Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. 90, No. 10 / October 2015 1340 Article A high-functioning service line (SL) is a recognizable, coordinated collection of health care services providing patients with a central access point to receive seamless treatment across multiple disciplines, care providers, care sites, and time. 1,2 The SL model has proven to help hospitals shift toward delivery of high-quality, cost-effective, and value- based services in a number of clinical areas. 3 SLs can improve the traditional department structure of academic medical centers, which can splinter management and coordination of care delivery (e.g., breast cancer care split over radiology, surgery, and oncology medicine). Academic medical centers continue to struggle with effectively establishing SLs that overcome organizational and cultural challenges in delivering the highest-value care to patients. 4–6 Here, we examine the heart and vascular service line (HVSL) at UMass Memorial Health Care (UMMHC) from 2006 to 2011. We discuss factors that contributed to its success and ongoing challenges. The chosen time period includes the most currently available quality data from the Centers for Medicare and Medicaid Services (CMS), the Society of Thoracic Surgeons (STS), and the Massachusetts Department of Public Health. Background and Context The clinical partner of the University of Massachusetts (UMass) Medical School, UMMHC is a five-hospital, not-for-profit health care system in central Massachusetts, with 9,400 staff employees and nearly 1,300 physicians. In 2013, the HVSL hub (682-bed UMass Memorial Medical Center in Worcester, Massachusetts) admitted 42,727 patients, performed 11,210 inpatient and 18,438 outpatient surgeries, and recorded 134,891 emergency room visits. One planned process and one unanticipated event catalyzed the formation of the UMMHC HVSL. In 2004, a formal strategic planning and gap analysis identified several operational and organizational issues: 1. Undeveloped strategic vision for heart and vascular services; 2. Infrastructure affecting quality and customer service; 3. Financial challenges in an era of declining reimbursement; and 4. A disconnect between accountability and responsibility for operational and financial performance. The HVSL was established in late 2005 with institutional support from the chairs of medicine and surgery and key leaders of the medical school. This new SL combined the divisions of cardiovascular (CV) medicine, 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. Acad Med. 2015;90:1340–1346. First published online July 24, 2015 doi: 10.1097/ACM.0000000000000839 Please see the end of this article for information about the authors. Correspondence should be addressed to Robert A. Phillips, Houston Methodist, 6565 Fannin St., Dunn 200, Houston, TX 77030; telephone: (713) 441-2192; fax: (713) 790-5086; e-mail: raphillips@ houstonmethodist.org. 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 Robert A. Phillips, MD, PhD, Jay Cyr, RN, MSN, MBA, John F. Keaney Jr, MD, Louis M. Messina, MD, Theo E. Meyer, MD, DPhil, Stanley K.C. Tam, MD, MBA, Kathleen Korenda, NP, MBA, Melinda Darrigo, PhD, NP, Pooja Kumar, MD, and Sailu Challapalli, MBA