Q & A with our new Managing Director, Tim Calhoun

ProspHire proudly welcomes Tim Calhoun as our newest Managing Director, bringing with him over two decades of invaluable healthcare experience. Formerly from Ernst & Young (EY), Tim has been instrumental in serving healthcare clients across commercial, nonprofit and governmental sectors. His decision to join ProspHire underscores our commitment to excellence in healthcare consulting. Tim’s wealth of knowledge will undoubtedly elevate our client offerings and our standing as industry leaders. Today, we are diving into Tim’s motivations for choosing ProspHire, his strategic vision for leveraging his healthcare experience to drive growth and his unwavering dedication to delivering exceptional project outcomes for our clients.

Can you share more about your background and what led you to join ProspHire as Managing Director?

I started out in accounting and auditing in both manufacturing and financial services industries; my undergraduate degree was in accounting from Penn State. I obtained my Executive MBA from Pitt and coming out of graduate school I was drawn to consulting because of the variety of opportunities and the challenge of working with clients on key initiatives that are important to them and their stakeholders. For most of my career, I have been involved with clients from regulated industries, financial services and utilities but making the decision to focus on healthcare required me to double down on understanding the industry and figuring out how to apply my earlier learnings and experience to a new space - what I refer to as pivoting.

What attracted me to ProspHire was the 100% focus on healthcare and when I arrived, it was the caliber of the people and their knowledge and experience that reinforced that I made the right decision. The entrepreneurial spirit, the culture and the ability to make quick decisions were also attractive.

Up until joining ProspHire, I spent my consulting career with global firms. In 2010, I had the opportunity to help rebuild a health practice, which I enjoyed a great deal. Because of that experience, I knew that if I were to make a change, I wanted to change it up. I found that with ProspHire – a focus and energy on healthcare, an entrepreneurial environment and an opportunity to have impact on building the next generation of leadership.

How do you envision leveraging your experience to help drive the strategic vision of ProspHire?

There is such a solid foundation and forward momentum to build upon. One of the key reasons for making the move to ProspHire was the opportunity to contribute to defining the future direction – understanding the strengths of the firm, envision the direction of our industry and how we can best help our clients and our teams achieve success. The leadership team is dedicated to our clients’ success, prioritizing support for our internal teams and leveraging our collective experiences to develop best practices for the future. I have had the opportunity in my previous role to gain experience in envisioning how we can help our clients and putting that into action.  I want to “capture lightning in the bottle” again.

What are some key challenges you anticipate facing in your new role and how do you plan to address them?

There are internal and external challenges. From an internal perspective, I have been with several firms. While there are common threads in consulting, each firm has their own focus and community culture. I need to take the time to learn about these and make sure that I do not undermine the culture and community that has made ProspHire successful. That means I need to listen more than talk… for those who know me, that is a tall order. Listening is also a key requirement to contributing to the refinement of the strategic vision.

Externally, re-engaging with client relationships, building new relationships and educating them on what ProspHire offers. I am anxious to contribute and be incremental to our success. Developing new relationships and maintaining those who already know me is something that I have had to do for some time so it is really understanding what we can offer today in addressing our client’s challenges and collaborate with clients to meet their needs and timelines.

Could you elaborate on your experience collaborating with health plans and state health agencies to streamline administrative processes and drive transformative initiatives?

One of the first opportunities that I had in getting involved with health care was my involvement with a US-based performance metrics study that examined and compared insurers performance across the entire process value chain, including costs, process, quality, technology and staffing. It gave me a solid foundation in understanding how top performing plans operate, as well as a keen understanding of how up- and down-stream processes impact each other.

I was also fortunate to get a great deal of insights in how state agencies and health plans worked and interacted with each other in the Medicaid space – both in the implementation of their core platforms but also in understanding how to communicate with the states and CMS.

On the Medicare book, it is about understanding the regulations and the impact to core clinical and administrative operations. A lot of that comes from just getting involved with those initiatives. This experience was tested when helping an insurer get its Medicare Advantage book of business out of CMS sanctions. Given the growth of Medicare and Medicaid, I am fortunate to have gotten involved in them early in my career.

What are your priorities in terms of expanding ProspHire’s client base and enhancing service offerings?

I am looking forward to learning more about our existing service offerings and solutions so that I can articulate to our current clients and future clients what we do exceptionally well. That is really the first order of business and everyone at ProspHire has been so good at educating me.

My initial thoughts on expansion are focusing on clients’ needs related to doing more with less while navigating the current uncertainties of the marketplace – economic, upcoming election, increased regulations and customer trust. This implies the need for strong core operations and administrative costs efficiencies across commercial, Medicare and Medicaid. Insurers need to take the opportunity to weather these challenges and come out well positioned to optimize expense management, technology to improve operation workflows and maintain quality and affordable care.

How do you build collaboration and innovation within the team to ensure continued success and growth?

I see my job as learning what is important to each of our team members to be successful and how they define success. It is going to be different for each of us. The trick becomes how do we align that with what is important to our client’s success. Sharing and collaborating on opportunities and taking the approach of pulling in the right set of team members to make the client successful will be key.

Can you provide insight into specific areas with healthcare consulting that you believe holds the most potential for growth and development in the coming years?

Medicare and Medicaid are lines of business that will continue to grow; it just so happens, processes and regulations will create the greatest needs because of the regulatory complexity. I do believe that ProspHire is positioned to help our clients meet those needs, along with supplemental benefits – the Firm has a very strong and growing dental operations solution.

We are also seeing growth potential for our “payvider” clients and believe that this segment will continue to grow and will have unique opportunities where we can support them.

What role do you see technology playing in shaping the future of healthcare consulting and how do you help to incorporate technology advancements into the firm’s strategies?

Technology serves as a driving force for innovation and transformation in navigating the complex healthcare landscape. We need to help our clients think through how to leverage technology tools and solutions that address today’s healthcare challenges.

In the near term, I see insurers focusing technology initiatives in the areas of improving workflow quality and timeliness in clinical and administrative operations, such as Appeals and Grievances, Provider Network data, Stars and Quality measures. These areas allow insurers to quickly address member and provider needs and regulatory changes.  And of course, we cannot talk about technology without mentioning how advanced analytics and Artificial Intelligence (AI) will impact healthcare. The value of AI will come in helping to identify clinical and administrative options. We still are learning how to use AI and what are the limits of its capabilities. My thinking is that healthcare should be using this technology in identifying potential options in care and claims management but human decision-making is still required in executing. 

I am excited to help think through how we incorporate technological advancements into our solutions and strategies that focus on how we help our clients transform.

How do you plan to uphold ProspHire’s commitment to providing unparalleled expertise and leadership to its clients and what measures will you take to ensure client satisfaction and success?

By listening to what our clients’ needs are and what it means to them personally and professionally. It is not enough that we help the client solve their challenges, but we want to help them to be successful too. We work in an industry where there is not much differentiation in what we do. Our clients need to know us as someone who they can call to help them solve a critical need.