The challenge of Networks in the HCn3D ecosystem framework is to know which network entity has the greatest potential to lower health care costs. Generic concepts such as coordination and collaboration are patient centered. Positioning the patient in the Network framework shows how linkages among providers, to coordinate care and promote collaboration, have the potential to position the patient on pathways. The endpoint of pathways can be many things, cost control being one of them. For the 3-Dimensional framework of HCn3D, cost control as a Value objective is mediated by network structure. Where the network is between the patient’s moment and the Value objective, executing pathways through a diverse network environment allows focus on components of the network linked to particular patients. Exploring the individual entities of a focused network has the potential to bring out relations among these entities where a particular patient has a particular entity, in this case a provider, who has the greatest influence on others in the network to control costs.

It is in the relation of patients to Value mediated by Network structure that counterfactual properties work to realize interoperability among the patient centered network entities . The other important counterfactual property of possibility that includes the future as well as the past will offer new and novel ways to achieve a destination of the pathway deemed Value. The details of patient characteristics, provider attributes, social inputs and other variables that carry forward on pathways lead to new possibilities when framed counterfactually.