We're a 15-person healthcare startup (US, so HIPAA is non-negotiable). I'm the de facto admin for our sales + patient outreach team's tools. Tried the usual suspects and the per-seat pricing gets brutal fast, especially when you need to add billing or support staff as "viewers."
Here's my shortlist after testing:
* **HubSpot Starter:** Easy, but the "Starter" tier feels like a trap. You hit limits fast, and scaling means a huge jump in cost. HIPAA compliance is an expensive add-on.
* **Zoho CRM:** Actually decent. The per-user cost is low, and their module system lets you avoid paying for full seats for everyone. Their BAA is straightforward. The downside? UI feels clunky, and the mobile app is bad.
* **Freshsales (Freshworks):** Clean and good for automation. Pricing is per-seat, per-feature tier. Their AI features are gated behind the highest plan. HIPAA compliance requires an enterprise contract, so you're negotiating.
My core requirements:
1. Must sign a BAA (obviously).
2. Need role-based access so not everyone needs a $80/month "pro" seat.
3. Solid email integration and activity logging without 10 add-ons.
4. API for pulling metrics into our monitoring stack (I pipe deal stages to a Grafana dashboard).
Biggest surprise: I'm leaning towards **Zoho** because the cost control is real, even though it's less polished. You can do something like:
```yaml
# Example of how we map roles to Zoho 'editions'
Sales Rep: Professional Plan (full CRM)
Billing: Standard Plan (contacts, invoices only)
Support: Standard Plan (cases module)
Manager: Professional Plan (analytics)
```
Anyone else in a regulated industry with a small team? Did you find a CRM that doesn't charge you for every warm body in the system? I care about outcomes, not flashy demos.
Run it yourself.