Why Experienced Teams Refuse to Hardcode Care Flows

‍Q: "Why can’t we let engineering code our care flows? Or better, build a low-code orchestration engine ourselves?”

It's a question we hear from every care organization that considers Awell.

And for good reason. On paper, building in-house sounds tempting—complete control, tailored to your exact needs, no vendor costs. But if you've walked this road before, you know where it leads: complexity, delays, and a patchwork of solutions that crumble under the weight of growth.

“Honestly, my gut reaction was ‘we can just hardcode our care flows.’ But building was only half the battle—the constant upkeep, scaling, and improvements would have sunk us in the long run. Awell frees us from that burden.” - Paddy Rehill, Chief Technology Officer at Perci Health

Second-time operators don’t waste time. They’ve seen what happens when you try to maintain your care flows in-house. They’ve dealt with the chaos and the ClinOps debt that drags the team down. So when they start fresh, they know better. They want a solution that scales without the pain. And our data shows this too. Second-time operators sign deals twice as fast as first-timers.

This is because first-timers underestimate how fast complexity snowballs. 

I’ve lost count of how many “Wiki’s” I’ve seen, stuffed with hundreds of care flows—each one slightly tweaked to match contract requirements. For sales, every request for a care flow tweak is an easy yes. Saying yes means faster deals, commissions in the bank, and another fancy dinner with the fam. But for the care team, it’s chaos.

They’re left juggling dozens of care flows—one contract says escalate at PHQ-2 score 2, another says 3. Multiply that across 20 contracts and suddenly the team is drowning in complexity. The cognitive load is overwhelming. They spend more time remembering which process applies than delivering care.

Don’t believe me, hear it from those who've lived it

Take Tia, for example, a hybrid care delivery organization focused on women's health. When they started, they had a "build everything" mindset. Back then, there weren’t as many tools on the market, and they thought, "How hard can it be?". But as they delved deeper, they quickly realized healthcare is like an onion—layer upon layer of complexity.

In a recent panel, Felicity Yost, President of Tia, reflected on this shift:

"Healthcare is incredibly complex, and building everything yourself just doesn’t scale. There are exceptional solutions that can solve our problems in days. So why waste time and resources reinventing what’s been built—only to do a worse job?"

To give another example, we recently announced our partnership with Astrana, a publicly traded company on NASDAQ with a $2.7 billion market cap and 1.2 million patients in VBC arrangements. When I spoke to their CEO, Brandon Sim—an engineer by background—he shared that they initially considered building something like Awell in-house. But they quickly realized the speed advantage of going with Awell was impossible to ignore. In his words:

“Awell accelerates our ability to create and iterate on care flows. We don’t have to wait for it to go through engineering, hit the next sprint, go through QA, and then—two months later—finally get it into production. With Awell, it’s just so much faster.” - Brandon Sim, President and CEO at Astrana Health 

And if you don’t want to take the word of a CEO leading a multibillion-dollar healthcare company, maybe you’ll trust the CEO of a $1.41 trillion business. Mark Zuckerberg recently said on a podcast: 

"Our product strategy isn't about one specific thing. It's about how fast we can iterate and learn. If we can learn faster than every other company, we’ll win, because we’ll build a better product than anyone else."

In healthcare, it’s the same principle. The organizations that figure out their workflows and care models faster are the ones that will lead.

But here’s the truth: the tech behind your workflows won’t set you apart. It’s how fast you can deliver care that matters. As Brandon Sim said, Awell gave Astrana Health the flexibility to focus on the care flows itself—not building the orchestration engine. Just like in D2C marketing, successful brands don’t waste time building their own analytics tools. They use what works, so they can learn faster.

Better Health is a great example of this. By using Awell, they saved 66% of their engineering capacity on care flow development, which they reinvested into product innovation.

“With Awell, our clinical and operations teams automate workflows independently, without relying on IT. It’s been transformative—allowing those who know the workflows best drive continuous improvements while our engineers focus on impactful projects.” - Adam Breckler, Co-founder & Head of Product at Better Health

Don’t get me wrong—we love engineers and want them to thrive. That’s why we invest in our developer docs, allow syncing with SCM systems, and offer open-source components. Awell doesn’t replace engineers; they still contribute but on the right things.

Conclusion 

Yes, some organizations have succeeded in building workflows in-house. But they spent millions doing it, shed more than a few tears along the way, and probably aged a few years in the process. Meanwhile, you have the chance to partner with a platform battle-tested by respected companies like Astrana. What’s the smarter move?

P.S.: We believe in showing, not telling. If you’re ready to fix your workflow bottlenecks, join us for a free bootcamp. In just 2.5 days, you’ll see firsthand how Awell can transform your care flows—no commitments, no costs. Learn more about our bootcamps here.