Healthie vs Spruce (2026): which should you pick?

Pick Healthie if

• Fits if you're a dietitian or health coach who runs programs and wants clients journaling between visits
• Works for a solo clinician starting out with 10 or fewer active clients, on Core at $18 a month

Look elsewhere if

• Tight if you have more than 10 active clients, as Core stops there and Essentials stops at 250
• Pricey if you need unlimited clients or group telehealth, which start on Plus at $115 a month
• Watch out: claims need Claim.MD, listed at $25 to $30 a month plus a $50 to $100 setup fee, and cards cost 2.9% + 30¢
• Watch out: AI charting and the API cost extra, ePrescribing is $40 per clinician, and an inbound fax line is $10 below Plus
• Not for you if you have several clinicians and want a low price, as Group is $135 plus $50 per clinician

Pick Spruce if

• Fits if you want one shared inbox for calls, texts and faxes
• Works for a practice that already has an EHR and needs the phone side

Look elsewhere if

• Not for you if you want scheduling, charting or billing, as it needs a separate EHR
• Watch out: business text sending needs a one-time A2P 10DLC fee of $19.50 per organization
• Pricey if you want call flows, integrations or the API, all on Communicator at $49
• Watch out: desk phone hardware for VoIP is extra

Healthie

• Core stops at 10 active clients and Essentials at 250; unlimited clients start on Plus, and adding clinicians needs Group.
• Card payments cost 2.9% + $0.30. Claims go through a Claim.MD account, listed from $25 to $30 a month plus a $50 to $100 setup fee.
• AI charting and API access cost extra, ePrescribing through DoseSpot is $40 per clinician a month, and an inbound fax line is $10 a month below Plus.

Spruce

• It does not do scheduling, charting or insurance billing; a practice still needs a separate EHR.
• Sending business SMS requires a one-time A2P 10DLC registration fee of $19.50 per organization.
• Integrations and API access are limited to the $49 Communicator plan, and VoIP desk phone hardware is an extra.
• The free trial includes Basic features but not SMS sending, which needs the registration process first.

Healthie

Scheduling and client portal

Calendar and online scheduling with email and SMS reminders, a client portal, secure messaging and a client mobile app.

Charting and care plans

An EHR with smart-fill charting, a form builder, electronic forms and waivers, care plans, and goal and metric tracking.

Telehealth through Zoom

Individual video calls run on HIPAA-compliant Zoom at no extra cost on every plan; group telehealth and webinars start on Plus.

Online programs and journaling

Automated programs with fixed or rolling start dates, plus food and lifestyle journaling that clients fill in between visits.

Payments and insurance

Cards are charged and invoices sent through built-in Stripe. CMS-1500s start on Essentials, and Claim.MD handles claims and real-time eligibility checks.

AI charting

Healthie-built tools turn in-person, phone and Zoom sessions into structured chart notes and transcripts, for an added fee.

Spruce

Phone, text and fax in one inbox

Calls, SMS, e-fax, app-based secure messages and video visits arrive in a customizable shared inbox, with new or ported phone and fax numbers.

Secure messaging and team chat

Staff can message patients inside the Spruce app, share files, and talk to each other in internal chat on the same plan.

Automations for common replies

Auto-replies, saved and scheduled messages and bulk text broadcasts cut down repeat typing.

Call routing

Phone trees and extensions come with Spruce's phone system. Self-service call flows, urgent escalation and after-hours triage are on Communicator.

AI transcription

Voicemails are transcribed on both plans. Communicator also transcribes and summarizes call recordings and audio messages.

BAA and security claims

Spruce says every eligible organization gets a HIPAA BAA at signup with no extra fee, and describes the platform as SOC 2 Type II audited.

Healthie

• Core$18

  per month, billed annually ($19.99 billed monthly)

  Up to 10 active clients, with scheduling, payment processing, charting, telehealth, the client portal and the mobile app.

• Essentials$45

  per month, billed annually ($49.99 billed monthly)

  Up to 250 active clients; adds free outbound fax, custom forms, CMS-1500s, group and blast messaging, and the Claim.MD link (from $30 a month).

• Plus$115

  per month, billed annually ($129.99 billed monthly)

  Unlimited clients; adds group telehealth and webinars, automated online programs, and a dedicated inbound and outbound fax line.

• Group$135

  per month billed annually, plus $50 per clinician added

  For practices with several clinicians: shared color-coded calendar, roles and permissions, internal team chat. $149.99 a month billed monthly.

Spruce

• Basic$24

  per user / month, billed monthly

  Phone, text, video, fax and team chat, a shared inbox, auto-replies and AI voicemail transcription.

• Communicator$49

  per user / month, billed monthly

  Adds call flows (IVR), urgent escalation and after-hours triage, integrations and API access, VoIP phone service and AI call summaries.

Healthie

• Annual discount

  Save 10% with yearly billing

  Healthie's pricing page lists a 10% saving for yearly billing, for example Plus at $115 a month instead of $129.99.

Spruce

No public discounts listed.