Cover Story

6 Consultants Have Their Say

Timothy Kelley
Senior Contributing Editor

David Betts, 50

Principal and National Leader for Customer Transformation in Health Care, Deloitte Consulting LLP

Based in: Pittsburgh

Education: MFA in theater—production management, University of Texas–Austin; MBA in strategy, finance and quantitative analysis, Carnegie Mellon University

Started out: First project after joining Deloitte 15 years ago was to help a hospital system redesign revenue cycle processes and nonclinical interactions. “To be honest, at first I didn’t share my theater background with clients until I was well into a project and had built credibility for my technical capabilities and understanding of the industry. But as consultants our job is to help clients understand the issues they’re facing—to tell them a story, in effect—and then motivate them to take action. When you think about it, that’s not too different from what we do in theater, engaging an audience and moving them in some way.”

Main focus: Advising clients on improving the consumer’s experience in health care, sometimes in ways that break with the orthodoxies of the past.

Advice: “Be curious. Get into the weeds a little in your understanding of how organizations create value for their constituencies. But also read books, go to movies, listen to music, visit museums. Learn about how the world works and what motivates people, what engages them and excites them—and how things are changing in other industries in ways that could be brought into health care. That’s critical, and it’s often overlooked by young consultants who think they just need to know everything about the industry.”

What people should understand better: “There’s tension in the system right now between efficiency and empathy. Because of margin pressure and increasing regulation, the industry has at many points traded off empathy in favor of efficiency. We need to find a better balance between the two in order to perform well financially.”

Donna Cameron, 60

Managing Director of Health Care, Navigant Consulting

Based in: Indianapolis

Education: MAT in speech/language pathology, Indiana University

Started out: A speech therapist who worked her way up in health care administration to become a hospital COO. “I’ve walked in the shoes of a clinician, a supervisor, a manager, and an administrator, so as a consuItant I understand the perspectives of many people in the ecosystem.”

Main focus: Strategy, operations improvement, and value transformation, principally affecting the patient experience and the continuum of post-acute care.

Advice: “Be a purposeful learner. Find a mentor or mentors. Then, as you continue to grow, serve as a mentor for others and pay it forward.”

What people should understand better: “The need for connectedness and collaboration. People working at a particular site of care tend to understand that site—a hospital, a skilled nursing facility, a physician’s office. But across these sites, a patient believes that care should be seamless—and that the right hand should know what the left hand is doing.”

Julia A. Gaebler, 50

Partner, Health Advances

Based in: Weston, Mass.

Education: MA in international economics, Johns Hopkins University School of Advanced International Studies; PhD in health policy and decision analysis, Harvard University

Started out: Trained in mathematical modeling, she was recruited after varied experience in academics and the pharmaceutical industry—and after helping the Rand Corporation fulfill a two-year Gates Foundation contract to model hypothetical diagnostic tests for infectious diseases in the developing world, with results published in Nature.

Main focus: Facilitating global market access to innovative medicines, dealing with issues of pricing, coverage and health policy.

Advice: “As you develop relationships with clients, it makes the consulting and advisory role really fun if you can help them with something you know well and feel passionate about.”

What people should understand better: “The dynamics of drug pricing. As the industry moves toward very high-priced and personalized medicines, we need to find a way, across countries, to pay for these things because patients want them, need them, and deserve them. My concern is that if only the pharmaceutical industry is targeted to reduce prices, there will be unintended consequences and tradeoffs. We simply won’t get everything we want.”

Jack Cook, 74

Independent consultant

Based in: Williamstown, Mass.

Education: MA, Dartmouth University; MA and PhD, Oxford University—all in mathematics

Started out: A job with the New Jersey Department of Insurance led to a stint with Maryland’s Health Services Cost Review Commission, which set private-sector hospital reimbursement rates and, thanks to a federal waiver, started in 1977 to do the same for Medicare and Medicaid. “Applying mathematics in a moderately sophisticated way to health care finance was not really done to any extent before, say, 1970.”

Main focus: Designing reimbursement systems.

Advice: “The name of the game is to find something that you know a lot about that most people don’t know much about and that is important to providers or other clients.”

What people should understand better: “The industry’s main underlying problem—besides unconscionable drug prices—is that private-sector payers are at a decided disadvantage when they negotiate with health systems, hospital groups, and physician groups. If they don’t contract with a provider, that provider can still charge for whatever services beneficiaries receive from them. The insurer, together with the beneficiary, is legally liable for those charges, which are excessive. And it’s not easy to keep your members away from those other hospitals or physicians, because so much care is provided on an emergency basis.”

Rex Holloway, 59

Partner and National Practice Leader, Hammes Company Advisory Services

Based in: Washington, D.C.

Education: MHA, Milken Institute School of Public Health, George Washington University

Started out: In the corporate offices of a national health system, then smaller regional hospital systems.

Main focus: Helping health systems develop and implement growth strategies with attention to market competition, facilities planning, physician alignment and business feasibility. For example, that could mean figuring out how many hospital beds will be needed. In most places, that number has been declining. But for certain tertiary centers—depending on their referral networks—it’s still on the rise.

Advice: “Your individual experience, while great, is not the same as a team with the complementary skill sets required to solve complex problems. So how consultants work together to get work done is very important. Also, learn to be truly clued into the decision-making process of an organization—and the project management skills needed to guide that process. It’s a large, complex engine you’re working on.”

What people should understand better: “The ACA opened the floodgates to people who previously didn’t have access to health coverage, and we’re coming to grips with that. However, we still have people in the system who are very expensive to care for. Unhealthy habits along with a lack of community commitment to deal with the socioeconomic drivers of health care create an uphill battle for achieving cost and quality goals.”

Kevin Thilborger, 47

Managing Director, Value-Based Care, Strategy and Transformation, Huron

Based in: Chicago

Education: MHA, Tulane University

Started out: Worked for a Louisiana medical group that took global capitation in the ’90s, then for a managed care payer.

Main focus: Helping health systems, community hospitals, medical groups, and other providers refine their overall strategy looking for merger, acquisition, and partnership possibilities and areas of potential performance improvement. The goal: achieving better outcomes, lower costs, or combinations of the two.

Advice: “One, it’s important to listen before you speak. Two, it’s not good enough to be a subject matter expert in one area; you must consider and understand the impact of your work on other areas and activities of the client organization.”

What people should understand better: “Different organizations don’t always agree on the meanings of the terms we use—such as ‘transparency’ or ‘value-based care.’ Depending on whom you’re talking to or what government form you’re reading, transparency about hospital costs can mean a chargemaster, or it can mean the actual reimbursement to the hospital—and honesty about the fact that the anesthesiologist and the pathologist are out-of-network at an in-network hospital.”

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