Build vs Buy vs Epic: How Health Systems Really Decide on RCM Solutions

A revenue cycle director at a 300-bed hospital stares at a spreadsheet showing 12,000 pending prior authorizations. Her billing team spent 847 hours on hold with payers last month. Epic can't automate the calls. IT says a custom solution would take 18 months. A vendor promises two-week deployment but adds another system to manage.

This is the build-vs-buy-vs-Epic decision in healthcare RCM. Not a whiteboard exercise, but a choice between real trade-offs: integration debt, opportunity costs, and staff burning out on phone queues.

The $150B RCM market still runs on phone calls to payers for eligibility checks, prior authorizations, and claim status updates. SuperDial raised $15M to automate these workflows because Epic doesn't solve this problem well, and building custom voice AI requires specialized teams most health systems don't have.

The framework below addresses what "integration with Epic" actually means, when duplication risk justifies point solutions, and how implementation variability across Epic instances affects outcomes more than vendor promises.

Why RCM Solution Architecture Matters

Manual phone workflows drain staff hours that could close claims faster. A billing specialist spending three hours on hold with Aetna isn't processing the 40 other claims in her queue.

Delayed cash flow from verification backlogs increases AR days significantly. Every week of prior authorization backlog pushes revenue collection further out, affecting organizational liquidity and operational capacity.

Legacy payer systems still require live phone calls for basic coordination. IVR menus, hold times, and representative transfers haven't disappeared just because EHRs got better.

Integration complexity multiplies across Epic instances with different configurations. What works at one facility may require custom development at another, even within the same health system.

Snapshot of Build, Buy, and Epic Approaches

Build custom gives maximum control over workflows but carries the highest development and maintenance costs. You own the code, but you also own every bug, every payer system change, and every security update.

Buy point solutions enables fast deployment with specialized functionality at the cost of integration overhead. SuperDial deploys in 2-4 weeks but adds another vendor relationship to manage.

Standardize on Epic provides deep EHR integration and a single system of record, but limited phone workflow automation. Epic prioritizes clinical and billing workflows, not IVR navigation and hold time management.

Build equals control at cost. Buy equals speed with specialization. Epic equals integration depth without phone workflow strength.

Decision Framework Analysis

Epic's Native RCM Capabilities

Epic excels at deep clinical and billing workflow integration within a single platform. Scheduling, registration, and claims submission work well because Epic built them as core functionality with years of refinement.

The single source of truth eliminates data synchronization issues that plague multi-vendor environments. When patient demographics, insurance information, and clinical documentation live in one system, you avoid the reconciliation headaches that come with point solutions.

Large Epic user communities share best practices and optimizations through forums and user groups. Implementation variability across instances affects real-world feature availability more than Epic's marketing materials suggest.

Epic's phone workflow limitations become apparent when staff need to verify benefits or check prior authorization status. Limited native functionality for automating outbound payer phone calls means billing teams still dial manually, wait on hold, and document results by hand.

Claims follow-up calls to payers remain manual processes. IVR navigation and hold time management aren't Epic's core competency, and the roadmap doesn't prioritize these workflows over broader customer needs.

Epic instances vary significantly in configuration and available modules across health systems, affecting which features are actually accessible versus theoretically available.

Building Custom RCM Phone Automation

Voice AI infrastructure requires specialized engineering team investment. You need developers who understand both healthcare workflows and conversational AI, a rare combination that commands premium salaries.

Payer IVR logic mapping demands continuous maintenance as systems change. Aetna updates their phone tree, and your code breaks until someone fixes it.

HIPAA and SOC2 compliance add significant security development overhead. You can't just spin up a Twilio integration and start making calls with patient data.

Initial development takes 6-18 months of engineering time and resources. Ongoing maintenance as payer systems, IVRs, and workflows continuously evolve requires dedicated staff who could be working on other projects.

The opportunity cost of an internal development team spending a year on phone automation instead of other critical system projects rarely gets calculated honestly. Those engineers could be improving patient portal functionality, optimizing clinical workflows, or addressing technical debt.

Building makes sense when you have extremely unique workflows not supported by any vendor solution, massive scale where per-call costs justify development investment, or an existing voice AI team with healthcare RCM domain expertise. Strategic priority to own intellectual property in the automation layer and available IT capacity without delaying other critical projects also tip the scales toward building.

Buying Point Solutions: SuperDial Approach

SuperDial's AI voice agents automate eligibility, prior authorization, claims, and credentialing calls. The platform integrates with Epic, eClinicalWorks, athenahealth, Dentrix, and other EHR/PMS systems through direct API connections.

Flexible integration supports API calls for bulk volume, CSV upload, or direct portal input. Human fallback teams handle calls AI cannot complete, ensuring reliability while the system learns from each interaction.

West Coast Dental now handles over 10,000 calls monthly through SuperDial, eliminating a 70,000 claim backlog that would have required five new hires. The team significantly reduced AR days within weeks of deployment.

Customers report up to 3x cost savings per call completed and 4x productivity gains for existing billing teams. Deployment within weeks addresses urgent operational backlog problems rather than waiting months for custom development or years for Epic roadmap priorities.

Best for: Health systems and RCM vendors facing immediate phone workflow backlogs who need rapid deployment with proven ROI.

Pros:

• Rapid deployment: 2-4 week implementation timeline gets teams productive fast without lengthy development cycles
• Proven cost savings: 3x savings per call and 4x productivity gains documented across customer base
• EHR integration included: Direct API write-back to Epic and other systems without custom development work
• Payer system maintenance: SuperDial manages IVR updates and payer system changes continuously
• Human fallback reliability: Calls AI can't complete get routed to backup team for consistent workflow completion

Cons:

• Initial setup time: Requires customization of call scripts and training period before full productivity
• Edge case limitations: AI struggles with highly unstructured conversations or unusual payer workflows
• Point solution overhead: Adds another vendor relationship and system to manage alongside existing stack
• Not Epic-native: Operates as integrated layer rather than built-in Epic functionality with deepest workflow embedding

SuperDial navigates IVR menus, holds for representatives, gathers required information, and writes results back into electronic health records. Custom payer logic and retry sequences handle edge cases that would stall simple automation.

Near-term focus includes deepening EHR integrations and expanding administrative workflow coverage. The platform is HIPAA and SOC2 compliant as a cloud-based solution.

West Coast Dental's case demonstrates the value proposition clearly. The dental group previously had nearly 70,000 claims in backlog from manual status check calls. Handling this volume would have required five new hires at roughly $200K annual cost with benefits. SuperDial automated the workflow, and the team reduced AR days within weeks rather than months of hiring and training new staff.

Integration Depth and Epic Duplication Risk

What "Integration with Epic" Actually Means

Read-only data pull means a system retrieves patient and claim data from Epic for processing. The tool can see what's in Epic but can't update records automatically.

Write-back capability allows a system to update Epic records with call results automatically. SuperDial provides API integration with write-back to Epic and other EHRs, closing the loop without manual data entry.

Workflow embedding means a tool operates within Epic's user interface and navigation. Users don't leave Epic to access functionality, reducing context switching and training burden.

Native module refers to functionality built by Epic as part of the core platform with the deepest integration possible. These modules benefit from Epic's full development resources and update cycles.

Epic duplication risk runs highest when vendors replicate functionality Epic already does well. Scheduling, registration, and claims submission are strong native capabilities where point solutions struggle to justify their existence.

Phone-based payer workflows represent a gap Epic doesn't effectively address. SuperDial positions itself as a complementary layer rather than an Epic replacement for core RCM functions.

Best-of-breed approaches accept integration overhead for specialized functionality superiority. The question becomes whether the operational bottleneck justifies managing another vendor relationship.

IT Steering Committee Priorities

System consolidation versus best-of-breed functionality creates ongoing tension in IT governance. Fewer vendors means simpler architecture but potentially weaker capabilities in specific domains.

Total cost of ownership includes integration maintenance over time, not just initial implementation. That API connection needs monitoring, updates when either system changes, and troubleshooting when data doesn't flow correctly.

Staff training burden across multiple systems adds up quickly. Every new interface requires documentation, training sessions, and support tickets as users learn the workflow.

Vendor roadmap alignment with organizational strategic technology direction affects multi-year planning. Betting on a vendor whose priorities diverge from yours creates risk.

Integration overhead becomes worth it when functionality gaps create measurable operational bottlenecks. A 70,000 claim backlog isn't theoretical, and ROI timelines shorter than Epic roadmap commitments for similar capabilities justify the complexity.

Point solution deployment faster than custom development or Epic implementation addresses urgent needs. Staff capacity that cannot absorb manual work volume without automation forces the decision.

Hidden Costs of Waiting for Perfect Solutions

Every month with a 70,000 claim backlog delays cash flow significantly. At an average claim value of $500, that's $35M in outstanding revenue waiting for phone calls to complete.

Manual staff time on hold costs more than integration layer overhead in most cases. Five billing specialists at $25/hour spending 30 hours weekly on hold represents $195K annually in pure wait time, not counting the claims they're not processing.

West Coast Dental avoided five new hires through SuperDial automation, representing substantial annual cost savings. At $40K per hire including benefits and overhead, that's $200K in avoided costs plus faster deployment than recruiting and training.

AR days reduction directly impacts organizational financial health and liquidity. Every day of AR reduction at a $100M revenue organization equals roughly $274K in freed working capital.

Epic roadmap dependency creates risk of being blocked by vendor priorities. Epic prioritizes features across a broad health system customer base, and phone workflow automation may not reach the roadmap for years. Implementation variability means features don't deploy uniformly across all instances even when they do arrive.

Decision Framework by Organization Profile

Large Health Systems (500+ Beds)

IT steering committees prioritize Epic standardization for clinical workflows where integration depth drives safety and quality outcomes. Best-of-breed point solutions get considered for specialized operational gaps that don't affect patient care directly.

Multiple Epic instances across facilities increase implementation variability complexity. What works at the main campus may require different configuration at community hospitals or specialty clinics within the same system.

Phone workflow volume at 10,000+ monthly calls justifies specialized automation investment. At that scale, even modest per-call savings compound into significant annual impact.

SuperDial fits when phone-based payer workflows create measurable backlog and AR days delay. IT capacity unavailable for 6-18 month custom development projects and Epic roadmap timelines that don't address operational urgency push the decision toward buying.

ROI cases built on cost savings per call and staff productivity gains resonate with finance committees. Deployment speed measured in weeks rather than months aligns with operational urgency and budget cycles.

Mid-Size Provider Groups and MSOs

Limited IT development staff makes custom automation projects unrealistic. A three-person IT team supporting 200 providers can't spare anyone for a year-long voice AI development project.

Provider groups cannot afford 5+ new billing hires to manage phone call volume. Margin pressure in value-based care arrangements makes labor cost management critical.

Rapid deployment addresses immediate backlog and cash flow needs. Waiting 18 months for a custom solution means 18 months of manual work and delayed revenue.

EHR integration gets required but Epic-native depth isn't a critical priority. Write-back capability matters more than workflow embedding when billing staff already context-switch between multiple systems daily.

Cost per call and productivity multiplier metrics drive purchasing decisions. CFOs want to see payback period measured in months, not years.

SuperDial handles 10,000+ calls monthly without new headcount requirements. The 3x cost savings per call versus manual staff or outsourcing and 4x productivity gains for existing teams create compelling business cases.

RCM Vendors and BPOs

Scalability requirements across multiple provider clients demand efficient phone workflow handling. Cost per call directly impacts service delivery margin and profitability in a competitive market.

Client EHR diversity requires integration flexibility. Supporting Epic, athenahealth, eClinicalWorks, and specialty systems like Dentrix through a single platform reduces development overhead.

Deployment speed enables faster client onboarding and revenue recognition. Weeks to productivity versus months of implementation affects how quickly new contracts become profitable.

SuperDial's flexible framework supports API calls for bulk volume, CSV upload, and portal input across different client needs. Human fallback ensures reliability when AI cannot complete edge cases, protecting service level agreements.

MBW RCM achieved 50% cost savings versus their prior per-call cost, demonstrating the margin improvement potential for BPO operations.

Specialty Practices (Dental, ASC, Specialty Groups)

High prior authorization and benefit verification call volume per patient creates disproportionate burden. Dental practices verify benefits for nearly every patient visit, and ASCs need authorization before scheduling procedures.

Limited billing staff capacity makes hours-long hold times with payers unsustainable. A three-person billing team at a specialty practice can't dedicate someone to phone queues full-time.

EHR systems may be specialty-specific like Dentrix for dental practices. Integration with these systems matters as much as Epic connectivity for specialty providers.

Cash flow sensitivity to verification delays and claim status uncertainty runs higher in specialty practices. Smaller revenue bases mean backlog impacts operations faster than in large health systems.

West Coast Dental's experience directly addresses specialty practice pain points. The dental group eliminated a 70,000 claim backlog through SuperDial phone call automation with integration to Dentrix and other specialty EHR/PMS systems.

Frequently Asked Questions

How quickly can our team deploy phone automation without custom development?

SuperDial typically deploys in 2-4 weeks per case studies. Build custom requires 6-18 months with a dedicated engineering team. Epic native phone automation remains limited with roadmap-dependent timelines.

Does SuperDial really integrate with Epic or just claim compatibility?

Direct API integration writes call results back into Epic automatically. The platform also integrates with eClinicalWorks, athenahealth, Dentrix, and others. Not an Epic-native module but provides automated result documentation in the EHR.

What happens when AI voice agents can't complete a call?

Human fallback teams handle calls AI cannot complete independently. This ensures reliability while the AI system learns from each interaction. Not all calls achieve full automation, but workflows still complete.

How do health systems measure ROI on RCM phone automation?

Cost per completed call versus manual staff time provides the clearest metric. AR days reduction from faster verification and claim status updates affects cash flow directly. Headcount avoidance like West Coast Dental's five hires creates tangible savings.

Can we customize call scripts for our specific payer workflows?

Teams can share current call scripts for customization or build from templates in the SuperDial portal quickly. Custom payer logic and retry sequences handle edge cases that standard scripts miss.

What's the real risk of Epic eventually building this functionality?

Epic roadmap prioritizes broad customer base needs over phone workflow niches. Implementation variability means features don't deploy uniformly across instances even when developed. Years-long waits maintain costly manual processes versus weeks of deployment with specialized vendors.

How does SuperDial pricing compare to hiring more billing staff?

Custom pricing based on call volume and requirements means no public rate card. Customers report 3x cost savings per call. West Coast Dental avoided five new hires, and MBW RCM achieved 50% cost savings versus prior per-call costs.

Final Verdict and Next Steps

Key Takeaways in One Table

When SuperDial Is the Clear Choice

Immediate backlog crisis situations like 70,000 stalled claims or weeks of phone work backed up demand rapid solutions. Cost pressure without headcount means you cannot hire 5+ billing staff for volume but need the work completed anyway.

Epic integration required but phone gaps exist describes most health systems accurately. You need EHR write-back plus automation that Epic doesn't provide natively.

Deployment urgency over perfect integration makes weeks versus months or years timeline critical. Proven ROI models with 3x cost savings and 4x productivity gains documented across the customer base reduce implementation risk.

RCM vendor and BPO scalability requirements to handle volume across multiple provider clients efficiently favor specialized platforms. Build custom makes sense only with massive scale, existing voice AI teams, and strategic IP ownership priorities.

Epic native remains appropriate for workflows it handles well, which doesn't include phone-based payer coordination. SuperDial removes phone-based work as a bottleneck in healthcare RCM operations.

Talk to SuperDial About Your Phone Workflow Backlog

Demos show real payer IVR navigation, hold management, and EHR result documentation in action. Proof of concept can process actual backlog claims within initial deployment periods.

Custom pricing based on your call volume and specific workflow requirements means the business case gets built on your numbers, not generic estimates. Talk to the SuperDial sales team to assess potential 3x cost savings for your organization.