You don’t need massive clinical evidence to get picked up by payors.
Most healthcare founders think the barrier is evidence. It’s not. It’s how hard you are to justify inside the buyer’s org. Here's what is never said on panels (but always behind closed door)s.
Founders love to say “we’re evidence-based.” Okay, cool, you should be. But a lot of times, you’re inadvertently starting down a path you don’t want to follow. because it makes revenue infinitely harder.
Because there’s a difference between getting covered and getting distributed through.
And most of you are building for the wrong one, particularly if you have clinical experience.
For the sake of understanding, I want to define two key terms:
Coverage means being baked into the major medical plan design. You’re getting paid out of highly regulated dollars, whether that’s ERISA plans or CMS.
Distribution means your product is in front of members, employers, and/or brokers, and they can say yes without having to rewire their ops. Your product can be purchased by these folks, but it does not have to sit directly under major medical, nor does it have to collect those regulated dollars.
Why is this so important?
Well, one requires multi-year data, actuarial validation, and several layers of clinical sign-off. Plus ops.
The other? Requires you to be the least painful yes on the table.
If you’re building for plan design, fine.
Hire actuaries. Chase MLR. Prepare for 18 months of meetings and a brutal sales cycle.
But most of you aren’t building for that.
You’re building carve-outs. Point solution style products. Member-directed add-ons.
And in that world?
Payors and employers will 100000% distribute your product without a lot of clinical evidence.
They do it all the time.
How? Make their job easier.
Here’s what actually move the needle to revenue in those conversations:
Pricing that’s simple, credible, and doesn’t spark a finance review
Implementation that takes weeks and one or two employees, not months (if it’s even less, even better)
No messy integrations: you work with the systems they already have in place
Compliance story that doesn’t introduce new oversight, audits, or downstream obligations (if you have an opinion letter, you’re miles ahead, but if you can explain it in a 30 minute meeting, that’ll do)
A way to roll out the product that doesn’t overload internal teams (read: you do it for them)
The thing is, in healthcare sales, it’s not necessarily a push. You’re not trying to win an argument.
A lot of times, you’re trying to avoid becoming a project. And if you can do that, you can get to yes.
When buyers say “no,” it’s rarely because they hate your product. or the evidence is insufficient.
It’s because someone in ops said, “We don’t have capacity for this right now.” IT said, “We don’t think they know what they’re doing.” Compliance said, “I don’t trust this if the regulators come sniffing.” Finance said, “There’s too much open-ended financial risk here.” And that’s true across payors, providers, and employers. If you’re in D2C? Well, a family member (or even the consumer themselves) said that.
So yes, evidence matters.
But it’s NOT the unlock.
The unlock is designing your model to be slotted in. EASY to buy.
The buyer’s real question isn’t:
“Is this clinically meaningful?”
It’s:
“Can I turn this on without making mine, and 3 other people’s lives harder?”
I’ve been in rooms where compliance leads scanned a product one-pager and said,
“Can you remove this piece? We’d like to slot this under ERISA.” The founder said, “yep, done.”
And the deal closed/won right there.
I’ve been in procurement loops where the entire question boiled down to:
“Can you accept our enrollment standard file with no custom fields?”
And if the answer was no? The buyer walked.
That’s what distribution actually looks like.
So no, you don’t need to be the lead author in JAMA.
You don’t need an FDA-cleared badge to start your motion.
And you definitely don’t need to wait until the data is perfect.
But if you can’t answer:
What’s your implementation pathway?
What team owns this once live?
What does customer service look like?
What are the top three compliance risks, and how are you mitigating them?
…you’re not ready. Not because your product isn’t good.
Because it’s not safe to buy.
The stuff people say on panels?
That’s what gets said when everyone’s watching.
What actually moves behind the scenes is quieter, and far, FAR more operational.
This market isn’t won with evidence.
It’s won with clean narratives, tight packaging, and being the lowest-friction yes.
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