Take Action on Payer Mix Erosion
Sg2 Take-Action Guide_Payer Mix Erosion Health systems nationwide are seeing their proportion of commercial volumes slide. Is there a way to regain lost ground?
Sg2 Take-Action Guide_Payer Mix Erosion Health systems nationwide are seeing their proportion of commercial volumes slide. Is there a way to regain lost ground?
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 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.
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 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.
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 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.
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.
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.
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.
Sg2 Perspectives received a 2022 Hermes Award for our podcast episode How to Build a Diverse, Inclusive Culture When Health Equity Is a Strategic Priority, but Culture Eats Strategy for Breakfast.
