Clinical Pathways have always been about a straightforward but difficult goal: Delivering the best possible care while directing limited clinical resources where they can do the most good. That goal has not changed – but the conditions around it have. Rising costs, more complex patients, and growing accountability for quality and total cost of care are exposing the limits of broad, guideline-based care management. Today’s health care delivery models have produced pockets of improvement but have not reliably kept pace with rising costs or the clinical and social complexity of today’s highest-need patients.