The impacts of consultants on financial, operational, and quality outcomes in the U.S. Health system

The National Institutes of Health Office of the Director awarded The University of Chicago $779,000 on September 15, 2026, under the Trans-NIH Research Support program (CFDA 93.310) to investigate the financial, operational, and quality impacts of management consultants on nonprofit health care delivery organizations in the United States.

The project applies modern empirical methods to evaluate consultant costs and effects by leveraging IRS Form 990 tax filings for nonprofit health care organizations, machine learning to identify consulting contracts, and causal inference techniques linked to organizational- and patient-level datasets. The research addresses three core questions: total consulting spending across nonprofit health care delivery organizations; the major types of organizations using consultants and the types of consultants engaged; and the causal impacts of consulting engagement on financial performance, operational efficiency, and quality of care. Findings will inform policies governing consulting contracts, financial transparency, nonprofit accountability, and health care waste reduction.

Performance takes place in Chicago, Illinois, with a period of performance extending from September 15, 2026, through June 30, 2031. The award is structured as a Project Grant, subject to NIH audit requirements under OMB 2 CFR 200.

Abstract

Health care delivery organizations in the U.S. Are increasingly turning to consultants for financial and operational expertise, fueling the rapid expansion of the consulting industry. Although consultants are often hired for their specialized knowledge and skills, they also come with significant costs. Health care providers - particularly nonprofit health care organizations - are among the industry's largest clients. Despite this growing reliance, little empirical research has examined the impact of consultants on financial performance and patient welfare. This project addresses that critical GAP by applying modern empirical methods to evaluate the costs and effects of consultants at nonprofit health care organizations. By creatively leveraging publicly available IRS tax filings (form 990) for nonprofit health care organizations, using machine learning to identify consulting contracts, linking to organizational- and patient-level datasets, and applying causal inference methods, I will address the following core questions: 1) how much money are nonprofit health care delivery organizations spending on consultants? 2) what are the major types of nonprofit health care delivery organizations that use consultants and which types of consultants? 3) what are the causal impacts of consultants on health care delivery organizations' financial performance, operational efficiency, and quality of care? The insights gained from this proposal provide unparalleled transparency into the consulting industry and determine whether this industry produces or undermines value in the U.S. Health system. Findings from this study will inform policies governing consulting contracts, financial transparency, nonprofit organization accountability, and health care waste.