Tomorrow's Medicine, Ep. 8: Consulting in Healthcare - Dr. Adam Powell

With Dr. Adam Powell, Health Economics Consultant. Hosted by Arseniy Arsentyev. Published October 7, 2025.

https://aarsentyev.com/podcast/ep8-adam-powell

Machine-transcribed and lightly edited: filler words and false starts are removed, and the wording is otherwise as spoken. Where the two differ, the recording is the record. Times are minutes into the recording. Not medical advice.

[0:00] Arseniy Arsentyev: It's an eighth episode of Tomorrow's Medicine Podcast. My name is Arseniy and today I'm talking to Dr. Adam Powell. Dr. Powell is a healthcare economist, healthcare consultant and a president of Payer+Provider, a management advisory and operational consulting firm. As you understand, today we're talking about consulting in healthcare. We'll dive deep into the topic and with no further ado, please enjoy my discussion with Dr. Adam Powell. My first question is about the firm where you're a president, the firm that you lead, Payer+Provider. Can you tell us more what are you doing there and what is the goal, the mission of Payer+Provider?

[0:44] Dr. Adam Powell: Sure. So in 2012, I founded Payer+Provider in order to help healthcare organizations solve real problems using quantitative techniques. And the primary thing we do at Payer+Provider is help healthcare organizations show that their products and services achieve their objectives. This often takes the form of contract research. So perhaps there is a prior authorization service that wants to show how it changes the flow of care. Or perhaps there is a behavioral health services provider that wants to show that its treatments actually do make people better.

[1:23] At Payer+Provider, we take the data and we examine the outcomes that these both administrative services and clinical services produce to help demonstrate impact. The second thing we do is we help organizations estimate the ROI of things that they intend to develop or have already developed. ROI can be, return on investment can be different for different use cases. It can be different for different populations. And so what we do is we unpack the benefits and costs behind different healthcare interventions. We think about the assumptions. We think about the assumptions that are being made behind those benefits and costs. We think about the ranges that those assumptions can take and then develop aggregate figures. And this way we can show under a range of conditions what the ROI of a product or service might be.

[2:16] Arseniy Arsentyev: That's great. And the follow-up question is what inspired you to found such a company? What was your inspiration? Or maybe you've seen an empty niche in the market that you want to fill?

[2:30] Dr. Adam Powell: Sure. So I've long been passionate about healthcare problems. Ever since I was an undergraduate at MIT, I've been excited about improving the quality of healthcare and reducing its cost. And after college, I did a PhD in healthcare management at the Wharton School of the University of Pennsylvania. And while I was at Wharton, I was the leader of a consulting club that worked with real organizations. And I also spent some time interning at a health insurance company called Humana. As a result of doing that, I realized that after I finished school, I wanted to spend my time going out into real organizations and using some of the quantitative techniques that I learned as a student in practice to basically help organizations show that what they do works and help them plan for the future.

[3:23] And over time, I went from helping organizations to understand ROI, to understand the cost implications of things, to also helping them plan strategically. And so I'm increasingly involved in organizational integration and mergers and in other discussions that are a bit less quantitative in nature, but nonetheless have quantitative impact.

[3:45] Arseniy Arsentyev: Can we clarify what quantitative means in such a context? For example, do you have any computer-based simulations or is it more like an analytical work made by humans?

[3:59] Dr. Adam Powell: So, when I say quantitative, it can mean several things. Sometimes it means statistical analyses to understand what the association is between an intervention and the outcomes it produces. And sometimes it can mean a model, understanding how the design of a product or service impacts outcomes that the people that are selling that product or service wish to achieve. Namely, clinical improvement, reduced costs, the financial impact of better return to work, things of that nature.

[4:33] Arseniy Arsentyev: And can you disclose to us any recent or maybe the projects that you're mostly proud of and just give an example where Payer+Provider helped an actual business case?

[4:47] Dr. Adam Powell: Sure, sure. So, Payer+Provider has over the years produced a lot of research that's in the public domain, as well as done things that are not in the public domain. And so, I can talk about the public stuff. I can't talk about the non-public stuff. But as for the public stuff, we've helped a number of organizations show that what they do works and what they do has an impact. Recently, we had a paper that was in JNCCN, the Journal of the National Comprehensive Cancer Network. And what this paper showed was that basically when people do what they should do using the results from a genetic test and take guideline concordant lung cancer treatment, they have better outcomes, that they're more likely to stay on the treatment, that they don't switch drugs as quickly.

[5:31] And overall, there's better outcomes for people that are doing this and using the right diagnostic based upon their genotype. Another thing that we've done is helped an organization that provides occupational therapy to people that have workers' comp needs and are experiencing issues due to injuries in the job recover and get back to work. And we've recently produced a series of posters that show that treatment in this program is producing better return to work. It's resolving PTSD. It's leading people to have lower anxiety and depression. And so, the consulting work involves taking their data, analyzing it, seeing what the associations are, and then ultimately packaging it so that it can be disseminated to the public.

[6:19] Arseniy Arsentyev: That was a nice overview. As you know, the main topic of this show is healthcare consulting. And let's dive more into that broader kind of occupation as a person can pursue. And my first question, is there really a huge demand for health consulting? And what are the usual backgrounds that people come from?

[6:47] Dr. Adam Powell: So, I think there is tremendous demand for this, but there's a lot of different types of healthcare consultants. I actually spend my time really in two separate niches in healthcare consulting. I spend some of my time in Payer+Provider in this more operational consulting realm. I also do strategic consulting with SSB Solutions. And so, I'm part of two different organizations that have somewhat different missions, but nonetheless both in healthcare consulting. And people in this field have a variety of backgrounds. Some are more clinical. Some are economists. Some come from public health or health administration.

[7:24] And a person's background often impacts their approach to the field and the types of problems that they end up solving.

[7:29] Arseniy Arsentyev: So, again, I hope this integration of people from different fields helps immensely to gain the various experiences and to put them into one solution. And my next question to you is, what are the common pitfalls do healthcare organizations like face when they come to you or come to any other healthcare consultant?

[7:57] Dr. Adam Powell: So it really depends on the type of organization. There's a lot of different subsectors in healthcare. There are provider organizations that deliver services. There's payer organizations that manage the cost of care. There are prior authorization organizations that approve the delivery of care. Oftentimes, they want to show that something works. They want to figure out what they want to do going forward. They want to plan something. And so it really depends. As for common pitfalls, I think that it's important to have a problem that has a definite scope, that has a definite timeline, and to have all the actors necessary to resolve that issue involved in the project.

[8:44] But it really depends. It's highly variable.

[8:47] Arseniy Arsentyev: So it depends whether you're working from a payer side or provider side. Is that correct?

[8:52] Dr. Adam Powell: And the nature of the project. There may be different objectives in different projects. Some are more product focused, some are more about a partnership. And so it all depends.

[9:04] Arseniy Arsentyev: Are you working primarily on strategy side?

[9:06] Dr. Adam Powell: I work on both strategy and operations.

[9:09] Arseniy Arsentyev: Strategy and operations. Okay, I get it. And as you said, there are different types of healthcare consulting. And I want you to just comment on the table I've seen on Payer+Provider website, that you're kind of unique in such a niche, you combine. So you mentioned the companies, the general consulting companies like McKinsey, and so on. And they do their particular job. So can you once again, why Payer+Provider is unique?

[9:43] Dr. Adam Powell: Sure. So this is boutique healthcare consulting. I don't consider McKinsey a competitor whatsoever. And the reason why I mentioned that is with a boutique consulting business, you're working with a small number of individuals that have a lot of expertise in a particular area, and have a lot of focus. It's like going to a restaurant that only serves the food of one region of a country. The cook really knows how to do that one thing, but isn't necessarily generalized into multiple other domains. So McKinsey has practices that deal with energy, I believe, and consumer packaged goods and healthcare. And there's all sorts of different practices. Payer+Provider, SSB Solutions, we are focused surgically on issues in healthcare.

[10:28] Payer+Provider's niches have tended to be things around prior authorization, around issues around the regulation of care, about where care can be delivered, where it can't be delivered, ROI modeling. Those have been traditionally some of the sweet spots of Payer+Provider's work. SSB Solutions has worked a lot on organizations that want to build partnerships, that want to either merge or do a joint venture or similar creative arrangement together. It's also historically focused a lot on rural organizations, thinking about what the needs are of a hospital in a low population density setting where there actually may not be very much value-based care or the viability of value-based care because there's just not that many people.

[11:19] And in these rural settings, there's likewise often monopolies, just because, again, there's a scarce number of people, so there may not be a highly competitive environment. The reason why I mention this is that when you work on one situation in a particular environment, a particular niche, it really prepares you to work on the next one. And so by focusing on relatively narrow areas within healthcare, we gain experience that we can use when working with the next organization or on the next problem.

[11:50] Arseniy Arsentyev: Professor Powell, let's imagine some stereotypical healthcare company and imagine two kinds of people working there, healthcare economists and healthcare consultants. Because many people, including myself to be honest, often confuse this kind of, not intersection, but this cutting point where one profession begins and the other ends. Could you please clarify on the differences between the two?

[12:19] Dr. Adam Powell: Sure. I'm both. I'm both a health economist and a healthcare consultant. So health economics is an intellectual discipline and it can be used for many different purposes. It can be used for consulting. It can be used for research purposes. It can be used internally by a pharma company to think about how to price a drug. Healthcare consulting is the act of going to organizations and helping them understand their objectives and then work towards solving those objectives. And sometimes the objectives are strategic. Sometimes they're more operational.

[12:54] Healthcare consultants can be many things. I work closely with a cardiologist. I work closely with a radiologist. I work with someone with a master's in public health. So I work with someone else with an MBA. So the people that I work with as a healthcare consultant are not all health economists. And likewise, all health economists are not healthcare consultants. But for someone like myself and a few people I know, we do exist at the intersection of these two fields.

[13:24] Arseniy Arsentyev: I think it's great that you kind of made the distinction between the two and it will simplify the further discussion. The next question is, if we'll take someone like my friends, young people who are studying at college and who are just at the beginning of their careers, what advice, what like practical advice can you give to them if they want to work in healthcare?

[13:52] Dr. Adam Powell: Sure. I guess the main piece of practical advice is that you can only do things new in one way. You can solve a new problem for an old client. You can solve an old problem for a new client. You cannot solve a new problem for a new client. And what I mean by that advice is that there's a lot of trust involved in consulting. And so once you build trust, you can potentially expand your work into adjacent areas with an organization that trusts you and knows you well.

[14:34] And once you know an area well and have a demonstration of prior performance and have really shown your ability to execute on something, you can take that prior performance to a new organization. And you can show to them, look, I've done this well over there. I'll do the same thing for you. And that's credible. What's not credible is to show up somewhere, don't know the people, and say you're going to do some random thing you've never done before. That doesn't work.

[15:00] Arseniy Arsentyev: Okay. And your work often involves analyzing complex data sets. And what methodologies and what set of skills do you find the most effective for dealing with this health, maybe business data, maybe healthcare related data? So can we say that mathematical, strong mathematical background is required?

[15:26] Dr. Adam Powell: Sometimes. I think more so for the operations and the strategy. So for the operational consulting work, my typical workflow is to first frame the problem. I have to figure out what are we analyzing? How do I take whatever might be in the claims and represent it in variables? What would be the dependent variable? What's the independent variable? What are the control variables? What are our sample selection criteria? Then the data has to be extracted from a database. And it has to be put in a format that can easily be analyzed where there's a clear column for the dependent variable. There's a clear column for the independent variable, for the control variables.

[16:08] Once we have the data, what we'll do is we'll look at the data, we'll examine it to see if there are any obvious errors or issues with it that need cleaning, and then ingest it into a statistical package. Typically, the statistical package I use is R, which is an open source statistical package. And then what I'll do is I will write a script that performs a series of analyses on that data based upon the hypotheses we have, the things we want to test and look for in that data.

[16:39] One of the reasons why I particularly recommend R, especially to people that are starting out, is because R is free and open source. Now you might wonder, well, why am I not just paying money to buy some package? And the answer is because oftentimes this data is highly sensitive. And what that means is the data has to reside in a secure environment. It's often easiest to keep that environment, that data on the client servers. So I'm actually not bringing the data to my own computer. I'm working with all the data remotely, perhaps via remote desktop somewhere else.

[17:15] And so how do I analyze all the data if I can't have it in my own computer? Well, we need a statistical package on the client's computer. And if I'm using R, which is open source, which is free, which is heavily vetted, there is a relatively straightforward pathway to getting that statistical package onto the client's computer. Whereas if I'm using something else that's proprietary, that's licensed, you've got to pay for it. Now it's a much harder proposition to get that onto the client's computer.

[17:44] Arseniy Arsentyev: I get it. And what is the percentage, what is the time split between talking to people and working on some data sets or some numbers? So would you say your job is more interacting with customers and your clients or more of an analyst one?

[18:05] Dr. Adam Powell: It depends on the project. I think the strategy work is entirely talking to people. So I'm currently working on essentially a merger between multiple rural hospitals. And that's all talking to the leaders of the hospitals, understanding their needs, understanding their constraints, and then putting together a proposal that is mutually appealing to them. Of course, no one gets fully what they want, but it's a compromise. So that's 100% talking to people. As for this contract research, there is a bit of talking to understand what the organizational goals are. Why are they producing their research? What do they hope to show? What are hypotheses they want to test? What are some of the nuances that impact how the program performs and why it does? Because perhaps I have to consider certain exclusion criteria, for instance.

[18:52] Certain patients maybe shouldn't be included because there was something unusual happening in their treatment that I should know about. And so at the front end, there's some talking. But then after that, there's the analysis process where you basically build a script that tests what you want to test. And then once you've tested it and found your findings, there's the presentation process. So oftentimes the results get packaged as a poster or as a peer reviewed paper. And then they have to be submitted to conferences, submitted to journals. And there's a whole process in thinking about how you want to communicate your findings to the public.

[19:30] Because ultimately, when you're working as a consultant, you're doing research with a purpose. And that purpose is to communicate something. And so you have to understand, one, what your client wants to communicate. And then two, you have to think about how you can use the reality you see with the data to communicate that objective.

[19:51] Arseniy Arsentyev: Okay. And do you have a team when you work on such huge projects? How many people usually are on the consulting team?

[19:58] Dr. Adam Powell: It depends on the project. So the team is really one to five people. The strategy projects tend to have a bigger team.

[20:06] Arseniy Arsentyev: Okay. Okay, and next interesting, fascinating aspect of your background is that you co-founded the Society for Digital Mental Health Apps, if I'm correct?

[20:21] Dr. Adam Powell: Society for Digital Mental Health, yes.

[20:23] Arseniy Arsentyev: Yes. And your main objective was to help, not to help, to identify and help to grow these digital solutions for managing some mental health problems. Can you elaborate or maybe correct my points?

[20:38] Dr. Adam Powell: Sure, sure. So, for many years, I was on the Scientific Advisory Board of One Mind PsyberGuide. PsyberGuide was a consumer guide to digital tools for mental health. At PsyberGuide, what we did is we evaluated the tools, looking at various forms of quality. So, for instance, was there an evidence base behind the tool? We had to develop a tool for people and presented this information to the public so that people could make better decisions when selecting a tool to use for themselves.

[21:08] Over time, what we realized was that there really needed to be some sort of a professional organization to bring together different people that are using these tools, that are building these tools, that are regulating these tools, that are researching these tools. And that was really a separate purpose than what we were doing, just examining the tools themselves. And so, what happened was, with some funding from the Bowman Family Foundation, we developed a nonprofit organization called the Society for Digital Mental Health.

[21:41] And what this organization does is it's a convening body. One of the things it is doing every year is holding an annual meeting. And this annual meeting brings in people with different perspectives. There are flash talks, there are poster presentations, and it's really a chance for people to share what they're working on in this space. So, at the most recent annual meeting, I shared a poster looking at how cyberchondria is being measured by researchers. So, there's a concern that people are essentially using the internet in an obsessive fashion to look for various things related to their health. It's almost like hypochondria, but on the web. And there are two different scales that are in use to measure this phenomena.

[22:28] And so, what we did is we looked at the relative use of these two different scales over time, and also how they're being used in different languages, because the scales have been translated and used across the world. So, again, this was academic research and a chance to share this with other people that are in the field.

[22:49] Arseniy Arsentyev: All right. And speaking broadly about the digital solutions for mental health, do you believe in it? Do you feel that this technology would allow us to help people?

[23:02] Dr. Adam Powell: Generally, yeah. I think I'd be highly supportive. That's why I was on the scientific advisory board of a nonprofit in the area and founded SDMH with my colleagues.

[23:12] Arseniy Arsentyev: Are we talking about fully automated solutions? Or is there an actual psychotherapist or any other physician related to mental health involved in the solutions you were researching?

[23:27] Dr. Adam Powell: There's really a gradient. It's all of the above. Some of them are fully autonomous. Some of them are basically telemedicine facilitators and somewhere in between. But really there's a wide spectrum of degrees of both clinician involvement and person involvement. So some of them don't have a clinician in the loop, but they do have a peer or some sort of other supportive individual. It really depends on the tool.

[24:00] Arseniy Arsentyev: And because I have an example, I know some people who are living in a community that does not have easy access to good healthcare. And I literally asked them, why are you going to talk to them? If he or she recommends some weird stuff, isn't it better? They're not in the US. And they do not have access to proper physicians. And they're going to the doctor purely because of the personal experience. And that's my point about digital health apps: you need an actual person, an actual face, because people are more inclined to have some face to associate with professional skills.

[24:59] Dr. Adam Powell: So there's really three modes. So there's really three modes in which the apps are used. One is people may not be sure if they're having a mental health condition and want to assess themselves. And so the apps could be really the starting point, the on-ramp to getting in-person care later. They could also be used essentially as a complement to that in-person care. And that could be direct. So one mode would be, you'd be working directly with a counselor. And the counselor is app-based telemedicine. You could also be working with an autonomous app alongside that counselor. So you could have an in-person experience.

[25:41] But then you could also have concurrently an app-based experience that is separate but supportive.

[25:47] Arseniy Arsentyev: I feel that in this pause I can also add my personal experience. I was attending the NYU Forum for Artificial Intelligence and there was this guy, I honestly do not remember his name. And his startup is basically putting certain computers into toys. And the children can just press on the belly of a toy and it activates and they can communicate to the toy. And through LLMs, it analyzes the speech. It has so many different kind of stopping points because it's children and you need to filtrate as much as possible whatever the answers of the toy are.

[26:36] And as he said, there is a statistical data at that point that suggests that they can help prevent suicides in some cases when even older teenagers who are near to finishing their high school talk to their geeky toys. And I felt that it's a great moment to tell my audience about it.

[27:05] Dr. Adam Powell: Interesting. Well, it's always great to hear about new technological developments. Everything requires research. And then also, it's important to think about the guardrails around things and how you handle edge cases.

[27:19] Arseniy Arsentyev: And concluding topic on my show can be inferred from the name Tomorrow's Medicine. I want to ask you, what is tomorrow's medicine and most importantly, tomorrow's healthcare for you? Every time it is the same scene, the same environment: imagine our world in 10 years, let's say in a decade. And imagine that there is a great political governance, there is a great innovators, business leaders, and what can our healthcare be transformed in a decade and what you wish to see in a decade in our system?

[28:01] Dr. Adam Powell: So I think the big change in the next decade is going to be that a lot of the diagnostics done by medicine are handled by AI, perhaps working with a person. So I envision a future in which you can have a person with minimal training that is essentially capturing metrics, so perhaps has like physician assistant skills to get a person's vital signs, and putting them into an AI model. And getting diagnoses. Now then the question is, what does a doctor do in that environment? And I think what will happen is we'll have our physicians increasingly focused on treatment and then procedural medicine with a lot of the non-procedural stuff handled by artificial intelligence.

[28:49] This will have the potential to increase capacity. Because what we'll do is we're going to change the tasks that physicians are performing. So right now, physicians are involved in both the diagnosis and the treatment of disease, and they'll probably be more really spending their time, or at least a greater percentage of their time, treating disease with the more straightforward diseases diagnosed by AI working with a less trained individual. And so this will hopefully resolve some of the workforce challenges that we currently have in medicine. There are many places where there is a shortage of doctors, or there's not a willingness of doctors to work there, as there's many relatively remote places where it's hard to hire people.

[29:34] I think going forward, we're also going to see an increase in personalized output. I think that generative AI will be able to provide documents that patients can follow to follow their treatment plan. Likewise, insurance companies will take the data they have on the care that patients have received everywhere and will summarize it in an easier-to-read fashion so that the primary care physician can assimilate that data quickly and read it and use it during the care process. Now, managed care organizations are already providing primary care physicians with lists of patients in need of certain tests, patients with diabetes, etc. I think with generative AI, we'll see that be done in a much more user-friendly fashion than has historically happened.

[30:24] And then another thing we're seeing now already happening is the use of ambient note-taking in the exam room. And so increasingly in Boston, we're having AI listen to the patient-physician conversation, record that conversation, document that conversation, enter it into the electronic medical record and facilitate billing from that conversation. So AI is already in our doctor's offices, and I think it'll be even more so going forward.

[30:50] Arseniy Arsentyev: And what's your stance on robotics? Because you mentioned this operational stuff of medicine. Do you think that in 10 years it's possible to outsource some of the manual procedures to maybe some arms or some other kind of robotic manipulators?

[31:08] Dr. Adam Powell: I'm not sure. So what I mentioned, operational consulting, a lot of the work involves operations where there's something that's about managing a claim or about managing authorization of care. It's not physically managing stuff with robots. I think it remains to be seen as to how long it takes for procedural work to be done robotically. And that's because there's a lot of variation between people's anatomies. And so it's hard to standardize. Just like we've had a lot of challenges in implementing self-driving cars. So people thought that by 2025 we're going to be in a self-driving car, and that is just not the case. And so it remains to be seen.

[31:53] Arseniy Arsentyev: I hope it will change because I'm a huge believer in medical robotics. And we'll see how it all plays out. Thank you very much, Dr. Powell, for attending my show. I know that the audience improved their understanding of what healthcare consulting is.

[32:10] Dr. Adam Powell: And yeah, thanks.

[32:12] Arseniy Arsentyev: Thank you. Everyone, subscribe to Tomorrow's Medicine podcast. You can always support me on my Patreon page. And that's it. That was the eighth episode. Bye.