The real consulting problem in healthcare is implementation | Viewpoint

Recent headlines have raised pointed questions about the billions nonprofit hospitals have spent on management consultants — and whether those dollars have meaningfully improved financial performance, staffing, operations or patient outcomes.

It’s a fair conversation to have. Health systems are operating under intense pressure, and every dollar spent should be tied to a clear purpose and measurable value. Leaders are right to ask harder questions about the return on outside advisory spend, especially as margins remain tight, direct-to-consumer models threaten traditional care models, and reimbursement dynamics grow more complex.

But concluding that external expertise broadly “doesn’t work” risks oversimplifying the issue. For many health systems, the need for outside support is not going away. In fact, this need is intensifying as the operating environment becomes more specialized and complex.

The real question is not whether hospitals should seek help. It is what kind of help actually delivers.

The Real Gap: Strategy Without Execution

The business case looks compelling. The final presentation lands well with senior leadership.

What happens next is where most engagements fall apart.

Many traditional management consultancies are structured around high-level strategy engagements with executive leaders to rationalize cost-cutting or quantify growth initiatives. But they rarely reflect the perspectives of the operator-level stakeholders who are actually accountable for bringing those plans to life. Their teams are often built around consultants who may be far removed from the day-to-day realities of running a department, managing a hospital P&L or navigating the bureaucracy of a large health system.

The result? Beautifully constructed strategic frameworks that are operationally disconnected from the teams, processes and organizational dynamics required to execute them. A five-year implementation roadmap sounds rigorous on paper — but a health system without the internal resources, talent infrastructure and day-to-day operational support has little chance of realizing it.

The real work happens in the trenches, where someone must be accountable for turning the savings figure on a slide into a measurable result.

What Health Systems Should Demand Instead

Health system leaders are being asked to manage a wider and more complex set of pharmacy priorities than ever before. Specialty pharmacy programs are maturing, but payer dynamics require continuous iteration. Hospitals that rely on the 340B program to support vulnerable patients are navigating growing compliance and operational requirements.

In that environment, health systems should expect more than recommendations. They should expect advisory partners who can stay accountable to measurable outcomes without absorbing an outsized share of the value they help create, and who bring the operator-level experience needed to turn strategy into sustainable execution.

1. Align incentives with measurable outcomes.

Traditional consulting models can create one kind of misalignment: firms are paid for the engagement itself, regardless of whether the strategy is implemented or successful. But performance-based models can create another challenge if they require health systems to give up a large share of the revenue or savings created by the work.

Health systems should look for partners whose incentives are tied to measurable outcomes, but whose model also allows the organization to retain the value being created. True alignment is not only about whether a partner benefits from success. It is also about whether the health system can sustain that success financially over time.

2. Prioritize partners who can implement, not just advise.

There is a meaningful difference between someone who can design a strategic framework and someone who has lived the operational reality it is meant to improve. The best advisory relationships bring operators into the work, including people who have managed pharmacy operations, led clinical teams or navigated the procurement complexities of a health system from the inside.

That experience changes the nature of the recommendation. It accounts for bureaucracy, staffing constraints, change management challenges and the daily friction that pure strategy can underestimate. It also keeps the focus on practical, scalable programs that can be implemented within the health system’s actual operating environment.

Health systems should also consider whether an advisory partner is truly aligned with their mission and market position. Part of the shared purpose is knowing that a partner is committed to strengthening the health system’s ability to care for patients, rather than also advising organizations whose strategies may move patients, prescriptions or market share away from that health system.

The Path Forward

The conversation about value and accountability in advisory relationships is the right one.

Health systems operate in resource-constrained environments, and every dollar should be justified by measurable results.

But the answer isn't to reject external partnership entirely; it's to demand a different kind of partner. One that brings operator expertise, not just strategic frameworks. One whose incentives are aligned with your outcomes, not their billable hours. One that stays in the work long enough to see a recommendation through to realized results.

The billions spent on consulting aren't inherently wasted. But the model that has produced uneven returns deserves a closer look, and health systems have every right to expect more from the partners they invite to the table.

Beth Riggio is vice president & GM, practice management solutions, Cencora