Article
Operational excellence is no longer enough. Here's how leading health systems are redefining the role of ambulatory partnerships.
Imagine reviewing your ambulatory joint venture (JV) at the next board meeting. The financial results are strong, quality metrics exceed expectations, and patient satisfaction remains high. By every traditional measure, the partnership is performing exactly as intended.
Then the conversation shifts. Where should the health system invest next? Which physicians should it recruit? How can it strengthen referral networks as more care moves into outpatient settings? How should it respond to new competitors entering the market?
Suddenly, the JV has little to contribute. That's becoming the difference between a good ambulatory partnership and a strategic one.
Five years ago, the conversation around ambulatory partnerships was relatively straightforward. Health systems looked for partners to build ambulatory surgery centers, expand imaging capacity, open the front door to the system, improve behavioral health access, or strengthen other outpatient services. For many organizations, joint ventures offered the capital, operational expertise, and experience needed to move faster than they could alone.
Those partnerships accomplished exactly what they were designed to do, but today's environment demands something different.
According to the Vizient 2026 Impact of Change forecast, outpatient volumes are projected to grow 20% over the next decade. As ambulatory care becomes the primary front door to healthcare, health systems are asking whether those partnerships are helping shape the strategic decisions that will determine future growth.
It's not because those partnerships have stopped working—many continue to perform exactly as intended. The challenge is that they were designed to solve a different set of priorities.
A decade ago, success meant opening facilities efficiently, improving margins, and bringing physician partners together. Those capabilities are no longer competitive differentiators—they’re table stakes.
The strongest JVs now are more deeply integrated and deliberate than ever. They’ve matured beyond day-to-day operations to provide market intelligence, strengthen referral networks, inform physician recruitment, guide ambulatory investments, and support long-term growth decisions.
The easiest way to determine whether a partnership has kept pace with the market is to look beyond traditional operating metrics for the full picture.
Executive teams should ask three questions:
1. Does the JV consistently deliver operational excellence?
Every partnership should provide efficient operations, high-quality care, strong patient access, disciplined financial performance, and a stable workforce. Without those fundamentals, little else matters.
2. Is the partnership shaping enterprise strategy?
This is where valuable partnerships begin to separate themselves. Some continue operating facilities successfully while contributing little to broader organizational priorities. Others become trusted advisors, helping leaders strengthen physician alignment, protect referral networks, guide ambulatory investments, and plan future service-line growth. The difference won't appear on a dashboard; it becomes evident in the conversations happening around the executive table.
3. Will this partnership help us compete five years from now?
Markets evolve quickly. Physician shortages, reimbursement pressure, consumer expectations, new technologies, and competitive dynamics continue to reshape ambulatory care. The strongest partnerships don't simply adapt—they help organizations lead by accelerating innovation, strengthening operations, and identifying new opportunities for growth.
Executive teams should regularly assess whether their partner has the vision and capabilities to support the organization's future strategy. That means revisiting governance, incentives, performance measures, and investment priorities to ensure the partnership continues creating long-term competitive advantage.
Although the specific priorities differ across ambulatory services, the underlying shift is remarkably consistent.
For example, in ambulatory surgery, that means participating in decisions about physician alignment, service line strategy alignment, and prioritizing where future outpatient investments should be made. In imaging, the focus extends beyond scanner utilization to protecting referral networks, improving patient access, and informing site-of-care decisions. Physical therapy partnerships increasingly serve as an entry point into musculoskeletal care, helping coordinate patients across urgent care, orthopedics, and primary care while strengthening referral pathways. Additionally, behavioral health partnerships have similarly expanded beyond adding capacity to integrating behavioral health into primary care, developing differentiated specialty programs such as adolescent and eating disorders, and addressing persistent workforce shortages.
Across every service line, the most successful partnerships are structured to provide executive perspective and strategic support. They combine shared governance, data transparency, aligned incentives, and collaborative planning processes that allow both organizations to continuously adapt as market conditions, care delivery and payment models, workforce challenges, and patient expectations evolve.
| Service line | Baseline priorities | Higher expectations | Strategic enablers |
|---|---|---|---|
| Ambulatory surgery centers | Build efficient outpatient surgical capacity | Help shape ambulatory growth strategy, physician alignment, and service-line expansion | Shared governance with service-line leadership, joint physician recruitment strategy, market planning, and capital investment roadmap |
| Imaging | Operate outpatient imaging centers efficiently | Protect referral networks, improve patient access, guide site-of-care decisions, and support physician recruitment | Shared referral analytics, network planning, access metrics, and physician engagement processes |
| Physical therapy | Deliver post-discharge rehabilitation | Improve musculoskeletal access, strengthen referral pathways, and coordinate care across ambulatory settings | Integrated care pathways with orthopedics, urgent care and primary care, shared performance metrics across the continuum |
| Behavioral health | Expand capacity | Integrate behavioral health into primary care, develop specialty programs, and address workforce shortages | Collaborative care model, embedded behavioral health clinicians, shared workforce planning, and specialty program development |
Ambulatory partnerships will continue to play an essential role as health systems expand access, strengthen physician relationships, and compete in a growing outpatient-focused market.
What's changing is how success should be measured.
The next generation of ambulatory JVs will be remembered for the strategic decisions they helped health systems make—where to invest, which physicians to recruit, how to strengthen referral networks, and how to compete in a healthcare landscape defined by ambulatory care.
Evaluating an established JV isn't about deciding whether to end the partnership but rather ensuring the partnership continues to support your organization's strategy.
Periodically revisit governance, priorities, and expectations to ensure the JV is evolving alongside the organization.
Your partnership may have outgrown its original business case if:
Senior Vice President
Lauren Clementi is a Senior Vice President of Kaufman Hall and a member of the firm’s Strategy and Business Transformation practice. She has more than 15 years of experience in strategic capital planning, with a focus on aligning strategy with achievable and sustainable long-term capital plans. Ms. Clementi helps healthcare leaders optimize decision-making using advanced analytics and scenario modeling to...
Managing Director
Adnan Qureshi is a Managing Director with the Mergers and Acquisitions practice at Kaufman Hall. He provides merger, acquisition, joint venture, and other strategic advisory services for healthcare providers and investors. Mr. Qureshi has over fifteen years of healthcare transaction experience spanning across roles in M&A advisory and corporate development/strategy. Prior to joining Kaufman Hall, he was a Director of...
