Third Coast Dynamics: five revenue pathways, one lead path, and a back office run on Claude

The problem we took

Third Coast Dynamics (TCD) was founded by physician-scientists at Northwestern University. Its product, TCDflow, derives hemodynamic insight for thoracic aortic disease from standard CT and MR angiography instead of a specialized 4D flow MRI. The science is ahead of the commercial model: a 1,700+ patient feasibility study in Radiology, a 4,000+ patient 4D flow validation dataset, a 20,000+ patient outcomes set, four pilot academic medical centers, a Northwestern Medicine partnership, and an FDA pre-submission that confirmed the 510(k) pathway.

It is STTR-funded and pre-revenue, with no commercial function and no budget to hire one before a seed raise. The unknowns were the ones that decide a MedTech company’s first years: the economic buyer, the price, the implementation burden inside a hospital, the status quo and the alternatives, and how defensible the story is against incumbents. The founders wanted a ranked view of where revenue comes from first, who to call, and what proof each buyer needs.

What the client already had

Founders with clinical standing and warm relationships at the pilot sites, the published evidence, and the STTR subawards that fund the pilots. 3Pillars holds an equity position in TCD and runs its sales and business operations as a fractional team; TCD leadership keeps every decision.

What we built

3Pillars applied the same top-down and bottom-up assessment it had run for a clinical data company’s entry into the payer market, adapted for a pre-revenue imaging company selling into health systems and, later, the plans those systems sponsor. Claude did the research synthesis, the segmentation and the drafting; 3Pillars operators set the frame and made the calls.

Top-down: five revenue pathways, scored. Per-click CPT reimbursement, enterprise health-system contracts, platform-embedded distribution, value-based care and payvider contracting, and device-company co-development, each rated on near-term revenue, long-term ceiling, TCD’s readiness, the evidence gap, sales-motion complexity and strategic optionality, with HeartFlow’s nine-year path from FDA clearance to majority commercial coverage as the analog. The finding: no pathway produces near-term revenue without prior readiness, and only enterprise contracts have both today.

Bottom-up: the buyer universe, segmented and sequenced. Health systems by type and pilot fit (about 100 to 120 academic medical centers, the multi-state non-profits, about 200 to 300 single-state non-profits that make the best pilot targets, and the innovator systems with venture arms). On the plan side, 3Pillars profiled every provider-sponsored health plan in its Medicare Advantage lakehouse, 169 parent organizations, and scored each for TCD fit on size, cross-line breadth, star ratings, growth, academic affiliation and the payviders the pathway research had already named; 15 sit in Tier 1. Buyer maps for each pathway named who signs, who champions and who blocks. Pricing: a flat site subscription of $50K to $200K per center for the first five to ten contracts; with about 850,000 chest CT angiograms a year amenable to TCDflow and even a quarter of HeartFlow’s per-patient impact, the directional savings run about $700K a year per center, an implied buyer ROI of 3.5x to 14x.

The 3Pillars solution deployed: the AI Imaging Intelligence Brief, a market, competitor and regulatory monitor generated as a branded deck (nine issues from March 19 to May 20, 2026); an investor newsletter skill that triages leadership submissions into four standing sections and regenerates a locked HTML and PDF template each quarter; a 60-month financial model with six toggleable revenue layers and three-statement output; exit-strategy and capital-raise readiness sessions; a four-page website prototype built in Claude and handed to a developer; and a deck-builder skill that holds the TCD brand rules.

What it returned

A ranked answer to where revenue comes from first, who to call and what proof each buyer needs: lead with enterprise contracts at the pilot sites, run per-click billing as the credibility track, explore platform partnerships without committing, and build the outcomes registry and cost-effectiveness evidence that open the provider-sponsored-plan and payvider pathway from 2028. A commercial back office that produces the weekly brief, the quarterly newsletter, the model scenarios and the branded decks without a hire.

Lead with health-system contracts. Let the early evidence decide which pathway dominates by 2028.

Third Coast Dynamics is pre-revenue. The contract range and buyer ROI are engagement outputs; the $300K a year is the loaded cost of the commercial hire TCD did not make. Every brief, newsletter and model output is reviewed by 3Pillars before it reaches TCD leadership or investors.