U.S. Healthcare Network Saves 30% on RISE with SAP and Protects Patient Care Budget

The Challenge

A regional US healthcare network operating fourteen hospitals and outpatient facilities received a RISE with SAP proposal from SAP's enterprise accounts team in Q3 2025. The proposal, structured as a five-year subscription commitment, was presented as SAP's preferred path for the network's planned ECC-to-cloud migration and carried an annual subscription fee of approximately $6.8M based on SAP's Flexible User Equivalents (FUE) pricing model.

Healthcare organisations face a distinct negotiating challenge with RISE with SAP. Unlike enterprise clients in financial services or manufacturing, healthcare networks operate under severe budget pressure: every dollar diverted from operational software spend is a dollar not available for patient care investment. The network's CFO had set an explicit constraint — the RISE with SAP transition could not increase the total cost of the SAP platform by more than 10% over the three-year post-migration period. SAP's initial proposal exceeded that threshold by a significant margin.

A secondary complication was SAP's proposal structure itself. The FUE count in SAP's proposal was calculated against the network's current SAP ECC user population without adjustment for the access model changes that RISE with SAP's S/4HANA Cloud private edition would introduce. Several hundred ECC users were provisioned with transaction-heavy profiles that would map to lower-cost FUE categories in the S/4HANA environment — a recalculation that SAP's commercial team had not reflected in the initial proposal and had no commercial incentive to raise proactively.

The Approach

Redress Compliance was engaged eight weeks ahead of the network's internal deadline for a board-level decision on the RISE with SAP commitment. The engagement focused on three interdependent workstreams.

Workstream 1: FUE Count Recalculation

An independent review of the network's current ECC user population was conducted against SAP's FUE mapping methodology for S/4HANA Cloud private edition. This required mapping each ECC user's actual transaction footprint — which SAP modules and transactions they accessed, at what frequency, and with what business criticality — against the FUE categories defined in SAP's RISE user classification framework.

The recalculation identified 340 users whose ECC profiles mapped to SAP's "Self-Service" or "Indirect Access" FUE categories rather than the full "Advanced User" category applied uniformly in SAP's initial proposal. An additional 85 users were identified as candidates for a "Limited User" FUE classification covering read-only reporting access. Adjusting the FUE count to reflect these reclassifications reduced the annual FUE-based subscription cost by 18% before any per-FUE rate negotiation.

Workstream 2: Per-FUE Rate Benchmarking and Negotiation

SAP's proposed per-FUE rate was benchmarked against independently sourced data from comparable healthcare and public sector RISE with SAP transactions completed in 2024 and 2025. The network's proposed per-FUE rate was confirmed to be approximately 22% above the median rate achieved by comparable organisations in SAP RISE negotiations — a position consistent with SAP's standard practice of anchoring initial proposals at or above the median market rate.

Armed with the independent FUE count recalculation and the benchmarking data, negotiations with SAP's enterprise accounts team produced a per-FUE rate reduction of 16% from the initial proposal. SAP's team acknowledged the FUE reclassification methodology and accepted the revised count without material challenge — a reflection of the technical rigour of the independent assessment.

Workstream 3: Contract Term and Flexibility Protections

Beyond the immediate cost reduction, the engagement focused on securing contractual protections appropriate to a healthcare organisation's operational environment. Key provisions negotiated into the final RISE with SAP contract included: annual true-down rights allowing the network to reduce FUE counts by up to 10% per year without penalty to reflect workforce and facility changes; explicit carve-outs for healthcare regulatory compliance software not within scope of the RISE bundle; and a defined commercial framework for adding new hospital facilities to the RISE subscription at agreed per-FUE rates rather than list pricing.

The Outcome

Key Takeaways

• RISE with SAP FUE counts are not fixed. SAP's initial RISE proposals are routinely built on the customer's existing ECC user population without applying the FUE classification methodology that S/4HANA's access model supports. Independent reclassification of users against S/4HANA FUE categories consistently identifies 15-25% FUE count reductions in enterprise healthcare and public sector environments.
• Per-FUE rates are negotiable and benchmark data is available. SAP anchors RISE proposals at above-median market rates. Independent benchmarking data from completed comparable transactions provides the evidence base to challenge initial rate positions. Organisations without this data accept the anchor as a baseline.
• Healthcare organisations must negotiate structural flexibility into RISE contracts. Workforce changes, facility additions, and regulatory compliance obligations make static five-year RISE commitments commercially inappropriate for healthcare networks. True-down rights, defined expansion pricing, and regulatory carve-outs are all negotiable and should be standard contract provisions.
• The board-level timeline creates artificial urgency. SAP's commercial process is structured to compress customer decision timelines. Engaging independent advisory support before the internal deadline — not after — is the only way to complete the analytical and negotiation work necessary to enter the SAP commercial process with a defensible position.