Build vs buy RCM: how healthcare CFOs should think about it.
Whether to build an internal RCM team, buy software platforms, or contract an outsourced partner is one of the biggest organizational decisions a healthcare CFO makes. The decision has cost, capability, and risk implications across years. This page walks through the framework we use when clients ask us to advise.
The vendor archetypes.
Vendors typically fall into structural patterns. Knowing the archetype helps you predict strengths, hidden costs, and integration risks.
Build (internal RCM team)
Hire RCM staff in-house, manage operations directly. Maximum control. Highest fixed cost.
When you have unique workflow requirements, regulatory complexity (multi-state academic medical), or strategic IP that needs to stay internal.
Buy (software + internal team)
License RCM software platforms. Internal team operates the workflow with software automation.
When you have an existing RCM team and want technology leverage, not staff augmentation.
Outsource (RCM service partner)
Contract a full-stack RCM partner. Variable cost per claim or per FTE. Partner accountability.
When you want outcomes not technology projects. When internal team is at capacity or non-existent.
Hybrid (mix of internal + outsourced)
Keep some functions in-house, outsource others. Common patterns: internal billing + outsourced denials, internal patient access + outsourced AR.
When you have strengths in some areas and gaps in others.
What to look for.
- Total cost of ownership across 5-7 year horizon (not just year one)
- Talent recruitment and retention reality for your geography
- Risk of capability gaps during build-up
- Speed to capability (12-18 months for build vs 30-60 days for outsource)
- Strategic IP and competitive differentiation considerations
- Exit ramps and switching cost
Common pitfalls.
- Building when geography or labor market makes recruitment hard
- Buying software without budgeting integration cost
- Outsourcing without clear KPI accountability
- Underestimating the year-1 transition cost in any direction
- Choosing based on cost alone without TCO over 5-7 years
FAQ.
What are the main types of build vs buy RCM?
Vendor archetypes typically include: build (internal rcm team); buy (software + internal team); outsource (rcm service partner); hybrid (mix of internal + outsourced)
What should I look for when evaluating build vs buy RCM?
Key criteria: Total cost of ownership across 5-7 year horizon (not just year one); Talent recruitment and retention reality for your geography; Risk of capability gaps during build-up; Speed to capability (12-18 months for build vs 30-60 days for outsource)
What are common pitfalls?
Common pitfalls: Building when geography or labor market makes recruitment hard; Buying software without budgeting integration cost; Outsourcing without clear KPI accountability
How does ASP-RCM compare?
ASP-RCM does not market itself as build vs buy RCM in isolation. We deliver these capabilities through a full revenue cycle service with senior partners on every account.
How can I get a free vendor evaluation?
Request a free 30-day RCM audit. We will assess current state and produce a written vendor evaluation framework.