From Pilot Purgatory to Paid: A practical case study in multi-stakeholder access and VAC-ready proof

Confidentiality Notice

All company names, individual identities, and specific details in this case study have been anonymized or fictionalized to protect client confidentiality. This composite narrative reflects real challenges commonly faced by MedTech startups advancing from pilots to paid contracts. The goal: deliver practical, actionable lessons for MedTech founders and teams.

TL;DR Outcomes

• 2 system‑level contracts signed — first paid agreements

• 31% pilot‑to‑contract conversion rate — from stalled pilots to repeatable revenue motion

• Commercial lift achieved without adding headcount — process optimized, not payroll

Multiple ongoing pilots, identified the strongest, and were able to drive those towards close.

 The Day‑1 Reality at AureliaDx (Anonymized)

AureliaDx had clinical proof of concept, engaged physician champions, and multiple completed pilots. On paper, they should have been “there.” In reality, zero paying customers were in the pipeline.

Pressure was mounting:

• Runway measured in months, not years

• Board and VC demand for credible revenue milestones this quarter

• Cost controls including hiring freeze, with further cuts looming

Pilots ended with clinical optimism but silence from Value Analysis Committees (VAC). Each cycle felt like starting fresh.

“No one knew who we were. Beyond our champion’s excitement and clinical data, we couldn’t get our message across.”

This was never a science problem. It was an access, alignment, and execution problem.

Where deals died:

• Buyer invisibility: key decision-makers didn’t know Aurelia; Aurelia lacked insight on committee drivers.

• Pilots launched without a strategic commercial path to contracts.

• Champions unprepared to navigate procurement roadblocks.

• ROI models failed to convince or provide economic justification.

• Supply Chain needed transparent device reliability data and comprehensive total cost of ownership (TCO).

• IT & Compliance required explicit risk profiles, integration roadmaps, and data governance protocols.

• Payers demanded reimbursement evidence aligned to VAC and ICER standards, not just clinical benefit.

Clinical data alone did not move the multi‑stakeholder buying group.

How Pathova Helped: The 3‑Phase Pilot‑to‑Paid Pathway™

(Story & Stakeholders → Proof & Pilots → Pipeline & Scale)

Phase 1 — Story & Stakeholders

Lever: Align the story, mobilize the coalition

Reality Audit — Identify blockersWe conducted a rapid, candid GTM diagnostic revealing root causes stalling conversion:

• Lack of structured engagement with Finance, Supply Chain, or IT

• Pilots without explicit commercial exit criteria

• Absence of a VAC‑grade package covering operational, financial, and risk concerns

Rebuild Access & Messaging — Engage every deciderWe mapped the full buying committee—including veto points—and equipped Aurelia with targeted, usable assets:

• Executive Business Summary aligned to VAC criteria (budget, risk, integration, outcomes)

• Champion Enablement Brief translating clinical benefits into finance and operations terms

• Sequenced outreach plan extending influence beyond the clinic (Finance → Supply Chain → IT/Compliance → VAC)

Phase 2 — Proof & Pilots

Lever: Engineer pilots that convert; deliver VAC‑ready proof

Engineer Pilots — Design pilots as mini‑dealsWe transformed pilots from mere “proof” projects into contract engines by locking in commercial mechanics up front:

• Success criteria tied to operational & financial KPIs owned by a budget holder

• Pre‑agreed next step (contract form, pricing tier, start date) contingent on KPIs met

• VAC Success Kit delivered before pilot close‑out: ROI & TCO models, reimbursement pathways, security & integration documentation, and scripted responses to common objections

Phase 3 — Pipeline & Scale

Lever: Build the engine, scale the market

We codified the process for repeatability without increasing headcount:

• Sales playbook with stage definitions, exit criteria, and VAC-stage checklists

• Commercial performance dashboards for weekly deal reviews focused on commercial risk

• Proof & messaging library; reference and expansion motions (e.g., payer evidence, GPO readiness)

The Results (Day 1 → Month 6)

Day 1 traction — Visible progress without new headcount

• Stakeholder map drafted, validated with champion; Finance, Supply Chain, IT/Compliance owners identified

• VAC‑grade Executive Business Summary created and circulated pre-pilot close‑out

• Sequenced outreach plan launched, replacing ad-hoc follow-ups (Finance → Supply Chain → IT/Compliance → VAC)

• Pilot exit criteria redefined around operational & financial KPIs with a responsible budget owner — no more “science project” wrap‑ups

By Month 6 — From stalled to systematic

• Two system-level enterprise contracts signed – first paid customers

• 31% pilot‑to‑contract conversion, converting pilots into a repeatable sales motion

• Commercial lift achieved without adding headcount — process leveraged instead of payroll

• Consistent VAC engagement — evolved from outsider status to invited participant in ROI and reimbursement discussions

• Transitioned from reactive to disciplined — a repeatable pilot‑to‑paid pipeline now runs across the portfolio

“We were a tiny team, invisible to decision-makers. With structured engagement and the right leave-behinds, our champions finally had the tools to carry the deal across Finance, Supply Chain, and IT.” — VP Sales, AureliaDx, 6 months post-engagement

Why It Worked (and Why It’s Repeatable)

• We sold the enterprise — not just the evidence. Clinical data opened doors; VAC-grade proof kept them open.

• Pilots had commercial teeth: KPIs with a budget owner plus a pre-committed next step generated momentum or a clean ‘no.’

• Champions were enabled as commercial storytellers focused on ROI, risk, and workflow impact — not just clinical outcomes.

• The process scaled the people: when headcount can’t grow, a well-crafted playbook must.

What MedTech Leaders Can Steal (Starting This Week)

• Red-team your last pilot: Name the budget owner, VAC criteria, and exact contract trigger if KPIs hit. Without these, you’re running a science project, not a sales motion.

• Ship a 2-page Executive Business Summary to Finance, Supply Chain, and IT before your pilot close-out meeting — make it skimmable and defensible.

• Arm your champion with three slides: ROI, workflow impact, and risk & integration — all in committee language.

• Make stage exits binary: Replace “good meeting” with documented criteria and an agreed next step.

• Run a weekly VAC review for each deal, encompassing stakeholder map, open risks, decision calendar, and the one commitment you are driving that week.

Closing Thoughts

Regulatory clearance and clinical validation are necessary but insufficient. The separation between pilots and payment occurs in Finance, Supply Chain, IT, and the Value Analysis Committee — not the lab.

AureliaDx’s turnaround was not a moonshot. It was a structured, pragmatic approach any lean MedTech team can run: multi-stakeholder access, engineered pilots, and a repeatable pilot-to-paid motion.

If you’re facing stalled pilots, shrinking runway, and increasing board pressure for revenue, you’re not alone — and you’re not stuck. Pathova partners with founders to translate clinical promise into commercial reality with a playbook built for small teams under pressure.

Ready to talk through your pipeline? Bring one stalled pilot. In a brief, focused working session, we’ll develop a shared stakeholder map, propose commercial exit criteria, and build a VAC-grade evidence package — all tailored to your inputs and system context.

Pathova — Practical GTM for MedTech. From pilot to paid.

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