Lynda Mischel
Lynda Mischel

Now is the time for healthcare organizations to take the next step in elevating quality while reducing the cost of care. This will involve creating service line structures designed to function in the developing environment of value-based payments. In contrast, the original purpose for most health systems was to more tightly tie specialists to each other and to health system programs, not necessarily to improve the patient experience and outcomes.

Service Line Structures

The goal in value-based service line structures is to organize the whole ecosystem of patient care around broad service lines that fall roughly into cardiology, neurology, women’s health, orthopedics, and oncology. Structures should be set up that provide seamless care, from the doctor’s office to the emergency room to the critical care unit, and everything in between, to create a single support system. That way, healthcare systems can eliminate the disjointed feel of much of patient care, cover the gaps between providers, and ensure better outcomes with less waste of resources.

This idea represents a further step in the maturation of value-based organizations such as clinically integrated networks (CINs) and accountable care organizations (ACOs). Early examples of this evolutionary process include co-management agreements that share incentive payments across the whole chain of caregivers and bundled-payment agreements with Medicare-Medicaid for standard procedures such as joint replacement. These setups are designed to create incentives for improving care by assigning more responsibility to provider groups for prudent use of resources while putting patient well-being first.

Service line structures can support value-based systems by putting the emphasis on patient outcomes. New ideas for increasing value for patients include developing total cost-of-care models to improve the understanding of all participants and encourage comparative cost and quality analyses. This could help change clinical protocols and lead to improved outcomes. With the right data, service line participants can develop and monitor clinical protocol adherence and performance.

Phases of Service Line Structures

How could an organization pull this off? Creation of a service line organization could unfold in three phases:

  1. Prepare for change. Identify anticipated points of resistance or gaps in readiness while defining goals.
  2. Conduct an analysis and move forward with execution. Carry out the clinical transformation across the service line. This will include developing the evidence-based clinical protocols, coming up with new processes in support of the protocols, and creating cost analytics and reporting tools.
  3. Monitor the service line structure and make adjustments. With many moving parts, it will be necessary to collect feedback, analyze the results, and identify and fix problems.

In a system of care that’s organized in this manner, the patient is at the center, not doctors or other providers. To improve patient care and reduce cost by eliminating wasteful or redundant processes and procedures, it’s necessary that participants in the entire service line understand and commit to the evidence-based protocols that drive the organization. Done properly, creation of service line structures can improve the patient experience and outcomes while reducing cost and waste.

Lynda Mischel is managing principal for Lumina Health Partners. Submit the form below to download a PDF of this article.

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