Spruce does two jobs at once, patient phone, text, fax and video plus team chat, at $24 per user per month. If you only need the staff chat half, Yodl covers it at $10 a month for 5 people with a signed BAA. If you need the patient half, OhMD (from $300 a month) and ModMed's Klara are the usual next looks.
Why people look for an alternative to Spruce Health
Spruce Health is a communication platform for solo practitioners and small practices. As of November 2026 the Basic plan is $24 per user per month, month to month, and includes the HIPAA BAA, a phone line, two-way texting, video visits, e-fax, team messaging and a shared inbox. Communicator is $49 per user and adds phone trees, after-hours triage and API access. Prices change; verify on Spruce's site.
A BAA (Business Associate Agreement) is the contract HIPAA requires before a vendor may handle protected health information, or PHI: any detail that identifies a patient and relates to their care. Spruce includes it on every trial and plan, which is a real strength. People still shop around for money and fit:
- Five people on Basic is $120 a month, and all users must be on the same plan, so one person who needs Communicator pulls everyone to $49.
- Taxes and telecom fees are passed through, and outbound SMS needs a one-time $19.50 registration.
- Some offices only wanted staff chat and pay for a phone system they do not use; others find the team chat thin.
So first decide which half of Spruce you are replacing. The list below is split that way; our Yodl vs Spruce Health page covers the staff chat half in detail.
The alternatives at a glance
Prices are for 5 people, read from each vendor's site on November 3, 2026. Verify before you buy; vendors change plans without notice.
| Tool | Price for 5 people as of November 2026 | Signs a BAA | Best for |
|---|---|---|---|
| Yodl | $10/mo flat (5 users, 20 GB) | Yes, every plan | Staff-only chat with channels and threads |
| Zenzap | Business+ $50 total/mo for up to 5 users; BAA add-on price not published | Add-on, by contacting sales | WhatsApp-style chat with AI agents and calls |
| Microsoft Teams | Teams Essentials $4/user/mo paid yearly = $20/mo | Yes, commercial plans by default | Offices already on Microsoft 365 |
| TigerConnect | Contact sales (not published) | Yes, standard BAA | Larger groups that need role-based routing |
| OhMD | Core starting at $300/mo | Yes, listed in its pricing table | Patient texting and AI phone answering |
| Klara (ModMed) | Not published | Not verified | Specialty practices on ModMed EMA |
| Updox | Not published (usage-based quote) | Site does not say | Fax-heavy practices with reminders and telehealth |
| Doximity | Free for verified US clinicians | Site does not say | Clinicians calling patients from a masked number |
Alternatives for the staff chat half
Yodl
Yodl is the internal half only, done simply. For $10 a month you get 5 users at one location, 20 GB of files, channels, group DMs, threads, saved messages and full-text search, with the BAA signed on every plan. Admins get invite-only workspaces, channel roles, an audit viewer, retention controls and legal hold. No phone line, patient texting, fax or video, on purpose. Keeping Spruce for patients and moving staff chat here avoids $24 seats for staff who never touch the phone.
Zenzap
Zenzap looks like WhatsApp and adds AI agents, to-dos, scheduled messages and voice and video calls. Business+ is $50 total a month for up to 5 users with the annual toggle selected; the Free plan allows unlimited users with 1 GB. HIPAA compliance with a signed BAA is a separate add-on sold through sales with no published price. A fit for teams migrating WhatsApp groups, once you have that quote.
Microsoft Teams
If the practice already runs on Microsoft 365, Teams is already there. Microsoft's BAA is available by default through its Online Services Data Protection Addendum on commercial plans, with Teams in scope. Teams Essentials alone is $4 per user per month, paid yearly on an auto-renewing subscription, with 10 GB of storage per user. It is more than a chat app: the appeal for some offices, the problem for others.
TigerConnect
TigerConnect is clinical communication for hospitals and large groups: messaging by role instead of by name, teams that follow the on-call schedule, escalation of unanswered messages and patient context from the EHR. It publishes a standard BAA but no price, and there is no self-serve signup. A 30-provider group that outgrew Spruce should book the demo; a 5-person office will find it heavy.
Alternatives for the patient communication half
OhMD
OhMD is patient messaging: two-way SMS, a text-enabled landline and voice and video calling on the Core plan, which starts at $300 a month. The AI and Automation plan starts at $500 and adds AI voice agents that answer routine calls and move them to text. A BAA appears in its pricing comparison table, though the plan column is not clearly shown. No free trial, and internal chat is not what it is for.
Klara (ModMed)
Klara is now ModMed Patient Engagement, and klara.com redirects to ModMed's site. It gives practices shared department inboxes for patient messages, internal staff comments inside the patient thread and a push of messages and files into the EMA chart. Pricing is not published, and we could not verify its BAA terms from the pages ModMed serves. It makes most sense for specialty practices already on ModMed EMA.
Updox
Updox bundles e-fax, patient texting, broadcasts, telehealth, appointment reminders and eForms into a platform priced per practice with usage caps, such as 1,000 fax pages and 500 texts on the Standard bundle. Prices are not published; you get a quote through a demo. Its site calls the fax and Direct Secure Messaging a HIPAA-compliant platform, but the pricing page does not mention a BAA, so ask for one in writing.
Doximity
Doximity is free for verified US clinicians and includes Dialer, which lets a physician, NP or PA call, video visit or text a patient from a masked number, plus secure mobile fax. Its site carries a HIPAA compliant badge but does not mention a BAA, and there are no seats for front desk or billing staff. It solves the doctor's call-back problem, not the practice's communication problem.
How to choose
Six questions, in order:
- Which half of Spruce are you replacing: patient communication, staff chat, or both?
- Does it sign a BAA on the plan you are buying, before you pay?
- What is the monthly total for your real headcount, with taxes and telecom fees where they apply?
- Does it work on staff phones and in a browser at the front desk?
- Can you export an audit log, set retention and place a legal hold?
- If you leave, how do you export messages, fax history and patient threads?
Yodl's $10 plan for 5 people includes the signed BAA; the full breakdown is at yodl.cc/pricing.
Decide which half of Spruce you are replacing before you compare prices. Yodl is the $10 answer for staff chat; OhMD, Klara and Updox are the usual answers for patient communication; and keeping Spruce for the phone while moving staff chat is a legitimate option.
Frequently asked questions
Is Spruce Health HIPAA compliant?
Spruce signs its BAA with every organization on every trial and paid plan; you agree to it electronically when you create an organization. Your practice still has to set up access and policies.
Can I use Yodl and Spruce together?
Yes. Spruce handles patient phone, text, fax and video; Yodl handles staff-to-staff channels. Different jobs, both under a BAA.
What is the cheapest alternative to Spruce for a 5-person practice?
If you only need staff chat, Yodl is $10 a month for 5 users. Spruce Basic for 5 is $120 a month but includes a phone line and patient texting. Prices as of November 2026.
Does OhMD replace Spruce completely?
For patient communication, largely yes: texting, calling, video and voicemail transcription. It starts at $300 a month and is not an internal chat tool.
Why does Spruce make everyone use the same plan?
Spruce's pricing page says all users in an organization must be on the same plan, so one person who needs Communicator moves the whole office from $24 to $49 per user.