How to Know When You Need a Consultant


Keeping up with all the changes and demands in the healthcare industry evokes the familiar analogy of ‘swimming upstream’ in a fast-moving current. It’s hard to get a firm grasp on rising costs, evolving technologies, and increasing consumer expectations, much less proactively manage them to gain an advantage.

Payers have work to do that’s complex and challenging; it includes implementing innovative, value-based reimbursement methodologies, replacing legacy systems with modern software applications, and launching multi-channel communication tools to engage members and providers.

While there may be resources in-house capable of researching and orchestrating these initiatives, typically they are stretched thin with the day-to-day pressures of administering benefits, paying claims, and addressing an onslaught of regulatory changes. Just mentioning the size and scope of this type of transformation project can send them running for cover, and in all honesty, you know it will dilute their focus and productivity

What to Consider

The idea of hiring a consultant is often met with procrastination. It seems most everyone has experienced the pain of paying big dollars to bring in expert help only to discover they’ve been handed a cookie-cutter plan off the shelf, or gained yet another queen vs. worker bee.

But when you are seeking organizational transformation—initiatives that will permeate your workflows and the essence of how you do business—an experienced, proven consultant can be worth his/her weight in gold. The leadership, guidance, management skills, and “let me roll-up my sleeves and make this happen” fortitude of a stellar consultant can position your organization to thrive in the future.

You must do your homework and choose wisely. Seek a consulting firm that uses a proven approach to study your processes, evaluate your systems, and craft a plan specific to your organization. A good consulting team can bring the expertise, experience, and sheer manpower needed to implement an initiative that will allow your organization to remain competitive. And a great consulting team will help your organization incorporate agility into your infrastructure and culture so you are prepared to continuously embrace change and meet future challenges head-on.

The Value-Add

Effective consultants are simultaneously leaders, managers, and worker bees. You’re paying them for their expertise and experience that will help you avoid pitfalls and implement initiatives in a timely, cost-efficient manner. Here’s the value-add an “outsider” brings to the table:

A fresh perspective

Because internal leaders and staff are ultra-close to the day-to-day business processes and systems, they often can’t see how “normal” or minor inconveniences affect employee morale, productivity, and customer satisfaction. Leveraging an external expert familiar with industry trends and benchmarks enables you to quickly identify areas for improvement that could produce immediate benefits.


Many processes and systems used by organizations were built and/or implemented by current staff, who understandably have emotional connections to what is being used. Change can be perceived as a critique or even a threat to their job/value, perpetuating the status quo. Consultants offer an assessment free of bias, and are adept at enticing stakeholders to embrace change.

An extra set of hands

The work of transforming an organization requires redesigning business processes, updating or replacing systems, and revising policies and procedures. But most payers run lean operations; staff are entrenched in day-to-day responsibilities and don’t have the bandwidth for significant additional work. While both management and staff must be engaged throughout the course of an initiative, much of the heavy-lifting should be handled by the consulting team.

With the Right Partner, Get Ready to Transform

The healthcare industry is evolving rapidly. Organizations that cannot adapt to market shifts will be left behind, lose their competitive advantage, and ultimately miss the opportunity to participate in the next generation of healthcare. The right consulting partner works side-by-side with you to define new strategies and unlock opportunities so you can chart a clear path forward, cut through complexity, and stay ahead of shifts in the market.

Knowing when to bring in outside help is the first step. Finding the right healthcare consultant is next.