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Hiring a health plan consultant? Follow these tips to select a consultant and make the most out of the investment

How to hire a health plan consultant

5 min read




This post is sponsored by GuideWell Connect.

Health plan consultants can provide significant help to payers in a variety of situations, including launching a new product, entering a new market, refining sales and marketing plans, updating standard operating procedures or optimizing go-to-market channels.[1] But to make sure you’re getting actionable strategic counsel, it’s important to know what to look for in a consultant and how to get the most out of the relationship.

Finding the right fit: Selecting a health plan consultant

Payers evaluating consulting firms should look at firms’ recent work, expertise in market, how they measure results and overall client-vendor rapport.[2] According to Charlie Kirksey, GuideWell Connect Health Care Consulting Practice lead, “consultants should first and foremost be experienced practitioners that have a proven track record delivering actionable recommendations in situations similar to the issue a health plan leader may be facing.”

A consultant’s engagement with a payer should be designed to achieve a specific goal. To deliver results, consultants should have experience successfully doing the type of work being discussed, rather than just consulting on it. Kirksey, who leads the GuideWell Connect health plan consulting practice, underscored the importance of consultants being able to blend strategic recommendations with implementable action plans to ensure work transcends theory and actually delivers tangible results.

Red flags to avoid when hiring a health plan consultant

There are several common red flags to watch for when choosing a consultant, particularly firms that use a cookie-cutter approach and don’t invest time in a true partnership with payers.[3] The guidance provided by a consultant should not be an industry-agnostic, best-practices solution; it should be a customized approach grounded in extensive expertise.

Before the engagement kicks off, the consultant must collaborate with the health plan to develop a strong understanding of the plan’s business needs.[4] The solution must address where the payer currently is in the market, and the two parties should work together on clear and definable objectives. “The real value in a consulting engagement is being able to bring in an objective third party that can tailor an action plan to a payer’s specific situation,” Kirksey said. “The end product should result in a measureable impact and transition from the plan’s current situation to an improved state.”

Another common red flag is when consulting firms bring out experienced professionals during the sales process but don’t involve those same employees in the engagement.[5] Payers should determine who will actually be working with them[2] and ensure they will have ongoing access to experienced subject matter experts and not just junior associates assigned to the project.

Maximizing ROI on a consulting engagement

Once a consultant is chosen, payers can take several steps to get the most out of an engagement. Embracing transparency is key. The payer must trust the consultant, because holding back information can jeopardize the outcome. The consultant will need access to the right people, processes and technology to fully assess any issues and identify other factors that may be contributing to a problem. Health plans should also be open to making changes and potentially broadening the scope of the engagement to get to the root cause of a problem.

Payers will see greater benefits from working with a consultant on an ongoing basis, tweaking and refining any changes to ensure the best long-term results. For example, engaging a consultant prior to open enrollment allows them to become familiar with the plans’ goals and marketing, which in turn helps maximize ROI from newly acquired or retained members.

An ongoing relationship can also help health plans stay ahead of regulatory changes, market trends and consumer behaviors. This awareness is increasingly important as tech-savvy consumers switch and choose insurers based on their digital experience.[6] Health plans with the best customer experience enjoy higher member loyalty, as well as member willingness to pay higher prices.[7]

Consultants can help payers attract and retain more members, enhance operating plans, launch new products and make sure they are up-to-date with industry trends and consumer preferences. Selecting the right consulting firm and leveraging a proven approach to maximizing the engagement can ensure health plans translate partnerships with a consultant into better financial results for the plan and better health outcomes for members. 

GuideWell Connect is a leader in integrated consumer engagement solutions that help health plans acquire, engage and retain members. GWC provides technology-enabled services across the member lifecycle to advance health plans’ financial performance and drive better health outcomes for members. Learn more at


[1] Bryant, Meg. When is it time to bring in a consultant? Healthcare Dive. August 8, 2016. Retrieved October 1, 2018 from
[2] Keckley, Paul and Karp, Marina. 10 Steps to Hiring the Right Health Care Consultant. H&HN. June 15, 2016. Retrieved October 1, 2018 from
[3] Krotz, Lois. Consulting Potholes: Watch Out for These 5 Things. KLAS. November 7, 2016. Retrieved October 1, 2018 from
[4] Krotz, Lois. Top 5 Attributes of Effective Advisory Firms. KLAS. October 31, 2016. Retrieved October 1, 2018 from
[5] Keckley, Paul. The Role of Management Consultants in Health Care: How to Buy Wisely. H&HN. November 2015. Retrieved October 1, 2018 from
[6] Trzcinski, Arielle. Health Insurers Must Improve Member Experience Now or Be Replaced. Forrester. August 21, 2018. Retrieved October 1, 2018 from
[7] McCarthy, Kate. The US Health Insurance Customer Experience Index, 2017. Forrester. October 4, 2017. Retrieved October 1, 2018 from