Nonprofit Hospitals Spent $7.8 Billion on Management Consultants. What Changed?
A May 2026 JAMA study looked for measurable change after hospitals hired consultants. It found almost none, and it raises a question every partner should be able to answer.
Between 2009 and 2023, nonprofit hospitals in the United States spent more than $7.8 billion on management consultants. Hospitals that hired them paid an average of $15.7 million.
In May 2026, researchers publishing in JAMA asked whether that spending was followed by measurable changes in hospital finances, operations, or quality of care. They compared hospitals that hired consultants for the first time against matched hospitals that did not, then tracked both groups afterward.
Almost nothing moved. Margins, revenue, cash reserves, staffing, length of stay, readmissions, mortality: across the board, the researchers found no evidence of meaningful improvement. One measure moved in the wrong direction, and even that did not hold up under a different set of assumptions. Read the study
It is worth saying what this does not mean. It does not prove that consulting never works, and it does not say that consultants harmed anyone. An average across hundreds of hospitals hides real differences between individual engagements, and this design shows association rather than cause. It also did not examine analytics vendors, data platforms, or software, so it should not be stretched to cover them, ours included.
What it does show is that at a sector level, $7.8 billion bought no consistent improvement in the things hospitals were hiring for. The study cannot tell us why, because it never looked at how any of those contracts were written. That is the part worth sitting with.
The contract matters
In a traditional consulting arrangement, a partner is hired to analyze a problem, develop recommendations, and deliver the work. Once those obligations are fulfilled, the fee is earned.
That does not mean the advice is bad. It means the economics of the engagement are separate from the outcome. A partner can satisfy the contract in full without the underlying metric ever moving.
Define success as a measurable change against a baseline both sides agreed to in advance, and the arrangement is different. The partner now carries some of the risk that nothing happens.
The same question applies to us
Clarify puts practice liaisons in the field as part of Meridian. A liaison sits down with an independent practice and shows the physicians, for every specialist in their market, how patients like theirs actually fared, episode by episode, and where the wait to be seen is measured in days rather than weeks. The referral decision stays with the physician. The liaison's job is to make sure the person deciding is not guessing.
It is fair to ask how that differs from the engagements the study examined. The answer should be visible in how the partnership is built, not in how we describe it.
Our fees follow measured improvement against a mutually agreed baseline at the service line level. The baseline is set before the work starts, while the answer is still unknown. Attribution then follows referrals into the claims, so both organizations can see whether referral patterns actually changed. If the agreed improvement does not happen, the associated fee is not earned.
Having people in the field isn't the distinction. The difference is what happens after they leave the room.
Three questions worth asking any partner
These apply to Clarify as much as to anyone competing for the same investment.
What happens to your fees if nothing moves? Is the fee earned when the work is delivered, or when the outcome is achieved?
What is the baseline, who agreed to it, and when was it set? Success should be defined before the results are known, not after.
How will we know something changed? Ask where the measurement comes from and whether the result can be independently validated. The answer should not rest on the partner reporting its own success.
The study will not tell a health system which partner to choose. But it does make one question harder to ignore: What happens to your partner's fees if nothing changes?
That question should have a clear answer before the engagement begins.
Schedule a briefing to see how Meridian's outcomes-based partnership works