Not long ago, an insurance contract dispute arose at my institution. Suddenly, changes in coverage threatened the continuity of care for dozens of our patients. The clinic soon convened meetings to manage the fallout. We deliberated over who could be transferred, who needed bridge coverage, and which patients were most at risk of falling through the cracks. We were reduced to scrambling for stopgap solutions while the real systems-level decisions were made by people who had never met our patients.