsidies, Excessive FTE per clinic, Inefficient referral management, Other
• How transparently do physicians understand how their pay is tied to referrals, quality, or system goals? Options: Very clear, Somewhat clear, Confusing, Not at all
• Share an example where a compensation design or employment term created unintended behavior or costs.
• If we could change one compensation or employment lever quickly, which would move the needle most for you? Options: Reduce guarantees, Tie to referral retention, Quality/value incentives, Productivity redesign, Standardize benefits, Other

Where are the gaps that let patients and revenue walk out the door?

• If I asked you to point to the three specialties or service lines where our network is most fragile, which would you name and why?
• Across your service area, where do patients need to go outside the system most often — neighboring system, ambulatory surgical center, or independent specialists? Options: Competing health system, Independent specialists, ASC or outpatient centers, Out-of-market tertiary centers, Other
• What geographic pockets show the highest referral leakage or lowest coverage for high-demand specialties? Options: Urban core, Suburban clusters, Rural counties, Satellite clinics, Multiple/varied
• How would you quantify the gap right now (e.g., wait times, uncovered zip codes, percent unmet demand)? Please share the most reliable metric you track.
• Which patient populations or payers are most affected when those gaps show up? Options: Medicare, Medicaid, Commercial, Self-pay/uninsured, Dual-eligible, Other

Who pulls the levers — and who quietly says no?

• When a major physician alignment decision comes up, who actually gets the final sign-off — and who has informal veto power? Options: Board/Executive Committee, CSO/CEO, Physician Enterprise President, CMO/Medical Staff, Large physician groups/clinician influencers, Other
• Tell us about a clinical leader whose support would make or break success — what motivates them and what worries them?
• How formalized is your governance for physician alignment and network decisions today? Options: Well-defined charter and processes, Some committees with unclear authority, Ad-hoc/leader-driven, No formal governance
• How do frontline physicians typically express concerns — through formal channels, leaders, or quietly in conversations? Options: Formal governance, Department leaders, Direct to executives, Informal hallway conversations, Not expressed
• What would 'good' look like to your executives versus your clinical leaders — list the two top expectations each group would use to say 'we're succeeding'.

If we flipped the script — what would success actually feel like?

• What single measurable outcome would make leadership say this engagement was worth it — referral retention, cost reduction, network coverage, or something else? Options: Referral retention percentage, Employment cost reduction, Network adequacy by specialty/zip, Value-based contract readiness, Physician engagement scores, Other
• What target ranges feel realistic for that outcome over 12 and 36 months? Options: 12 months: low / 36 months: aspirational, 12 months: modest / 36 months: meaningful, 12 months: aggressive / 36 months: transformative, Unsure — need benchmarking
• Which leading indicators would you want to see in month 3, 6, and 12 to feel confident progress is real? Options: Referral retention trends, New recruit pipeline, Comp alignment implemented, Governance cadence started, Analytics dashboards live, Other
• How much risk tolerance do leaders have for disruptive changes to physician contracts or referral patterns? Options: High — willing to move fast, Moderate — phased approach, Low — prefer minimal disruption, Depends on specialty
• What would success feel like to patients in your communities — faster access, local specialty coverage, lower costs, or something else? Options: Faster access, Local specialty coverage, Better-coordinated care, Lower out-of-pocket costs, Clearer referral pathways, Other

What’s stopped good ideas from becoming reality before?

• When past network or compensation initiatives stalled, what was the proximate cause — politics, data gaps, funding, or execution? Options: Politics/physician resistance, Insufficient data, No committed funding, Operational overload, Poor governance, Other
• Describe a time you pushed a change and the physicians responded in an unexpected way — what happened and what did you learn?
• How ready is your data environment to support referral-level analytics and tracking (claims, referrals, attribution)? Options: Ready today, Partially ready — some gaps, Major gaps — needs work, We don't know
• Which stakeholders must be involved before you can confidently start execution (names, roles, or groups)? Options: C-suite, Physician enterprise leadership, Finance/Comp, Operations/Access, IT/Analytics, Medical staff leaders, Payer contracting
• If we recommended a change that risked short-term revenue but improved long-term retention, how would your leadership evaluate it? Options: Accept with business case, Require pilot/guardrails, Unlikely to accept, Depends on specialty

Small bets, measurable wins — what's our first move?

• If we agreed on a 90-day proof-of-progress, what one thing must happen in that period to demonstrate we're on track? Options: Referral retention baseline established, Compensation pilot designed, Top specialist recruitment prioritized, Governance charter signed, Analytics dashboard live, Other
• What specific data access do we need to start (claims, referrals, HR/payroll, scheduling), and who owns each source?
• Who should be our sponsor and who will be the day-to-day owner inside your organization?
• What would success criteria look like for the 90-day window — name up to three measurable acceptance criteria?
• Realistically, when can your team commit to initial interviews, data pulls, and a governance kickoff? Options: Immediately / this week, In 2–4 weeks, Within 1–3 months, Longer / need internal prep, Unsure
• Are there any non-starters or absolute boundaries we must respect as we design a plan (culture, financial limits, political red lines)?

Starting Where You Are

• Give a brief snapshot of the network or service area we're mapping (size, geographies, anchor hospitals, and any recent consolidations).
• Which of these best describes your organization’s primary structure for physician relationships? Options: Mostly employed, Mostly affiliated/independent, Hybrid (mix of employed and affiliated), TIN/ACO-led network, Other
• What is the approximate count of PCPs and specialists each (provide ranges if exact numbers are not handy)? Options: <50, 50–199, 200–499, 500–999, 1000+
• Describe the top 3 strategic priorities for the system this year (e.g., grow market share, manage employment cost, prepare for value contracts).
• Which payer relationships or contract types are most material to your referral economics right now? Options: Commercial HMO/PPO, Medicare FFS, Medicare Advantage, Medicaid/Managed Medicaid, Risk-bearing ACO or VBP contracts, Other
• How would you rate your confidence that leadership shares a single view of the network’s biggest operational problem? Options: High alignment, Some alignment with key differences, Fragmented views across execs, No consensus

What’s Actually Happening with Referrals?

• How surprised would you be if a competitor already owns the referral flows you think are ‘safe’? Options: Very surprised, Somewhat surprised, Not surprised, Unsure
• Over the past 12 months, which direction have your total in-system referral volumes trended by specialty? Options: Increasing materially, Slight increase, Flat, Slight decline, Declining materially
• Which specialties have shown the largest percentage leakage of referral volume to competitors (name up to 5 and % if known).
• What are the top reasons you hear from referring physicians when they send patients elsewhere? Options: Access/wait times, Perceived quality or outcomes, Physician relationships/personal ties, Insurance/network status, Specialty/service not available, Other
• How reliable is your current referral attribution—are you tracking origin PCP, episode attribution, and downstream specialists consistently? Options: Yes - robust attribution, Partial attribution across systems, Limited attribution (sampled), No reliable attribution
• Can you share a specific recent example where referral loss materially impacted volume, margins, or payer negotiations?

Where the Dollars Are Getting Eaten

• Which employment cost drivers do you suspect are growing faster than the value they deliver? Options: Guarantees/compensations, Over-hiring/low productivity, Locum/contract coverage, Facility overhead allocated to employed groups, Malpractice/benefits, Other
• Do you currently separate productivity-based compensation from alignment/incentive payments in your reporting? Options: Yes, clearly separated, Mostly separated with gaps, No, blended and opaque, Unsure
• Which specialties or service lines have driven the largest employment cost increases in the last 24 months?
• How often do you run a total cost of ownership (TCO) model for employed physicians that includes lost referral impact and facility costs? Options: Quarterly, Semi-annually, Annually, Rarely/Never
• Tell us about a hire or expansion that ended up costing more than expected—what were the hidden or underestimated elements?
• What financial thresholds (ROI, payback period, referral retention %) would make an employment spend acceptable to your CFO?

The Soft Signals: How Physicians Really Feel

• If physicians could vote with their feet, how would you describe the current mood in your employed and affiliated practices? Options: Highly engaged and aligned, Somewhat engaged with pockets of frustration, Disengaged/transactional, Actively considering leaving
• What are the three most common complaints or hidden resentments you hear from physicians about system policies, comp plans, or governance?
• Have you measured physician sentiment formally (e.g., surveys, focus groups)? If so, share cadence and key trends. Options: Quarterly survey, Annual survey, Ad hoc focus groups, No formal measurement
• How often do physician frustrations translate into visible behaviors that affect referrals (e.g., direct scheduling elsewhere, suggesting competitors to patients)? Options: Frequently, Occasionally, Rarely, Never
• Are there physician leaders (informal influencers) whose views significantly sway referral behavior? Who are they and why?
• Describe a recent conflict between system initiatives and physician preferences—how was it resolved and what was the fallout?

Gaps in Care and Access That Bite Outcomes

• What high-demand services or specialties do your patients commonly travel outside the network to receive? Options: Cardiology (interventional/EP), Ortho/joint replacement, Neurosurgery/spine, Oncology/infusion, Pediatrics/subspecialty, Other
• Where are your longest patient wait times or largest appointment backlogs today (by specialty or location)?
• How do access gaps vary by payer (e.g., MA patients facing different barriers than Medicare FFS)? Options: Significantly different by payer, Minor differences by payer, No meaningful difference, Unsure
• What is your current recruitment pipeline for critical specialties—time to hire, key obstacles, and success rate?
• To what extent are telehealth, APPs, or extended clinic hours being used to mitigate access issues? Options: Widely used across specialties, Used selectively, Pilot stage, Not used
• Name two places where insufficient network capacity has directly harmed a contract or patient outcome.

Data Realities — What Can You Actually See?

• If asked to prove referral retention for a payer tomorrow, would your data team produce a credible report within 48 hours? Options: Yes — ready now, Yes — with up to one week prep, No — needs substantial work, Unsure
• Which data sources are reliably available for analysis today? Options: EHR/EMR appointments and encounters, Claims (internal and payer), Practice management / scheduling, Provider directories, HR/compensation data, Other
• Where do you experience the biggest data quality problems (matching patients, provider IDs, missing referral reason, timeliness)?
• Do you currently have dashboards that combine referral flows, compensation, and access metrics in one view? Options: Yes, integrated dashboards, Partial dashboards across teams, No, separate reports only, No reporting
• Who owns the master provider directory and attribution logic today? Options: Clinical IT/analytics, Revenue cycle, Network operations, Provider relations, Other
• How frequently can you produce provider-level referral trend slices (weekly, monthly, quarterly)? Options: Weekly, Monthly, Quarterly, Ad hoc/rarely

Governance, Decision Rights, and Speed

• Who in your organization can veto a network change (hire, closure, comp change) and how often is that power exercised?
• How long does a typical decision from proposal to final approval take for physician network changes? Options: <2 weeks, 2–6 weeks, 6–12 weeks, >12 weeks
• Which governance body currently sets compensation philosophy and who sits on it?
• Describe one governance bottleneck that has blocked a recruitment or retention action recently.
• How are physicians represented in decision-making forums (formal votes, advisory, informal influence)? Options: Formal voting members, Advisory representatives, Informal influencers only, No physician representation
• What escalation path exists when a local market needs a fast staffing or access decision? Options: Clear rapid-approval path, Ad hoc executive escalation, No formal escalation, Unsure

What Success Looks Like — Small Wins and Red Flags

• What one tangible change in 90 days would convince you this initiative is on the right track?
• Which KPIs would you prioritize to judge early progress (pick up to 4)? Options: Referral retention %, Time-to-appointment/wait time, Provider productivity (wRVUs or visits), Recruitment time-to-fill, Compensation alignment score, Patient leakage by specialty
• What outcomes would feel unacceptable and require course correction within the first 6 months?
• Are there existing contractual or regulatory KPIs we must preserve during any transition? Options: Yes — payer contract KPIs, Yes — regulatory/certification KPIs, Both, None/Not sure
• How will success be communicated internally to sustain momentum (who needs to hear what and how often)?
• Which stakeholder groups must visibly approve progress milestones for the program to continue? Options: C-suite, Physician leadership, Finance/CFO, Operations, Board/Trustees, Other

Ready to Act — Constraints and Non-Negotiables

• What single condition would cause leadership to stop this effort immediately?
• Which of the following are hard constraints we must design around? Options: Budget cap, Union/collective bargaining, Regulatory limits, Payer contract restrictions, Provider FTE caps, None of the above
• Are there political or cultural fault lines between hospitals/markets that could block network-wide solutions? Options: Yes — clear fault lines, Some tensions but manageable, No significant political barriers, Unsure
• What is the absolute earliest and latest timeline you must adhere to for any pilot or rollout? Options: Immediate (0–30 days), 30–90 days, 3–6 months, 6–12 months, Flexible
• Who must sign off on budget and scope for a pilot engagement? Options: CFO/Finance, CSO/Strategy, Physician Enterprise Head, Operations/COO, Board, Other
• What minimum level of physician participation or buy-in would you require to move forward with a pilot? Options: Specific leaders only, 20–49% of impacted physicians, 50–74%, 75%+, Not specified

Quick Audit — Access, Data, and People We’ll Need

• If you had to name the single most critical dataset we must have access to in week one, what is it?
• Which of these data or access items can you make available within 30 days? Options: Claims data (payer), Referral logs/appointment data, Provider compensation files, Provider directories and credentials, HR FTE and org charts, None immediately available
• Who are the three internal contacts we should engage first for analytics, provider relations, and clinical leadership?
• Are there security, legal, or payer approvals that typically add significant lag to data sharing? If so, which ones? Options: Data use agreements, BAA/HIPAA review, Payer approvals, Legal/contract review, None
• What prefered communication cadence do you want for discovery findings (weekly check-ins, biweekly summaries, milestone reviews)? Options: Weekly check-ins, Biweekly summaries, Monthly milestones, Ad hoc as needed
• What would be the quickest win we could pull from the data to demonstrate immediate value (e.g., top 10 leaky PCPs, a specialty wait-time snapshot)?

Quick Check: What Outcome Are We Chasing First?

• In one sentence, what must this deployment achieve in the first 90 days to feel like a win?
• Which single metric would you use to say 'we launched successfully'? Options: Referral retention rate, Referrals routed to target specialists, Governance meetings launched, Compensation alignment executed, Analytics dashboards live, Other
• Who will be the primary sponsor on your side who will publicly sign off on that 90-day success metric? Options: Chief Strategy Officer / VP Strategy, President, Physician Enterprise, COO, CIO/CMIO, ACO Executive Director, Other
• What would make you hesitate to declare success at 90 days even if the metric shows improvement?
• How confident are you that internal teams will prioritize deployment tasks over day-to-day operational demands? Options: Very confident, Somewhat confident, Not confident, Unsure

What Would Happen If We Launched Without the Right Data?

• If critical referral and provider data were incomplete at go-live, what are the two biggest problems you expect to see in weeks 1–8?
• Which of the following data sources are required for referral routing, performance tracking, and compensation modeling? Options: EHR encounter/referral logs, Practice management/scheduling, Commercial and Medicare claims, Provider roster/credentialing, Compensation & HR data, Third-party referral platforms, Patient attribution files, Other
• For the sources you selected, which systems currently allow automated export or API access? Options: All selected systems, Some systems (list in next field), None — manual extracts only, Unsure / need to confirm
• Who currently controls access to those systems (role/title), and what’s the typical lead time to grant a scoped read-only feed?
• How tolerant are you of partial data at launch (e.g., 60–80% coverage) vs. requiring full coverage before any deployment activities? Options: Accept partial coverage and iterate, Prefer most data (80–95%) before launch, Require full coverage, Undecided

Who's Actually Going To Make The Hard Calls?

• If a governance decision forces a trade-off between clinician autonomy and standardization, who will be the ultimate decision-maker? Options: System CEO/COO, Physician Enterprise President, Clinical Council/CMO, Joint governance committee, Other
• List the people or groups who must be actively involved in weekly governance for the first 3 months (title/role is fine).
• Which governance model best describes how you want decisions escalated during deployment? Options: Tight central decisioning with exceptions, Shared joint committee with equal votes, Clinical-led with system oversight, Advisory committee; execs approve, Other
• How quickly can you commit to a recurring governance cadence (e.g., weekly ops, biweekly leadership) once deployment begins? Options: Weekly, Biweekly, Monthly, Ad-hoc as issues arise, Undecided
• Are there known governance relationships (e.g., competing committees or parallel initiatives) that could block timely approvals? If so, describe.

Can We See the Data — and Trust It?

• If dashboards showed a sudden 15% drop in referral retention, how confident would you be that the underlying data is accurate? Options: Very confident, Somewhat confident, Not confident, Would need investigation
• Which validation checks do you currently run (or want run) before accepting referral or attribution metrics? Options: Record-level reconciliation, Provider roster match, Sample clinical chart review, Claims-to-EHR cross-check, Statistical anomaly detection, Other
• Who owns the data quality escalation path (title/role) when a metric fails reconciliation? Options: Analytics/BI lead, CMIO, IT/data engineering, Third-party vendor, Other
• What cadence for data refreshes is needed to support operational workflows (e.g., weekly, daily, real-time)? Options: Real-time / near real-time, Daily, Weekly, Monthly, Other
• If we find systemic gaps in historical referrals during validation, how would you prefer we handle reporting to stakeholders (pause, annotate, or proceed with caveats)? Options: Pause and remediate, Proceed with annotations and confidence bands, Continue but highlight limitations, Other

How Anchored Are Your Physicians To This Plan?

• If you had to guess, what percentage of your employed and affiliated physicians are likely to view this deployment as an opportunity rather than a risk? Options: 0–20%, 21–40%, 41–60%, 61–80%, 81–100%
• Which physician cohorts are most at risk of disengaging (by specialty, employment status, or geography)? Options: Hospital-employed specialists, Independent affiliates, Primary care employed, Community-based specialists, Rural providers, Other
• Describe the last time physician sentiment materially affected a rollout. What happened and how was it resolved?
• Which engagement tactics have historically moved physicians (select all that worked and add notes in the next field)? Options: One-on-one leader meetings, Clinician peer champions, Transparent data-sharing, Financial incentives/comp changes, Operational support (staffing/scheduling), Quick-win pilots
• What communications and feedback loops should be in place pre-launch to prevent surprises on day one?

What Blind Spots Could Derail Deployment?

• What compliance, legal, or payer risks would keep you up at night if not addressed pre-deployment? Options: Anti-kickback/AR issues, Contractual attribution conflicts, Privacy/PHI exposure, Payer contract requirements, Employment/compensation disputes, Other
• Do you have escalation protocols for adverse events (clinical, financial, reputational)? If not, who should own creating them? Options: Yes, existing protocol, Partial protocol — needs updates, No protocol — need to create, Unsure
• What contingency budget or resource pool exists to address unexpected physician departures, data remediation, or incentive misalignment? Options: Dedicated contingency budget, Reprioritize existing budgets, No contingency — would escalate, Unsure
• Are there specific regulatory reporting windows or payer milestones tied to this schedule we must not miss? Options: Yes — list in next field, No, Unsure
• Who should be included on a rapid-response team if a governance or compliance issue requires a decision within 48 hours?

Do We Have Defensible Acceptance Criteria and Measurement?

• If a vendor or partner says 'dashboards live' — what minimum elements must be demonstrably working for you to accept that? Options: Referral routing visualizations, Provider roster match, Baseline referral retention metric, Governance issue tracker, Compensation impact preview, Other
• What baseline data (time period and metrics) should be used to measure post-launch changes? Options: Rolling 12 months, Most recent 6 months, Pre-defined contract baseline, Custom period (specify)
• Which stakeholders must sign acceptance and what level of evidence do they expect (anecdote, sample reconciliation, full audit)?
• How will we operationalize tracking of referral retention and value-based readiness — internal analytics, vendor dashboards, or a hybrid? Options: Internal analytics team, Vendor-managed dashboards, Hybrid (vendor + internal), Third-party auditor
• What red-lines or thresholds would trigger pause or rollback of deployment (e.g., >X% drop in referrals)? Please specify.

Who Owns The Tasks, And Are They Resourced?

• Which functions must be staffed and active at launch (select all that will need owners we can hold accountable)? Options: Provider recruitment, Governance facilitation, Compensation administration, Data engineering/feeds, Analytics & reporting, Communications/physician engagement, Other
• For each function you selected, can you name the person or role and whether they are fully allocated, part-time, or need to be hired?
• What external partners (if any) will we rely on during first 90 days and what dependencies do they introduce? Options: Network strategy vendor, Analytics vendor, Compensation consultant, Recruiting firm, None, Other
• What is the realistic earliest date each core owner can begin dedicated deployment work? Options: Immediately, Within 2 weeks, 2–6 weeks, 6–12 weeks, Unsure
• Where do you anticipate resource pinch points that could delay sequencing (e.g., IT backlog, credentialing delays, legal review)?

If This Works, Will It Stick?

• If we meet the 90-day acceptance criteria, what governance or operational changes must be in place to sustain progress long-term?
• Which success signals should trigger expansion of the program vs. pausing to optimize (select all that apply)? Options: Sustained referral retention improvement, Positive physician engagement metrics, Projected net financial benefit, Quality measure improvements, Operational reliability (data + governance)
• What ongoing rhythm for measurement and review would you prefer after launch (monthly KPI review, quarterly strategy, annual comp refresh)? Options: Monthly KPI reviews, Quarterly governance deep-dive, Biannual compensation review, Other
• What would cause you to revert to the previous operating model even after initial success? Options: Leadership change, Negative financial shock, Clinician backlash, Payer contract change, Other
• What is one small, concrete commitment you can make today that would materially reduce deployment risk (e.g., named data owner, provisional governance slot, contingency fund)?

Setting the Table: Who's in the Room?

• Who from your team will be the primary decision-maker and which leaders must be involved for a network strategy to move forward? Options: Hospital COO, Chief Strategy Officer, VP/Director, Physician Enterprise, Chief Medical Officer, Chief Financial Officer, ACO Executive/Director, Board representative, Clinical Service Line Director, Other
• What timeline are you operating under for a decision and initial deployment? Options: Immediately / within 30 days, 1–3 months, 3–6 months, 6–12 months, 12+ months
• Which outcomes would leadership prioritize in the next 12 months? Options: Referral retention, Reduce physician employment cost, Close specialty/network gaps, Improve value-based readiness, Increase patient access, Improve quality metrics (e.g., HEDIS, readmissions), Other
• Who outside formal leadership—specific influential physicians, practice managers, or external partners—could block or accelerate adoption, and why?
• How aligned are your executive and clinical leaders about what 'good' should look like for this effort? Options: Fully aligned, Mostly aligned with some differences, Strongly misaligned, No shared view yet

If Your Network Could Tell the Truth About Referrals...

• Roughly how many referrals per month do you estimate are shifting away from your system by specialty, and what would that loss mean financially and strategically?
• Do you currently track referral retention and leakage in a repeatable way? Options: Yes — by physician and patient, Yes — by specialty only, Ad hoc/manual analyses, No — we do not track reliably
• Which referral data sources do you reliably access today? Options: EHR referral records, Claims data, Physician self-report / surveys, Patient scheduling/call center logs, Care navigation / CRM tools, None / limited
• Can you share a recent example where referral movement materially changed a service line, budget, or payer negotiation outcome?
• What are the most common reasons physicians or patients give for choosing competitors—are these operational, cultural, financial, or access-related? Options: Access/appointment availability, Specialist reputation, Financial incentives/compensation, Patient preference/location, Clinical autonomy for physicians, Other

What's Costing You Sleep (and Margin)?

• If physician employment costs continue to rise faster than revenue, which parts of your network do you expect to shrink, fragment, or create operational stress first?
• How transparent are your current physician compensation models to the physicians affected by them? Options: Fully transparent and documented, Partially transparent, Not transparent, Varies widely across groups
• Which compensation levers are you willing to adjust to influence referrals and alignment? Options: Productivity-based pay, Panel/population-based incentives, Quality/performance bonuses, Sign-on or retention bonuses, On-call / premium stipends, Not willing to change compensation
• Tell us about a compensation change you tried—what worked, what backfired, and how did physicians react?
• How often do you benchmark physician compensation and total employment cost against comparable markets? Options: Quarterly, Annually, Irregularly, Never

What Assumptions Are Quietly Steering Your Plan?

• Which 'truths' about your physicians, referrals, or market behavior have never been tested—and what would change if they turned out to be false?
• Which assumptions do you rely on when forecasting where to recruit or invest in specialty capacity? Options: Recruitment will be fast, Patient demand is stable or growing, Referrals are sticky / loyal, Payer contracts will improve, Competitors will hold steady, Other
• Where in prior network projects did an unstated assumption create the biggest surprise or setback?
• How confident are you in your specialty demand forecasts and the data that informs them? Options: High confidence, Moderate confidence, Low confidence, No reliable data
• What evidence—data points, physician behaviors, or market signals—would make you change a long-standing assumption quickly?

Picture a Network That Actually Works

• If you could measure two signals that would prove your network is truly aligned and competitive, which two would you choose and why?
• Which KPIs matter most for the next 12 months to convince leadership this work is succeeding? Options: Referral retention rate, Network adequacy by specialty and geography, Physician engagement/Net Promoter score, Total physician cost per RVU, Value-based contract performance (shared savings, quality), Patient access/wait times, Utilization/ER diversion metrics
• What numerical targets or thresholds would make leadership consider this engagement a clear win (please provide numbers where possible)?
• Who will ultimately judge success—executive leadership, physician governance, payers, board—and how should their criteria be weighted? Options: Executive leadership, Physician governance/committee, Payers, Board, Other
• If success requires trade-offs (e.g., short-term revenue vs. long-term referral retention), which trade-offs are acceptable and which are deal-breakers?

The Structural Gaps We Can't Ignore

• Which governance, data, or operational gap would cause a deployment to stall within the first 90 days if not addressed?
• Which of these capabilities are fully operational today? Options: Real-time referral dashboards, Governance committee with charter and meeting cadence, Active physician recruitment pipeline, Automated compensation modeling and payroll integration, Claims + EHR data integration, None of the above
• Describe your current governance model for physician network decisions—who approves recruitment, compensation changes, and referral policies?
• Do you have a single source of truth for physician attribution and patient panels? Options: Yes — claims-based attribution, Yes — EHR-based panels, Multiple conflicting sources, No single source of truth
• What practical risks (data privacy, legal/contract limits, political resistance, vendor dependency) keep you awake about implementing change?

Are You Ready to Measure What Matters?

• If we delivered dashboards and acceptance criteria next week, what would you still doubt most—our measurements, your data quality, or your team's willingness to act?
• Which analytics outcomes must be live before you would sign off on a pilot or pilot expansion? Options: Referral retention dashboard, Specialty gap map, Compensation alignment model, Attribution accuracy >90%, Predictive recruitment candidate list, All of the above
• What reporting cadence and governance meeting rhythm would realistically sustain momentum for you (weekly, bi-weekly, monthly)? Options: Weekly, Bi-weekly, Monthly, Quarterly
• How willing is your organization to tie commercial milestones (payments, renewals) to measured referral or value-based performance? Options: Very willing, Somewhat willing, Reluctant, Not willing
• What's one concrete commitment (data access, named owner, budget line) you could make now to materially reduce deployment risk?

First Small Moves That Prove Progress

• What's the smallest change we could implement within 60 days that would demonstrate momentum and build trust with physicians and leaders?
• Which pilot area would you choose for a rapid test? Options: Single high-leakage specialty, Hospital-owned clinic group, ACO-attributed panel, Geographic market with high competition, Payer-contracted population, Other
• What specific data access or approvals must be granted to start a 60-day pilot?
• How will we define pilot success—quantitative thresholds, physician feedback, or a combination? Options: Quantitative thresholds only, Qualitative physician feedback only, Combination of both, Unsure — need help defining
• Who should be the owner from your side for this pilot and what level of decision authority will they have?