The Anti-Epic Playbook: How Health Tech Startups Can Turn Incumbent Advantages Into Vulnerabilities
Epic's AI vault looks impenetrable, until you realize the cracks are where the real opportunities lie.
Epic just unveiled Art, Emmie and Penny: three AI assistants that theoretically eliminate entire startup categories. Art handles clinical documentation. Emmie tackles patient engagement. Penny automates revenue cycle management.
These AI assistants leverage Epic's Cosmos platform with 16 billion patient encounters. Combined with Epic's 42.3% acute care EHR market share and their record-breaking addition of 176 facilities in 2024, these numbers suggest an absolute dominant position.
But Epic's dominance creates specific structural vulnerabilities. While Epic builds for 300+ million patients, Abridge reached a $5.3 billion valuation by delivering measurable outcomes (like enabling 90% of clinicians to provide undivided attention to patients vs. 49% pre-implementation). While Epic's AI promises general improvements, Abridge focuses on specific, verifiable results.
Epic's customers have become hostages. And hostages are always looking for escape routes.
The Hostage Situation
Most hospital systems hate their Epic implementation. They hate the cost. They hate the complexity. They hate the 18-24 month implementations. But they can't leave.
Switching EHR systems costs hospitals millions of dollars and takes years to complete. Hospitals find themselves locked into a relationship they can't afford to leave.
This creates an interesting dynamic. Hospitals can't replace Epic, but they're desperately seeking alternatives for everything Epic doesn't do well. They want to reduce their Epic dependency without ripping out Epic entirely.
Your solutions should be framed as Epic relief, not Epic replacement. You're selling incremental independence. Every successful solution that works alongside Epic reduces their leverage and gives hospitals negotiating power.
Why Epic's Scale Forces Them to Fail Specific Users
Epic's AI assistants reveal a fundamental constraint: when you build for everyone, you excel for no one.
Their Cosmos platform, trained on 16 billion encounters, optimizes for the statistical middle. But healthcare happens in the specifics. The interventional cardiologist doesn't need general documentation; she needs structured data for TAVR procedures. The rural critical access hospital doesn't need enterprise patient engagement; they need COPD readmission prevention for their specific population.
Look at how different companies exploit this dynamic:
Regard (Series A) found success by focusing solely on one problem: catching missed diagnoses in hospitalized patients. They're expanding across major health systems because of their narrow focus, not despite it.
Notable (Series B), instead of competing with Epic's broad patient engagement tools, focused exclusively on automating prior authorizations. One workflow. One pain point. They succeed by solving one problem completely rather than many problems partially.
The strategic framework: Epic's growth literally creates your market. Every hospital Epic adds increases the number of underserved specific use cases.
The Business Model Moat Epic Can't Cross
Epic's greatest strength (their enterprise software licensing model) has become their strategic prison. They can't pivot to outcome-based pricing without cannibalizing their entire revenue structure.
This structural constraint creates an entire messaging opportunity. Epic has to talk about features and licenses, while you can talk about outcomes and ROI. Companies like SmarterDx don't message about their AI capabilities; they message about the $2 million average revenue recovery per 10,000 patient discharges. CodaMetrix doesn't lead with technology features; they lead with 98% coding accuracy guarantees.
According to Bessemer Venture Partners, demonstrating hard ROI for customers (either dollars saved or gained) can help healthcare SaaS companies to achieve sales cycles under six months.
The marketing positioning opportunity: Your messaging framework should completely avoid Epic's territory. Sell outcomes while they sell comprehensive platforms. Provide ROI calculators while they require RFPs about technical specifications. Their sales materials run 50+ pages; yours fit on a napkin: "We capture missed revenue. We keep 30%. You keep 70%. No revenue, no fee."
Even if you ultimately use a SaaS model, your marketing should emphasize outcomes over features, results over capabilities.
Navigating the Political Reality
Selling into Epic environments involves navigating around Epic’s implementation and support teams, whose unofficial job includes subtly undermining competitive solutions. They won't say "don't buy that." They'll say "we're building something similar" or "that might complicate your upgrade path."
But this political dynamic creates opportunity if you understand it. Epic's interests may not always align with ensuring modules deliver value after they're sold.
The navigation strategy: Align with Epic’s incentives. Your solution helps hospitals get value from their Epic investment. You make Epic look good by solving problems they can't. Frame your solution as protecting the Epic investment, not threatening it.
The smartest approach involves building relationships with Epic's services partners. Companies like Nordic, Optimum and Sagacious work with hundreds of Epic implementations. They know every gap, every frustration, every workaround. They become your channel into Epic accounts because they're measured on implementation success rather than Epic license revenue.
The Trust Equation and Reference Customer Paradox
Every healthcare CIO evaluating your solution has one unspoken question: "Will you exist in three years?"
This creates the classic catch-22. Healthcare buyers want references from similar organizations. Similar organizations won't buy without references. Epic faced this problem once. You face it every day.
The traditional approach (hiring grey-haired healthcare veterans) costs too much and moves too slowly. The startup approach ("we're disrupting everything!!!") terrifies risk-averse buyers.
The strategic solution: Borrow trust rather than building it.
Partner with organizations that already have healthcare's trust. Medical societies, GPOs, regional health collaboratives. When the American College of Cardiology recommends your solution, you bypass the trust equation entirely. When Premier or Vizient vets your solution, you inherit their credibility.
Commure accelerated adoption using this exact approach before their Augmedix acquisition. Instead of building trust from scratch, they partnered with health system innovation labs and got health system leaders as investors. Every announcement included validation from HCA Healthcare or Intermountain ventures.
But borrowed trust only gets you in the door. Sustaining that trust while navigating enterprise healthcare requires something more fundamental: capital.
The Capital Reality of Healthcare Sales
Most health tech startups targeting Epic's market will fail… not because they can't build better products, but because they'll run out of money before achieving product-market fit.
CB Insights reports that 70% of health tech startups fail within 20 months of their last funding round. The pattern is predictable: promising pilot, extended enterprise sales cycle, depleted runway, desperate pivot, closure.
The capital requirements are brutal:
Enterprise healthcare sales cycles average 12-18 months
Pilot programs often run 6-12 months (usually unpaid)
Full deployment takes another 6-12 months
You won't see significant revenue for 2-3 years
Abridge raised $150M+ to survive these timelines. Suki raised $70M primarily for sales cycle survival, not product development. Even "successful" exits like Augmedix to Commure came after years of grinding through these cycles.
If you're going after Epic's market, you need one of three things:
Deep venture backing: Multiple rounds to survive long cycles
Revenue bridge model: Outcome-based pricing that generates cash faster
Partnership leverage: Using established players' infrastructure to accelerate adoption
The companies succeeding choose their capital strategy before their product strategy. They know that in healthcare, running out of money poses a bigger risk than product failure.
Playing the Long Game in Epic's Shadow
Epic's dominance defines your market opportunity. Every hospital using Epic becomes a potential customer for enhancement, relief and independence. Every hospital avoiding Epic needs solutions that work with their chosen alternative.
The playbook focuses on completing Epic, not competing with it. Find the gaps their scale creates. Serve the segments their model can't. Deliver the outcomes their structure won't allow.
Success requires three alignments:
Strategic alignment: Build what Epic structurally can't: specialized over generalized, outcomes over licenses, speed over comprehensiveness.
Capital alignment: Ensure your funding strategy matches healthcare's timeline reality, whether through venture backing, revenue models or partnerships.
Execution alignment: Bridge the gap between strategic insight and market reality through experienced operators who know which messages resonate, which channels work and which partnerships matter.
Epic's strength creates your opportunity. The more dominant they become, the more gaps they leave for those who understand both the strategic dynamics and have the experience to execute against them.
The question becomes whether you have the capital to survive the journey and the marketing expertise to navigate the terrain.
Understanding Epic's vulnerabilities is one thing. Building the go-to-market machine to exploit them is another. As a fractional CMO, I guide health tech companies through this exact challenge, from messaging strategy to team building to market execution. I can help you translate these insights into action. Let's discuss your specific situation and build a marketing strategy that works.
About the Author
Heather Lodge, Fractional Chief Marketing Officer, The Hybrid CMO
Heather helps growing health tech and healthcare service companies transition from ‘spaghetti-against-the-wall’ marketing to scalable operations so they can go toe-to-toe against better-funded rivals. She helps establish clear market positioning, develop focused account-based marketing programs and build the systems and teams needed to scale effectively. Heather’s approach combines strategic leadership with hands-on execution, building marketing programs that drive consistent revenue growth.