Choosing between MSP and MSSP for HIPAA compliant email

Many IT service providers need HIPAA compliant communication solutions, but picking the right service can be tricky, especially when breaches are growing increasingly sophisticated and costly. According to the 2025 Paubox Healthcare Email Security Report, 180 healthcare organizations reported email-related breaches to the HHS Office for Civil Rights between January 2024 and January 2025. 

The financial impact of these breaches can be staggering, with the average cost of a healthcare data breach reaching $9.8 million, more than double the cross-industry average, according to IBM. The need for serious email security is proven by the fact that only 1.1% of breached organizations were classified as “low risk” for email security posture, while 31.1% were “high risk” and 67.8% were “medium risk.”

In other words, the vast majority of healthcare organizations experiencing breaches had weaknesses or only partial safeguards in place, leaving them vulnerable to attack. This shows that even among those who do invest in security, major misconfigurations or gaps are still common and dangerous.

Moody’s data cited in the Paubox report shows that cybersecurity spending in healthcare rose by 70% over the past four years, and cybersecurity’s share of IT budgets increased by 50% between 2019 and 2023. Still, Microsoft 365 alone accounted for 43.3% of all healthcare email breaches, and only 5% of known phishing attacks are reported by employees, according to a Paubox survey.

Even the configurations that should prevent attacks are often neglected. Paubox found that 12.2% of breached organizations lacked email SPF records, 40% had weak ‘soft SPF’ settings, 30.6% were missing DMARC records, and 34.4% had DMARC set only to monitoring, allowing threats to slip through. No surprise, then, that confidence in the field is low, just 27% of IT leaders surveyed by Paubox feel confident about avoiding breaches in the coming year.

As OCR Director Melanie Fontes Rainer warns in the Paubox report, “HIPAA-regulated entities need to be proactive in ensuring their compliance with the HIPAA Rules, and not wait for OCR to reveal long-standing HIPAA deficiencies.” The 2025 data shows that stopping healthcare email breaches is not simply about spending more; it’s also about making sure the right protections are truly in place and properly managed.

Learn more: 

• A guide to SPF in healthcare email security
• Implementing DMARC for healthcare email security

MSPs vs MSSPs

Before exploring compliance strategies, it’s important to clearly define the roles of Managed Service Providers (MSPs) and Managed Security Service Providers (MSSPs), as well as how their approaches differ.

MSPs are generalists in the IT world, serving as the single point of contact for a client’s broad technology needs. Their services often cover everything from setting up and maintaining network infrastructure to managing helpdesk tickets, performing software updates, handling data backups, and implementing routine security measures. This all-in-one model allows organizations to outsource much, or even all, of their day-to-day technology management, freeing internal staff to focus on core business priorities.

MSSPs, on the other hand, deliver specialized expertise. Their focus is mainly on cybersecurity, defending against digital threats, analyzing security events in real time, responding rapidly to incidents, and guiding clients through risk assessments and regulatory requirements. To accomplish this, MSSPs operate dedicated Security Operations Centers, command hubs built to monitor and respond to threats 24/7. This level of specialization enables MSSPs to keep pace with the rapidly evolving threat landscape and offer advanced protections that most businesses would find difficult to replicate internally. This expertise is needed because global costs of cybercrime are projected to surge from 9.22 trillion in 2024 to 13.82 trillion by 2028, according to Statista’s Market Insights.

This operational difference is most visible in how they deliver their services. MSPs usually run Network Operations Centers (NOCs), where the emphasis is on keeping technology systems running smoothly and efficiently. MSSPs, by contrast, manage Security Operations Centers (SOCs) dedicated exclusively to threat detection, analysis, and incident response.

As digital transformation accelerates, organizations’ technologies need to evolve. In fact, about 90% of healthcare executives expect digital technology use to accelerate in 2025, with half anticipating a significant impact on health systems, according to a global outlook survey by Deloitte. 

Many organizations are turning to hybrid providers who combine traditional IT management with specialized cybersecurity services. This blended approach reflects a growing understanding that today’s healthcare organizations and businesses in every sector require both the broad oversight of an MSP and the focused defense of an MSSP to stay secure and competitive.

The rising compliance pressure in healthcare

Healthcare organizations must now navigate a complex landscape of digital regulations that directly govern their electronic communication practices. Frameworks such as HIPAA and the HITECH Act require stringent controls over electronic protected health information (ePHI), from encryption and detailed access logs to strict access controls and rapid breach notification procedures. Noncompliance exposes organizations to significant financial and reputational risk, with penalties that can escalate dramatically based on the seriousness of the violation.

For example, in 2020, a major health insurance company was fined 6.85 million by the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) following a breach of nearly 10.4 million people’s ePHI. Hackers gained access via a phishing email that installed malware, with the breach going undetected for nine months. OCR’s investigation cited “systemic noncompliance,” such as failure to conduct comprehensive risk analysis, implement sufficient monitoring controls, and prevent unauthorized access to sensitive records. The repercussions didn’t stop with the federal fine; the company also faced a 10 million multi-state settlement and a $74 million class action lawsuit. 

Yet, staying compliant is only part of the challenge. In recent years, cybercriminals have evolved their attacks, targeting healthcare providers with advanced phishing and spoofing campaigns designed to bypass traditional defenses. For example, in March 2025, a zero-day vulnerability in Google Chrome (CVE-2025-2783) was exploited by the threat actor TaxOff to deliver a stealthy backdoor called Trinper. The attackers sent targeted phishing emails, impersonating high-profile event invitations. Simply clicking the link triggered the exploit and installed the Trinper backdoor without further user interaction. Once installed, the malware harvested keystrokes, searched for sensitive documents, and established persistent remote access, bypassing even sophisticated endpoint protections. Google quickly released a patch after the campaign was discovered, but security research revealed similar attacks had been active for months, often leveraging finance- and event-themed phishing to compromise government and private sector organizations.

This case exemplifies how modern threats exploit both human vulnerability and undisclosed software flaws, making phishing campaigns more effective than ever, and demonstrating why even organizations with solid compliance programs must remain vigilant and proactive in their defense strategies.

For IT service providers, this shifting landscape creates both urgency and opportunity. Healthcare clients are seeking security and compliance safeguards that are strong, efficient, and practically invisible to end users, solutions that support their essential work, rather than slowing it down.

Where Paubox bridges the gap

Paubox fundamentally transforms the compliance equation for both MSPs and MSSPs by removing many of the biggest obstacles that usually complicate secure email solutions. Unlike traditional secure email systems, which often rely on clunky patient portals, complex key exchanges, or separate applications that users must learn, Paubox makes sending HIPAA compliant email as easy and intuitive as using regular email.

This design provides several key advantages for both managed service models. Because Paubox works seamlessly inside Google Workspace and Microsoft 365 environments, users require no additional training; emails are sent and received through the familiar platforms healthcare teams already use. This eliminates one of the stumbling blocks for secure communication projects–user adoption and workflow disruption. With HITRUST CSF certification, Paubox also delivers the third-party validation that healthcare organizations and regulators expect from cloud vendors.

Centralized management through the Paubox dashboard allows providers to oversee multiple client environments from a single, intuitive interface, streamlining ongoing administration and reducing operational overhead. This not only simplifies implementation for MSPs but also enables MSSPs to deliver secure email as part of a larger security operations strategy, without the need for extra infrastructure or specialized training.

From a business perspective, partners managing over 1,000 email addresses can achieve margins of up to 80%, establishing a significant source of recurring revenue while addressing a critical compliance challenge for clients. With its combination of simplicity, security, and integration, Paubox empowers IT service providers to deliver effective, scalable email security without the massive upfront investments or operational headaches that have traditionally made healthcare compliance such a daunting proposition.

Related: Paubox Partner Program

Integrating Paubox into your MSP or MSSP approach

When considering how to approach HIPAA compliant email security, start by evaluating the makeup of your client base and their compliance requirements. Consider whether your team prefers simple, turnkey tools or enjoys customizing and fine-tuning security solutions. Factor in your business goals. Are you seeking new recurring revenue or aiming to increase margins on current services? Decide whether you want to own the management of secure email in-house or work with partners that can take on the technical heavy lifting. With Paubox, there is no need to compromise; its flexibility supports both standalone deployment for MSPs and seamless integration within advanced security portfolios for MSSPs.

Now is the time to audit your current approach, assess which clients transmit ePHI via email, estimate the recurring revenue potential using the Paubox margin calculator, and request a demonstration to see how centralized management simplifies multi-client administration.

Ultimately, the decision is not about whether MSPs or MSSPs are "better" for HIPAA compliant email, it's about whether you’re ready to provide seamless, secure communication that both protects your clients and strengthens your business. With Paubox, what was once a compliance burden transforms into a competitive advantage, delivering secure, client-friendly email workflows while scaling your business for lasting growth.