The 2015 Seven Small Jewels: Top Tier

Woodland Hills, Calif.-based Top Tier Consulting celebrated its 10th Anniversary last year as an 80-person consultancy with more than $17 million in revenue. Brad Armstrong, Christopher Downy and Greg Anderson started the firm after working together for more than two decades at a Big 4 firm.

"We think very highly of those firms," Armstrong says. "But we started Top Tier to be a little closer to our clients, to have a complete focus in the healthcare niche and to specialize. We wanted to get back to our roots, and spend more time in front of our clients."

Armstrong began his career in a small firm and Top Tier has allowed him to come full circle, he says. "At smaller firms the overhead is so much lower so clients are getting the same level of expertise and value but at a lower price point, so it's sort of a win-win," he says. "It's been a steady climb. We started off with the three of us doing all the work, but eventually we started bringing on a few people, experienced people. That model is one of our differentiators."Armstrong says the firm has always grown slow and steady, careful not to chase the waves that are all too common in healthcare. "Our sweet spot is knowing how technology works within the business and then using whatever tools are available at that point in time to make the business successful."