Diagnostic support
A care map is only as good as the people who will actually run the study, the assay or the consult it calls for. This domain is the supply side: who does it, what it costs, whether they will run the protocol you asked for, and whether they write back. Its five cohorts are rosters, not care maps.
Why this is a domain
Independent physicians order the right test and then lose the patient to a system that runs the wrong one. A brain MRI without spectroscopy. An echocardiogram without aortic root measurements. A send-out enzyme assay that nobody at the hospital lab has ordered before. A second opinion that takes four months and comes back addressed to no one. The patient cohorts in domains 1 to 3 fail at exactly these points, and the fix is a vetted list of centers and people who will do what was asked, for a price the patient can see in advance.
Every entry on a roster in this domain is there because a member vouched for it and because the center meets the vetting criteria for its cohort. No center pays to be listed. Prices are reported as the center publishes them, or as "on request," and they are the center's, not ours.
The five cohorts
| Cohort | Who it covers | Status | Slack |
|---|---|---|---|
| Advanced imaging Which centers will run the protocol the physician asked for, read it with a subspecialist, and quote the cash price before the patient arrives? | Specialized MRI protocols, cardiac MRI, nuclear and vascular imaging | Launch | #cohort-advanced-imaging |
| Procedural studies Who will do the physiologic study the care map calls for, with the measurement the anchor physician actually asked for, read by someone who knows what the question was, at a price the patient saw in advance? | Echo, CPET, electrophysiology, PFTs, EMG and NCS, autonomic and tilt testing, skin and muscle biopsy | Forming | #cohort-procedural-studies |
| Esoteric assays Which lab runs the send-out test, at a published cash price, and how fast does the result come back? | Biochemical genetics, specialty immunology, endocrine and autoimmune testing, sequencing and reanalysis labs | Seeking a lead | #cohort-esoteric-assays |
| Clinical expertise Who will take a hard case from an anchor physician, on a cash basis, and answer the question asked? | Cash-basis genetics and subspecialty consults: variant interpretation, second opinions, academics who'll take a case from an anchor | Seeking a lead | #cohort-clinical-expertise |
| Empiric therapies Where does this treatment actually come from, and how does the patient get it? | Infusion centers, compounding and specialty pharmacy, expanded access, trial enrollment, off-label and compassionate use | Seeking a lead | #cohort-empiric-therapies |
What a roster in this domain contains
Each roster has four parts, in this order.
- What the care maps need. A table of the studies, assays or consults that the patient cohorts call for, with the cohort that needs each one and the detail that is usually missed (the protocol, the reader, the turnaround).
- Vetting criteria. What a center or person has to do to be listed. The criteria are specific to the cohort, but all five share four: a published cash price or a price on request, willingness to run or honor a requested protocol, a written report returned to the ordering physician, and a member who has used them and vouches.
- Current entries. Name, what they do, where, the price basis, protocol flexibility, and the member who vouches. Entries are dated and re-vouched yearly.
- Build plan. The gaps the cohort is trying to fill and who is working on them.
Rosters live on this site for members and are summarized in the document library as PDFs. Proposals and vetting happen in the cohort's Slack channel.
What this domain needs from members
Members are the vetting mechanism. A roster entry starts with a member who has sent a patient somewhere and got back what they asked for, and says so in the channel. The anchor physicians in the patient cohorts know which centers fail, and that knowledge is the asset this domain exists to capture.