The Missing Middle of Medtech: Why Innovation Alone Doesn't Scale
BY THOMAS HICKEY
Partner
[March 6, 2026] – We’ve seen it play out in the world of consumerism and sport. That 100% sure shot, can’t miss, next great thing that arrives amid outsized, all world fanfare and unlimited upside … and then something happens.
Actually, nothing happens.
Remember how New Coke was the even better version of original Coca-Cola?
Remember how the Segway would “revolutionize mobility” on all seven continents?
And more recently, remember how U.S. Olympic figure skater Ilia Malinin, who hadn’t lost a competition in more than two years, was a shoo-in for the Gold medal in Milan-Cortina? In his words after his final event of the 2026 Winter Games, “I blew it.” He finished 8th overall, a full five spots behind the third-place Bronze medalist.
Alas, we all know what they say about the word “assume”.
That same “destined for greatness but flops” dynamic can also be found in the world of healthcare, and medtech in particular. It seems most in medtech still ascribe to the belief: If the technology is good enough, adoption and profiteering will naturally follow. Not so fast, my friend.
I call it The Missing Middle of MedTech: Why Innovation Alone Doesn’t Scale. And there are three key reasons why it occurs. Let’s break them down:
FDA CLEARANCE ≠ CLINICAL ADOPTION
A few years back in the midst of the opioid crisis, a company produced a Patient Controlled Analgesia [PCA] device that was beautifully designed and easy to use, allowing the patient to self administer pre-set doses of oral pain medication by pressing a button on a device that would dispense the tablet and log time and dosing information.
It allowed for safe, measured and timely dosing, and patients who used it in trials got off their meds more quickly and managed their pain better during recovery. Just as importantly, the self-administered dosing freed up nursing staff to tend to other critical duties and operate at the top of their licensure.
But …
In its eagerness to commercialize and begin logging sales and posting profit, the manufacturer hadn’t taken into consideration lingering opioid fears and the hesitancy to delegate this task to patients themselves. Simply put, clinicians didn’t completely trust patients to do the right thing. The manufacturer was left asking, “How do we gain clinical acceptance without someone watching over the patient administering the med?” … which defeated the whole intent of the PCA device.
All logic indicated the technology was smartly and efficiently designed and would’ve made the lives of patients and clinicians easier, and enhance the ability to manage and track meds more efficiently. By failing to take the temperature, so to speak, of the healthcare environment, the product failed to get out of the starting gate, even though it was a viable offering.
Another piece to the FDA Clearance ≠ Clinical Adoption is being so eager to gain FDA approval, companies often forget to simultaneously study and gain a full understanding of the healthcare workflow, steps to adoption, and data based, successful clinical outcomes that set the stage for marketplace acceptance.
In many cases, the FDA hurdle has been cleared and companies are left asking, “What next?” as it relates to competitive landscape, value proposition, market access, sales messaging, clinical workflow, etc. These are all just as important as prepping for FDA approval and should be done in advance to avoid a lag in the journey to commercialization or, worse yet, allowing your innovation to simply “die on the vine” or be overtaken by a competitor.
STRONG INTELLECTUAL PROPERTY ≠ COMMERCIAL SUCCESS
Blind taste tests proved New Coke’s formula was preferred by consumers. The Segway was easy to master. Heck, even the Edsel way back when was pre-destined for greatness as a more affordable, midsized automobile … unfortunately, just after consumer preference had shifted to smaller, even more economical models. Ah, the best laid plans of mice and men …
Two things can be true at once: A great innovation can improve patient outcomes but fail to gain clinician acceptance. In many cases, that reality is, once again, due to a failure to gain a comprehensive understanding of the clinician’s workflow.
Is there enough data proving your device improves patient outcomes? Absolutely!
Will the device create any obstacles or additional steps for the provider? Unfortunately, yes.
Sorry, your baby is ugly and nobody has told you yet.
Asking a physician to push two more buttons or change what they’re used to doing is difficult in most cases and impossible in some. When these conflicting realities merge, I say, “They developed an elegant solution to a non problem.” It’s a trade off. Yes, improved outcomes are critically important but if the device is a burden on efficient workflow, well, back to the drawing board.
CAPITAL RAISED ≠ MARKET PULL
Remember the dot com boom a quarter century ago when startup capital flowed like a river and there was a mad rush to hop aboard the dot com train, any train, to be part of all the excitement and cash in on the promise of riches?
We see similar situations in healthcare where a startup has raised an embarrassing amount of capital for their new AI based widget or similar. They roll out massive and impressive booths at trade shows and conventions, they hire dozens of direct sales professionals, and all outward signs point to greatness.
Unfortunately in many cases, practicality and clear thinking were on vacation while checks were being cashed. So much green, not enough grist. Having funds alone is not enough without a clearly defined value prop, meaningful ideas, targeted messaging, products that stand above all others and enhance workflow, and a go to market sales strategy that’s ready to launch.
I’ve also seen big name, well known healthcare giants who spy these flashy, up and comers, make an acquisition, and assume market demand will automatically follow along with impressive volume and profit. Unfortunately, they discover too late that it was all a façade made possible by deep pockets. Buckets of money don’t guarantee success. A well thought out, comprehensive approach to commercialization is truly your roadmap to success.
These are but three reasons why there’s often a “middle” missing in medtech. There are more, many more. If your innovation’s journey to successful market commercialization appears to be a “sure thing”, you’re likely overlooking something. Not to worry, it’s OK to not know what you don’t know.
As talented and determined as your internal team may be, having outside, experienced partners is very likely to push your innovation over the finish line. Align with a team that has been where you are today, and that knows how to complete the journey to successful commercialization.
Contact Excelerant today at info@excelerantconsulting.com. Our team of deeply and broadly experienced Partners and Consultants would be honored to guide you through the process and open the right doors for you.
ABOUT THOMAS HICKEY
Thomas is expert at developing innovative strategies and tactics and possesses a deep understanding of sales strategy and sales channels that combine to produce impressive results. With more than 35 years’ experience in the medical device industry and executive-level experience with manufacturers and Group Purchasing Organizations [GPOs], Thomas is skilled at launches, start-ups, international distribution, technology assessment, and assessing market feasibility. He has successfully launched several products and hired, coached, trained, motivated and optimized literally hundreds of independent and distributor sales team members.
ABOUT EXCELERANT CONSULTING
Excelerant Consulting is the go-to organization for med-tech companies that need to position products and services successfully for Value Analysis Committees [VAC], contract acquisition, and sales modeling and execution to commercialize the launch of medical devices or services with Group Purchasing Organizations [GPO], Integrated Delivery Networks [IDN], or Regional Purchasing Coalitions [RPC]. Our clients rely on us to identify their value proposition, enhance product positioning, navigate corporate contracting opportunities, and provide sales support to accelerate growth.
For more info, contact Excelerant Consulting at info@excelerantconsulting.com