US healthcare market access: what four operators told Canadian healthtech founders

Canadian health technology founders got a blunt primer on US healthcare market access on 8 June 2026, when Quebec’s Health Technology Catalyst (CTS) put four US-based operators in front of a room in Montréal. The Global Horizon session, held at Ax.c, carried a title that doubled as its thesis: the US healthcare market does not reward good technology, it rewards commercial readiness.

Natasha Mayfield, Michael Stamatinos, Yulie Klerman and Adam Block have each spent years on the other side of the deals founders are trying to close. Over an hour and a quarter of panel discussion and audience questions, they worked through who actually pays for innovation, when a US hire earns its cost, why pilots stall, and how pricing works in a system where the same MRI can cost $200 or $2,000.

Who actually funds innovation

Asked whether US hospitals fund innovation the way Canadian hospital foundations do, the panel was consistent: they do not. Hospital foundations in the US tend to cover care for patients in financial distress, not novel technology, Stamatinos said, though he has started to see disease-specific philanthropic groups step in.

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Stamatinos described the pitch he now hears from groups such as the Michael J. Fox Foundation:

“We’ll fund this pilot that is being done with hospital X, Y, and Z so that it can create more evidence for us to be aligned with our mission.”

Mayfield pointed to patient assistance and advocacy groups, naming the PAN Foundation, HealthWell and the National Organization for Rare Disorders (NORD) as the organisations most willing to fund early concepts. Block added that some state-level bodies, such as the New York State Health Foundation, also fund innovative projects, but “usually not run through the hospital system level.”

Do you need a US hire

The panel was wary of the reflex to hire a US-based salesperson. Stamatinos framed it around what he called the “problem priority stack”: if the problem a company solves ranks low on a health system’s list, an insider can get a meeting, but the wait remains. Klerman added a more universal point: the real question is not US versus Canadian, but when to hire anyone commercial at all.

“You don’t want to bring this person too early,” she said, because a founder with runway for one or two pilots should lean on advisory boards and contractors rather than burn cash on a full-time hire.

“You don’t hire a US person, but you hire someone that has a deep knowledge of California-based Medicare Advantage if that’s where you want to go sell.”

Block put an economic spin on relationships: a $300,000-a-year hire buys the relationships they already hold, which can get a founder fifteen minutes in front of the right people, but those people “know their market value and they are going to charge you for it.” Mayfield warned founders not to delegate commercialisation entirely. “No one is going to care about the problem more than you do,” she said, and pedigree does not equal the skill of creating urgency in an abstract market.

Follow the money in US healthcare market access

The session’s recurring theme was that a company has to understand which buyer has a real incentive to pay. Block separated a narrow set of risk-bearing organisations, such as Kaiser Permanente, from roughly 600 accountable care organisations with “mixed feelings about the risk,” and a larger group of hospitals that say they want to lower costs but do not really want to.

Klerman made the incentive mismatch concrete with the polypharmacy problem in Israel’s HMO-based system. Eliminating the problem saves money, but the health system has no budget to pay for the software, because it earns its margin from the very visits the software would remove. An American company, she said, sidestepped this by selling to payers on claims data alone and letting care coordinators act on the results. Block reduced the approach to three words:

“Follow the money.”

He also noted the actuarial reality behind private insurance: most plans benchmark on the assumption that a patient stays for three to five years, while CMS plans for twenty. That, he said, determines how fast a return has to appear and who cares. The panel pointed to one advantage the US market has over systems such as the UK or Canada: employers, who care about productivity and will pay for tools that address anxiety, depression and insomnia because those conditions drag on output.

The FDA, AI and a year of chaos

On regulation, Mayfield, who works across pharma, biotech and digital therapeutics, described the past year as “complete chaos” that is only now showing “signs of optimism.” She recounted how several rare disease developers had trial designs agreed with the FDA only to see the rules change at approval time, and how industry lobbying ended with FDA commissioner Marty Makary leaving the agency in May 2026.

She described how a founder should plan:

“I would be setting different expectations with my investors around the level of volatility… adding more time buffer for that volatility.”

Klerman’s advice on AI-enabled devices was to start the pre-submission conversation as early as possible. With AI, she said, the gap between a 510(k) and a de novo is often smaller than founders think, because the agency still wants the data, the sensitivity and the specificity. Block added that the administration has been friendly to AI companies, but that health plans and hospital systems are not yet seeing the returns they expected, pointing to upcoding as one reason costs have not fallen.

Mayfield also flagged a new kind of friction: procurement and legal teams who assume they can “just use Claude Code to do the same thing.” Her response, at [36:32], is to downplay the AI and lead with the proprietary data and processes that create the value, rather than letting the solution be priced as a commodity. Her summary of why pilots fall down:

“The secret is not always in the technology. The secret is in how you implement in a practical way.”

Pick your partners, then price for value

A founder from Neuroservo with several paid pilots waiting asked how to reconcile quality with the pressure not to lose big accounts. The panel’s reaction was blunt: “you’re doing too many pilots.” The consensus was that more than about three partners means a company is implementing, not testing, and that expectations have to be set up front, down to the specific metrics and the checkpoints.

“The only ships that don’t sail are bad partnerships.”

On pricing, Block used the spread in MRI prices as the clearest sign that differentiated pricing is normal in US healthcare. Klerman added a caveat: where reimbursement is uniform, as with a device such as FibroScan, a clinic in Manhattan and one in rural Texas pay the same, because the ROI is calculated from the reimbursement rate. Where reimbursement varies widely, pricing can follow, but the ROI has to stay stable.  Block closed with the rule he applies to every price:

“Whatever you charge, is it going to deliver 10x value?”

Source: CTS Global Horizon session, “The U.S. healthcare market doesn’t reward good technology; it rewards commercial readiness,” Montréal, 8 June 2026. See the event page and the Global Horizon programme PDF.