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The healthcare service line concept blows up the traditional

department- or silo-oriented approach to clinical care, replacing it
with a product-line model that follows the patient’s path through
the care process. With a focus on patient-centered, coordinated
care, a service line aims to provide a one-stop shop for a specific
set of services, such as cardiac or obstetrics. Ideally, patients
receive all needed services (e.g., diagnostic, medical, surgical,
rehab) from an integrated team of providers at a single location or
set of locations.
 
󰊐
Some healthcare organizations refer to key service lines as
Centers of Excellence. By distinguishing themselves in particular
service lines—due to high clinical quality or patient satisfaction,
innovative offerings, and/or lower-cost approaches—providers
aim to attract commercial insurance contracts and boost volumes
and revenues.
 
As David McCready wrote in a 2015 blog post: “The [service line]
concept is simple to describe and very challenging to
implement.”1 As an executive leader of two services lines at
Brigham and Women’s Hospital, McCready knows whereof he
speaks. Getting all the needed service line players and processes
properly aligned to attain shared clinical and business goals can
be complex and politically fraught.
 
Today, leading a service line is particularly difficult given the
shifting sands beneath the healthcare industry. Numerous
changes are afoot, from the shift to fee-for-value from fee-for-
service payment to the rapid consolidation of market players as
hospitals, physicians, and other stakeholders merge and affiliate.
 
Leaders with a reactive mindset will likely be left in the dust. What
is needed is an ability to get ahead of coming changes and
determine how to build a next-generation service line.
 
Three Futuristic Questions

To develop a service line that will continue to flourish five, 10, or

20 years from now, leaders need to think beyond what is state-of-
art today to imagine what the state-of-the-future might be. Here
are three questions to get started on this journey.
 
State-of-the-art question: “How can we lower our costs to
Medicare payment level?”
State-of-the-future questions: “How can we achieve the best
possible patient outcomes at the lowest possible cost?
 
Believing that health plans will eventually match Medicare rates—
󰊐
which are approximately 30 percent less than commercial
payments—many providers have been focusing on reducing
expenses. 2 However, many have primarily paid attention to
tightening labor, supply, and other budgets. Yet, Harvard Business
School’s Michael Porter believes that redesigning the clinical care
provided to patients is the most powerful improvement tool of all,
offering cost-reduction opportunities of 20 to 25 percent.3
 
Stanford University’s Clinical Excellence Research Center (CERC)
offers one promising approach to clinical redesign for service line
leaders.4 CERC is testing new care approaches for cancer, stroke,
and other services that focus on “ambush points,” or critical but
often overlooked junctions in a patient’s care.
 
One example is when chronic kidney disease worsens to the point
where patients need dialysis. By ensuring that patients get home-
based versus center-based dialysis, as appropriate, providers and
payers can dramatically reduce costs while also improving patient
experience. CERC estimates that the United States would save $63
billion a year by switching to home-based dialysis and ensuring
effective management of early-stage kidney disease.
 
State-of-the-art question: “How can we encourage the adoption of
evidence-based practices?”
State-of-the-future question: “How can we rapidly identify and
adapt new innovations and insights?”
 
This set of questions relates to the last set. Many service line
leaders are working diligently to improve care by reducing
variability, encouraging physicians to adopt and adhere to
evidence-based practices. This is a meaningful endeavor.
However, service line leaders need to update their approach to
address another critical question: “When better approaches to
care are uncovered (e.g., treatments, technologies, process
improvements), how can we ensure that we adopt/adapt them
quickly?” In other words, how can a service line become more
nimble and agile, quick to identify and adopt the latest
innovations?
 
󰊐
Traditional forms of disseminating new practices (e.g.,
publications, presentations) may not be enough. Research shows
that it can take 17 years for front-line physicians to adopt
research-backed practices.5
 
What does work? According to Joe McCannon, co-founder and
principal, The Billions Institute, it takes “…distributed, networked
hands-on learning—where every targeted adopter a) becomes an
active agent of local change and adaptation … and b) actively
studies and learns from the challenges and solutions of their peer
organizations.”6
 
A well-known way to achieve this “networked hands-on learning”
is to participate in a collaborative, or a network of healthcare
stakeholders that test and adapt new practices at the local level
and share lessons learned. For instance, the Institute for
Healthcare Improvement has sponsored more than 50
collaborative projects with commendable results, such as
reducing heart failure hospitalizations by 50 percent.7
 
Numerous collaboratives that focus on specific service or product
lines now exist. Examples include the Michigan Spine Surgery
Improvement Collaborative and CERTAIN’s Lung Cancer Quality
Improvement Collaborative. Some health systems have also
started their own service line collaboratives. For instance,
UnityPoint Health has an Orthopedic Physician Collaborative that
allows independent orthopedists from across the health system
to share practices and ideas.8
 
State-of-the-art question: How can we start incorporating digital
technologies into our practice?
State-of-the-future question: What will care look like when digital
technologies become ubiquitous, and how can we prepare?
 
Experiments with digital health technologies are helping service
lines reduce costs and improve patient care. For instance,
Partners HealthCare reduced heart failure-related readmissions
by 50 percent among patients who used digital devices to share 󰊐
daily measurements (e.g., blood pressure readings, weight, pulse)
with nurses who intervene as necessary.9
 
But there’s a big difference between experimenting with digital
technologies and interweaving digital health into the day-in and
day-out workings of a service line. In his book, The Third Wave,
Internet pioneer Steve Case argues that the Internet will
transform “from something we interact with to something that
interacts with everything around us.”10 A digital connection will
become as ubiquitous and required as electricity has become.
 
What could this mean for an obstetrics, primary care, or cancer
service line? Leaders need to contemplate what their service line’s
role will be in this changing landscape.
 
Cardiologist Eric Topol, MD, director, Scripps Translational Science
Institute, and chief academic officer, Scripps Health, believes that
patients/consumers will soon be able to perform some types of
healthcare services themselves as sensors and tracking devices
become more sophisticated. For instance, he envisions a day
when patients could perform their own cardiograms, painlessly
measure glucose levels in their tears by wearing smart contact
lenses (currently under development by Google), and perform
their own sleep study using a sensor worn via a band-aid.11
 
More Futuristic Questions

What other state-of-the-future questions should service line

leaders consider? Start with what is state-of-the-art today and
then project out five to 10 years. For instance, many progressive
organizations are investing in clinical/business analytics today.
They are asking, “How can we turn all this data into useful
knowledge?” But what happens when they reach that goal? What
will be the next big question? Or coming at it a different way: How
might data analytics change in the future based, in part, on
current trends?
 
References
1. McCready, D., “A Shift to Service Lines in Hospital Service 󰊐
Delivery,” Healthcare Leaders Blog, October 7, 2015.
 2. Cleverley, W.O. “Making Money with Medicare Payments,”
Strategic Financial Planning, Winter 2015.
3. “Determining the Pace of Population Health,” ACHE’s Healthcare
Executive, July/August 2016.
4. Huges, L. et al., Designing More Affordable and Effective Health
Care,” The Commonwealth Fund, February 8, 2016.
5. Balas, E., and Boren, S. e. (n.d.). Managing Clinical Knowledge
for Health Care

Improvement. Bethesda, Md: National Library of Medicine,

2000. Bemmel J.,

McCraw A, eds. Yearbook of Medical Informatics.

6. Spurlock, B. and Teske, P.A. editors. ALL IN:  Using Healthcare
Collaboratives to Save Lives and Improve Care. CQSI dba
Cynosure Health, December 21, 2015.
7. Institute for Healthcare Improvement, The Breakthrough Series:
IHI’s Collaborative Model for Achieving Breakthrough
Improvement, 2003.
8. UnityPoint Health, UnityPoint Health Orthopedic Physician
Collaborative, accessed July 12, 2016.
9. Klein, S., et al. A Vision for Using Digital Health Technologies to
Empower Consumers and Transform the U.S. Health Care
System, The Commonwealth Fund, October 2014. \
10. Case, S. The Third Wave. An Entrepreneur’s Vision of the
Future,” New York City: Simon & Schuster, 2016.
11. Slabodkin, G. “Medicalized Smartphones to Put Health Data in
Hands of Patients,” Health Data Management, July 1, 2016.
 
 

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Category: Healthcare Transformation By Anita Burroughs November 22, 2016

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