Hi Reader,

This week, we’re diving into a key topic shaping the future of health and technology:

Must-Have or Might-Do: There’s No Middle Ground
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​There’s a thing I’ve been paying particular attention to, and it’s becoming a sales challenge health tech people in particular need to be aware of, anticipate, and address.

Solutions, proposals, deals get enthusiasm, acknowledgement, and even tacit acceptance... and then go nowhere. I’m hearing too many stories about health tech founders building genuinely excellent solutions. Their products work. Their ROI cases are solid. Their reference clients are real. And they watch deals stall anyway.

The Cambrian explosion of AI-driven innovation in healthcare isn’t just changing what’s possible. It’s changing the buying environment in ways most founders haven’t fully reckoned with yet.

New solutions, new platforms, new capabilities are arriving every week... in revenue cycle, care management, clinical documentation, prior authorization, population health, compliance, you name it. For health tech execs and sales teams, this feels like unlimited opportunity. But for the health plans and health systems, it feels overwhelming.

Every CMO, CFO, and VP of Strategy is staring at a list of compelling, valuable, important initiatives: most of which are genuinely worth doing. The problem isn’t finding good ideas. The problem is that they have 50 of them... and capacity for maybe five.

And they’re not sure which five.

And it’s likely three of the innovative new initiatives they’ve already started aren’t going well.

And their board just asked for a briefing on the company’s AI strategy.
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And so on.

Into that environment, you walk in and tell them your solution delivers real value and strong ROI.

They even believe you. And like what you’re offering, and need it. But they still don’t move.

What ‘must-have’ initiatives actually require
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To break through in today’s environment, it isn’t enough to deliver value and have an ROI. Your solution needs to check a set of boxes that will feel, frankly, unreasonable. But they’re not negotiable. They’re the actual buying criteria we’re dealing with going forward, even if your customer never says them out loud (or even realizes they exist.)

If you’re looking to get deals closed and achieve customer success, your solution needs to be seen as:

• Inevitable to succeed. Not probably going to work: Absolutely certain to work. The perceived fear of backing a well-intentioned initiative that fails publicly is death. Your customer’s name is on it. Remove that fear or your deal stalls.
• Certain to deliver results they can point to. Not general improvement: specific, visible, attributable outcomes that align with the company’s strategic goals. The CFO wants numbers. The CMO wants measurable outcomes. The CRO wants meaningful revenue growth. Give them all three before they ask.
• Politically safe. Every new initiative creates potential losers inside the organization: people whose turf gets crossed, whose budget gets touched, whose team gets disrupted. If your solution creates enemies, you’ve got obstacles. (And they’re often invisible.) Know who loses, and have a strategy.
• Effortless to launch and maintain. Your customer is already at capacity. Any solution that requires significant headcount, meaningful budget beyond the contract, or sustained effort to keep running is a solution that competes with everything else on the list. The bar for ‘easy’ is higher than you think.

Yes, these are unreasonable expectations. But life isn’t always fair.

Positioning matters more than you think

The mistake most founders make is to respond to this challenge by building a better ROI case: More data. Stronger proof points. A tighter pitch.

But that’s not where the problem lies.

It’s not evidence. It’s positioning..

Positioning your solution as an incremental improvement says: ‘We do this better than what you’re doing now.’ Faster/cheaper prior auth processing. More accurate clinical documentation. Reduced readmission rates.

These are real, valuable outcomes. But they typically get routed to the operational buyer who owns the current process (the person who might have the least incentive to change it), and from there to procurement, where your solution gets compared against four alternatives on a spreadsheet...and the whole initiative comes to a standstill.

But positioning your solution as transformational conveys something different: the organizations that adopt your breakthrough approach and advancements in the next three years will operate in a fundamentally different and better way than the ones that don’t. You’re affording them the opportunity to be on the right side of the future.

Microsoft DAX and the ambient documentation companies like it aren’t pitching faster note-taking. They’re pitching the end of physician burnout as a structural problem, and the practices that solve it first will stop losing doctors to the ones that haven’t. That’s a different conversation. It resonates differently, gets prioritized differently, reaches the executive team differently. And it gets evaluated on different criteria.

Cohere Health and the prior auth automation companies that are winning aren’t pitching cost savings. They’re pitching survival in a world where revenue growth is survival and the manual authorization infrastructure of the last 20 years is about to become a competitive liability. That story gets the attention of a CFO worried about being leapfrogged... not an RCM director who is satisfied with their denial rate.

Transformational position doesn’t work on everyone. It won’t matter to the operational buyer protecting the current process. But it will resonate with the people who have the authority, vision and motivation to actually decide.

And those are the only people who can help you get your deal done anyway.

One more thing

This is hard. Building a solution that is genuinely must-have, structurally risk-free, politically safe, and effortless to adopt, while also being financially sustainable for your company, is not a small thing to ask.

But it’s not impossible, either.

The founders who crack it don’t do it by building a better product alone. They do it by understanding the organizational dynamics they’re selling into as well as they understand their own solutions.

They design their pilots to succeed. They identify and equip their champions before the internal conversation happens without them. (Look for a follow-on post about this.) They know which fears are blocking the deal and address them directly... before anyone asks.

That’s the challenge. And it’s exactly the work I do with the companies I coach. (Just did a deep dive on this for the Techstars health tech accelerator.) So if you’re a health tech founder tired of having good deals hang up... deals where you know the solution works, the ROI is real, and the client genuinely needs it... ping me here.

Best,

B.

PS. A Quick Takeaway

If you’re in health tech (or a healthcare consumer) and don’t know who Dr. Eric Bricker is, let me change that right now. He does explainer videos on health care, and they’re an invaluable resource.
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A recent video post highlighted the sheer magnitude of impact mental health has on utilization, including this: The stat that will land hardest in content: 62–77% of high ER utilizers have a prior mental health diagnosis. That's not a footnote — it's the central fact. Any cost reduction strategy built around chronic disease management that ignores behavioral health is solving the wrong problem.
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​Anyone who can take a chunk out of that number has a legit rocketship of a startup.

Let me know your thoughts—just hit reply.