Spruce vs Klara for Medical Practices: Which Fits in 2027

Start with the category decision

Klara is no longer a standalone product you can buy on its own. ModMed acquired Klara on February 8, 2022, and the platform is now sold as ModMed Patient Engagement, powered by Klara, according to Practiceall. ModMed's own patient-engagement page presents the offering as ModMed Patient Engagement, powered by Klara, according to ModMed.

So the real decision is between a ModMed suite and a standalone texting and phone platform. If your practice already runs ModMed's EMA or Practice Management software, ModMed Patient Engagement is the option to price first. If it runs another EHR, Spruce is easier to evaluate on paper, because its plan prices and API conditions are published, while ModMed's integration path has to be confirmed with ModMed before you can judge it.

A patient communication platform is software that routes patient calls, texts, and faxes to staff and, when integrated, files those conversations in the patient's chart.

TL;DR: If your EHR is not ModMed, start with Spruce and get its EHR support confirmed in writing. If your EHR is ModMed, start with ModMed Patient Engagement and get a quote that spells out the integration scope.

Key Takeaways

• Klara is now sold as ModMed Patient Engagement, so the purchase runs through ModMed.

• Spruce publishes per-user prices, while ModMed publishes none for this product and quotes it instead.

• Spruce is not an EHR, so charting and billing stay in your chart system either way.

• Spruce's API and webhook access sits on its Communicator plan and must be requested from Spruce.

• ModMed's integration is tightest with its own EMA, Practice Management, and ModMed Pay products.

• Any automation needs a named owner, a signed business associate agreement, and a human review step for clinical messages.

How we evaluated these tools

This is a buyer's guide built from public vendor pages, third-party reviews, and an industry ranking. It is not a hands-on test. The weights below are this guide's judgment about what a small practice has to settle first.

The weights favor the choices that are hardest to undo. A weak phone menu can be replaced with a different tool, but an EHR connection that writes messages to the wrong chart is harder to unwind.

Best in KLAS 2025 list: 8 vendors, neither Spruce nor Klara according to KLAS (2025). Market ranking therefore does not separate these two products, which is why the weights lean on contract and integration evidence.

What each product publishes side by side

Read the matrix as a list of questions to put to each vendor in writing. Spruce's public pages answer most of them, but they do not list every EHR. ModMed's public pages describe its strongest integrations, yet the pages reviewed did not include public API documentation, so the Klara column has more blanks. The ModMed roadmap is also worth a written answer on timing, because the roadmap page says timing "may be subject to change."

Pricing and five-user cost math

Pricing checked October 26, 2026.

Spruce's Basic plan costs $24 per user per month and its Communicator plan costs $49 per user per month, both billed month to month and excluding taxes and fees, according to Spruce. Basic includes a free 14-day trial with no credit card, and the same page says the trial excludes SMS texting. Outbound SMS adds a one-time $19.50 fee per organization, invoices carry pass-through taxes and telecom fees that depend on the business address from November 1, 2025, and larger practices may need an annual commitment with onboarding fees.

Klara has no published price. Its cost stays Quote-based until ModMed sends one.

The table below is arithmetic, not a quote. It uses a hypothetical five-user practice and multiplies the Spruce plan prices above by five users and twelve months. Five users at $24 is $120 a month, or $1,440 a year. Five users at $49 is $245 a month, or $2,940 a year. The gap is $1,500 a year before taxes and fees.

Spruce in detail

Best fit. Spruce suits a solo clinician or small team that wants medical phone, text, fax, and video in one app with a shared inbox. The review that covers Spruce says eligible organizations automatically receive a HIPAA Business Associate Agreement, and it lists Spruce's plans at $24 and $49 per user per month, according to Practiceall.

Limitations. Spruce is not an EHR. Notes and messages have to move into the chart separately or through a limited set of integrations, and practices that need scheduling, charting, or billing in one system should look elsewhere. Call handling such as IVR and after-hours triage sits on the Communicator plan, and so does API access.

Implementation. Spruce's athenahealth post describes an integration that syncs messages and notes into the patient chart, with a support team that walks practices through setup. The review also describes an Elation integration that syncs demographics and selected conversations into that chart. For anything beyond these native connections, the API route requires a request to Spruce and engineering time on your side.

Klara, now ModMed Patient Engagement, in detail

Best fit. This product suits a practice already running ModMed's EMA or Practice Management software, where the review says integration is tightest, and where ModMed Pay is also in use.

Limitations. Digital intake and AI retention are limited to EMA specialties or select specialties. Practices on other EHRs must confirm integration first, and the same review describes the platform as a poor fit for practices on other EHRs that need deep two-way integration. It also flags primary care and behavioral health practices outside ModMed's specialties as a weaker match.

Roadmap. The ModMed roadmap lists autoclose and urgency detection for patient collaboration, plus a unified patient intake offering, for 2026. Its Front Office Assistant targets a reduction in manual front-office work, ModMed's Front Office Assistant target: up to 60% less manual work according to ModMed (2025). That figure is a vendor target, not a measured result.

Implementation. Expect a quote first, then an EHR confirmation, then a specialty check for each feature you plan to use. No public API documentation for ModMed Patient Engagement appeared in the pages reviewed.

Where US Tech Automations fits the workflow

The gap in either product is what happens after a message arrives. US Tech Automations can design a routing layer for that gap. The workflows below are proposed and configurable. They are not features of either vendor, and this guide does not claim a measured result for any of them.

Proposed workflow A is Spruce-only, and its trigger is a conversationItem.created event. Webhook cap: 1,000 events per minute per endpoint according to Spruce (current docs). Prerequisites are a Communicator plan, an API access request through Spruce's form, and an engineer or contractor who owns the endpoint, verifies each payload's signature, and handles events that arrive out of order. The action reads the message text and sorts it into queues the practice has approved, such as refills, scheduling, and billing. Any message that matches a clinical or urgent keyword goes to a licensed staff queue with no automated reply. The output is a task in the practice's work queue that links back to the Spruce conversation. There are two human review points: a staff member signs off on the keyword rules before go-live, and someone reviews misrouted messages every week.

Proposed workflow B connects Spruce contacts to the chart. The trigger is contact.created, and contact.merged catches duplicates. The action compares the new contact with the patient record in the EHR. The output is an exception list for front-desk staff, never an automatic chart edit. The prerequisite is a read path from the EHR, such as an export or API the EHR vendor enables, plus a written answer on which system is the source of truth. The athenahealth post says contact details and provider assignments stay up to date between the two systems, but it does not say which side wins a conflict. Front-desk staff approve every merge.

Worked example for a hypothetical five-user practice on the Communicator plan, which costs $245 a month for five users before taxes and fees. Suppose the practice receives 300 inbound messages a week and a staff member needs one minute per message to triage by hand. That is 5 hours a week, or 20 hours in a four-week month. Spruce's pricing does not rise with message volume, since it has no per-text charges and no usage caps, so any saving would come from triage time, not the subscription. Workflow A's conversationItem.created trigger would sort each of those 300 messages as it arrives, which targets the 20 monthly hours, but no reduction is claimed here.

The do-it-yourself alternative is Zapier, Make, n8n, or an in-house script. Those tools can keep run histories, retries, error branches, and audit evidence when they are configured that way. The practice still has to design and own observability, idempotency (so a repeated event does not create a second task), escalation, access controls, and maintenance after each vendor change. A proposed US Tech Automations design could configure the retry, deduplication, and escalation logic before go-live and document an owner for each step, so the practice can see who is responsible before paying for the build.

For ModMed Patient Engagement, the pages reviewed did not include public API documentation. No workflow can be proposed for a non-ModMed practice until ModMed confirms in writing which export or API path is available and whether it depends on specialty.

Who should choose which

Who this is for

Spruce fits a practice that is not on ModMed, wants published per-user prices, needs phone, text, and fax in one inbox, and can assign an engineer if it wants API work. ModMed Patient Engagement fits a practice already on ModMed EMA, Practice Management, or ModMed Pay that is willing to request a quote and confirm specialty coverage.

Red flags: charting or billing must live in the same product, the vendor will not confirm your EHR version in writing, or no written quote or integration scope arrives before the budget decision.

When not to use US Tech Automations: a simpler option wins in three cases. If you only need Spruce's built-in phone, text, and fax inbox with no custom routing, the native features cover it. If you only need the EHR sync each vendor already offers, the built-in integration is enough. If no one on staff or under contract can own a webhook endpoint, a built-in setup is the honest choice until someone can.

If your main pain is referral intake rather than front-desk messages, read the therapy referral coordination guide before you compare these two products.

Decision checklist

1. Which EHR and practice management system do you run, and has each vendor confirmed that version in writing?

2. Can each vendor give a written quote that includes term length, onboarding fees, and taxes?

3. Do you need phone, text, and fax in one inbox, or is texting enough?

4. Do you need API or webhook access, and who on your side will maintain it?

5. Will the vendor sign a business associate agreement before any patient data moves?

6. Which features depend on your specialty, and are they the ones you plan to use?

Glossary

• BAA: business associate agreement, the contract a vendor signs before it handles protected health information.

• EHR: electronic health record, the system that holds the chart.

• IVR: interactive voice response, the automated phone menu callers press through.

• Webhook: an HTTP message a vendor sends to your endpoint when a record changes.

• Idempotency: handling a repeated event once, so a retry does not create a second task.

• TCO: total cost of ownership, here the subscription plus one-time fees.

Frequently asked questions

Is Klara still sold on its own?

No. The product is sold as ModMed Patient Engagement, powered by Klara, so the purchase goes through ModMed, as covered in the first section.

Which costs less, Spruce or Klara?

Spruce publishes per-user prices, so you can compare its cost directly, while Klara's cost stays unknown until ModMed quotes it.

Does Spruce sign a BAA?

Spruce says eligible organizations receive a BAA automatically, but get the signed copy before any patient data moves.

Does Spruce connect to my EHR?

Only if your EHR is on Spruce's confirmed list. Spruce's own materials describe an athenahealth integration, a review names Elation, and the pages reviewed did not list Epic, so confirm your exact EHR version in writing.

Does either product rank on the market leader list?

No. Neither appears among the eight vendors on the KLAS 2025 patient-communications list, so ranking should not decide this for you.

Bottom line

If your EHR is ModMed, request a ModMed Patient Engagement quote and get the integration scope in writing before you compare anything else. If it is not, Spruce gives you the most to check on paper first, starting with the Communicator plan's API access and its EHR list. Then see how US Tech Automations configures this for a routing design you can review before you buy.