Health care consulting to hospitals and health systems, post-acute and ambulatory providers, medical groups and other provider organizations is big business. The $42 billion U.S. market for management consulting is growing at a 7 percent annual clip with health care consulting leading the way with growth of 9.5 percent in 2015.

No one knows for sure how many health care consultancies there are because they range from solo operators to global mega-firms. Likewise, no two firms are comparable: each touts unique strengths and most are privately owned and operated. That makes drilling down into consultancies focused on providers even more challenging.

Five consulting firms that can be considered to be established leaders are: Accenture, Bain, Boston Consulting Group, Deloitte and McKinsey. Analyses by companies like ALM, KLAS, and others profile the capabilities of health care consulting organizations, offering ratings that can be useful. And cursory analysis of citations from leading trade publications like H&HN reference others prominently, including PwC around health trends, Leavitt Partners around accountable care organizations, Huron around revenue cycle management, Advisory Board around physician employment by hospitals, and Kaufman Hall around financial planning for hospitals, just to name a few. But together, these still provide only a partial picture of the provider health care consulting sector. For purchasers of consulting services in the provider sectors, they’re only a start.

Not a homogenous field

Consulting is a tough business. The travel can be horrendous, the pressures to generate revenues for the practice demanding and work-life balance sometimes impossible. On a good day, knowing a client appreciates the work makes it worth doing it again the next day. On a bad day, the culture and politics of a firm can be debilitating.

Having had the opportunity to work for and with consultancies ranging from the biggest and best-known to “single shingles” and virtual shops and everything in between, the realities are that the depth and breadth of their expertise vary widely. In larger organizations, turnover in their lower ranks is usually high as principals and partners “churn and burn” through younger colleagues who do the grunt work. In these, advancement often has more to do to with selling and client relationship management than subject matter expertise. Consultants with operating experience who come from industry into consulting tend to struggle with corporate cultures and pressures to sell. Some consultants are exceptional; some are not, and in larger firms, there’ll be both. Variability is just as prevalent in smaller firms and solo shops: some quite good, and some not so much. And there’s no textbook for health care consultants in large or small settings: you learn by watching and doing.

No “Consulting Compare”

Unlike hospitals, physicians, nursing homes and other providers, report cards about the performance of consulting firms are not readily available. Transparency is not requisite. Most of what’s known is self-reported. The credentials of consultants provided in response to Request for Proposals are rarely checked for accuracy, and only the firm’s satisfied clients referenced. So as provider organizations compare consultancies, here are the 10 considerations that should be included as qualified consultancies are sourced and compared:

1) Reputation: Credible consulting organizations, especially the larger firms, do not believe their own publicity. They consistently measure and monitor their reputation noting their strengths and weaknesses, and how well current, former and non-clients view them.

Action: Ask for the firm’s latest analysis and ask about changes they have made as a result.

2) Industry Insight: Health care is complicated. Effective provider consultants must understand the intersection of industry trends and the regulatory climate that encompasses the industry. Credible consultancies are those that measure and monitor key trends and issues across the industry and embrace a holistic view of the entire system. They see the big picture and where specific sectors and subsectors fit. They follow clinical innovations and health policy as intently as changes in reimbursement. They’re committed to thought leadership that’s substantive, primary research that’s publicly accessible and training in their organizations from top to bottom so professionals are equipped to answer tough questions. They are coaching their professionals to study the industry, require participation in professional development and shy from “death by PowerPoint” as they engage with clients.

Action: Evaluate the firm’s view of the industry’s future, its trend analyses and thought leadership, and its investment in professional development.

3) Quality Controls:The deliverable from a consulting firm’s assignment is typically a report that provides an answer to the client’s question with practical insight about its implementation. As important, consultants bring technical expertise and relevant client experiences that can accelerate implementation and build internal consensus.

Action: Ask how the firm measures the value of its work performed for its clients, and the quality and accuracy of the recommendations and conclusions derived from its engagements.

4) Turnover: The most important asset in consultancies are its seasoned professionals. Keeping competent professionals is a key indicator.

Action: Ask about the firm’s turnover at every level with special attention to how “industry hires” are integrated. And investigate the reasons for departures of senior professionals in the firm.

5) Analytics: Increasingly, provider-focused health care consultancies use proprietary databases to calculate best practices around a host of solutions; i.e. operating and supply chain efficiency, accountable care savings, enrollment projections, and many others. The firm’s investment in its own analytics and how data is compiled in the proprietary models is often a key selling point for the firm. In some, forecasts and best practices are methodically designed and verifiable; in others, they’re based on inadequate rigor or simply concocted.

Action: Ask about the methodologies on which they’re based, and the quality controls are integrated in their design, verification and modification.

6) Relevant Engagements: Consultants provide the highest and best value when they approach problem-solving with a background of recent, relevant client experiences. In many cases, a firm will have no relevant experience: disclosure that a firm has not done a similar project is not a disqualification, it’s a signal of the firm’s candor and integrity. Likewise, disclosures that some team members might not have relevant experience is telling: firms frequently assign staff based on accessibility rather than experience.

Action: Inquire about the credentials and relevant experiences of the team proposed for a specific assignment, and how staffing for the particular engagement was determined.

7) Client Retention: It’s said that 80 percent of a firm’s revenue will come from its current clients, putting a premium on client relationship management and satisfaction. Firms that maintain multi-year relationships with clients fare best.

Action: Inquire about the firm’s five biggest clients for a period of the last 3 to 5 years and note changes.

8) Industry Association Relationships: Consultancies that “give back” to the industry through active participation in key trade and professional associations. Advertising in their publications, or hosting receptions in their meetings, and exhibiting at trade fairs is marketing; by contrast, serving on boards, participating in issue and advocacy efforts, means a firm is giving back in terms of the time and talent of its practitioners.

Action: Ask about how the firm is giving back to the industry and the trade groups with which it is partners.

9) Leadership: Leading a practice is tough. Consultants are prone to strong egos and a firm’s evaluation criteria keys to their behaviors. The firm’s leaders set the tone for how work is delivered and valued by its professionals and how their work is judged. Effective consulting firm leaders are recognized for their integrity, work ethic, industry competence and good will toward their teams. They are not threatened by those smarter than themselves and welcome divergent views.

Action: Inquire about the firm’s leaders—how they’re evaluated by their peers and underlings—and investigate their reputations.

10) Health care consulting serves a worthwhile and increasingly important role in assisting organizations by providing expertise and methodologies for analyzing problems and finding solutions. There are firms that do some things better than others, and there are clients that work better with certain types of consultancies.

People matter more than processes

Most of all, it’s a people business. Setting aside the importance of analytic tools and problem-solving methodologies, it’s the professionals the organization positions as its best and brightest that matters most. The integrity and character of its leaders, the strength and commitment to their professional development, and quality controls for work performed are imperatives for all, large and small.

For provider organizations, transparency is now standard operating procedure. For the consultants engaged to assist in finding solutions and charting courses of action, it’s useful to know as much about them as they and others know about you.

Paul H. Keckley, Ph.D.,, does independent health research and policy analysis and is managing editor of The Keckley Report. He is a member of Health Forum’s Speakers Express; for speaking opportunities, please contact Laura Woodburn. Marina Karp can be reached at