Rethinking RTSM Software: When Bigger Isn’t Better

In the world of clinical operations, bigger often feels safer.

Familiar brand names, multi-asset platforms, and providers with a decade or more in the space can give the illusion of stability, a sense of reduced risk when the stakes are high. But for small and mid-sized biopharma companies navigating the complexity of clinical trials, that assumption is becoming more dangerous than dependable. 

A quiet but profound shift is happening in the RTSM (Randomization and Trial Supply Management) landscape. As consolidation sweeps through the eClinical ecosystem, RTSM software vendors that were once nimble and service-focused are increasingly absorbed by private equity firms or folded into large, multi-product platforms. On paper, these mergers promise streamlined operations and scalability. In practice, they often deliver the opposite: stagnation, stretched teams, and a sharp decline in service quality. For smaller sponsors, the consequences can be costly. 

“When companies transition away from being founder-led” says Ryan Keane, Korio co-founder and CEO, and a veteran of the RTSM space, “you may start to see a shift in priorities. The original mission often fades, and the focus on long-term product innovation and investment tends to give way to short-term financial goals.” 

This loss of appetite isn’t just theoretical. Sponsors often start to feel it first-hand. Feedback goes unanswered. Roadmaps remain unchanged. Teams you once relied on for deep domain expertise disappear, either because of layoffs driven by margin pressure or attrition from a culture that has lost its spark. The result? Product stagnation and a revolving door of service staff who must be constantly re-educated on your study. 

It’s a pattern that many in the industry recognize: a product that once thrived on customer input and iterative improvement becomes an immovable object. The urgency is gone. The fire to build and innovate dims. And the burden of navigating this inertia shifts onto the shoulders of already overstretched sponsor teams. 

For smaller biotechs, this dynamic introduces a unique risk. Unlike big pharma, which often has repeatable internal standards, dedicated RTSM leads, and the muscle to demand priority, smaller sponsors rely heavily on their vendors to act as an extension of their team. They need flexible partners who can guide, adapt, and invest in the nuances of each trial. That kind of relationship isn’t just helpful; it’s essential. 

Unfortunately, it’s also increasingly rare. 

Many consolidated vendors have thinned their support layers or generalized their teams across multiple products in an attempt to cut costs and “integrate” offerings. What was once a dedicated RTSM project manager may now be someone responsible for five or six different technologies, none of which they know deeply. For a domain as technically and operationally complex as RTSM software, this dilution is disastrous. 

“RTSM has always stood on its own,” says Keane. “It’s not just another box to check. It requires depth, precision, and full attention. You can’t just throw it in with the kitchen sink and expect it to be managed the same way as everything else.” 

The consequence is creeping fragility. Mid-study changes take longer. Manual workarounds become the norm. Documentation gets sloppy. The system meant to ensure blinding, randomization, and supply chain integrity becomes the bottleneck instead of the enabler. 

Ironically, many sponsors continue to partner with legacy vendors precisely because they believe it lowers risk. But as Keane notes, there’s a different way to think about risk: 

“There are companies that see the bigger risk as sticking with the legacy provider: because in today’s competitive environment, things can’t wait. If you don’t have white-glove, attentive, consistent service, that is what will put your trial at risk.” 

This is especially true for smaller sponsors who can’t afford the delays, missteps, or communication breakdowns that often accompany big vendor inertia. These teams need partners that reflect their own pace, hunger, and culture. They need vendors who are in growth mode, not in maintenance mode. 

That’s why some of the most forward-looking biotechs are re-evaluating what “low-risk” really means. Instead of defaulting to the biggest name, they’re seeking partners who are built for this moment in clinical development: complex protocols, tighter budgets, constant amendments, and fluid timelines. They’re choosing vendors who haven’t just survived scale, but who have been designed from the ground up to handle it. 

That’s the path we’ve chosen at Korio. We’re focused exclusively on RTSM, with experienced teams, flexible technology, and service models purpose built for small and mid-sized biopharma. Our promise isn’t just about features. It’s about fit. 

Our founding team is made up of RTSM professionals who have spent decades in this space.  Many of us left larger, legacy providers after seeing firsthand what wasn’t working. We didn’t build Korio to be just another vendor. We built it to correct course, to fix what we saw broken, and to build a smarter future for RTSM from the ground up. That means modern technology, yes, but also the deep, seasoned experience that gives sponsors real confidence. 

Learn more about Korio RTSM by scheduling a call