Spruce Health Alternatives for Patient Messaging (2027)

What Are the Best Spruce Health Alternatives?

The best Spruce Health alternatives in 2027 are OhMD for practices that want patients to text their existing office number, Weave or Podium for practices that want phones, reminders and payments from one vendor, and Luma Health for larger groups that want automated outreach tied to the EHR. If you already run Hint, Atlas.md, Elation or Akute, the messaging built into that platform may cover what you used Spruce for. Klara now lives inside ModMed, and Twilio is the build-it-yourself route for practices with a developer. Some options below publish a BAA and some do not, so get one in writing before patient messages go through any of them.

Spruce is one of the most common messaging tools in direct primary care and concierge practices, so most people searching for an alternative are not unhappy with texting in general. They usually want one specific thing to change, such as pricing that does not grow with every staff seat, messaging that lives inside the EHR, or a phone system that also handles payments. This guide starts with who each tool is best for, then compares BAA status and published prices taken from each vendor's own site, and the Sources line at the end says when each page was last checked. Vendors change plans often, so confirm everything on a demo call.

Spruce Health Alternatives at a Glance

The four messaging tools that publish a price, every value from the vendor's own page. A blank cell means the table holds no value there, not that the tool lacks it. The list below covers the rest.

Who each tool fits, and where its BAA stands:

• Spruce Health (the baseline). Small practices that want phone, text, fax and telehealth in one shared inbox. Its plans page lists a BAA.
• OhMD. Keeping patients on the office number they already know. Its plan comparison lists a BAA, and Enterprise is custom priced.
• Weave. Replacing desk phones and adding texting, fax and text to pay. It publishes its BAA.
• Podium. Texting, reviews and payments, with a phone system as an add-on. Its BAA is in its legal terms.
• Luma Health. Larger groups that want automated outreach tied to the EHR. It publishes its BAA, and we found no published price.
• Klara (now ModMed Patient Engagement). Specialty practices already on ModMed. We could not find a public BAA page or a published price, so ask ModMed.
• Twilio builds. Practices with a developer building a custom inbox. It signs a BAA on its Security or Enterprise Edition, and texting is priced by usage, at $8.30 per 1,000 outbound SMS segments on a long code.
• Hint messaging. Hint practices that want chat, SMS, phone and fax next to the member record. Hint publishes a customer BAA.
• Atlas.md messaging. Atlas.md practices that want correspondence tracked in the EMR. We could not find a public BAA page, so ask on a demo.
• Elation Patient Passport. Elation practices that want portal and app messaging inside the chart. Elation publishes its BAA.
• Akute portal messaging. Akute practices that want secure portal messaging included. We could not find a public BAA page, so ask on a demo.

The EHRs price the whole platform, not messaging alone. Hint's Launch plan is $290 a month, Atlas.md is $300 per registered provider per month, and Elation's product guide lists a Standard DPC Provider at $375 per provider per month, or a quote.

Akute's plans run from $300 to $550 a month, with a $100 plan also shown on some visits (checked November 4, 2026).

You only compare those to Spruce if you would be using that EHR anyway, or are already thinking about a switch.

What Spruce Does Well (So You Know What You Are Replacing)

Before you compare alternatives, it helps to be clear about what Spruce already covers, so a new tool does not quietly drop something your team relies on. Its plans page describes HIPAA-grade phone, text, fax and telehealth with a signed BAA, a 14-day free trial with no credit card, and month-to-month billing that you can cancel any time. That mix, priced per user, is why it shows up in so many small DPC and concierge practices.

Per its plans page, Spruce Basic is $24 per user per month and Communicator is $49 per user per month, before taxes and fees.

For a solo physician with one staff member, that is easy to plan around. As a team grows, per-user pricing grows with it, and that is often the moment owners start looking at flat-priced tools. If you want to keep Spruce and get more out of it, our Spruce messaging workflow for DPC and Spruce phone message workflow show how practices set it up.

Spruce vs OhMD

OhMD is the closest like-for-like alternative to Spruce for a small practice. Both are built around patient texting for medical offices, both publish a BAA, and both handle calls and video as well as text. The difference is mostly in how they think about your phone number and how they price.

OhMD's pricing page is built around a text-enabled landline, which means patients can text the number already printed on your website and membership agreement. Its Core plan lists two-way SMS, voice and video calling, voicemail transcription, call handoff to text, website chat, team messaging, standard automated workflows and a BAA. Higher tiers add automatic message routing, customized workflows, broadcast calling and appointment scheduling, with calling usage billed separately. Unlike Spruce, OhMD prices per practice rather than per user.

OhMD Core starts at $300 per month, the next tier (Automate) starts at $500 per month, and Enterprise is custom pricing with minimums.

At list prices, a practice would need about 13 users on Spruce Basic, or 7 on Spruce Communicator, before Spruce cost more than OhMD Core's starting price. So for a solo or two-person DPC, Spruce usually costs less on paper, while a larger team with many front desk seats may find OhMD's flat price easier to budget. OhMD is best for a practice that wants to keep its existing office line and wants routing and scheduling automation as it grows.

Spruce vs Weave

Both can replace your desk phones. Spruce has its own medical phone system, with number porting on both plans and phone trees and VoIP desk phones on Communicator, while Weave is a phone system and patient communication platform in one. Weave's pricing page lists VoIP phones, a phone tree, appointment reminders, two-way text messaging, bulk texting, missed call texting, fax, text to pay and review requests, with plan options for medical, dental, optometry and veterinary offices.

Weave says its plans start from $199 per month.

Weave publishes its Business Associate Addendum on its own site, last updated April 10, 2026, and it also addresses substance use disorder records under 42 CFR Part 2, which matters if your practice offers addiction medicine.

Weave is best for a practice that wants to replace its desk phones, add payment requests by text and run reminders from the same vendor. A small DPC that already has phones it likes and mainly needs one shared patient inbox is often a better fit for Spruce. There is more on each tool on the Weave and Spruce integration pages.

Podium for Texting, Reviews and Payments

Podium bundles texting with review management, text marketing and payment processing. Its pricing page lists unlimited one-to-one text messages on every plan, monthly bulk message credits (250 on Core, 500 on Pro), included phone numbers and a phone system available as an add-on. Its legal page includes a Business Associate Agreement and a downstream BAA.

Podium lists Core at $399 per month and Pro at $599 per month, with each extra phone number at $5 per month.

Podium is best for a practice that cares a lot about online reviews and wants payment requests and texting in the same place. If your main need is clinical messaging with patients and staff in one thread, compare its inbox side by side with Spruce on a demo.

Luma Health for Larger Groups

Luma Health is aimed at groups and health systems with high visit volume. Its communication page describes texting, RCS messaging and broadcasts that help patients schedule, prepare, pay and ask questions, connected to the EHR, with use cases such as reminders, referrals, lab results, no-show follow-up and care gaps. Luma publishes its HIPAA Business Associate Agreement on its policy site.

We could not find published pricing on Luma's site, so ask for a quote. Luma is best for a multi-location group or an employer-focused DPC network that wants automated outreach at scale. A solo DPC with a few hundred members may find it more than it needs.

Klara, Now Part of ModMed

Klara was one of the early patient texting tools, and many physicians still search for it by name. ModMed announced it acquired Klara's maker, and klara.com now redirects to ModMed Patient Engagement. That page is organized around specialties such as dermatology, orthopedics, gastroenterology, ophthalmology and urology.

That makes Klara most natural for specialty practices already on ModMed. We could not find a public BAA page or published pricing for it, so a primary care or DPC practice on another EHR should ask ModMed how it connects, whether it is sold on its own and for a BAA in writing before committing.

Twilio-Based Builds

Twilio is not a finished messaging app. It is the infrastructure many healthcare tools are built on, and some practices with a developer or integration partner build their own inbox on it. Twilio's HIPAA page says customers who want to sign its Business Associate Addendum must be on the Security Edition or Enterprise Edition and use only HIPAA-eligible products and services.

Twilio's US SMS pricing page prices SMS on long codes per message segment: $8.30 per 1,000 outbound segments and $8.30 per 1,000 inbound, with carrier fees and A2P 10DLC registration fees on top, and edition pricing through Twilio sales.

The low per-message cost is real, but the practice then owns everything a finished product does for you, including the shared inbox, staff permissions, audit trail, after-hours rules and saving clinical threads to the chart. A Twilio build is best for a larger organization with engineering support, or a practice that wants texting built into a custom patient app. Our HIPAA texting guide explains 10DLC registration in plain terms.

Using Your EHR's Patient Messaging Instead of Spruce

Many DPC platforms now include patient messaging, so the cheapest Spruce alternative may be the one you are already paying for. The questions to ask are whether patients can text a normal phone number or have to log in to a portal or app, whether staff can work the same inbox together, and whether phone and fax are included or sold separately. Our DPC EHR comparison for 2027 covers the charting side of each platform.

Hint

Hint's communications page describes secure chat, SMS, phone and fax in one inbox, with every conversation linked to the member record, staff-only team notes inside conversations and assignment so conversations have a clear owner. Hint publishes a customer BAA on its site. It is best for practices already on Hint that want messaging next to memberships and billing.

Hint's pricing page lists the Launch plan from $290 per month, including one clinician and unlimited members, with nothing to pay until the practice launches.

Atlas.md

Atlas.md's pricing page lists unlimited integration of faxes, phone calls, email and text messages, with automatic tracking of patient correspondence, plus a Patient Hub and a patient app. We could not find a public BAA page on its site, so ask on a demo. It is best for practices already on Atlas.md that want every message tracked inside the EMR.

Atlas.md lists its subscription at $300 per month per registered provider.

Elation

Elation's help center describes Patient Passport as a secure portal where practices and patients send secure messages to each other, on the web and in an iPhone and Android app. Elation publishes its Business Associate Agreement on its site and lists per-provider EHR prices in its product guide alongside personalized quotes. It is best for practices on Elation that are comfortable with portal-style messaging rather than plain texting.

Akute

Akute's pricing page includes secure portal messaging, a patient self-scheduling portal and faxing on its Essentials plan, and describes the platform as fully encrypted and HIPAA-compliant. We could not find a public BAA page, so ask on a demo. It is best for practices on Akute that want messaging included in a published plan.

Akute's plans run from $300 to $550 a month, with a $100 plan also shown on some visits (checked November 4, 2026). Essentials is $300 per month for one clinician and 100 patients, with a virtual phone line available for $15 per month, and Premium is $550 per month for two clinicians and 300 patients and includes a virtual office phone line. Visits that don't show the Launch plan show a Developer plan priced by quote instead.

How to Choose a Spruce Alternative

• Pick Spruce if you want texts, calls, faxes and video with patients in one shared inbox. Where it wins: calls, texts and faxes in one place; one per-user plan for the whole team.
• Pick OhMD if you want your existing office line text-enabled, with routing and scheduling automation as you grow. Where it wins: texting with voice and video calling on its base plan; AI voice and text on its automation plan.
• Pick Weave if you want phones, texting, reviews and payment requests from one vendor. Where it wins: text-to-pay and payment reminders; reviews collected and managed in one place.
• Pick Podium if online reviews matter most and you want texting and payment requests in the same place. Where it wins: an AI employee from first inquiry to booking.
• Pick Luma if you are a larger group that wants automated patient outreach tied to the EHR. Luma says it is for health systems. Where it wins: outreach tied to your EHR and workflows.
• Pick Klara if you already run on ModMed and want its patient communication. Where it wins: patient communication and collaboration, now part of ModMed.
• Pick Twilio if you have engineers and want texting built into your own patient app. Where it wins: developer APIs priced by the message.
• What Tabflows does not do: replace your patient messaging.

Start with the one thing you want to change, then check each tool against the jobs Spruce does today. These questions keep a demo honest:

• Can patients keep texting the number they already have, and can the vendor move your existing number over?
• Does it cover the phone, text, fax and video you use now, or will you need a second tool for fax? Our HIPAA fax software guide covers that piece.
• Can a nurse, the front desk and the physician share threads, assign them and leave internal notes?
• Do clinical conversations land in your EHR on their own, or does someone have to copy them over?
• Will the vendor sign a BAA before go-live, and does it cover every product you plan to use?
• What will it cost at today's headcount and at the team you expect in two years? Per-user and per-practice pricing cross over as you grow.

If you are also reconsidering your EHR, read our guide to switching EHRs without losing patient data first, because moving messaging and charting at the same time doubles the work for your team. The wider picture of how messaging fits with billing and charting is in our best DPC software for 2027 guide, and concierge practices can compare their own stack in best concierge medicine software for 2027.

Keeping the Work Moving Whichever Tool You Pick

Switching messaging tools rarely fixes the part that wears a team down, which is everything a message starts. A patient text becomes a refill, a lab order, a billing question or a referral, and each of those gets finished in a different system. When the messaging tool and the EHR do not talk to each other, the follow-up depends on someone remembering it on a busy afternoon, and that is a tooling gap rather than anyone's fault.

Tabflows is a dedicated tech team that connects the tools a clinic already uses, including Spruce, Weave, Hint, Atlas.md, Elation or Akute, so the work between them gets done. Follow-ups become tasks, patient context sits in one place and the thread does not get lost between the inbox and the chart. You can see the tools we connect on our integrations page.

The Bottom Line

Spruce remains a strong default for small DPC and concierge practices that want one shared inbox with published per-user pricing. OhMD is the closest alternative if you want patients texting your existing office line on a flat monthly price, Weave and Podium make sense when you want phones, reviews and payments from one vendor, and Luma Health fits larger groups. If you already use Hint, Atlas.md, Elation or Akute, test their built-in messaging before adding another subscription.

Whichever way you go, get the BAA in writing, confirm how threads reach the chart and run the numbers at your real team size. If you are still planning the practice itself, start with our guide to starting a DPC practice, or browse how other practices set up in the DPC Finder.

Sources

Checked on November 5, 2026: getweave.com, podium.com, lumahealth.io/solutions/outreach/communication, lumahealth.io, modmed.com/press-release/modmed-acquires-maker-of-the-klara-practice-patient-collaboration-platform and twilio.com/en-us/messaging/channels/sms. Checked on November 4, 2026: sprucehealth.com/plans, ohmd.com/pricing, getweave.com/pricing, podium.com/pricing, getweave.com/legal/baa, legal.podium.com, twilio.com/en-us/hipaa, twilio.com/en-us/sms/pricing/us, hint.com/pricing, atlas.md/pricing, elationhealth.com/ehr-product-guide and akutehealth.com/pricing. Spot a wrong fact? Email a correction.