When the functional scores say "ready," the home decides.
How a physician-executive discovery sprint mapped the US adoption path for a VR stroke-rehabilitation platform, through the clinicians and executives who actually buy and use it.
The problem
Stroke rehabilitation runs on functional scores. FIM and Section GG, Berg balance, Barthel ADLs, gait speed. Those numbers drive billing, length-of-stay authorization, and the formal discharge decision. A device company building toward that market naturally assumes the path to adoption is proving it moves those scores. The discovery surfaced a more important truth: the scores decide the paperwork, the home decides the patient, and almost nobody has an objective way to measure the gap between the two.
What A3HCS did
A3HCS designed and ran the discovery as a physician-executive, peer to peer with every participant. Rather than interviewing a single persona, we mapped the full decision chain: the clinical gatekeepers (physiatrists who write the orders), the clinical operator (an outpatient clinic owner who has deployed VR), and the economic buyers (a rehabilitation-hospital CEO and a post-acute CFO). We built tailored discussion guides for each role, went deep on the discharge and technology-adoption decisions, and synthesized six conversations into one cross-interview thesis. The clinical fluency was the unlock. Because the interviewer had sat in the same rooms, participants spoke plainly about reimbursement pressure, workforce burden, capital limits, and the things they cannot currently measure.
What the discovery revealed
Every clinician independently named the same blind spot: near-zero visibility into what a patient does between therapy sessions and after discharge. Today’s bridge is a paper exercise sheet that, in the CEO’s words, "is so static that it doesn’t get used." That gap, not the functional score, is the product’s clearest point of entry.
Discharge to home versus a skilled nursing facility turns on family confidence and burden of care, not the score alone. Readmissions cluster precisely where a patient "wasn’t quite ready, but because of insurance, we were limited in our options."
Workflow fit (it must reduce clinician burden and write into the EHR note), reimbursement (billable, trackable time and a credible coding path), and budget (a 60-bed rehab hospital runs a total capital budget near 2 to 3% of net revenue). Any one of these can disqualify a device before the clinical conversation starts.
The clinician champions, but the purchase runs from CFO to department and COO to CEO sign-off, gated by customer references and a slow six-to-eighteen-month cycle. Trust is earned by transparent data, including the non-responders, and lost the moment a tool is positioned to replace the clinician.
The result
The company walked away with a launch-shaping strategy rather than a pile of transcripts: a validated product wedge anchored in a real, unmet clinical need, a prioritized buyer map with the evidence each stakeholder requires, and a clear-eyed view of the workflow, reimbursement, and capital constraints to design around before committing US launch capital. In short, the difference between a device that is clinically interesting and a device that hospitals actually adopt.
A3HCS is a physician-executive advisory practice. The same person who reads the clinical data sits across from the CEO, the CFO, and the physiatrist, and translates what they say into an adoption strategy a device company can act on. Where clinically credible meets operationally rigorous.