About the only con I see is that we are not doing as much "ignite outcomes improvement" work as we would like. I know we have the talent and other resources to do it, but in some instances, our clients default to the most urgent -- not necessarily the most important -- projects, such as work on compulsory reporting projects (quality measures, etc.), rather than work on pure improvement projects. To the extent we can help our clients catch the vision of how we can help them in these projects, we will really solidify our strong relationships with them.