There's a question I've been asking for 25 years, and the industry still hasn't given me a good answer:

Why do most healthcare technology vendors get paid for activity instead of outcomes?

Calls placed. Messages sent. Reports generated. Seats licensed. The practice gets a monthly invoice and a dashboard full of metrics — and none of them connect to the thing that actually matters: did a patient get the care they needed?

I've spent my career at the intersection of healthcare and technology — from the early days of digital point-of-care at Epocrates, to launching mobile solutions at WebMD/Medscape, to scaling Jumo Health's commercial engine through a PE acquisition. Across every one of those chapters, the vendors who built lasting businesses had one thing in common: they figured out how to align their success with their customers' success.

The ones who didn't? They survived on inertia until someone better came along.

The Activity Trap

Here's how the typical cycle works.

A practice buys a patient outreach tool. The vendor charges per call, per message, or per seat. The tool generates activity — thousands of touchpoints a month — and produces a report showing how much activity occurred.

The practice administrator looks at the report and thinks: "I guess it's working?"

But nobody is asking the question that actually matters: how many of those touchpoints resulted in a booked appointment? How many patients who were contacted actually showed up? How much incremental revenue did this generate versus what the practice would have captured on its own?

The activity trap is comfortable for vendors because it decouples their revenue from their performance. Whether the tool works brilliantly or barely moves the needle, the invoice looks the same.

It's a model built for the vendor, not the client.

What Changes When You Align Incentives

When I joined Parakeet Health, the first thing that got my attention wasn't the conversational AI or the voice technology. It was the business model.

Parakeet gets paid when appointments get booked. Not when calls get placed. Not when texts get sent. When patients actually get scheduled.

That single structural decision changes everything downstream.

It changes how the product gets built. When your revenue depends on appointments actually being booked, you can't ship a product that's 80% accurate and call it good enough. Every failed interaction is a missed appointment — and a hit to your own bottom line. The engineering team isn't optimizing for "engagement." They're optimizing for the outcome that matters.

It changes how you onboard. There's no incentive to rush a deployment and start billing. If the system isn't tuned to a practice's specific scheduling rules, insurance matrices, and provider configurations, it won't book appointments — and you won't get paid. So you invest the time upfront to get it right.

It changes how your team shows up every day. When your incentives are identical to your client's incentives, every conversation is collaborative, not adversarial. You're not defending a dashboard. You're solving problems together because you both lose when something doesn't work.

The Pattern I've Seen Before

This isn't the first time I've watched incentive alignment reshape a business.

At Epocrates, the company that started the digital point-of-care revolution, the breakthrough wasn't just putting a drug reference on a physician's Palm Pilot. It was building a model where pharmaceutical sponsors got value — reaching physicians at the moment of prescribing — and physicians got value — free, fast, reliable clinical information. When both sides won, the business scaled to an IPO and a $356M valuation.

At Jumo Health, we saw a similar dynamic. The company provided health education content to patients and families — but instead of measuring success by impressions or page views, we tied outcomes to real patient engagement and comprehension. That alignment helped drive 35x revenue expansion and an 80x EBITDA multiple at exit.

The pattern is always the same. When you align incentives, you build trust. When you build trust, you build a business that lasts.

What Healthcare Buyers Should Be Asking

If you're a practice administrator, COO, or PE operating partner evaluating AI or patient outreach technology, here are the questions I'd push on:

How does the vendor get paid? If the answer is per seat, per call, or per message, ask yourself: what happens if the tool doesn't actually improve my outcomes? Do they still get paid the same amount?

Can they show you outcomes, not activity? Any vendor can show you a dashboard with call volumes and message counts. Ask to see appointment conversion rates. Ask to see the delta between what your team was capturing before and what the tool is generating now. If they can't show you that, the data either doesn't exist or doesn't tell a good story.

What happens when something goes wrong? This is the real test. When an AI system misroutes a patient or a campaign underperforms, does the vendor scramble to fix it — or do they point to the activity metrics and say "the system is working as designed"? Partners fix problems. Vendors explain them away.

Are their incentives aligned with yours? The simplest filter. If the vendor makes the same money whether you succeed or fail, that's not a partnership. That's a subscription.

The Shift Is Coming

The healthcare technology market is moving — slowly, but unmistakably — toward outcome-based models. PE-backed practices are increasingly sophisticated buyers who understand unit economics and demand measurable ROI. Health system leaders are tired of paying for tools that generate reports but don't generate results.

The vendors who figure out how to share risk with their clients will win. The ones who keep hiding behind activity dashboards will find their contracts up for review — and their replacements already in the building.

Healthcare doesn't need more vendors selling activity reports. It needs partners who share the risk.

Rick Scorzetti is the Chief Commercial Officer at Parakeet Health, an AI-powered patient access platform for large specialty practices. He has 25 years of experience in healthcare technology sales leadership, including three major exits at Epocrates, WebMD/Medscape, and Jumo Health. Connect with him on LinkedIn.