Organizations that build FIM programs in-house tend to gain:

• Greater control over program design and patient experience
• Deeper integration with clinical teams and community partners
• Strong alignment with mission and place-based strategies

In exchange, they take on:

• Higher fixed costs
• Greater operational complexity
• Limited scalability beyond local contexts

Organizations that buy FIM services through vendors benefit from:

• Faster implementation timelines
• Variable cost structures
• Greater ability to scale across geographies and/or populations

In exchange, they manage:

• Dependence on vendor capabilities
• Data integration and oversight challenges
• Potential loss of customization

In practice, many organizations adopt a blend of these approaches.

For example, a health system may operate an in-house produce distribution program for high-need local patients while contracting with a vendor for MTM. A health plan may start with a vendor-led pilot and later internalize select functions such as care coordination or analytics. As FIM programs mature, organizations often revisit choices in response to new evidence, evolving payment pathways, or changes in internal capacity.

Blended models may include:

• Piloting FIM programs internally, then contracting to scale
• Launching through vendors, then building internal capabilities over time
• Using different operating models for different populations or lines of business