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Circling the Dome

So Long, Siloes

illustration depicting healthcare tools and professionals

Illustration by Scott Roberts

Beginning in July, Johns Hopkins medicine embarked on a sea change in patient care—the creation of service lines that integrate multidisciplinary services across the Johns Hopkins enterprise in three key areas: solid organ transplantation; hip, knee and low back pain through a musculoskeletal service line; and transgender health needs.

Historically, a patient with low back pain wanting care at Johns Hopkins may have had to choose from multiple phone numbers or links on websites to navigate his or her way to a first appointment, which could have been with an orthopaedic surgeon, a physiatrist or an internist. From that point, the patient would then have to work through the system piecemeal as needed.

In the new service line model, such a patient calls one number and is scheduled with the most appropriate specialist in the ideal type of setting for his or her needs, whether an outpatient appointment or a presurgical consultation, at any Johns Hopkins location, says Susan Phelps, executive director for the Johns Hopkins Medicine Office of Integrated Health Care Delivery.

“We’re really thinking about service lines as being organized around a population or disease state,” adds Phelps. “It’s a way of getting out of that siloed approach by department and looking at patient journeys from a much more interdisciplinary perspective.” 

The Johns Hopkins Comprehensive Transplant Center already involved experts in multiple departments, so it served as a good starting point, explains Theodore DeWeese, director of radiation oncology and molecular radiation sciences and vice president of interdisciplinary patient care for Johns Hopkins Medicine. 

Bundled payment structures being adopted are largely oriented around musculoskeletal disorders, like joint replacements and back pain management, so creating those service lines made sense, he says. Transgender health was added to provide holistic care in an arena where many patients just have individual interactions with providers as needed. 

Each service line has shared leadership, including department directors for the specialties involved and representatives from community hospitals, primary care and finance, Phelps says. Not only are they creating validated, patient-centered care pathways in each service line, but they also are creating new financial models for these joint efforts and working with the Office of Managed Care to match payers’ needs.

“Our access process, for many reasons, has not always been very easy,” says Phelps. “We are creating a system that will provide a much faster process for patients to enter our system at the right place, and into a care path that hopefully will lead to shorter episodes of care and a quicker return to work and daily living.”