November 10, 2023 by Emily Wong

Ambulatory Shift of Cardiovascular Procedures

Sg2 FAQ_Ambulatory Shift of Cardiovascular Procedures

As payer support, technological advances and care redesign enable care to be delivered in lower-acuity and lower-cost settings, the opportunity to shift procedures to the ambulatory setting is now top of mind. This shift, however, is highly market dependent. A complex combination of forces, including federal and local regulations, workforce, patient population, and the current market landscape, must be assessed to understand if this shift aligns with and supports the broader goals of an organization’s cardiovascular program.

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The Sg2 Consulting Team

Our multidisciplinary experts—including clinical leaders, strategists and former health care executives—work with leading hospitals and health systems around the globe to provide innovative, actionable business solutions. Read more about our team:

Amit Sharma Expertise: Facility planning, strategic planning, virtual health strategy

Amit Sharma Expertise: Facility planning, strategic planning, virtual health strategy

Amit is an international health care business leader with 15 years of experience in solving key business and clinical questions. He has led health care projects in 10 countries, across Canada and in 30 US states. Amit has been with Sg2 since 2004. As a lead on Sg2’s Consulting team, Amit manages complex strategic engagements in the United States and Canada with academic medical centers, national health systems, regional health systems/community hospitals, industry clients and the investment community. As a trusted advisor to many health care executives, Amit answers challenging questions related to market relevance, sustainable growth, strategic partnerships, major investments and innovation. Amit previously led consulting and advisory work at Sunnybrook International, a part of Sunnybrook Health Sciences Centre in Toronto, Canada. His work focused on supporting governments, private investors and health care providers to enhance existing clinical capabilities, build new facilities/infrastructure and deliver education/training. He also was a picture archiving and communication system (PACS) project manager with McKesson Medical Imaging Group in Vancouver, BC, Canada, where he led health care IT implementations for hospitals and health systems in Canada, the US and Europe. Amit earned an MS in biomedical engineering from Northwestern University and a BS in electrical engineering from The University of Western Ontario. He enjoys playing sports, reading, watching movies, and exploring new places with his family and friends.

Tawnya Bosko, DHA Expertise: Payer and employer strategy, risk-based payment models

Tawnya Bosko, DHA Expertise: Payer and employer strategy, risk-based payment models

Drawing upon 20 years of experience in health care management and strategy, Tawnya collaborates with health systems and payers to develop innovative and detailed plans for future growth. She has advised clients on strategies for mergers/acquisitions and the development of clinically integrated networks, strategies for provider-owned health plans, and overall strategies to enable organizations to transition to value-based payment and evolving delivery system structures. Tawnya’s areas of focus and expertise include health care reform, market forces and strategic analysis, specifically around hospital-physician alignment, emerging reimbursement and incentive models, performance optimization, payer strategy, and the intersection of health policy with delivery system transformation. As a nationally recognized speaker on health care market trends and insights, Tawnya frequently presents at industry conferences on the financing and delivery of care. She has authored many articles for industry-leading publications on health system strategy and the conversion to value-based reimbursement. Previously, Tawnya was a vice president in the population health and strategic advisory practices for GE Healthcare Camden Group. Before entering consulting, she spent over 10 years with Western Reserve Health System (OH) and its affiliated multispecialty medical group and management company as vice president and chief operating officer. For Summa Health Network (OH), she led network contracting and provider relations. She has additional experience overseeing underwriting for a health plan. Tawnya holds a doctorate in health administration from the Medical University of South Carolina, a master of science in applied economics from Georgia Southern University, a master of science in health law from Nova Southeastern University Shepard Broad College of Law and a master in health care administration from the University of North Carolina at Chapel Hill. She received her bachelor of business administration in economics from Kent State University. Strengthening her ties to Kent State, she has served as an adjunct instructor of the economics of health care and managerial economics for health care managers and was also a member of the health care executive MBA task force. She is currently a member of the economics advisory board for the department of economics at Kent State University.

Jim Reilly Expertise: Bundled payment strategy, physician alignment strategy, service line strategy

Jim ReillyExpertise: Bundled payment strategy, physician alignment strategy, service line strategy

Jim provides leadership and strategic direction for Sg2 Consulting, overseeing the development of strategies for health systems and medical groups to drive growth and elevate the value of care provided. Jim’s health care career spans more than 25 years and includes significant nationwide consulting engagements with health systems and physician practices. He has led more than 350 engagements at some of the country’s largest and most respected institutions, focusing on the areas of physician alignment, strategic planning and value-based care initiatives. Additionally, Jim has more than 2 decades and industry leading experience in bundled payments strategy, analytics and physician sharing models. His strengths include a proven track record in physician relations, project management, communication skills, team building and financial analysis. Jim was a founding member and managing partner of TRG Healthcare Solutions from 2001 to 2014, focusing exclusively on physician alignment, service line strategy and bundled payments. Prior to that, he led the consulting division of GE Medical Systems focused on clinical and operational performance improvement. A recognized national speaker on hospital-physician alignment models, bundled payments and value-based care strategies, Jim has addressed such organizations as Healthcare Financial Management Association, American College of Healthcare Executives, American College of Cardiovascular Administrators, American Medical Group Association, Vizient National and Regional Collaboratives, The Health Management Academy, and The Society of Thoracic Surgeons. Jim graduated from the University of Colorado with a degree in finance and lives in Denver with his wife and 2 children.

Michael Strilesky Expertise: Value-based care strategy, clinical integration, physician alignment

Michael StrileskyExpertise: Value-based care strategy, clinical integration, physician alignment

Mike brings over 15 years of health care strategy and consulting experience to his role as principal at Sg2. He has worked across all aspects of the provider continuum and has developed strategies and led engagements for community hospitals, integrated delivery networks, academic medical centers and independent provider organizations. He contributes to thought leadership in the areas of hospital–physician alignment, clinical integration, value-based reimbursement and health care disruption. Mike's consulting work has focused on innovative projects, including the development of some of the first clinically integrated networks in the country, the expansion of community-based medical groups and provider networks on behalf of academic medical centers, and transformational strategic plans for health systems and community hospitals. An emphasis on physician relationships and alignment strategies that are designed to improve the financial results and clinical delivery capabilities of each organization has been common among these innovative consulting projects. Prior to joining Sg2, Mike was a principal for Dixon Hughes Goodman in the National Strategy Practice, and he held multiple positions at Charis Healthcare. He started his health care career working at St Elizabeth's Medical Center in Boston. Mike received his bachelor of science degree in business administration from Boston University.

David DiLoreto, MD, MBA, FACS Expertise: AMC strategy, physician alignment, managed care strategy

David DiLoreto, MD, MBA, FACSExpertise: AMC strategy, physician alignment, managed care strategy

David DiLoreto is a principal at Sg2 and a physician executive with 2 decades of experience in health system, physician practice and managed care strategy and operations. Prior to Sg2, Dr DiLoreto provided health care consulting and advisory services as senior vice president at GE Healthcare. Additionally, he served as corporate CMO at Presence Health in Chicago, IL, and he was simultaneously CEO of both SmartPlan Choice and Medicare Value Partners. He also served as the chief clinical officer at Baptist Health Care in Pensacola, FL. Furthermore, Dr DiLoreto worked at the Louisiana State University (LSU) School of Medicine in New Orleans where he was a tenured faculty member before founding the university’s faculty group practice in 1995. During his 15-year career as an orbital and ophthalmic plastic surgeon at LSU Healthcare Network, he performed over 5,000 major surgical procedures and received numerous clinical and teaching awards. Dr DiLoreto is a diplomate of the American Board of Ophthalmology and serves as a director on the boards of health systems, professional societies, national trade associations, and early-stage IT and analytics firms. After receiving his undergraduate degree from Loyola University New Orleans and medical degree from the University of Florida, Dr DiLoreto completed an ophthalmology residency at California Pacific Medical Center in San Francisco, CA, as well as fellowship training at the University of British Columbia in Vancouver, Canada, and an MBA from Emory University in Atlanta, GA.

Matthew Fadel Expertise: Physician-hospital alignment, value-based care strategies, strategic planning

Matthew Fadel Expertise: Physician-hospital alignment, value-based care strategies, strategic planning

As a leader on Sg2’s Consulting team, Matt is focused on physician-hospital alignment, value-based care strategies and strategic planning, both service line–wide and enterprise-wide. He has experience in the design, development and implementation of accountable care organizations, clinically integrated networks (CINs) and comanagement agreements. Prior to Sg2, Matt served as senior manager within the National Strategy Practice of Dixon Hughes Goodman (DHG). In this role, he designed a CIN playbook for a large regional health system in the Southeast that expanded across 2 states and over 7 different health system partners. He also was involved in several internal cost savings/gainsharing engagements to help health systems, hospitals and large physician groups improve quality and reduce costs. Furthermore, Matt acquired technical expertise in developing funds flow methodologies based on rewards and created through value-based agreements (eg, shared savings, pay-for-performance, capitation). Additionally, Matt previously worked in the performance improvement consulting division at Ernst and Young, where he designed a new operating model for a state health care agency. He also worked with numerous health systems on meaningful use attestation requirements. Matt has written extensively on clinical integration, funds flow methodology, risk-based payments, narrow networks and community health needs assessments. His work has been published through DHG and in Becker’s Hospital Review. Matt holds a master of business administration degree, with a concentration in finance and financial reporting, and a master of science in management degree from Case Western Reserve University. He earned a bachelor of arts in political science from Denison University.

Ron Herzig, PhD Expertise: Strategic engagements with the pharmaceutical industry, medical device companies and distributors, market insights

Ron Herzig Expertise: Strategic engagements with the pharmaceutical industry, medical device companies and distributors, market insights

As a consulting principal on Sg2’s Life Sciences and Industry team, Ron leads strategic engagements with the pharmaceutical industry (pharma), medical device companies and distributors to provide market insights and direction on their strategically important growth areas. He brings over 2 decades of international experience working in strategic leadership roles driving competitive market success across product and service lines. His career spans the discovery, product development and marketed products business segments in biotechnology, pharma and medical device, which has allowed him to have a broad and deep perspective on the complexity involved in achieving product-market fit, penetration and share. Ron is passionate about bringing together his scientific rigor and business acumen to solve strategic challenges for Sg2 clients. Ron moved away from the bench early in his career to profit and loss ownership roles for products and services companies like Millipore and Thermo Fisher targeting the drug discovery market. He is as familiar with smaller start-up companies as he is with very large multinationals. As the program development leader for a late-stage start-up, Ron was instrumental in the development of a next-generation drug eluting coronary stent and the subsequent acquisition of the company by Medtronic. Additionally, he served as the chief operating officer of the only internationally based research center for the Smithsonian Institution. Upon returning to the US, Ron joined a strategic and innovation consulting firm focused on helping Fortune 100 companies in the life sciences industry realize major new growth. Finally, prior to joining Sg2, Ron was the VP of BioPharma Commercial Strategy for PPD, carrying forward strategic growth initiatives across the enterprise. Ron confirmed his passion for the life sciences while pursuing his BS in biology at the University of California, Los Angeles, where he also supported research on the molecular etiology of HIV and leukemias in the Division of Hematology and Oncology. He subsequently earned his PhD from Northwestern University in molecular and cellular biology studying the molecular basis of metabolism as it relates to disease progression. Early in Ron’s career, he co-invented an innovative gene therapy technology that today is bringing hope in the clinic to individuals suffering from conditions such as neuroblastoma.

Karl Karlsson, PhD Expertise: Supplier strategy, ambulatory strategy, facility planning, service line strategy

Karl Karlsson, PhD Expertise: Supplier strategy, ambulatory strategy, facility planning, service line strategy

As the lead on the Sg2 Life Sciences and Industry team, Karl leverages nearly 20 years of life sciences experience to develop strategies and solutions for biopharma, medical device, distributors, health IT and finance services. On a day-to-day basis, he helps position Sg2 as a strategic advisor in partnerships between leading health systems and life sciences firms. He brings extensive experience from his prior role as Sg2 consulting principal, wherein he worked with leading US and global health care providers affiliated with several of Sg2’s 1,700 client health systems. Karl also spent 5 years working out of Sg2’s international office in London, England, where he supported clients in the National Health Service, South East Asia, Hong Kong, Australia and the Middle East. Karl earned a PhD from the University of Oxford in the United Kingdom, where he developed models using stem cell technologies to study HIV drug targets. He received a BSc in biochemistry and pharmacology from King’s College London. Karl is married with 2 sons and a daughter and lives in Chicago, IL. He enjoys teaching his children Swedish, being an amateur photographer and expressing his scientific curiosity through cooking.

Kevin Lieb Expertise: Bundled payment strategy, physician alignment strategy, service line strategy

Kevin LiebExpertise: Bundled payment strategy, physician alignment strategy, service line strategy

Kevin is responsible for business development and client relationship efforts. He has more than 24 years of health care–related experience delivering solutions across a broad spectrum of hospital based initiatives, which include project leadership related to physician alignment, quality improvement, patient satisfaction, service line strategy and market development, as well as cost reduction initiatives at some of the country’s largest hospitals and health systems. Prior to joining Sg2, Kevin worked for TRG Healthcare Solutions in Denver, CO. He helped the firm double in size by offering entrepreneurial solutions to hospitals that were seeking better physician relations, with solutions that included employment models, professional service agreements, comanagement programs, bundled payment initiatives and other joint venture opportunities. Prior to TRG, Kevin worked for several well-known health care companies including JD Power and Associates, GE Medical Systems, HCIA and LBA Healthcare Management in Denver, CO. Leveraging his experience across multiple service line settings—including cardiovascular, orthopedics and women’s health—Kevin provided insight and leadership while helping his clients improve physician relations and quality. He also gained extensive experience in cost management, market share development for new service lines, physician alignment initiatives, consulting management, product development and direct sales. Over the years, Kevin has enjoyed speaking publically to numerous health care associations, including American Alliance of Orthopaedic Executives, American College of Cardiology, American College of Healthcare Executives, Medical Group Management Association and Society for Healthcare Strategy & Market Development. While at GE Medical Systems, Kevin was also certified in Six Sigma.

Jamie Logsdon Expertise: Ambulatory growth projects, financial impact analysis

Jamie LogsdonExpertise: Ambulatory growth projects, financial impact analysis

As an associate principal on Sg2’s Consulting team, Jamie manages strategic engagements and customized market analysis for national health systems, integrated delivery networks, regional health systems and provider organizations. She offers Sg2’s members innovative approaches to growth and sustainability, specializing in ambulatory growth projects and financial impact analysis. Prior to joining Vizient, Jamie was vice president of strategy at Ascension Wisconsin, where she was responsible for creating the organization’s multiyear ambulatory development plans, service line distribution plans, build-partner strategies for joint venture development and a three-year strategic plan. Jamie also served as an internal consultant to other markets on Ascension’s national ambulatory strategy development team. In addition to this role, Jamie’s extensive experience includes strategic planning, financial management and accounting in the health care and insurance industries. Jamie received her master of business administration degree from Marquette University and a bachelor of business administration in accounting from the University of Wisconsin-Madison. Jamie is a Certified Public Accountant and a member of the American Institute of Certified Public Accountants.

Michael Lutkus Expertise: Strategic planning, physician alignment

Michael LutkusExpertise: Strategic planning, physician alignment

Michael is an associate principal on Sg2’s Consulting team and has extensive experience working on strategic planning and physician alignment projects with various specialists and primary care physicians across the US. In addition to facilitating independent physician practice acquisitions and performing physician/extender compensation modeling, Michael has distinct expertise helping hospitals and physicians jointly craft clinical comanagement agreements that are win-win for both parties. Michael also often works on projects involving change management, and he provides ongoing implementation and execution assistance after the discover/vision and develop/design phases. Prior to joining Sg2, Michael worked for Charis Healthcare and the National Strategy Practice of Dixon Hughes Goodman (DHG). At DHG, Michael helped to standardize the firm’s approach to clinical comanagement and developed a tool kit for use with clients. He was also intimately involved with clinically integrated network development projects. Michael has more than 10 years of experience in the health care industry and has worked with numerous hospital clients on projects ranging from physician alignment initiatives to ambulatory strategy projects and freestanding ED validation to service line, hospital and system planning. He and his colleagues have performed detailed service line assessment and strategic planning work across a broad range of service lines, including hospital-based specialties. In addition to hospital-physician strategy work, Michael has helped design cutting-edge system-to-system service line affiliation models. Three growing areas of activity and expertise for Michael include clinical service distribution and medical group and virtual health strategy. His clients have ranged from county-owned critical access hospitals to national for-profit health systems and have included some of the largest and most prestigious academic medical centers and academic health systems in the United States. Michael received a bachelor of science degree in chemical engineering from the University of Notre Dame.

Kristin Oberfeld Expertise: Physician alignment, bundled payment, value-based care services, episodic analytic support mechanisms

Kristin OberfeldExpertise: Physician alignment, bundled payment, value-based care services, episodic analytic support mechanisms

As an Sg2 Associate Principal, Kristin specializes in projects across the spectrum of physician alignment, paying particular attention to bundled payments and other value-based care services. She is a continuous innovator of episodic analytic support mechanisms, a mentor to consultants and an industry presenter. Kristin has over a decade of health care experience in both finance and consulting. Prior to joining Sg2, she spent 7 years with TRG Healthcare Solutions. She has unparalleled experience in and extensive knowledge of all facets of bundled payments, having worked with every hospital in Medicare’s Acute Care Episode demonstration as well as with over 40 hospitals and 60 medical groups in Medicare’s Bundled Payments for Care Improvement initiative. Her consulting focuses on creating strategies for success under episode payment models, developing gainsharing programs to align providers, producing actionable data analytics solutions, and assisting with care redesign initiatives that will improve both cost and quality. In addition to bundled payments, Kristin’s value-based care work includes providing organizational readiness and feasibility analyses, supporting organizations that are participating in shared savings models, and assisting providers with the Medicare Access and CHIP Reauthorization Act of 2015. She has participated in commercial payer bundled payment initiatives as well as nonalternative payment methodology work such as practice/physician compensation valuation and service line comanagement development. Kristin received her bachelor’s degree in finance from Texas A&M University.

Heidi Pandya Expertise: Strategic planning, operational improvement

Heidi PandyaExpertise: Strategic planning, operational improvement

Heidi has nearly 20 years of health care provider and professional service experience, with expertise in strategic planning and operational improvement. As a principal on Sg2’s Consulting team, she manages complex strategic engagements with academic medical centers, national health systems, regional health systems and community hospitals. A trusted advisor to many health care executives, Heidi answers challenging questions related to market relevance, sustainable growth, strategic partnerships, major investments and disruption/innovation. Prior to joining Sg2, Heidi served as vice president of strategic planning for Medical City Healthcare (HCA North Texas Division), where she partnered closely with the Sg2 team. She was responsible for leading short- and long-range strategy development, executing strategic growth and expansion across the system. In addition, she oversaw the teams that support system operations and strategic planning. Previously Heidi was a director in the strategic transformation group of the PricewaterhouseCoopers health care advisory division. She led a broad range of strategic planning, operational improvement and transformation engagements. She has worked with acute care providers, academic medical centers, safety net systems, ambulatory networks and international health systems. Heidi holds both a master of science in health care administration and a bachelor of arts in business administration from Trinity University in San Antonio. She is currently on the faculty for Trinity’s health care administration executive program. Heidi’s passion for the outdoors has also led her to serve as a board member for the Texas Trust for Public Land, whose goal is to improve physical and mental health by bringing parks and green space into communities.

Darcy Shanks Expertise: Health care reform initiatives, bundled payments and hospital/physician strategic alignment models

Darcy Shanks Expertise: Health care reform initiatives, bundled payments and hospital/physician strategic alignment models

Based in Sg2’s Denver office, Darcy manages and leads a team of consultants and directors responsible for delivering specialized consulting services to hospital and physician group practice members. She also personally consults with hospital executives, physicians and physician group practice administrators on implementing health care reform initiatives, with a heavy concentration in bundled payments and hospital/physician strategic alignment models, such as gainsharing and comanagement. She brings more than 20 years of experience in health care consulting and has worked with more than 125 hospitals nationwide. Prior to joining Sg2, Darcy spent 4 years with TRG Healthcare Solutions, partnering with active hospital and physician group practice participants in CMS’s Bundled Payments for Care Improvement initiative. Her consulting focused on creating strategies for succeeding under episode payment models, developing gainsharing programs to align with provider partners, and developing care redesign initiatives to improve quality and outcomes. Additionally, Darcy worked for Healthgrades and was responsible for consulting with hospitals on the impact of transparency, quality ratings, health care consumerism and improving quality outcomes. She also worked with GE Medical Systems, where she was trained in Six Sigma and was responsible for analyzing market share data trends. Darcy received her bachelor of science in communications with a minor in business from the University of Texas in Austin, TX. She and her husband live in Evergreen, CO, and enjoy hiking, boating, skiing and taking long drives in the beautiful Colorado Rocky Mountains.

Melissa Threlkeld, FACHE Expertise: Academic medical centers, national health systems, regional health systems and community hospitals

Melissa Threlkeld, FACHEExpertise: Academic medical centers, national health systems, regional health systems and community hospitals

As a principal on Sg2’s Consulting team, Melissa manages complex strategic engagements with academic medical centers, national health systems, regional health systems and community hospitals. She is a trusted advisor to health care executives, answering challenging questions related to market relevance, sustainable growth, strategic partnerships, major investments and disruption/innovation. Melissa has more than 20 years of health care provider and industry experience, with expertise in strategy and business development, service line leadership, solution development, hospital operations and finance. Before joining Sg2, Melissa served as regional vice president of oncology for Sarah Cannon and HCA Healthcare in two divisions: Medical City Healthcare (HCA North Texas Division) and Methodist Healthcare (San Antonio Division). At Medical City Healthcare, she was responsible for developing the vision, strategy and tactical plans for the largest oncology service line in HCA. Under her leadership, HCA built a destination strategy, opened the first Sarah Cannon Cancer Hospital in Texas, grew market share and increased margins by double digits each year. Previously, Melissa worked at Cardinal Health in a variety of roles ranging from strategy and business development to account management and consulting to an internal start-up. She led teams that worked directly with large health systems and academic medical centers across the US. She also held leadership roles at St. Luke’s Episcopal Hospital in Houston and at the University of Texas MD Anderson Cancer Center. Melissa holds a master of health care administration and a bachelor of journalism from the University of Missouri. She is board certified in health care administration as a Fellow of the American College of Healthcare Executives. Melissa also serves as a board member for Cancer Support Community North Texas.

Susan Ventre, PhD, MHA Expertise: Life sciences and industry, strategic growth, market insights.

Susan Ventre, PhD, MHAExpertise: Life sciences and industry, strategic growth, market insights.

As a consulting principal on Sg2’s Life Sciences and Industry team, Susan leads strategic engagements with pharmaceutical, medical device and diagnostics manufacturing companies to provide market insights and direction to their most strategically important growth areas. Susan’s extensive experience includes working in life sciences contract research and health service delivery organizations across the US and Canada. This background provides her a comprehensive view of customer needs, values and preferences that she shares with Sg2 members. Before joining Sg2, Susan led global scientific and technical teams at ACM Global Labs and PPD, Inc, developing service strategies to support new therapeutic products and devices in clinical development. Prior to her work in clinical trials, she was an associate technical director of biochemical genetics and genomics with Labcorp. Susan earned a PhD in human genetics from McMaster University in Hamilton, Canada; a master of health administration degree from the University of North Carolina at Chapel Hill; and a BS with honors from the University of Waterloo in Waterloo, Canada.

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Ambulatory Shift of Cardiovascular Procedures

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