Every player has a specific job. The linemen block. The receivers catch passes. The running backs carry the ball. The defense has its own responsibilities. Every one of them is highly skilled at what they do.

But without a quarterback seeing the entire field, calling the plays, and making sure everyone is working toward the same goal, even the most talented team struggles.

Modern healthcare has become much the same.

We have remarkable specialists. Every physician is highly trained, dedicated, and focused on the problem they are there to solve.

The challenge is that no one may be seeing the entire field.

Years ago, that role often belonged to the family physician. They knew your medical history, your medications, your family, your fears, and the specialists involved in your care. They coordinated everything because they knew the patient—not just the diagnosis.

I still believe in that model, but healthcare has changed.

Primary care physicians today face enormous patient loads and reimbursement systems that reward volume far more than coordination. Family medicine and internal medicine physicians - who are asked to know the whole patient - are among the lowest-paid specialties while carrying some of the broadest responsibilities. It is difficult to see patients in the office all day and then spend evenings making hospital rounds as previous generations did. The old model simply isn’t sustainable.

Hospitalists have become an important part of that solution. They are highly skilled physicians who care for hospitalized patients every day, and in many ways they have improved inpatient medicine.

But hospitalists usually meet patients during one of the most stressful moments of their lives. They often inherit years of medical history, multiple specialists, long medication lists, and complicated family dynamics - all within a matter of hours.

Imagine asking a football team to change quarterbacks in the middle of the biggest game of the season.

The new quarterback may be exceptionally talented.

He just hasn’t played every down with the team.

Today, healthcare is more advanced than ever, but it is also more fragmented than ever.

Everyone owns a piece of the patient.

Too often, no one owns the whole patient.

That isn’t a criticism of physicians, nurses, or hospitals. It’s the unintended consequence of extraordinary specialization. As medicine has become better at treating individual diseases, it has become harder to coordinate the care of the person who has all of them.

That’s why I believe every patient - especially those living with multiple chronic illnesses—needs more than an advocate.

They need a navigator.

Whether that person works independently or within a primary care practice matters less than having someone whose responsibility is to understand the whole picture. Someone who knows every medication, every diagnosis, every specialist, every hospitalization, and every goal of care. Someone who helps patients ask the right questions, keeps communication flowing, and notices when something doesn’t fit before it becomes a crisis.

The irony is that this kind of coordination would likely save lives while reducing costs. Better communication means fewer medication errors, fewer unnecessary tests, fewer hospital readmissions, and fewer emergency department visits. Yet our reimbursement system pays far more readily for procedures than it does for coordination.

But even if we created the perfect quarterback, we’d still face a larger problem.

The incentives throughout healthcare are misaligned.

It isn’t that physicians, nurses, hospitals, insurers, pharmaceutical companies, or government are bad.

It’s that each is being rewarded for something different.

Hospitals are often paid more when beds are full than when people stay healthy at home.

Physicians are generally reimbursed for office visits and procedures, not for spending an hour coordinating care among five specialists.

Insurance companies are rewarded for controlling costs, which can create barriers such as prior authorization.

Drug companies are rewarded for developing and selling medications, not necessarily for reducing the overall cost of care.

Patients often don’t know what their care actually costs until long after it’s delivered, making normal market forces almost impossible.

Government attempts to control spending through regulations and payment rules, but those efforts often add even more complexity.

No one wakes up intending to provide poor care.

They’re responding to the system they’ve been given.

Using the same football analogy, imagine paying players for completed passes, rushing yards, tackles, and field goals - but never rewarding anyone for winning the game.

Every player would work hard.

Every player might even excel.

But they wouldn’t necessarily be working toward the same goal.

Healthcare often feels exactly like that.

We reward individual activities far more than coordinated outcomes.

A quarterback who helps patients navigate the system would be a tremendous improvement. But until we align the incentives so that every part of healthcare succeeds when the patient succeeds, care will continue to be fragmented.

Because every great team needs a quarterback.

But even the best quarterback can’t win until every player is actually rewarded for winning the game or in this case what is best for the patients.

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Roger D. Forgey, FACHE, is a retired healthcare executive, nurse practitioner, and Army Lieutenant Colonel with more than 40 years of experience in healthcare leadership. During his career, he served as CEO of multiple hospitals and held senior leadership roles with Erlanger Health System and other regional healthcare organizations. A Fellow of the American College of Healthcare Executives, Forgey has spent his career leading hospitals through growth, change, and crisis. Today, he enjoys writing thoughtful columns on life, leadership, healthcare, faith, and the issues that shape our communities. He lives in Northwest Georgia with his wife. He can be reached at rogerforgey@gmail.com