title: Creating and Maintaining a Successful Service Line in an Academic Medical Center at the Dawn of Value-Based Care: Lessons Learned From the Heart and Vascular Service Line at UMass Memorial Health Care.
abstract: The service line (SL) model has been proven to help shift health care toward value-based services, which is characterized by coordinated, multidisciplinary, high-quality, and cost-effective care. However, academic medical centers struggle with how to effectively set up SL structures that overcome the organizational and cultural challenges associated with simultaneously delivering the highest-value care for the patient and advancing the academic mission. In this article, the authors examine the evolution of UMass Memorial Health Care's heart and vascular service line (HVSL) from 2006 to 2011 and describe the impact on its success of multiple strategic decisions. These include key academic physician leadership recruitments and engagement via a matrixed governance and management model; development of multidisciplinary teams; empowerment of SL leadership through direct accountability and authority over programs and budgets; joint educational and training programs; incentives for academic achievement; and co-localization of faculty, personnel, and facilities. The authors also explore the barriers to success, including the need to overcome historical departmental-based silos, cultural and training differences among disciplines, confusion engendered by a matrixed reporting structure, and faculty's unfamiliarity with the financial and organizational skills required to operate a successful SL. Also described here is the impact that successful implementation of the SL has on creating high-quality services, increased profitability, and contribution to the financial stability and academic achievement of the academic medical center.
authors.affiliation: R.A. Phillips is executive vice president and chief medical officer, Houston Methodist, Houston, Texas, and president and chief executive officer, Houston Methodist Specialty Physician Group, Houston, Texas. At the time this article was written, he was physician executive director, Heart and Vascular Center of Excellence, UMass Memorial Medical Center, professor of medicine, University of Massachusetts Medical School, and faculty member, Clinical and Population Health Research PhD Program, UMass Graduate School of Biological Sciences, Worcester, Massachusetts.J. Cyr is senior vice president, Heart and Vascular Center of Excellence, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts.J.F. Keaney Jr is chief of cardiovascular medicine and medical director, Heart and Vascular Center of Excellence, UMass Memorial Medical Center, and professor of medicine, University of Massachusetts Medical School, Worcester, Massachusetts.L.M. Messina is chief of vascular and endovascular surgery, UMass Memorial Medical Center, and professor of surgery, University of Massachusetts Medical School, Worcester, Massachusetts.T.E. Meyer is director, Advanced Heart Failure Program, UMass Memorial Medical Center, clinical chief of cardiovascular medicine, and professor of medicine, University of Massachusetts Medical School, Worcester, Massachusetts.S.K.C. Tam is executive director, Cardiovascular Services, Steward Health Care System, Boston, Massachusetts. At the time this article was written, he was chief of cardiothoracic surgery, UMass Memorial Medical Center, and associate professor of surgery, University of Massachusetts Medical School, Worcester, Massachusetts.K. Korenda is senior director, Heart and Vascular Center of Excellence, UMass Memorial Medical Center, Worcester, Massachusetts.M. Darrigo is executive director for heart and vascular services, Saint Vincent Hospital, Worcester, Massachusetts, and MetroWest Medical Center, Framin
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
authors.forename: Jay
authors.initials: J
authors.lastname: Cyr
authors.forename: John F
authors.initials: JF
authors.lastname: Keaney
authors.forename: Louis M
authors.initials: LM
authors.lastname: Messina
authors.forename: Theo E
authors.initials: TE
authors.lastname: Meyer
authors.forename: Stanley K C
authors.initials: SK
authors.lastname: Tam
authors.forename: Kathleen
authors.initials: K
authors.lastname: Korenda
authors.forename: Melinda
authors.initials: M
authors.lastname: Darrigo
authors.forename: Pooja
authors.initials: P
authors.lastname: Kumar
authors.forename: Sailu
authors.initials: S
authors.lastname: Challapalli
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D002309:Cardiology / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D013504:Cardiovascular Surgical Procedures; D003362:Cost-Benefit Analysis; D006296:Health Services / Q000191:economics* / Q000592:standards; D006298:Health Services Administration; D006801:Humans; D008404:Massachusetts; D011787:Quality of Health Care; D013903:Thoracic Surgery / Q000191:economics / Q000458:organization & administration* / Q000592:standards