For much of hospice's history, leaders benefited from a reimbursement environment that afforded both time and financial flexibility. As a result, when organizations identified a need, the default response was often to build it themselves. Whether launching palliative care programs, expanding community bereavement services, creating pediatric hospice offerings, or developing other mission-driven initiatives, organizations often had the resources necessary to design, staff, and sustain these programs internally.
Today's reality is different. Margin pressure, workforce challenges, increasing regulatory complexity, and evolving community needs require a greater level of strategic discipline than ever before. The "good old days" of abundant reimbursement provided a latitude that most organizations can no longer assume. Leaders must now make intentional choices about where to invest limited resources and how to bring new capabilities to their communities most effectively
That is why the discipline of Build, Buy, or Partner has become so important. Rather than automatically building every new program or service internally, organizations must carefully evaluate whether they should develop a capability themselves, acquire an existing solution, or partner with another organization that brings complementary strengths. The most successful organizations of the future will not be those that do everything themselves, but those that make thoughtful, strategic choices about where to build, where to buy, and where to partner.
Start With Strategy, Not Structure
When an organization needs a new capability, the first question is often, “How do we get it?” A better starting point is, “What are we trying to achieve?” The Build, Buy, or Partner framework turns that distinction into a practical strategic planning process. Rather than defaulting to internal development, acquisition, or collaboration, it helps leaders choose the path that best supports their goals, capabilities, and appetite for risk.
Before weighing options, clarify the outcome. Is the organization’s priority growth, speed, innovation, market entry, or a capability essential to long-term success? Consider whether the initiative differentiates your organization and how much control you need over its delivery.
These questions establish the criteria for the decision. They also prevent leaders from mistaking a preferred transaction or organizational structure for a strategy. The right approach begins with the value you want to create, not the arrangement you already favor.
Build: Develop What Makes You Distinctive
Building means developing the capability internally. It is especially compelling when the capability is central to your identity or competitive advantage, and when control over quality, intellectual property, or customer experience matters.
The key is an honest assessment of readiness. Do you have the talent, technology, and knowledge required? If not, can you develop them quickly enough? Building makes sense when internal strengths are substantial and the timeline allows development. It may also be necessary when no suitable external solution exists. Confronting the brutal facts, as Jim Collins would say, is essential at this point. Not acknowledging an organization’s internal weaknesses sets it up for failure in the future.
The trade-offs are real: slower progress, higher internal costs, and capability gaps. Choose build because internal development supports the strategy, not simply because independence feels more comfortable.
Buy: Accelerate Through Ownership
Buying means acquiring an organization that already possesses the capabilities you need. It can be the strongest option when speed matters, exclusive access is important, or ownership creates more value than collaboration.
But availability does not equal suitability. Leaders must assess acquisition cost, operational compatibility, and cultural fit. A capability that looks attractive on paper may be difficult to integrate into the organization.
The central question is whether ownership delivers enough additional value to justify the investment and integration burden. Buying can accelerate access to capabilities, but high acquisition costs, integration challenges, and cultural mismatch remain significant risks.
Partner: Combine Complementary Strengths
Partnering is attractive when another organization brings assets that amplify your own. It can help address opportunities too large or complex to pursue alone while sharing costs, risks, or market access.
The distinction between complementary and overlapping assets matters. A strong partnership is not merely two organizations doing similar things together. It combines different strengths in ways that create more value than either organization could generate independently.
Partnerships are particularly useful when flexibility matters more than control and coordination needs are moderate. They still require aligned incentives, effective relationship management, and protection against risks such as coordination friction and intellectual property leakage.
Create Value, Then Make It Work
The framework draws on Benjamin Gomes-Casseres’ Remix Strategy, which emphasizes three principles: a combination should create more value than its participants could generate separately; it must be designed and managed to realize that value; and each participant must receive sufficient returns to justify its investment.
These principles push the discussion beyond choosing a path. Leaders must ask how activities will be coordinated, who holds decision rights, how value will be shared, and whether incentives will sustain the relationship. They should also consider ecosystem fit: will the move strengthen their position or open doors to additional markets and partnerships?
Ultimately, build when internal capability, differentiation, and control are decisive. Buy when speed and ownership justify the acquisition and integration demands. Partner when complementary assets and shared risk make collaboration more valuable than acting alone.
Before committing, compare capability, integration, coordination, timing, and cultural risks across the options. Ask what could prevent the expected value from materializing, not just what makes each option attractive. That comparison keeps the decision anchored in execution rather than enthusiasm.
No single option is automatically right for every organization. The takeaway is simple: start with strategy, evaluate each option honestly, and choose the approach best positioned to turn your organization’s ambition into lasting value.
Every organization faces unique market conditions, financial realities, strategic priorities, and partnership opportunities. Determining the right path requires an honest assessment of capabilities, risks, timing, and long-term value creation. Whether you are considering launching a new service line, expanding into a new market, evaluating an acquisition opportunity, or exploring a strategic partnership, the decision deserves a structured and objective approach.
Take The Next Step
Teleios Consulting Group helps healthcare organizations navigate the Build, Buy, or Partner decision-making process with clarity and confidence. If your organization is evaluating its next strategic move, we'd welcome the opportunity to help you assess your options, identify the greatest value-creation opportunities, and develop a path forward that aligns with your mission and strategy. Reach out to Teleios Consulting Group to begin the conversation.
Gloria Brooks
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An organizational model that allows nonprofit hospices (Members) to leverage best practices,
achieve economies of scale and collaborate
in ways that better prepare each agency to participate in emerging alternative payment models and advance
their charitable missions.