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Service Lines, Integration, and Population Health

Michael Zeis, for HealthLeaders Media, June 13, 2013
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"The quality and the financial pieces are very hospital-centric," she says, "because that is what hospitals are used to focusing on. We think that the industry has to become different by offering different access points—meaning convenience—and providing service that is second to none. At Centura, we are working to have all four—cost, outcome effectiveness, service, and convenience—at a high level."

Physician alignment and matters of leadership

Achieving alignment with physicians is critical for success, but presents challenges, survey respondents report. Alignment with specialty physicians is included as a top challenge to service line adoption or expansion by 66% of respondents, and is called a critical success factor by 61%.

According to Nicholson, "You want to work with your providers to have them help drive toward the best clinical pathways. How do we coordinate care? How do we make sure we are transitioning correctly? The key is that you have the right specialists that the primary care wants to use. You can hire physicians for alignment, but you must also make sure to partner with the full continuum of primary care specialists and agree on how you are going to work together and build together, trying to optimize healthcare value."

For the majority of respondents (56%), service lines are administration-led, although that structure is more common in hospitals (62%) than health systems (46%). Only 22% of respondents report that dyads lead their service lines, a number that seems bound to increase.

Says Allison Rogers, vice president of strategic planning for Mountain States Health Alliance, a not-for-profit health system based in Johnson City, Tenn., that operates 13 hospitals in four states, "You've got to have the outcomes, but you've also got to keep your eye on costs, so you are really going to need a management team that can focus on both of those perspectives. I think just having administration-led service lines only leads to challenges in getting physician buy-in and physician engagement. With physician leadership only, you may achieve quality, but at what cost? I would anticipate dyad-led going up over time."

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