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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