Sutter Health’s virtual review board enabled general neurologists to safely prescribe and monitor amyloid-targeting Alzheimer’s therapies in community settings. Among reviewed patients, 77% were eligible, and ARIA rates were reported below phase 3 trial levels. The program functioned as a governance layer—reviewing risk and suitability before treatment begins, with structured monitoring after dosing. The result indicates a pathway for scaling high-cost, risk-managed therapies beyond academic centers. For healthcare systems, the operational model is as important as the clinical claim: it provides a concrete blueprint for reducing variation in patient selection and adverse-event readiness while keeping care closer to where patients live.