What it really takes to commercialize health tech in the US
Last week, I moderated a panel on US commercialization at the Nashville Israel Summit.
I was joined by four people who see commercialization from very different sides of the healthcare system: Michael Werner, who has spent nearly three decades working at the intersection of FDA regulation and reimbursement; David Whelan, SVP of Strategy and Development for HCA Healthcare’s TriStar Division; Ray Guzman, an operator and board director who has led multiple healthcare and technology exits; and Dr. Jordan Asher, a longtime health system executive who is now Chief Medical Officer at digital health company OneStep.
That mix made for an interesting conversation because US commercialization looks very different depending on where you sit.
At Aytza, we think about commercialization as a set of interlocking strategic decisions. Who exactly is the customer? What creates value for them? Who pays? How do they pay? What evidence is required? How does the organization actually make a purchasing decision? And does your capital plan give you enough time to get there?
These decisions are deeply interconnected. A strong GTM strategy depends on how well they work together, and how they are sequenced, not just whether each one works on its own.
I’m sharing a few themes from the discussion that reinforced this idea.
1. “The US market” is not a market
One of the easiest mistakes to make when entering the US is treating health systems as though they are a single customer segment. Most people know that payors, providers, and pharma are very different buyers, but what is less obvious is how deep the differences can be between different health systems.
David pointed out the differences between an integrated system like Kaiser, an academic medical center, and a more traditional community health system. They may be buying similar technologies while solving for very different pain points. Even within a health system, the value proposition can change depending on who is sitting across the table.
A CFO cares about margin. A service-line leader cares about growth. A physician cares about clinical outcomes and workflow. A system strategy leader may be looking for something that helps attract physicians, differentiate the organization, or build a new program.
That means segmentation cannot stop at “large US health systems.” You need to understand what that particular type of organization is optimizing for and build the value proposition from there.
2. Yes is not always yes
Cultural differences between stakeholder types and even regions can make a big difference on how your outreach is received and how the relationship progresses. Because we were in Nashville, we got to learn the secret behind the local, “Southern No.”
Ray described the experience of having warm, polite meetings that continue for months while the prospective buyer has little real intention of moving forward. The risk is obvious: the pipeline looks active, but there may be no real deal underneath it.
The better signal is movement. Are they introducing you internally? Are they clarifying next steps? Are they helping you understand the buying process? As Jordan put it, when the response becomes some version of “let me talk about it internally,” the useful follow-up is: Who are you talking to, and how can I help you have that conversation?
Especially in healthcare, friendliness is not the same thing as traction.
3. Cleared does not mean Commercial
Michael made a key point that companies often miss the significance: FDA clearance does not by itself create a commercially viable product. The regulatory system and the reimbursement system have different stakeholders, criteria, and timelines.
A company can successfully get through the FDA and then discover that nobody has a reimbursement pathway to pay for the product.
If Medicare is an important payer, do you have evidence in the Medicare population? If the technology will be used as part of an inpatient procedure, how is that procedure reimbursed today? Does your economics model work inside that reimbursement structure?
You need to plan way ahead to the evidence you’ll need, not just for your regulatory clearance, but what you’ll need for your payment model and commercial customers.
4. One champion, many gatekeepers
Founders are often told to find a physician champion. That is critical to getting into most health systems, but is just a start. David described the additional hurdles that new technologies have to clear inside a health system: compliance, cybersecurity and medical economics.
Jordan framed the buying group another way: you are effectively selling to a triad of clinical, operational and financial stakeholders, with other functions such as IT and security holding potential veto power.
Your job is not only to persuade the person in front of you. It is to equip that person to navigate the organization after you leave the room. Can they explain the financial case to finance? Can they respond to IT’s security questions? Do they know where the product fits into reimbursement? Can they explain why the clinical benefit is meaningful enough to change behavior?
The strongest commercialization strategies go beyond the external pitch and anticipate the internal decision process.
5. Value is in the eye of the buyer
Ray put this most simply: “Nobody cares about your technology. They care about the value that you're going to create for them.”
That is particularly important in healthcare where a technology can create real clinical value and still have bad economics for the organization it’s being sold to. Jordan shared how he evaluates vendor ROI models: he discounts the vendor’s projected benefit by 50% and then asks whether the economics still clear the organization’s internal hurdle rate.
Understand what value the buyer can actually capture, make the assumptions transparent, know how the economics interact with their reimbursement, then price against that reality. Come prepared to share the math.
6. Capital strategy underpins commercial strategy
The final connection is one I think founders often underestimate, and then can get stuck as they are running up the hill. Commercialization in healthcare takes time, sales cycles are long, contracting takes a long time. The panelists shared that from first meeting a startup till signing can take 18 months and full implementation and roll out can take as long 23 months after that!
That means your commercialization assumptions are also financing assumptions. You need to raise enough capital to get through that long spell, because otherwise, you may end up needing to raise capital before you have generated enough commercial proof to support the next round.
The pieces have to fit together
These decisions are tightly connected. Who you sell to affects the value proposition. The value proposition affects the evidence you need. Reimbursement affects what the buyer can afford. The buying process affects how long commercialization takes. And that timeline affects how much capital you need.
The earlier you work through the connections between them, and the more you deeply get to know the market you are selling into, the fewer surprises you are likely to hit later.
Author: Sari Kaganoff, CEO, Aytza
Distilled from a live panel conversation moderated by Sari Kaganoff at Nashville-Israel Health Summit. Quotes lightly edited for clarity.