The most important thing they never teach you in your HEOR program is this: your job exists because someone approved a line item on a P&L.

Not because HEOR is intellectually interesting. Not because real-world evidence is shaping the future of medicine. Those things are true — but they are not why you got hired, and they are not why the role persists. You got hired because someone made a business case that investing in HEOR generates more revenue, protects margin, or reduces risk than not investing. Full stop.

If you understand that, you understand everything about how to build a career in this field — whether you're in consulting or on the pharma side. This is Part 1. We're starting with consulting, because the business model is the most transparent and the lessons are the most portable.

HEOR consulting firms run on selling more projects. More projects sold, more revenue generated, more profit distributed. That's it. Everything else — the quality frameworks, the thought leadership, the conference presence — is in service of that engine.

What does that mean for you as a junior or mid-level professional? It means your value is not just in delivering good work. It's in enabling the next sale.

And those are not the same thing.

The average consultant delivers a slide deck or a report and disappears. That's the rookie game. It keeps the lights on but it doesn't build anything.

The good ones deliver clean work on time, maintain client relationships, and leave clients satisfied. Table stakes. But the excellent ones operate differently. They deliver packaged solutions and thought partnership that the client can take and run with minimal lift. They are data-driven, articulate, fluent across functions, and they know the client's situation well enough to anticipate what's coming before the client does.

They know what the client needs — and more importantly, what the client doesn't need. They don't oversell. They don't nickel and dime when the situation calls for grace. They know when the shit is about to hit the fan and they work solutions in ahead of time.

And above everything else: they make the client look good in front of their boss. And they make their own boss look good to his line management and cross-functional peers.

That is the actual job.

The excellent ones become embedded partners. Not vendors. Partners. They're the preferred Seal Team 6 — just a call away, ready to deploy. They've earned a level of trust that converts into repeat business without the friction of a competitive pitch process.

Here's what that looks like in practice.

It was the middle of the pandemic. Consulting businesses were starting to hurt — spending had tightened and the pipeline was drying up in slow motion. I was on a lucrative contracting engagement, on-site with a biotech partner, serving as their global RWE and Epidemiology lead. Supporting ex-US launch, commercial long-range planning, US label expansions, FDA filings — days were long and the learning was in dog years. I was on the floor in the VP's office every other day, reporting.

Per habit, I had my ear to the ground on what additional business we could drum up. An opportunity came up to do some strategic evidence planning work, and the conversation turned to vendor selection.

Guess who was in a position to put their hand up and comfortably say: we can do it.

How often have you been in a position where someone looks at a mid-six-figure SOW, asks for your opinion, and simply nods yes at your approval?

That only happens when you rise from service provider to trusted partner.

That trust flywheel — quality → relationships → strategic edge → more business — is the whole game. Earn trust → get repeat business → generate revenue → become more valuable than a delivery person. Rinse and repeat.

You educate the client. You make them sharper based on your experience. You are transparent about what you cannot do. You treat their internal reputation with the same care you treat the deliverable. You show up consistently, not just when the project is hot.

The clients remember who made their lives easier when it was hard. They forget the people who handed over a polished report and went silent.

If you're a graduate student or early-career professional reading this, here's the practical translation:

You don't need to be a rainmaker on day one. But you do need to understand the game you're in. Every client interaction, every deliverable, every internal communication is either building toward the next project or eroding it. There is no neutral.

The HEOR skills — the modeling, the RWE, the HTA navigation — are the entry ticket. The business instincts are what determine how far you go.

Follow the money, and you'll learn to attract the money.

Part 2 covers how this logic plays out inside pharma — where the P&L pressure is less visible but just as real.

— Sanket

P.S. Hit reply with the question you've never been able to ask anywhere else. I read every one.

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