What Healthcare Vendors Won’t Tell You

A diligence guide for medical practice leadership

Financial models · Enrollment reality · Implementation burden Total cost · References · Reporting · Contract leverage

Healthcare vendors are trained to show medical practices what their service can become.

They present the technology, financial opportunity, patient benefits, and strongest client results. What often receives less attention is the work required from the practice, the assumptions behind the projections, the full cost, and the limitations that emerge after signing.

This does not mean every vendor is misleading. Strong vendors are transparent about pricing, dependencies, limitations, and shared responsibilities. Practice leaders still need to know what questions to ask.

Their financial model may represent the best-case scenario

A pro forma can make almost any program look attractive when it applies aggressive eligibility, enrollment, engagement, billing, and collection assumptions to the practice’s total patient population.

Ask for conservative, average, and aggressive models. Each should disclose its assumptions for:

• Patient eligibility
• Enrollment and retention
• Billable-code attainment
• Payer mix and reimbursement
• Denials and collections
• Vendor fees
• Internal costs

Do not evaluate the opportunity based on projected billings alone. Understand what the practice is realistically likely to collect and retain.

Eligible patients do not equal enrolled patients

A vendor may identify thousands of potentially eligible patients. That is not the same as the number who are clinically appropriate, reachable, willing to participate, and likely to remain engaged. Ask the vendor to separate total eligibility from expected enrollment, active engagement, and monthly billable patients. These are different stages of the opportunity and should not be presented as one number.

“Turnkey” does not mean no work for your practice

Even a fully managed program may require the practice to provide patient data, approve workflows, complete integrations, introduce the service, train staff, manage escalations, coordinate billing, and participate in performance reviews.

Before signing, document every responsibility that remains with the practice and estimate the internal time required.

A service is not turnkey if it quietly transfers administrative work back to your staff.

Implementation and integration may be more complicated than presented

A demonstration occurs in a controlled environment. Implementation takes place inside the practice’s EHR, staffing model, billing operation, and clinical workflows.

Even “integrated with your EHR” can mean anything from a bidirectional interface to a manual file upload or attached PDF.

Request an implementation plan identifying every dependency, owner, deadline, integration, manual process, and additional cost. Ask to see the actual workflow your staff will use, not simply the ideal-state demonstration.

The lowest PMPM price may produce the weakest return

A low PMPM rate says little about the vendor’s ability to identify patients, drive enrollment, sustain engagement, complete billable services, reduce staff workload, and support collections.

A heavily discounted contract may also affect how the vendor prioritizes your account. If the economics are less attractive to the vendor, your practice could receive fewer implementation resources, less experienced support, slower response times, or less internal attention.

That does not mean practices should avoid negotiating. It means any discount should be paired with clearly defined service levels, staffing commitments, implementation resources, response times, and performance expectations.

Instead of comparing price alone, ask:

• How many patients are successfully enrolled?
• How many billable codes are completed per patient?
• What percentage of billed services is collected?
• How large are the care-manager panels?
• What work remains with clinic staff?
• What implementation and account-management support is included?

The correct comparison is not vendor fee versus vendor fee. It is total clinical, operational, and financial value.

The quoted price may not be the total cost

Pricing can change once implementation fees, integrations, minimum-volume commitments, training, hardware, annual increases, and internal staffing requirements are included.

Practices should also understand how the vendor handles annual changes to CMS reimbursement. If reimbursement increases, does the vendor automatically raise its

PMPM fee or claim a percentage of the increase? If reimbursement decreases, does the vendor’s price adjust downward, or does the practice absorb the entire reduction in margin?

Ask for a complete pricing schedule showing what is included, what is excluded, and what can trigger a price change. The contract should clearly define how future reimbursement adjustments affect vendor fees so both parties share the economics fairly.

Strong vendors should explain the full cost and how pricing will respond to reimbursement changes before the agreement is signed.

Their strongest results may not represent the average client

Vendor presentations naturally feature their highest-performing clients. Those organizations may have stronger physician support, better data, more internal resources, a different payer mix, or patients who are easier to reach.

Ask for average or median performance across comparable clients. Review results by specialty, practice size, program maturity, and operating model.

A success story is useful, but it is not a performance benchmark.

Their references were carefully selected

Vendors are unlikely to introduce you to an unhappy client. Ask references:

• How long did implementation take?
• What work remained with the practice?
• Did the vendor meet enrollment expectations?
• Were final costs consistent with the proposal?
• How responsive is the support team?
• What changed after the sales process?
• Would you select the vendor again?

Speak with multiple clients that resemble your specialty, size, patient population, and operating model.

Care-manager capacity affects patient engagement

A vendor may emphasize its care team’s credentials without discussing panel size, turnover, outreach frequency, or continuity.

Large panels can produce repetitive conversations, delayed follow-up, inconsistent relationships, and outreach focused on reaching billable time rather than creating value.

Ask how patients are assigned, how large the panels are, and how meaningful engagement is measured. Minutes recorded are not the same as value delivered.

Their reporting may show activity without showing performance

A dashboard can display calls, minutes, and enrolled patients without showing whether the program is clinically or financially successful.

Leadership should have visibility into eligibility, enrollment, engagement, code attainment, escalations, claims, denials, collections, retention, staff workload, and net contribution.

Ask to see the reports before signing. If the data cannot help leadership identify problems and make decisions, it is not sufficient.

Features on the roadmap do not exist yet

Planned integrations, analytics, automation, and clinical capabilities may be discussed as though they are nearly available. Product roadmaps change.

Evaluate the vendor based on what works today. If a future feature is essential, document the expected delivery date and the practice’s options if it is not delivered. Do not purchase a current service based primarily on a future promise.

Their model may not fit your specialty

A vendor that performs well in primary care may struggle in neurology, nephrology, urology, behavioral health, or another specialty with different patient needs and clinical workflows.

Ask how the service has been adapted for your specialty. Review relevant care plans, staffing, patient communication, escalation protocols, reporting, and client outcomes.

A general capability is not the same as specialty-specific execution.

You may lose leverage after signing

Practices have the most leverage before executing the agreement. Long terms, automatic renewals, restrictive termination language, unclear performance standards, limited data access, and hidden price increases become harder to correct afterward.

Negotiate measurable service levels, transparent pricing, reporting requirements, data ownership, billing responsibilities, pricing protections, corrective-action procedures, and reasonable termination rights before signing.

The contract should protect the operating relationship, not simply establish the fee.

The vendor cannot create internal buy-in for you

A vendor can provide training and enrollment materials. It cannot force physicians and staff to support the program.

Patients are less likely to engage when an unfamiliar third party contacts them without a credible introduction from the practice. Employees are more likely to resist

when leadership has not explained the program’s purpose.

Position the vendor as an extension of the clinic. Provide visible leadership support, clear responsibilities, and a consistent explanation of how the service benefits patients and staff.

You will still need to manage the relationship

Even a strong vendor should not be placed on autopilot.

Hold regular operating reviews. Compare performance with the contract and financial model. Monitor patient enrollment, engagement, staffing, clinical escalations, claims, collections, workload, and outcomes. Assign corrective actions and deadlines when results fall short. Vendor management is not evidence that the partnership failed. It is part of making the partnership work.

What strong vendors will tell you

The best vendors are transparent about pricing, capabilities, limitations, implementation dependencies, and the work required from the practice. They distinguish average performance from best-case results and welcome measurable accountability.

Be cautious when a vendor:

• Cannot explain its financial assumptions
• Will not provide complete pricing
• Describes implementation as effortless
• Shares only its strongest results
• Will not provide sample reporting
• Cannot define responsibilities
• Resists measurable service levels
• Relies heavily on future capabilities
• Pressures the practice to sign before completing diligence

The objective is not to distrust every healthcare vendor. It is to evaluate each opportunity with the discipline applied to any other strategic investment.

ConnectedCare Advisory Group helps medical practices assess ancillary opportunities, compare vendors, challenge financial assumptions, negotiate pricing and terms, design workflows, and manage implementation.

The goal is not to introduce another vendor. It is to determine whether the opportunity fits the practice and whether the vendor can deliver within the realities of its patients, staff, systems, and financial priorities.

Ask the questions before the contract

• ConnectedCare Advisory Group helps practices assess ancillary opportunities,
• compare vendors, challenge financial assumptions, negotiate pricing and terms,
• design workflows, and manage implementation — so the fit is proven first.