Service lines vs employed medical groups: How to partner as change agents to build accountability, achieve health system goals, and improve outcomes

In our last discussion, Jessica and Whitney spoke about how service lines and medical groups can live symbiotically, rather than just “coexisting” within the same organizational ecosystem

 In this follow-up post, they look more closely at how the groups should work together to achieve the goals of the overall health system and be jointly accountable for world-class, patient-centered outcomes.

How are service line councils and medical group boards able to pursue value-based care strategies?

Whitney: This should be the responsibility of the service lines. It may start as a larger initiative at a medical group level, but the execution should be at a service line level, especially if there are value-based initiatives unique to that service line. To ensure ownership from service line physician chiefs, health systems are now beginning to institute incentive-based payment structures aligned with the value-based outcomes.

Jessica: While Whitney’s statement is true from the perspective of traditional service lines, a different construct may be needed for primary care. Typically, primary care is within the purview of the medical group depending on how its structure is organized. We see primary care evolving as the most influential service line right now due to value-based care changes in the market. The importance of primary care and a strong primary care network continues to grow in relation to supporting the overall performance of various service lines.

How can service line and medical group leadership work together to build a comprehensive KPI platform?

Whitney: KPIs should be inclusive to both patient-centered outcomes and compliance metrics. There is a laser-sharp focus right now on patient-centered and patient-reported outcome measures to ensure that patients are receiving care that has the most value to them. Value, to the patient, is more defined by quality of life, degree of recovery, treatment time, access of care, recovery time, and long-term consequences of the treatment. Compliance metrics will always be a priority because of regulatory and reimbursement standards, but a focus on patient engagement across the continuum of care is of utmost importance to build an effective KPI platform.

Jessica: Data transparency is the best way to develop a good understanding of the drivers of performance on both sides. If there are silos or power struggles between medical groups and service lines, this can, at times, limit the transparency of data. When we look at industry-leading systems that organize around service lines and have supported a high level of performance, the clear theme is absolute transparency of data. To elaborate even further, obtaining physician-level data transparency for a system is truly the way to drive ownership and true change when it comes to quality improvement. When physicians see their own impact against hospital quality scores and service line KPIs, they will take ownership and make changes that immediately impact patient care. The key for service line and medical group leadership is to provide not only the data but also the tools to support subsequent improvement efforts at a local level.

How can service lines and medical groups work together to address physician burnout?

Whitney: The answer is to develop a robust support system for every physician in the organization. Physicians are high-functioning perfectionists, and many times it is at their own personal expense. Typical EAP programs offered by healthcare systems are not sufficient to move the needle on physician burnout. Both service lines and medical groups must work together to foster an environment of openness and community and help reinvigorate the true passion for medicine in each and every physician. By creating a collegial support system for physicians within the organization, service lines and medical groups can effectively tackle both causes simultaneously.

Jessica: I would add that the lack of resources to improve physician burnout is a prevalent issue in most health systems today. One particular area of focus is the electronic health record (EHR) and physicians’ increased workload in managing daily tasks within the EHR. One question that always surfaces is the accountability from IT and operations to change and make physicians’ lives easier. Overall workflows and designs within the EHR must be addressed and improved to increase efficiency and allow physicians to operate at the top of their license. Typically, service line expertise has to be involved in any opportunities to redesign workflows in the clinical setting, and the physicians have to be engaged and champion this improvement. Medical groups and service lines must work together to resolve or provide a platform where physicians can see an immediate win.

What are the major takeaways for a service line VP and a medical group VP from this discussion?

Whitney: The keys to a successful partnership between the two entities are transparency and alignment. If you can eliminate the silos between medical groups and service lines and align everyone in pursuit of the same goals, that’s really where systems can take off in terms of quality improvement and overall performance in the eyes of a patient.

Jessica: We understand that resources are the limiting factor and, in an organization where margins are decreasing, it’s difficult to execute various strategies and really impact change. It is then an imperative to have clear communication from the top around the integration of service line and medical group priorities to make sure that folks are pulling together for the good of the organization.

As you strive to create and hardwire a culture of collaboration and transparency between your service lines and medical group, it will become even more critical to provide appropriate resources as well as decision-making authority to empower physician leaders to effect change. By continually engaging both groups and aligning incentives, the collective impact of the “whole” will greatly exceed that of the “parts,” and patients will become the primary beneficiary of the partnership.

Click here to read Part 1: Service lines vs employed physicians: How to live symbiotically within an organizational ecosystem >>


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