For four health systems, managing Epic means something closer to an ongoing relationship than a software contract — regular executive meetings, direct developer access, and, at times, weekend-long emergency support.
That closeness matters because of Epic’s scale: the company accounts for 43.7% of the U.S. acute care hospital EHR market and 56.9% of hospital beds as of 2025, up from 31% in 2021. Last year alone, it added 77 hospitals and 18,679 beds, according to KLAS data.
Jason Joseph, chief digital and information officer at Corewell Health, which has dual headquarters in Grand Rapids and Southfield, Mich., saw that firsthand as the organization prepared to move its health plan onto Epic.
Corewell encountered go-live preparation issues, some of which Mr. Joseph said were related to Epic. The company responded quickly.
“They literally flew out and engaged 25 developers,” he said.
The developers arrived on roughly a day’s notice, and some worked through the weekend to address issues holding up the project.
“I’ve never, ever in my life seen a vendor that responsive,” he said.
The episode reflects the type of relationship technology and informatics leaders at Corewell, Parkview Health, UMass Memorial Health and Montefiore Einstein described. Their interactions with Epic can include regularly scheduled executive meetings, direct access to developers, on-site visits, early product testing and participation in customer councils.
The cadence itself can be striking.
“Montefiore Einstein has daily interaction with Epic’s team,” Joe Palombit, associate vice president of IT enterprise applications at New York City-based Montefiore Einstein, said.
At Parkview, based in Fort Wayne, Ind., the CIO and chief medical information officer meet with their Epic “BFF,” the company’s term for a primary customer contact, every other week for an hour. Mr. Joseph has a monthly BFF meeting at Corewell, alongside regular contacts between Epic and other teams across the health system. UMass Memorial Health, based in Worcester, Mass., has Epic executive and technical contacts, and Eric Alper, MD, senior vice president, chief quality officer and chief clinical informatics officer, said he also meets quarterly with an Epic physician leader and knows developers working in areas important to the organization.
How customers help shape Epic
Epic’s customer relationships have not stopped at check-ins.
Corewell sometimes hosts Epic developers who shadow workflows to understand how the health system uses the software and where it could improve, Mr. Joseph said. Epic also asks to be included in discussions even when Corewell is not requesting something specific, in part to better understand what the health system is trying to accomplish.
Parkview has positioned itself relatively early in Epic’s development cycle.
Mark Mabus, MD, senior vice president of electronic health records and chief medical informatics officer, said Parkview takes Epic upgrades about 14 weeks after release.
Dr. Mabus estimated the health system has participated in more than 50 early-adopter features over the past five years. Epic developers and quality managers can work with Parkview during those projects and gather end-user feedback after a feature goes live.
“It’s kind of like co-development, where they’ll do the final touches with your health system,” he said.
Montefiore has similarly worked directly with Epic’s research and development teams.
“The relationship extends beyond traditional vendor feedback,” Mr. Palombit said.
One collaboration focused on New York-specific regulatory requirements. Epic and Montefiore IT worked with clinical departments to understand where existing workflows could be improved and translate those needs into new development.
Another effort involved Montefiore Einstein Comprehensive Cancer Center and scalp cooling cap devices used to help prevent chemotherapy-induced hair loss. Montefiore and Epic worked on workflows around access to the devices, including authorization, scheduling and other administrative functions.
“Our feedback to Epic is not simply about improving what exists today; it is also an opportunity to help shape capabilities that support new models of care, regulatory requirements and emerging clinical innovations,” Mr. Palombit said.
UMass Memorial also believes its feedback has contributed to changes in Epic software, Dr. Alper said.
But access does not mean a health system gets every change it requests. Epic has to balance the requests of one customer against the needs of a broader customer community.
“Overall, Epic is outstanding at listening to their customers and prioritizing patient safety concerns. At times it can be a challenge to prioritize our enhancement requests due to the high volume of requests they receive from customers across the globe,” Dr. Alper said.
That distinction matters. The health systems described meaningful access to Epic’s teams and development process, but not control over Epic’s road map.
Budgeting for a platform that does not stand still
The same relationships extend into conversations about money.
At Parkview, Epic budgeting includes license fees, maintenance fees and potential new modules, Dr. Mabus said. While completing Parkview’s 2027 budget, he said he could review anticipated costs by application and was already considering two additional modules.
“There always needs to be a little placeholder for something new,” Dr. Mabus said.
Parkview also has to account for its own growth, including acquisitions and new facilities, when forecasting future costs, he said.
AI is introducing another variable. The EHR vendor has said that it plans to roll out more than 150 AI features in 2026.
Dr. Mabus said Parkview is preparing for an Epic generative AI platform to move from a monthly fee to usage-based pricing at the end of 2027. He said a new Epic dashboard is giving the health system more information about usage to help forecast expenses.
“First everybody moved to subscription based, and now they’re moving to token based,” Dr. Mabus said, referencing broader changes in technology pricing models.
At Montefiore, IT and finance leaders meet with Epic quarterly to make sure the organization understands its requirements and anticipated costs, Mr. Palombit said.
“We consider Epic to be a foundational tool for our health system,” he said.
Montefiore also continually evaluates new functionality while gathering input from clinicians and operational leaders as it decides how to allocate resources.
Corewell approaches the Epic bill partly by looking at how much of the organization the technology supports.
“Epic is certainly a sizable expense for the organization,” Mr. Joseph said.
With Corewell’s health plan moving onto Epic, Mr. Joseph said the platform would be running “$18 billion worth of our business.”
“The cost value proposition is actually very strong,” he said.
Corewell has also run calculations around whether it makes financial sense to move certain functions away from Epic, Mr. Joseph said. He said those analyses rarely point the health system in that direction.
Mr. Joseph also described Epic’s cost increases as generally reasonable and understandable.
And despite Epic representing a sizable expense, he said he has not encountered significant resistance from Corewell’s finance leadership over its place in the technology stack.
At UMass Memorial, Dr. Alper connected his view of Epic’s pricing to the broader relationship.
He said improvements and optimizations are frequently provided without an additional charge, while more substantial additions can require a greater outlay.
“You never feel like Epic is gouging you,” Dr. Alper said. “I feel more trust with Epic than I do with just about any other vendor.”
For the four health systems, the Epic budget is not viewed solely as the price of maintaining an EHR. Leaders are also considering how much of the organization the platform supports, which capabilities they already license, what functionality may come next and what it would take to add another vendor.
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