Nine questions for health plans and risk-bearing provider organizations that expose the gap between the sales pitch and the search you actually receive.
By Steve McGovern, President & CEO, McGovern Executive Search
The pitch is polished. The partner is impressive. The promises are reassuring. Then you sign the agreement.
That is when you discover what you actually bought. Does the senior partner stay involved? Are the candidates being assessed against your requirements? Can anyone explain what the firm has accomplished beyond sending messages and scheduling calls? In my conversations with healthcare leaders, the frustration is familiar: the firm that sold the search and the firm delivering it can feel like two different organizations.
This is a guide for health plans and risk-bearing provider organizations. Here, the consequences extend well beyond an inconvenient vacancy. You are entrusting a firm with a consequential leadership appointment and your reputation in the executive market. You deserve to see behind the presentation before you commit.
The Association of Executive Search and Leadership Consultants’ Client Bill of Rights sets expectations for its members around candor, business knowledge, clear engagement terms, and communication. 1 The questions below apply those principles to our market and add service expectations drawn from my own work.
The questions below are designed to make that examination uncomfortable where it needs to be. A capable, accountable firm should welcome them. Apply them to my firm, too. Green flags indicate evidence you can examine. Yellow flags demand a direct answer. Red flags signal a material failure of capability, candor, or delivery.
1. Is your search a client obligation or a sales credit?
Ask what distinguishes the firm’s best search consultants. Listen for how completion, timely delivery, placement outcomes, and client feedback affect recognition and rewards.
Ask what the firm rewards after the assignment is won. One large search firm’s 2024 annual report explicitly links part of consultant compensation to revenue, while allowing nonfinancial measures as well. 2 Revenue-linked compensation does not establish poor service. It does make this a fair question: how much does delivering your search matter compared with selling the next one?
Request completion rates for comparable assignments, typical time to qualified candidates, and placement retention at twelve and twenty-four months. Ask how the figures are calculated, how many searches they cover, and how cancellations and unfinished assignments are treated. Retention also deserves context: remaining in a role does not establish that the executive is achieving the client’s objectives.
- Green: The firm can demonstrate client outcomes and explain how they influence consultant evaluation.
- Yellow: Its answer centers on billings, growth, rankings, and assignments won.
- Red: It misrepresents results or conceals material exclusions in its performance figures.
Ask: How do the results of our search affect how you evaluate and reward the consultant responsible for it?
2. Are they specialists, or generalists with a healthcare label?
“Healthcare” is too broad a claim to establish expertise in your business. A record of assignments in pharmaceuticals, durable medical equipment, or traditional health systems does not, by itself, establish expertise in health plans and risk-bearing provider organizations. A generalist with healthcare clients should not be confused with a specialist in your market.
The distinction is the business model. Health plans see care across settings and episodes, with financial exposure to its total cost and obligations for quality. Providers accepting meaningful population risk share that exposure. Their leaders must connect clinical decisions, utilization, care coordination, member and patient experience, and financial performance. A familiar title at a diversified healthcare company does not establish that experience.
Controlling cost does not inherently mean diminishing quality. Preventing avoidable admissions, coordinating care, and delivering effective treatment earlier can improve outcomes while reducing unnecessary expense. Cutting necessary care fails that test. A search partner should be able to assess whether an executive has improved clinical and financial performance together.
CMS describes risk-based arrangements as involving financial responsibility for quality and cost, with exposure to losses varying by arrangement. [3] Your search partner should understand your particular arrangements and what the CEO and board’s direction demands of the next leader. Depending on the assignment, that may require depth in Medicare Advantage, Medicaid, D-SNPs, I-SNPs, ACOs, or PACE.
Ask the person conducting your search to explain where your organization bears risk, what drives its performance, and which capabilities its next stage requires. Then ask for comparable assignments that person personally completed. “We have a healthcare practice” is an organizational description. It is not evidence of specialization in your business.
- Green: Candidate requirements connect directly to the organization’s strategy and operating needs.
- Yellow: The firm offers a broad healthcare client list but struggles to explain the economics of your business or the experience your next leader needs.
- Red: Generalists are presented as specialists, and candidates lack essential capabilities the firm does not understand well enough to assess.
Ask: What makes you a specialist in our business, and what evidence supports that claim?
3. Are you buying the partner and getting someone else?
Before signing, meet the person who will understand your business, evaluate candidates, advise you, and remain accountable.
There is nothing inherently wrong with a team approach. There is a serious problem when the partner who won your confidence becomes a name on the proposal while people without the promised expertise conduct the work. If the senior partner’s role is largely business development, you should learn that before signing.
Also examine what a firm means by “retained.” AESC describes retained executive search as an exclusive advisory engagement encompassing identification, assessment, and selection. 4 Ask for comparable completed assignments, references, the assessment process, and the lead executive recruiter’s current workload and support.
A firm entering retained search should be able to demonstrate the capabilities and capacity the assignment requires. Taking a retainer creates an obligation to deliver the promised service.
- Green: Named people have clear responsibilities, relevant experience, and capacity.
- Yellow: Senior involvement is prominent in the pitch but vague in the engagement.
- Red: The promised expertise disappears after signing or resurfaces only when the search is in trouble.
Ask: Who will personally assess the candidates, and how involved will the person presenting today remain?
4. When does “these things take time” become an excuse?
A credible firm should challenge expectations before accepting the work. Compensation, geography, technical requirements, culture, and unusual combinations of experience all need examination. The firm should explain what comparable situations have taught it, what the market can support, and where a requirement may constrain the search.
For a VP through C-level assignment with realistic, agreed parameters, my expectation is three extensively vetted, qualified candidates within the first 45 days of the agreed search start.
That commitment should follow a substantive assessment of the assignment. The firm should explain material constraints before accepting the engagement and agree a concrete delivery plan.
By qualified, I mean candidates who meet the essential requirements, understand the position, and are interested in substantive client discussions. The firm should specify which evaluation steps will be complete at presentation and which checks occur later.
- Green: Commitments follow a serious discussion of requirements, feasibility, and evaluation.
- Yellow: The firm promises quick results before understanding the assignment or gives vague timing without an explanation.
- Red: Months pass without acceptable candidates, followed by pressure to abandon essential requirements.
Ask: What supports this timetable, and what assessment will be complete when you present candidates?
5. Did anyone actually assess this candidate?
A résumé is not an assessment. A conversation is not necessarily an assessment, either. Every recommendation should explain why the candidate deserves consideration, what gives the firm pause, and what remains to be established.
The firm should know the organizations and business units behind the résumé well enough to distinguish an employer’s capabilities from the individual’s responsibilities and results. A recognizable company name cannot do that work.
Ask about career progression, decisions made, measurable contributions, communication, and reasons for leaving prior roles. Require evidence against the agreed criteria. An essential requirement should not quietly become optional because the firm has struggled to find candidates.
Apply the same discipline to executives between positions. In my experience, capable leaders can spend an extended period looking for the right role. Examine their record and verify their account of departures. Time between jobs alone is an inadequate assessment.
- Green: The firm discusses strengths, limitations, motivations, and evidence of fit with candor.
- Yellow: Its assessment largely repeats the résumé and offers unqualified praise.
- Red: Client interviews expose fundamental mismatches that a substantive assessment should have identified.
Ask: What concerns you about this candidate, and what have you done to investigate those concerns?
6. Is this your search, or a rotation of familiar résumés?
An established network is valuable. Trusted contacts can provide informed referrals and candid insight, including when they are not candidates themselves.
The firm should combine those relationships with research and outreach specific to your assignment. Previously known candidates should receive a fresh assessment against your requirements.
A retained search should not become an exercise in finding a client for the candidates already at hand. The concern is convenience becoming the selection criterion. Availability does not establish suitability. Equally, appearing in a database or actively seeking work does not make someone a weak candidate.
- Green: The firm can explain how relationships, referrals, and new research contribute to the search.
- Yellow: Familiar names appear without a convincing explanation of how they were selected.
- Red: The firm repeatedly promotes readily available people who fail the agreed requirements.
Ask: What work have you conducted specifically for this assignment, and how did it lead to these recommendations?
7. Are you seeing the work or being managed?
“We are making progress” is reassurance. It is not a report. You should receive a written account weekly or every two weeks, on an agreed schedule, with substantive updates between reports when needed.
The detail should match your preference. A comprehensive account should distinguish attempted contacts from actual conversations and explain relevant organization types, executive functions, geography, responses, concerns, exclusions, and next steps. Compensation, relocation, and role scope are examples of feedback the client needs to understand.
Candidate confidentiality must be protected through appropriate authorization and de-identified reporting. That still allows the firm to give a meaningful account of its work.
For an active search, I consider acknowledgment of client outreach within 12 hours a reasonable expectation, with dependable coverage for urgent matters outside business hours. If an answer requires further work, the response should explain when it will arrive.
Transparency is reciprocal. Clients should disclose material changes in strategy, compensation, scope, or internal circumstances and provide candid feedback.
- Green: Reports explain progress and obstacles, and the knowledgeable partner remains accessible.
- Yellow: Updates offer activity totals and reassurance with little substantive detail.
- Red: The firm will not explain its work or repeatedly leaves the client pursuing unanswered questions.
Ask: Can we see what you are doing, what you are learning, and how that changes your next steps?
8. What are candidates hearing when you are not in the room?
The search firm represents you whenever it approaches an executive, explains the role, answers a difficult question, communicates a delay, or ends a candidacy.
Candidates should receive an accurate account of the position, respectful treatment, confidentiality, responsive communication, and a clear conclusion when they leave the process. AESC’s Candidate Bill of Rights expressly addresses communication and candidate care, including for people who are not selected. 5
Ask about follow-through after acceptance as well. The transition into a leadership role remains important to both the organization and the executive.
- Green: The firm represents the organization accurately and communicates throughout the process.
- Yellow: Candidates receive inconsistent information, incomplete answers, or unexplained delays.
- Red: The firm misrepresents material facts, breaches confidentiality, or repeatedly leaves candidates without closure.
Ask: How do you manage communication with people we do not hire, and what support continues after an offer is accepted?
9. What disappears when the fee drops?
Compare the actual terms. A percentage based on base salary is different from one based on broader compensation. Clarify included compensation components, later adjustments, expenses, and other charges.
A substantial, unexplained discount deserves a question. If the promised work remains identical, what explains the reduction?
There can be sound reasons for a concession. The client should understand the rationale and whether staffing, assessment, research, or other commitments change. Price alone cannot establish quality.
- Green: The fee, scope, resources, and any concession are explained clearly.
- Yellow: A dramatic discount arrives without a credible explanation of how the promised service will be sustained.
- Red: Material charges or reductions in service emerge after signing without disclosure.
Ask: What changes, if anything, in the service we receive at this price?
Turn the assessment around
Ask the prospective partner to put its commitments in writing: who leads the work, how candidates will be assessed, when qualified candidates should be presented, how progress will be reported, and what successful completion means.
Then ask the question that connects all of them:
What has to happen for you to consider our search successful, and how will we know?
The firm is asking you to trust its judgment about executives. Start by examining its judgment, incentives, and delivery with equal rigor. A polished presentation should earn the next question. Accountability should earn the assignment.
References
1. AESC Client Bill of Rights. Professional expectations for member firms, including candor, business knowledge, engagement clarity, communication, and follow-through.
2. Heidrick & Struggles 2024 Form 10-K. See “Our Compensation Model.” A documented example of revenue-linked consultant compensation that also allows nonfinancial measures.
3. CMS Value-Based Care Spotlight for Providers. Context on quality, cost accountability, and differing risk arrangements.
4. AESC Global Guide to Choosing an Executive Search Firm. See pages 3–6 for engagement models and selection considerations.
5. AESC Candidate Bill of Rights. Expectations for information, communication, confidentiality, assessment, and candidate care.