Instead of only selling to individual dental offices, Flossy leverages its deep relationships with private equity firms. By selling directly to the PE firms that own large dental service organizations (DSOs), they create an efficient top-down channel to sign deals covering hundreds of locations at once.

For its $5k average deal size, SkillVari found a direct US sales model unviable, as travel costs could erase profits. Instead, they built a network of 10 regional resellers, incentivized with commissions up to 20%, to provide local, hands-on demos and support.

A MedTech startup's initial go-to-market may be hospital-by-hospital sales. However, after building a robust evidence base of clinical and economic impact, the sales focus can shift to enterprise-level deals with regional or national healthcare systems, accelerating growth.

To scale into the long tail of mid-market partners, arm distributors with a 'better together' narrative. Instead of a standalone product pitch, they should explain how your offering enhances solutions partners already sell, making the conversation more relevant and scalable.

For its high-touch VR training product, direct sales were uneconomical due to high travel costs for a relatively low ACV. SkillVari built a network of 10 regional resellers, enabling local, in-person demos that are crucial for closing deals and scaling nationally without an expensive sales team.

For a biotech with an established commercial infrastructure, the most efficient growth strategy is to in-license late-stage or already-approved products. This leverages the existing sales force and operational teams to sell new products without adding significant overhead, maximizing operational efficiency and revenue.

Disruptive MedTech ideas attract investment, but they are high-risk. Founders should de-risk these big bets by developing market access and commercial strategies simultaneously with product development, not after FDA approval.

Actuate Therapeutics maintains high capital efficiency by keeping its full-time headcount low. The company is built around a trusted core team and supplemented by an extensive stable of "best of breed" consultants who are engaged on an as-needed basis, minimizing overhead costs.

For small biotechs, the playbook for success extends beyond scientific discovery. It requires creativity and innovation in the operational process itself—finding efficient paths through regulatory checkpoints, securing non-traditional funding, and leveraging external resources to advance development with limited capital.