Let’s get the eligible patients treated.

Almost nothing in the diagnosis below will be new to you. You know your members struggle to stand up anti-amyloid programs, you know precisely why, and you have very likely had some version of this conversation with a manufacturer in the past year.

So we won’t spend your time on the problem. What stays unresolved — the reason that conversation keeps recurring without much changing — is that everyone agrees on the diagnosis and nobody owns the execution layer underneath it. That is the only thing we are here about.

And it is worth being clear about what is at stake before any of the commercial argument, because the commercial argument is downstream of it. There are people alive today with early Alzheimer’s disease who meet the criteria for a therapy that could slow it, whose neurologist believes the evidence, whose insurance would cover it — and who will not receive it. Not because anyone decided they shouldn’t. Because the practice they happen to attend cannot absorb the surveillance schedule, the imaging cadence, the authorisation and the reimbursement exposure that come attached.

Nobody agrees on the exact eligible denominator. Everybody agrees the treated numerator is small. That gap is not a scientific failure or a clinical one — it is an operational failure, which means it is the kind that can actually be fixed.

In commercial terms, the same sentence reads: it turns the distribution and manufacturer contracts you already hold into actual utilization. Both framings describe the identical mechanism, and it matters that they do — this only works as a cause because it also works as a business. A programme that depends on goodwill lasts until the first budget review. What follows is the case that this one doesn’t need any.

Where the Patients Are Lost

You measure contracted volume precisely. The gap underneath it is harder — not for want of anyone thinking about it, but because a patient who was never started leaves nothing behind to count. Below is our attempt at the shape of it. You will know better than we do whether we have it right.

The five, and what carrying them looks like

You can name these as fast as we can — they surface in every conversation your member services team has. The left column is only here so the right one has something to sit against. The right column is the part worth arguing with us about.

Why Neurology, and Why This Year

You chose neurology already, so this part is brief. Three things are converging, and only the third is a timing argument.

Sources at the end. We have used only figures traceable to a primary source, and labelled the rest as what it is: judgment.

The therapies arrived, and the operational burden arrived with them — landing on practices that were never built to carry it. Between anti-amyloid, MS biologics, immunoglobulin, CGRP and ALS therapy, neurology has become an infusion specialty staffed like an office practice.

And the window is open now, briefly. The practices that build this capability now become the regional referral destination for complex neurology; the ones that wait get acquired by a health system that already has it. Which network they belong to when that happens is decided in the next eighteen months, not the next five years.

The Flywheel Nobody Draws

This is where the GPO argument stops being about member satisfaction and starts being about your own revenue line, because the two are connected far more directly than a technology conversation normally implies.

Your economics depend on volume flowing through your contracts. And the binding constraint on neurology therapy volume in the community setting is not price, and it is not clinical willingness. It is operational capability. A practice that cannot run the protocol does not buy the drug at a worse price — it does not buy the drug at all.

There is a corollary worth stating, because it is the version of this that shows up in your data before anything else does. A member who takes a five-figure write-off on a high-cost infusion claim does not buy that drug again. They do not file a complaint or renegotiate. They quietly stop stocking it, tell the next patient they don't offer it, and your volume in that product declines for reasons no rate sheet will ever explain.

The Coalition That Could Actually Move This

You deal with Eisai, Lilly, Biogen and Genentech directly, so none of the following needs explaining: their binding constraint is conversion at community sites rather than evidence or contracts, and site-of-care readiness budgets exist for precisely that reason.

The observation we would add is narrower. Three parties each hold a third of this problem — the manufacturer with the readiness budget, you with the network, the practice with the patients — and you are the only one of the three positioned to convene the other two. A manufacturer cannot assemble your members. Your members cannot get a manufacturer on the phone. The arrangement more or less designs itself once somebody calls the meeting, and there is no structural reason that somebody isn't you.

We are not speculating about the manufacturer side of this. We have had inbound interest from a therapy manufacturer on practice enablement — which is a good deal less impressive than a signed program, and we would rather state it at exactly that weight. What it tells you is that the appetite is real and the budget line exists.

How such an arrangement is structured — who contracts with whom, how readiness funding flows, and how it is kept clean of anything touching purchasing decisions — is a question for your counsel and the manufacturer's, not for us. We raise it because it is the difference between a proposal you have to fund and one that funds itself, and because a GPO executive is going to think about it within thirty seconds of reading the paragraph above.

And, Not Incidentally, They Stay

The retention argument is short, and you have almost certainly made it yourself in a board meeting: nothing you currently offer is genuinely hard to leave. A practice administrator with two rate sheets can evaluate you in an afternoon.

What Your Members Actually Get

For this to work as a retention instrument it has to be something members use daily and would genuinely mourn. Not a portal they log into quarterly. Four things do that work in a neurology practice.

We have written about the first of those at length in Every Practice You Acquire Is Already Doing the Work, which was written for platform operators but whose clinical argument applies identically to an independent member practice. The difference is only who captures the value: there, the holding company; here, your member — and, through the flywheel above, you.

One Standard, Across a Network You Don't Own

An MSO can mandate. You cannot, and it is worth being honest that this is the real difference between the two models. What you can do is make a standard available that is better than what any individual member would build alone — which is the founding logic of a GPO applied to operations instead of to purchasing.

That turns out to be tractable, because neurology infusion therapies differ enormously while the operational discipline behind them barely differs at all. Six rails carry every infusion your members deliver. Only the payload changes.

That last point is the one with strategic weight for you. When the next neurology therapy launches, a network with the rails already built can be ready across every member at once. That is a genuinely rare thing to be able to say to a manufacturer, and it is worth considerably more than aggregated spend.

Two Ledgers, One Deployment

It is worth separating what your member gets from what you get, because they are different arguments and both have to hold for this to be worth doing.

How It Deploys Across Independent Practices

The practical objection comes fast, and it should: your members are independent, each with their own EHR, their own staffing and their own appetite for change. Three things make this workable, and one of them is a limit rather than a feature.

It is multi-tenant by architecture, not by configuration. One deployment serves the whole network with complete data isolation per member. A practice's data is theirs; network-level reporting is aggregated. No member is onboarding a system built for somebody else.

It runs alongside the EHR rather than replacing it. This is the only version that survives contact with a physician who has spent four years learning their chart. At the neurology group we run today we are integrated with Epic, exporting each patient's monthly CCM summary directly into the EHR — so the documentation that substantiates the claim lands where the practice already works and where an auditor would expect to find it. That is a deliberately narrow integration and we would rather describe it accurately than dress it up as full interoperability.

And the limit: each EHR is its own piece of work. We scope it per member, and in any conversation with you we will be specific about what exists today and what would be built for the first time. A network rollout is a sequence of practices, not a switch you throw.

On commercial structure, your existing partnership models already cover the shapes this can take — referral, reseller, or white-label under your own brand. Which of those is right depends on how much of the member relationship you want to own, and on how your counsel prefers to structure a value-added service that touches purchasing decisions. We have worked with all three and have no preference beyond wanting the arrangement to be one you can defend comfortably.

Most of the Panel Will Never Be on an Infusion

Everything so far has been about the patients your members can't start on therapy. There is a second, larger group worth talking about before we finish: the dementia panel that is already in the practice, most of whom will never be candidates for an anti-amyloid drug at all, and every one of whom generates continuous work that currently goes unpaid.

This matters to a member for a reason that has nothing to do with infusions. It is the part of our platform they touch every single day — and, in plain financial terms, it is what makes a small neurology practice able to afford the ambition in the rest of this article.

The work is already happening. The billing usually isn't.

CMS has paid for between-visit care management for years, through the four programmes named earlier. Your members are already delivering it: the call to the daughter about evening agitation, the medication list rebuilt after a hospitalisation, the fall alert reviewed, the coordination with primary care nobody logged. What is missing is not the clinical work. It is documented, attributable proof that the clinical work happened.

And the reason it goes undocumented in dementia specifically is structural. Mainstream care management software assumes the patient is the participant — that they consent, answer the outreach, pair the device, report the symptom. A patient with moderate Alzheimer's disease can do none of that. So the work migrates to a nurse's mobile phone and a caregiver's text thread, where it is invisible to the system meant to be counting it.

Our model treats the caregiver as a named, permissioned, first-class user; handles surrogate consent as a native path rather than an exception; and captures coordination time automatically as a by-product of the work rather than as a chore somebody remembers at month end. That is the entire difference between a month like the one above being worth nothing and being worth something every month, for years, on a patient the practice already has.

Three parties, and none of them lose

It is worth being explicit about who this serves, because it is unusually well aligned for something that also makes money.

• The patient gets proactive coordination instead of a crisis-driven relationship with their practice — which, in this population, is the difference between a managed decline and a sequence of emergency department visits.
• The family gets a care team that already knows what happened last week, a dementia agent that answers at two in the morning without impatience, and someone to escalate to who has the context attached. Anyone who has been the adult child in this situation understands what that is worth.
• Your member gets paid for work they were already doing for free — recurring, per patient, per month, on a panel they already hold, without adding a single clinician hour.

We wrote about the mechanics of this at length in Every Practice You Acquire Is Already Doing the Work. It was written for platform operators who own their practices, but the clinical and billing argument is identical for an independent member — only the question of who captures the value changes.

Where We Actually Are

We would rather you hear the size of this from us than find it later.

That last sentence is the actual proposal. We are not asking a GPO to roll this out to two hundred members. We are asking to do it properly with a handful of your members who feel this pain most acutely, measure it honestly, and let the results decide what happens next.

The Questions We Would Ask If We Were You

You will be pitched on member technology by several companies, us included. Here is the list we would use. It is deliberately unkind to weak answers.

The Patient Who Was Never Started

Somewhere in your network this month, a neurologist will sit across from someone in the early stages of Alzheimer’s disease, believe they are a genuine candidate for therapy, and decide not to start them. Not for a clinical reason, and not because of anything in your contract — but because starting them means owning a surveillance schedule, an authorisation, a dose calculation and a reimbursement risk the practice cannot absorb.

That patient goes home. Perhaps they get referred somewhere that can take it on and perhaps the referral holds, but the disease does not pause while the logistics resolve, and early is the only window these therapies have. The cost to your member is a therapy line and a relationship. The cost to you is a vial that was contracted, priced, available — and never bought. The cost to the patient is not denominated in any of those units.

None of this appears in anyone’s reporting. A patient who was never started leaves no trace — which is exactly why it persists, and why it takes somebody with a view across an entire network to see it at all.

Sources & Further Reading

• Alzheimer's Association. 2026 Alzheimer's Disease Facts and Figures — an estimated 7.4 million Americans age 65 and older are living with Alzheimer's in 2026, projected to reach 13.8 million by 2060; the great majority of day-to-day care is provided by unpaid family caregivers, which is the structural fact underneath the caregiver-first argument here.
• Centers for Medicare & Medicaid Services. Chronic Care Management Services and Care Management Services booklets (Medicare Learning Network) — source for the four program families referenced (CCM, PCM, RPM, RTM) and their consent, care plan and documentation requirements.
• Prescribing information for lecanemab (Leqembi) and donanemab (Kisunla) — source for infusion cadence, MRI surveillance for amyloid-related imaging abnormalities (ARIA), and pre-treatment evaluation including APOE genotyping. These remain the two FDA-approved anti-amyloid therapies as of this writing.
• FDA-approved prescribing information for the neurology infusion therapies in the standardisation matrix — ocrelizumab and natalizumab (multiple sclerosis), immunoglobulin products used in CIDP and myasthenia gravis, eptinezumab (migraine, 30-minute infusion every three months) and intravenous edaravone (ALS, 60-minute infusions daily for 14 days in the initial cycle and 10 of every 14 days thereafter). Characterised at a deliberately summary level; the matrix is illustrative and is not clinical guidance.
• MemberCare internal figures — the production deployment, Epic integration and patient counts described above are ours and the group's, not independently audited, and we present them as such.

A note on sourcing: figures widely repeated in this market — adoption percentages, referral-leakage rates, switching benchmarks — frequently cannot be traced to a primary source. We have omitted them rather than repeat them. The switching-cost ladder is our judgment, presented as judgment, and we would be glad to be argued out of it.