Healthcare · Upsell Call
Upsell Script for Healthcare Customers: Expanding an Ambient Documentation Deal Without Burning the Account
You're calling a VP of Clinical Operations who thinks this is a quarterly check-in. You are live in 14 primary care sites, your family medicine cohort has pulled after-hours EHR time from ninety-something minutes a day down under 45, and nobody has logged into the admin dashboard since the last QBR. Meanwhile ortho, derm, and behavioral health have seats sitting dark, revenue cycle is still eating prior-auth denials for missing clinical documentation, and the EHR governance committee meets the third Tuesday of every month and rejected two vendors last cycle. That's the board you're playing on.
An upsell script for Healthcare customers only works if it opens with their audit-log numbers, not your roadmap. This buyer has survived an EHR conversion, a telehealth scramble, a portal rollout, and at least one scribe vendor that half the docs abandoned in month two. The second you say "I wanted to walk you through something we just launched," they file you under vendor, give you a polite ten minutes, and ask you to send something. The version that works says: here is what your providers did with what you already bought, here is the seam where value is still leaking, here is the price out loud, and here is the smallest pod I'm willing to run it in.
This playbook assumes you sell into clinical workflow — ambient documentation, in-basket drafting, coding capture, prior-auth support — and that your expansion is either a new specialty line, a new module, or both. Swap the module names, keep the structure. And be honest about the park signals: an open SSO ticket after the last EHR upgrade, a champion who just moved to a system CMIO role, or a renewal inside 60 days with an unresolved value question all mean you run a value-realization call today and come back for the money next quarter.
The upsell call script
Say it in your own words. The structure is the part that matters.
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0. Pre-call usage audit — do not dial without these seven lines
Fill these in from your own systems before you touch the phone. If you can't, you're not ready. - **Adoption by specialty**: licensed providers vs. weekly active, split by service line. "Family med: 96 licensed, 88 weekly active. Ortho: 22 licensed, 5 weekly active. Behavioral health: never onboarded." - **Clinical outcome, from their audit logs, not your benchmark**: after-hours EHR time per provider per day at go-live vs. last month. Chart closure rate within 24 hours. Pull the exact figures. - **Depth**: are they using the specialty templates, the coding suggestions, the in-basket drafts? What have they never turned on? - **Sponsor engagement**: last dashboard login for the CMIO and the VP of Clinical Operations. If it's been six weeks, that's a talking point, not a secret. - **Commercials**: contract value, renewal date, who signed the original order form, whether they're still in the seat, discount level, co-term math. - **Support history**: open tickets, the SSO break after their last EHR upgrade, any P1 in the last 90 days, CSAT from the clinician survey. - **Governance calendar**: when the EHR governance / clinical informatics committee meets, what it approved and rejected in the last two cycles. The test: can you say one thing about their account that mildly surprises them? "Your Tuesday afternoon derm clinic is the single highest-utilization pod in the whole system" beats "how's everyone finding it?" every time.
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1. Frame the call in the first 30 seconds
"Thanks for the time. Two things. First — I pulled your after-hours EHR time and chart closure numbers for the last two quarters before this call, and there's a split across service lines I want to check with you, because I think it means something. Second, depending on what you say about that split, there's a piece of the platform I think is relevant to it. If I don't think it is by the end, I'll tell you and we'll skip it. Fair?" Don't sandbag and don't ambush. Pre-committing to walking away lowers the guard faster than any rapport-building, and this buyer has been ambushed by vendors before.
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2. Anchor on the result they already own — in their numbers
"When we went live in the family medicine pods in February, your audit logs had providers at about 94 minutes of after-hours EHR time per day. Last month the same cohort is sitting at 41. Chart closure inside 24 hours went from 61 percent to 88. Does that match how it feels in your clinic managers' meetings, or am I reading that optimistically?" Let them correct you. Their correction is the metric they actually defend internally — write it down verbatim, because that sentence becomes the first line of the business case they take to the CFO. **If they can't confirm a result, stop the upsell.** "Then let's not talk about anything new today. Let's spend the half hour figuring out why you're paying for something you can't point at in the audit logs." That's not a lost call. That's the only version of this call that protects the renewal.
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3. Say the underuse objection out loud before they do
"Here's what I'd push back on if I were sitting in your chair. You're paying for 210 providers and about 128 of them are in it weekly. Ortho has 22 licensed and five active. Behavioral health never onboarded at all. Why on earth would you buy more before you've used what you've got? So let me tell you what I think those 82 are doing instead — they're not idle. Your ortho docs are dictating into the old system and finishing at home, and behavioral health never got templates that handle a 50-minute therapy note, so they never started. That's not wasted spend, that's unrouted work. Now — whether the fix is a new module or just an onboarding push, I genuinely don't know yet. That's what I want to figure out with you." Sometimes the honest answer is "you have an onboarding problem, not a product gap." Saying that buys you the right to come back in 90 days with the real ask.
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4. Find the seam, don't pitch the module
Diagnostic questions that open the gap in this industry: - "What did you deliberately cut from scope last time because it was too big a bite?" (Highest-yield question on the call. Most healthcare upsells were already scoped and cut once — usually behavioral health, usually the in-basket.) - "After the note is signed, who touches it next? Does it go to a coder, or straight out the door?" - "Where's the Monday morning fire drill — is it the in-basket backlog, the prior-auth queue, or the denial worklist?" - "Who's asking you for reporting on this that you can't produce today? Is your Director of Revenue Cycle Management asking about E&M distribution or HCC recapture and you're sending them a spreadsheet?" - "Which service line has the worst third-next-available right now, and is that a scheduling problem or a documentation-drag problem?" - "What's your physician and APP turnover running this year, and which specialty is the sore spot?"
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5. Build the incremental case in their arithmetic
Structure it as unit → volume → conservative capture rate → net, and say the price in the same breath as the value. "Let's do the math with your numbers, not mine. You told me contribution margin per encounter in ortho is about [X]. Your ortho providers are averaging [Y] visits a day. If specialty templates get them the same 45-minute recovery family med got, that's one to two additional slots a provider per day — you tell me if that's real or if the ortho schedule is capacity-constrained for other reasons. Separately: you said prior-auth denials for missing clinical documentation ran [Z] percent last quarter. If structured capture at the point of care catches even half of those — and I'd rather under-promise — what does that do to your days in A/R? The add-on is $[price] a month on top of your current contract. Against what we just did, that's roughly a [N]x. If you think my capture rate is generous, say so and we'll rerun it at whatever number you actually believe." Handing them the pencil on the assumptions is the difference between a business case and a pitch deck.
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6. Cost the implementation in hours and names
Bandwidth is the real objection; budget is the costume. Quantify the ask. "Rollout for the behavioral health pod is one 90-minute template session with your Director of Clinical Informatics and two clinical leads, then about two hours a week from one informatics analyst for three weeks. My CSM runs the clinician enablement — you don't staff it. No new build in the EHR; it's the same SMART on FHIR launch you already approved, we're adding specialty templates behind it, which means it may not even need a new governance submission. Your informatics analyst can confirm that in ten minutes. If it needs more than that, I've mis-scoped it and I'll come back and tell you." Put the work you'll absorb on the table here, not later as a concession.
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7. The ask: one pod, one quarter, their success metric
"Give me the behavioral health pod at [site] and six ortho providers for one quarter. You define success on this call — I'd suggest after-hours EHR time under 45 minutes a day for that cohort and 80 percent weekly active use by day 60, but you pick the numbers. If we miss it at day 90, we pull it out and you owe nothing further. If we hit it, we roll it to the other service lines at renewal and co-term it so you're managing one agreement instead of two." Co-terming is the most underused unlock on this call. It removes a procurement cycle, keeps one negotiation instead of two, and makes the expansion feel like an amendment rather than a new purchase. And volunteering the exit clause is what physicians and the people who serve them actually trust — every scribe vendor promised success; nobody offered to leave.
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8. Read the buying committee — it has probably moved
"Last time the order form went through [name] and it cleared under the departmental threshold. Is that still the path, or has anything changed since the new CFO landed?" Then the healthcare-specific version: "Does this need to go back to the EHR governance committee, or does it ride on the original approval? And does your Director of Revenue Cycle Management need to co-sponsor if we're touching E&M capture, or is that still your call alone?" The documentation-quality pain is owned half by the CMIO and half by revenue cycle. If you're selling into that seam, you need both names on the recap email or it dies in the third week.
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9. Close and document — write it for the forwarder
Same-day recap containing: the result they confirmed in their own words ("94 to 41 minutes of after-hours time, chart closure 61 to 88 percent"), the gap they described, the value math with their assumptions labelled as theirs, the price, the implementation ask in hours and named roles, the pilot scope, the success metric they chose, the exit clause, and the governance date. This email is the artifact your champion forwards to the CMIO and the CFO. Write it for that reader, not for your CRM. Offer explicitly: "If it's useful, I'll rewrite this as a one-page governance submission in whatever format the committee requires — send me the last packet that got approved and I'll match it."
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10. Park signals — walk away and keep the account
Park the expansion, don't push, if any of these are live: an open P1 or an unresolved SSO break after their last EHR upgrade; a champion who just moved roles or got quietly sidelined; a renewal inside 60 days with an unanswered value question; a flat or declining weekly-active curve you can't explain; a system-wide hiring freeze, cost review, or merger announced in the last quarter; or a medical staff complaint about note quality that hasn't been closed out. Pushing an upsell over the top of any of those converts a healthy account into a churn risk to book incremental revenue you won't keep.
How the call actually sounds
Prospect on the left, the rep on the right.
Rep
Thanks for making the time, Dana. Two things today. First, I pulled your after-hours EHR time and chart closure by service line for the last two quarters, and there's a split I want to check with you because I think it means something. Second, depending on what you say about that split, there's a piece of the platform that might be relevant — and if I don't think it is by the end, I'll say so and we'll skip it. Fair?
Buyer
Before you get into any of that — SSO broke for about forty people after our August Epic upgrade and it took your team nine days. My clinic managers heard about it directly. So start there.
Rep
That's fair and I'm not going to talk past it. Ticket 4471, nine days, and the delay was on our side — we didn't have the upgrade in our regression queue. It's in there now, and your CSM is on your informatics team's upgrade distribution list so we get the notice at the same time you do. What I'd like to know is whether that nine days cost you clinician trust that hasn't come back, because that changes what I should be asking you for today.
Buyer
It cost me some. Family medicine shrugged it off. The ortho group used it as proof they were right about the whole thing.
Rep
Understood. Let me put the family medicine number on the table and you tell me if it's real. At go-live in February your audit logs had that cohort at about 94 minutes of after-hours EHR time per provider per day. Last month, 41. Chart closure inside 24 hours went 61 percent to 88. Does that match what you're hearing in your clinic ops meetings, or am I reading it optimistically?
Buyer
The after-hours number is real. I'd argue the chart closure number is partly because we changed the encounter-lock policy in March, not because of you. And I've got two family docs who still say it's faster to type.
Rep
I'll take that — the policy change is fair, and I'd rather you correct me than nod along. So let's say the defensible number is the after-hours time. Here's what I'd push back on myself with, though. You're paying for 210 providers and 128 are in it weekly. Ortho has 22 licensed and five active. Behavioral health never onboarded at all. If I were you I'd be asking why I'd buy anything more before I've used what I've got.
Buyer
That is exactly what I'd be asking. And you should know Epic told our CMIO they're shipping ambient natively next year, so I'm not signing anything that Epic's going to give me for free in twelve months.
Rep
They probably will, and it'll be good for the average primary care note. Two honest questions. Which of your sites is actually in the release wave, and when — do you or your CMIO have that in writing? And what's the specialty coverage in the first release? Native tools tend to launch strong in family med and internal med and thin in ortho, derm, and behavioral health — which, from your own numbers, is exactly where your charting pain is worst.
Buyer
Nobody has a date. It's 'on the roadmap.' And no, I don't know about specialty coverage. But that doesn't change my margin. We closed last year at 1.8 percent. There's no line for another documentation tool.
Rep
Then let's not talk about a documentation tool, let's talk about a line item you already own. What was your physician and APP turnover last year, and where was it worst?
Buyer
Fourteen percent overall. Behavioral health was worse — we lost three psychiatrists and a psych NP, and I still have two of those slots open at nine months.
Rep
So here's the question I actually want to ask. When we scoped the original deal, behavioral health got cut. Why?
Buyer
Two reasons. Your templates couldn't handle a 50-minute therapy note or a structured psych eval, and our general counsel got nervous about recording behavioral health encounters. We're a two-party consent state.
Rep
Both of those are answerable now and I'll be specific. The behavioral health template set went GA in June — structured psych eval, therapy note with time attestation, and it handles the E&M plus psychotherapy add-on coding, which matters to your revenue cycle director. On consent: three systems in two-party states operationalized it as one line added to the existing consent-to-treat in the intake packet, verbal reconfirmation at rooming for behavioral health specifically, and if the patient declines, the encounter runs with the microphone off and the clinician charts the old way. I'll send you the actual language two of them used and your counsel can red-line it. Would that clear it, or is there a second concern under it?
Buyer
It might clear counsel. It won't clear governance. The EHR governance committee meets monthly, they rejected two vendors last cycle, and I'm not spending my capital there on an expansion.
Rep
Then let's find out whether we even need them. This is the same SMART on FHIR launch they already approved — we're adding templates behind an existing integration, no new data flow, same BAA. Your Director of Clinical Informatics can confirm that in about ten minutes, and if it does need a submission, I'll write the packet in whatever format the last approved one used and your CMIO co-presents rather than you. Who on that committee is the skeptic?
Buyer
The ortho chief. Which is the other problem — his group is your five-out-of-twenty-two.
Rep
Then he's the person I most want in the pilot, not the person I want to route around. Here's my ask, and here's the price so you don't have to pull it out of me. Behavioral health pod at the Riverside site — that's eleven providers — plus six ortho providers including whoever the chief nominates. One quarter. It's $4,900 a month on top of your current contract, and I'll co-term it to your March renewal so you're negotiating one agreement, not two. Rollout is one 90-minute template session with your informatics director and two clinical leads, then two hours a week from one analyst for three weeks. My CSM runs the clinician enablement — you don't staff it.
Buyer
And if the ortho chief kills it in week three like he did with the last scribe vendor?
Rep
Then we pull it out at day 90 and you owe nothing further — I'll put that in writing. You pick the threshold: I'd suggest 80 percent weekly active use by day 60 and after-hours EHR time under 45 minutes a day for that cohort, measured off your audit logs, not my dashboard. We review it weekly. If we're under the number at day 60, I'll be the one telling you to stop. What would you want the behavioral health success metric to be?
Buyer
Honestly? Whether the two psychiatrists I do have are still here in June. I can't put that in a pilot doc.
Rep
No, but you can put after-hours time and weekly active use in the doc and tell your CMO privately that retention is the real scoreboard. I'll write both into the recap today — the confirmed 94-to-41 result in your words, the pilot scope, the exit clause, the price, and the hours we're asking from your analyst. Two questions before I let you go: does this need your Director of Revenue Cycle Management as a co-sponsor given the psychotherapy coding piece, and is the order form path still the same as last time, or has the new CFO changed the threshold?
Objections you will hear
What they say, and what you say back.
| Objection | How to answer it |
|---|---|
| “We barely use what we already have. Ortho has 22 licenses and five weekly actives — why would I buy more?” | Say it before they do, then diagnose instead of defend. "You're right, and I'd ask the same thing. Let me tell you what I think those 17 are doing — they're not idle, they're dictating into the old system and finishing notes at 9pm, because we never built templates that handle a procedural visit. That's unrouted work, not wasted spend." Then be honest about whether the expansion fixes it. If the real problem is onboarding, say so and go fix adoption first — that concession buys you the right to come back next quarter with a bigger ask and a credible reason. |
| “Our operating margin is 1.8 percent. There's no budget for another documentation tool this year.” | Stop selling software and move to a P&L line they already carry. Two levers: physician retention — one avoided psychiatrist or ortho departure often covers a multi-site expansion once you count recruiting plus 12–18 months of lost panel revenue during ramp — and throughput, where 45 minutes recovered per provider per day is one to two additional encounters. Make them do the arithmetic out loud: "How many providers in that pod, and what's your contribution margin per encounter?" Then ask what the money is committed to and when it resets, and whether it can come out of the service line's budget rather than IT's. Never discount — it tells them the original contract was overpriced and teaches them to wait every time. |
| “Epic says they're shipping ambient documentation natively next year, so I'm not buying more of yours.” | Concede the point, then narrow it. "They probably will, and it'll be fine for the average primary care note. The question is what your ortho and behavioral health providers do for the next 18 months while it's in early adopter release." Then ask two questions nobody can usually answer: which of their sites is in the release wave and on what date, and what the specialty coverage looks like in v1. Native tools launch strong in family and internal medicine and thin in ortho, derm, and behavioral health — which is exactly where their after-hours EHR time is worst. Offer the co-term so the expansion ends at the same renewal date, which removes the lock-in fear entirely. |
| “Anything touching clinical workflow goes back to the EHR governance committee, and they meet monthly. They rejected two vendors last cycle.” | First, test whether you need them at all: if the expansion rides the existing SMART on FHIR launch and the same signed BAA with no new data flow, their Director of Clinical Informatics may be able to confirm it's an amendment, not a new submission. If it does need governance, don't route around it — get on the agenda and get the CMIO or Director of Clinical Informatics to co-present. Ask what the committee approved and rejected in the last two cycles and why, what the submission packet has to contain, and who the named skeptic is. Then write the packet in the format of the last approved one and arm your champion with a reference call before the meeting. Deals die in governance because the sponsor walked in alone with a vendor slide deck. |
| “We cut behavioral health from the original scope because we're a two-party consent state and counsel got nervous about recording therapy sessions.” | Have this ready before they raise it or you'll lose the line permanently. Name the mechanism: one line added to the existing consent-to-treat in the intake packet, verbal reconfirmation at rooming for behavioral health specifically, and a documented behavior when a patient declines — microphone off, clinician charts manually, no partial capture. Offer to send the actual consent language two comparable systems in two-party states used so their general counsel can red-line rather than draft. Then ask whether counsel is the only concern or whether there's a clinical concern underneath it, because in behavioral health there usually is. |
| “My team is underwater. Front desk vacancy is 20 percent and my informatics group is mid-upgrade. We can't absorb another rollout.” | This one is almost always true — arguing with it makes you the vendor who doesn't understand their world. Respect it and shrink the ask: one pod, not a system rollout. Quantify it in hours and names: one 90-minute template session, two hours a week from one analyst for three weeks, and your CSM runs the clinician enablement so no clinic staff time is consumed. If their upgrade freeze is real, move the start date past it — but leave the call with a calendar date and a signed order form, not "let's circle back after the upgrade." |
| “We had an SSO outage after our last upgrade and it took nine days. Why should I extend anything with you?” | Park the money and fix the trust. Name the ticket number, own the root cause, and state what changed structurally — their upgrade calendar in your regression queue, their CSM on the informatics distribution list. Then ask the question that tells you whether to proceed at all: "Did that cost you clinician trust that hasn't come back?" If the answer is yes and it's unresolved, this is a value-realization call, not an upsell call. Booking an expansion over an open escalation is how a renewable account becomes a churn risk. |
Questions reps ask about this call
- What usage data do I need before running an upsell call with a healthcare customer?
Seven things, minimum: weekly active providers vs. licensed seats split by service line; after-hours EHR time per provider per day at go-live vs. last month from their audit logs; chart closure rate within 24 hours; last dashboard login for the CMIO and VP of Clinical Operations; contract value, renewal date and whether the original signer is still in role; open tickets and any P1 in the last 90 days; and the EHR governance committee's meeting cadence and recent approvals. If you open with "so how's everyone finding the platform?" when you have their instance data in a dashboard, you get downgraded from partner to vendor in the first two minutes.
- Who should actually be on the call — the CMIO or the VP of Clinical Operations?
It depends on what you're expanding into. Service-line expansion and adoption problems belong to the VP of Clinical Operations and the Practice Administrator. Anything touching note quality, specialty templates, or clinician trust needs the CMIO or Director of Clinical Informatics. If the expansion touches E&M capture, HCC recapture, or prior-auth documentation, you need the Director of Revenue Cycle Management as a second sponsor — that pain is owned half by informatics and half by revenue cycle, and single-sponsor deals in that seam stall in week three. Ask on the call: "Does this need a co-sponsor from revenue cycle, or is it still your call alone?"
- How do I upsell when they say their operating margin is under 2 percent?
Don't sell software, sell a line item they already carry. Physician and APP turnover is the strongest one — a single avoided departure in a hard-to-recruit specialty costs six figures in recruiting plus 12–18 months of lost panel revenue during ramp, and most systems run 10–15 percent turnover. Throughput is the second: if a provider recovers 45 minutes a day, that's one to two more encounters, and they know their own contribution margin per encounter better than you do. Make them say the numbers out loud so the business case is in their handwriting. Never discount to solve a margin objection — it just teaches them to wait for the discount on every future expansion.
- What's the right size of ask on an expansion call in a health system?
One pod, one quarter, one workflow — with success criteria they define on the call and a written exit clause. "Give me the behavioral health pod at Riverside and six ortho providers for a quarter; if we're under 80 percent weekly active use at day 60 or after-hours time isn't under 45 minutes at day 90, we pull it and you owe nothing further." Clinicians and the leaders who serve them trust a vendor who volunteers an exit more than one who promises success — they've all been through a scribe vendor that half the docs abandoned in month two. Then co-term the add-on to the existing renewal so it reads as an amendment, not a new procurement cycle.
- Do I need to go back through security review and governance for an expansion?
Often no, and it's worth testing on the call. If the expansion rides the existing SMART on FHIR launch, under the same signed BAA, with no new data flow or new PHI category, their Director of Clinical Informatics can usually confirm in minutes that it's an amendment rather than a new submission. If it does need governance, get on the agenda rather than around it: ask what the committee approved and rejected in the last two cycles and why, what the submission packet must contain, who the named skeptic is, and get your CMIO or informatics director to co-present. Offer to write the packet in the format of the last one that passed.
- When should I not upsell a healthcare account at all?
Park it if there's an open P1 or an unresolved integration break after their last EHR upgrade, if your champion just changed roles, if renewal is inside 60 days with an unanswered value question, if weekly active use is flat or declining and you can't explain why, or if a hiring freeze, cost review, or merger landed in the last quarter. Also park it if they can't confirm a result from the original purchase — that's a value-realization call, not an expansion call. Say it plainly: "Then let's not talk about anything new today. Let's fix the fact that you're paying for something you can't point at in the audit logs."