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August 10, 2011

Is primary care a service line?

Daily Briefing

At first glance, primary care services may not fit the technical definition of a service line. Service lines bring together different diagnostic and therapeutic services that apply to similar disease types and conditions, and organize them under a single administrative and clinical structure. As an organizing model, service line management assigns strategic oversight over profitable business units to manage budgets, identify new procedural investment opportunities, align different specialties, improve quality outcomes, and ultimately grow volumes under fee-for-service incentives.

To date, the service line model has primarily been applied to acute care services such as cardiology, orthopedics, and neurosciences. While primary care does not fit the classic definition of the service line model, some organizations are now applying service line management principles to primary care to achieve similar goals:

  • Strategic ownership for volume growth
    Hospitals and health systems investing in primary care practices must capture significant ambulatory market share to improve return on investment and increase downstream referrals. By assigning administrative and clinical oversight over primary care, organizations can potentially create a focused platform for implementing new delivery models and practice redesign.

Central to this job function will be the prioritization of primary care growth initiatives (e.g., deploying mid-level providers, implementing group visits) that augment the ability of the primary care network to reach more patients without overwhelming the already packed schedules of primary care physicians.

  • Improved coordination across disparate business units
    Like acute care service lines, primary care often includes different types of business units, including retail clinics, urgent care, worksite clinics, and multi-service outpatient healthplexes. Organizations pursuing a primary care service line are hoping to improve access across these different patient entry points and better direct patients to the most appropriate sites of care.
  • Platform for positioning services to consumers
    The acute care service line model allows organizations to better communicate related marquee service offerings to consumers. Similarly, the primary care service line concept may provide hospitals and health systems with a more effective mechanism for marketing primary care services and engaging patients to engender long-term loyalty.

Hospitals increasingly experimenting with different service line models
While the primary care service line concept is still emerging, these experiments are growing. One organization is applying the traditional service line leadership dyad model to primary care, creating both administrative and physician leadership positions for ambulatory care to promote growth and improve clinical processes. Another organization is augmenting the scope of the vice president of ambulatory services position to include both the primary care and outpatient procedural networks. Still others are creating a "primary care institute" to support medical home development, unify employed and independent physicians, and improve care coordination across ambulatory settings.

Regardless of preferred model, strategic oversight is becoming imperative given that growing ambulatory volumes and improving coordination and quality are pressing challenges for many organizations.

Do you know your local primary care volumes?
Marketing and Planning Leadership Council members may size their local primary care market by following the steps in the Our Take, Estimating local need for primary care providers.

Evaluate your options for improving primary care access
Marketing and Planning Leadership Council members may access the Primary Care Access Opportunity Audit, a resource guide to assist members in identifying the most relevant access levers for their institutions.

For more information
To access the Council’s latest research on ambulatory care, visit the Ambulatory Care Strategy topic page. Daily Briefing readers with questions about the Marketing and Planning Council may email

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