A four-hospital (350-bed) community health system had achieved strong operating margins for many years and was dominant in its primary service area. But as with many strong health systems, it was concerned with the impact of healthcare reform and state budget cuts on future performance. The organization’s financial goals included the need to improve bottom-line performance by $40 million over a two-year period. Preserving its culture of excellence and continuing its tradition of receiving numerous quality and service awards, including Truven’s “15 Top Health Systems,” was a priority. Tanner Health System collaborated with BRG to help reduce expenses, identify areas for growth in market share and revenue, and implement management tools to help sustain the many improvements made throughout the twelvemonth engagement. BRG assisted Tanner in implementing over $40 million in annualized improvements.