Full-Managed vs. Co-Managed IT

What each model covers.

Full-service managed IT

MSP handles everything — endpoint management, server administration, network operations, helpdesk and user support, patch management, cybersecurity, backup, disaster recovery, vendor coordination, and compliance support. Practice has no internal IT staff. Practice contact is operational (who to call for what) rather than technical. See our full-service managed IT page.

Co-managed IT

MSP and internal IT share responsibility with explicit scope split. Typical co-managed split: internal IT handles day-to-day user support, practice-specific software, and local relationship management; MSP handles 24/7 monitoring, specialized cybersecurity, compliance work, infrastructure design, and specialty expertise (EHR consulting, HIPAA, etc.). See our co-managed IT page.

Where the split matters

Clear scope definition prevents the most common co-managed failure mode — accountability gaps where MSP assumes internal IT is handling something and internal IT assumes MSP is. Formal Responsibility Assignment Matrix (RACI or similar) prevents these gaps.

Practical fit patterns.

Full-managed typically fits

• Practices under 25 users where full FTE cost doesn't justify.
• Practices that want a single accountable vendor rather than managing internal staff + external MSP.
• Practices without existing IT staff where hiring is operationally difficult.
• Leadership preferring to focus on clinical operations rather than managing IT staff directly.

Co-managed typically fits

• Practices with existing internal IT staff (100+ users commonly, 50+ sometimes).
• Practices valuing on-site physical presence and practice-specific knowledge.
• Larger practices where specialist expertise gaps exist (cybersecurity, EHR administration, compliance).
• Multi-location practices where internal IT can't physically cover all sites.
• Practices wanting redundancy — internal IT gets sick/leaves, MSP continues operations.

Economics of each model.

Full-managed is priced per user (typically $150-400/user/month for healthcare-specialized MSPs). 25-user practice: $45K-$120K annually. No internal IT staff cost.

Co-managed is lower per-user MSP cost (typically $80-200/user/month) because scope is narrower — but add internal IT staff cost. For 100-user practice with one internal IT FTE ($100K loaded) + co-managed MSP at $150/user/month ($180K): total $280K annually. Full-managed for same practice at $250/user/month: $300K annually. Costs converge; coverage and expertise differ.

Value evaluation — decision rarely turns on raw cost. It turns on coverage breadth, specialty expertise availability, operational preferences, and strategic priorities. Cost parity is common; capability differs materially.