If you sell into hospitals, you’ve probably told yourself some version of “build it and they will come.” It’s a comforting story founders tell themselves when the pipeline is thin and the product feels ready. It’s also the single most expensive belief in healthtech sales, because it convinces smart founders to spend months building a better mousetrap for a house that was never going to notice they existed.
Stop fighting a fight you can’t win
Here’s the trap: a founder gets a shot at an Epic-first health system, and the instinct is to lead with the technical case, how the product works, how tightly it integrates, why it’s better than what Epic has on its roadmap. That instinct isn’t just the wrong opening move. It’s a losing strategy dressed up as a sales pitch, because the fight it picks was decided before it started.
Epic has more capital than you. They also have more engineers and more leverage with the health system than you’ll ever have. If your pitch is “our technology versus their technology,” you’ve already lost, because they can build what you built, buy a solution from someone who’s already built it, or simply announce they’re building it and freeze your deal in place. It’s a pattern startups run into every time they position themselves as a competitor to the platform instead of a complement to it.
The health systems know this too. According to a Redesign Health survey of 112 executives at Epic-based health systems, reported by MedCity News in July 2026, 71% describe their organization as “Epic-first,” and none said they prefer external vendors by default. Epic isn’t just the incumbent; it’s the default assumption walking into every conversation you have.
So the strategy can’t be “prove we’re better than Epic.” The strategy has to be “prove we make Epic work better for you.” Those are entirely different sales messages.
Visibility is the first sale you have to make
Before a health system ever evaluates whether your product is any good, they have to know you exist and trust you enough to take the meeting. That’s the sales motion, not marketing sitting on top of it, and it’s the piece most technical founders skip past because it feels soft compared to a product roadmap.
Real visibility looks like this: executives building relationships before there’s a deal to close. A steady cadence of email and thought leadership that keeps you in front of the right people even when they’re not buying. Showing up at the events your buyers attend, and eventually, hosting your own. None of that is glamorous. All of it is what makes the eventual pitch land instead of getting filed under “another vendor we don’t know.”
If you’re only investing in the technical case, you’re building a great answer to a question nobody’s asked you yet, because they don’t know you well enough to ask it.
Fit the workflow, don’t fight the platform
The vendors that actually win Epic-first deals aren’t the ones with the most aggressive competitive positioning. They’ve figured out how to disappear into how the health system already operates. Think about how a company like Arrowhealth approaches this: instead of “replace what you’re doing,” the pitch is “plug into the EHR you’re already running and make it do more.” That posture gets adopted because it doesn’t ask a clinician or an administrator to change their behavior. It just makes their existing behavior work better.
That same Redesign Health survey mentioned above names ambient scribing and imaging AI as the categories where startups are winning business, and those aren’t categories where startups are out-teching Epic. They’re categories where Epic hasn’t built a strong answer yet, and a workflow-native tool can step into the gap. The bottom line is this: startups aren’t beating Epic. They’re finding the rooms Epic hasn’t fully furnished yet.
Don’t assume you already know what they need
Here’s the part that’s hardest to hear: if you’re struggling to sell, it’s tempting to assume the product is wrong. Often it isn’t. The positioning is wrong, and it gets mistaken for a product problem because nobody stopped to ask the buyer what they actually need versus what you assumed they needed.
That means real research: interviewing the people you’re trying to sell to, not just the people who already like you. What you hear back might not change your roadmap at all. It might just change how you talk about it, who you talk to first, and what problem you lead with.
The founders winning Epic-first deals right now aren’t the ones with the sharpest “why we’re different from Epic” deck. They’re the ones who spent months building trust before the deal existed, and built a product that fits quietly into the workflow instead of demanding the health system rearrange itself around it. That’s not a smaller strategy. It’s the only one that truly works with where the market is at today.
