Most small practices need two different tools: one to message patients and one for staff to talk to each other. For patient messaging our pick is Spruce Health ($24 per user a month as of November 2026, BAA on every plan). For staff chat our pick is Yodl ($10 a month for 5 people, BAA on every plan). Buying one tool for both jobs usually means overpaying for the half you use less.
Patient messaging and staff chat are different jobs
When people search for HIPAA messaging apps they mean two things at once. Patient messaging is texting patients from the practice's number: confirmations, intake links, a photo of a rash before a visit, a video call. Staff chat is the medical assistant telling the provider that room 2 is ready, or the front desk asking who covers Thursday. Both carry protected health information (PHI), which is anything that identifies a patient and relates to their care, so both need a vendor that signs a Business Associate Agreement (BAA): the contract HIPAA requires before a vendor may handle PHI on your behalf.
The tools are built differently. Patient-messaging platforms sell phone lines, fax, telehealth and a shared inbox, priced per user. Staff chat tools sell channels, threads and search, priced per user or flat. One tool can do both, but you pay the patient-messaging rate for every staff member who only needs internal chat.
How we chose
- A BAA on the plan a small practice would actually buy.
- A published price for 5 people, with the billing catch noted.
- Which job the tool does well: patient-facing, staff-facing, or both.
- Apps on the phones staff already carry.
- Audit and retention controls, and honesty about what each tool lacks.
Prices are as of November 2026 and come from each vendor's own site. They change, so verify on the vendor's site before you buy.
The list at a glance
| Tool | Price for 5 people as of November 2026 | Signs a BAA | Free tier | Best for |
|---|---|---|---|---|
| Spruce Health Basic | $120 a month ($24 per user, taxes and fees extra) | Yes, all trials and plans | No (14-day trial) | Patient texting, phone, fax and video |
| Yodl (Team plan) | $10 a month flat, 5 users included | Yes, every plan | No | Staff-to-staff chat |
| OhMD Core | Starting at $300 a month (per-user or per-practice basis not stated) | Yes, listed in its plan comparison | No | Patient texting with AI phone agents |
| Updox | Not published; usage-based, quote via demo | Pricing page does not mention a BAA | No | Fax-heavy practices wanting texting and reminders in one bundle |
| Klara (ModMed Patient Engagement) | Not published | Not verifiable from the pages we could read | Not published | Specialty practices on ModMed EMA |
| Zenzap Business+ | $50 total a month, up to 5 users, plus an unpriced HIPAA add-on | Yes, as a paid add-on | Yes (unlimited users, 1 GB) | Staff chat for teams leaving WhatsApp |
| TigerConnect | Contact sales, no published pricing | Yes, standard BAA published | Not published | Hospitals and large groups |
The tools, one by one
Spruce Health
Spruce leads the patient side because it publishes a price, signs the BAA on every trial and plan, and sells itself without a sales call. Basic is $24 per user a month (taxes and fees extra) with HIPAA phone lines, two-way patient texting, video visits, e-fax, a shared inbox and team messaging. Communicator is $49 per user and adds call flows, after-hours triage and API access. All users must be on the same plan, and enabling outbound SMS costs a one-time $19.50. See Spruce pricing explained.
Yodl
Yodl is the staff side: Slack-style channels, threads, direct messages, file previews and search, with a signed BAA on the $10 plan. One location with 5 users and 20 GB is $10 a month; extra users are $2 each and extra locations $10 each. Admins get an audit viewer with CSV export, retention controls, legal hold, channel roles and invite-only workspaces. It does not message patients, make calls or send SMS, and the iPhone app is in beta while the web app works on any phone.
OhMD
OhMD is patient communication with two-way SMS, a text-enabled landline, voice and video, and AI voice agents that answer routine calls. Its Core plan starts at $300 a month, and the page does not say whether that is per user or per practice. The BAA is listed in its plan comparison. It is built for practices with real call volume, not a 3-person office.
Updox
Updox bundles e-fax, patient texting, broadcast messages, telehealth, appointment reminders and an internal messaging add-on, with usage caps per bundle. Pricing is not published; you get a quote through a demo. Its pricing page does not mention a BAA, so ask for one in writing before you sign. Strongest for practices that still live on fax.
Klara (ModMed)
Klara is now ModMed Patient Engagement, and klara.com redirects there. It offers patient messaging with shared department inboxes, internal staff comments inside the patient thread, and pushes messages and files into the ModMed EMA chart. We could not read a price or a BAA statement from the pages available, so treat both as questions for ModMed. It makes sense mainly if you already run EMA.
Zenzap
Zenzap is WhatsApp-style staff chat with AI agents, to-dos and a WhatsApp migration tool. Business+ is $50 total a month for up to 5 users (annual toggle selected by default), and HIPAA compliance with a signed BAA is an add-on whose price is not published. Teams above 5 users see 'Book a Demo'. It does not message patients.
TigerConnect
TigerConnect covers both jobs for hospitals: role-based staff messaging, on-call teams, EHR patient context and alerts, plus patient and family communication. There is no public pricing, the standard BAA is published, and the sales process is built for health systems, so a small practice will spend more time than money getting a quote.
Which one for your team
The cheapest honest combination is usually a patient-messaging seat for the people who actually text patients and flat-price staff chat for everyone. Take an 8-person practice where only the two front-desk staff message patients. Two Spruce Basic seats are $48 a month, and Yodl for all 8 is $16 a month ($10 plus three extra users at $2), so $64 in total. Putting all 8 on Spruce Basic is $192. If every person needs patient messaging, Spruce alone is simpler and its team messaging covers staff chat.
- Solo or two-provider practice: Spruce Basic for the patient line, Yodl for the team.
- Specialty practice on ModMed EMA: ask ModMed about Klara, and add staff chat.
- Fax-heavy practice: Updox for fax and reminders, with a BAA confirmed in writing, plus staff chat.
- High call volume and interest in AI phone answering: OhMD, from $300 a month.
- Hospital or large group: TigerConnect, with time for a sales cycle.
If the staff half is the part you still need, Yodl is $10 a month for 5 people with a signed BAA, on the pricing page.
Buy a patient-messaging tool for the people who talk to patients and a flat-price staff chat for everyone. Both must sign a BAA, and neither replaces the other.
Frequently asked questions
Can one app handle both patient messaging and staff chat?
Yes. Spruce Health includes team messaging, so if every staff member needs a patient-messaging seat anyway, one tool works. If most staff only need internal chat, a separate flat-price chat tool is cheaper.
Is plain texting with patients HIPAA compliant?
Carrier SMS has no BAA and no encryption, so it is not appropriate for PHI. Patient-messaging platforms like Spruce and OhMD route texts through a BAA-covered system instead.
Does Yodl message patients?
No. Yodl is for staff talking to staff. It has no SMS, no calls and no patient-facing features.
Why do Updox and Klara not publish prices?
Both sell through demos and quotes, and our research could not read a price for either. Ask for the plan name, the price, the usage caps and the BAA in writing.
What should I ask any messaging vendor before signing?
Which exact plan you are buying, whether that plan comes with a signed BAA, what the per-user or usage fees are, and how you export your data if you leave.