Health Care Consultants

The job title of consultant can sometimes seem nebulous to the average person, but consultants are basically experts who help clients solve problems. Health care consultants apply their expertise in one or more health care areas to help clients with matters ranging from reducing operational costs, to helping a drug company conduct market research and launch a new drug, to ensuring compliance with complex health care laws. External health care consultants are employed by consulting firms such as Huron Consulting Group and GE Healthcare, or management consulting firms such as McKinsey & Company and Booz Allen Hamilton that have health care consulting practices. They work with clients on a project basis, and clients are billed by the hour for consultants’ services. Internal health care consultants work as salaried employees for companies and other organizations, and they provide advice only to their employer. Other health care consultants are self-employed and run their own consulting firms.

These are some of the clients that health care consultants work for: health care providers (e.g., hospitals, outpatient centers, academic medical centers, clinics); government agencies (e.g., U.S. Departments of Health and Human Services, Defense, Veterans Affairs, local and state agencies); pharmaceutical, biotech, and medical device companies; insurers and payors (e.g., HMOs, Blue Cross/Blue Shield organizations); health organizations (e.g., health policy groups, nonprofits); and health care associations at the local, state, and national levels.

Health care consultants have a wide range of duties, depending on their employer and the needs of their clients. Examples of typical health care consulting engagements include the following: advising a pharmaceutical company on marketing, human resources, information technology, or regulatory issues; offering recommendations to insurance companies on how to comply with regulations put forth in the Patient Protection and Affordable Care Act and other laws; providing advice to two large medical practices that plan to merge; developing software to help a hospital better manage its employee benefits program; helping a large hospital to reduce expenditures without negatively affecting patient care by redesigning its supply chain process, centralizing purchasing, and renegotiating staff contracts; brainstorming with government officials in response to the threat of bioterrorism; and reducing employee turnover at a large hospital by improving its benefits plan and creating a marketing campaign that educates health care professionals about the benefits of employment at the facility. Other examples include enabling a drug manufacturer to increase its factory capacity, and therefore improve profits, by suggesting a redesign of the production layout and identifying underutilized areas that could be converted into additional manufacturing space; assisting a client with the creation of a private health exchange for employers with 5,000 or more benefits-eligible employees; helping a hospital transition to the latest edition of the International Statistical Classification of Diseases and Related Health Problems, a medical classification system that is used for reimbursement and resource allocation in the U.S. health care system; providing a software solution to a research hospital so that it can automate financial disclosures that are required for all research; and advising doctors, hospitals, and medical practices on ways to avoid medical-malpractice suits.