Greater Philadelphia does not have a discovery problem.
Walk through this region's labs, hospitals, and universities and you will find breakthroughs in diagnostics, medical devices, therapeutics, and data science arriving at a pace that would be the envy of almost any city in the world. The science is here. The clinical power is here. The talent is here.
And yet a striking number of those breakthroughs never reach a patient.
Not because the science failed. Because the system between the science and the patient is complicated in ways no single institution can see, let alone fix. A therapy that works in a controlled trial meets a clinician managing a full waiting room. A device with a clean regulatory path meets a health system that cannot operationalize it. A curative treatment meets a reimbursement model designed to pay for acute episodes. Each stakeholder in that chain is behaving rationally inside their own incentives — and the innovation stalls.
We call that space translation. It is the distance between discovery and real-world adoption, and it is the reason the Science Center convened the Healthcare Innovation Translation Council.
Why a council, and why now?
The Science Center has spent six decades as a catalyst for entrepreneurship in Greater Philadelphia by filling gaps in the innovation ecosystem, a pursuit that has generated an estimated $7.6 billion in regional economic impact. That track record is real. It is also, on its own, not enough to address the gap between breakthrough science and healthcare solution.
What we have learned over the last 60+ years is that teaching a founder to navigate a broken system is a limited kind of help. It works, company by company, and it leaves the system exactly as it was.
So we asked a harder question: rather than only coaching startups through the friction, could this region — with its unique concentration of health systems, payers, pharma, academic medical centers, and investors within a few miles of each other — actually reduce some of that friction?
Answering this question requires the people who make and shape adoption decisions to sit at the same table and describe, candidly, where things break from where they sit.
With support from Genentech, we’ve assembled roughly a dozen of those leaders: health system strategy and innovation executives from Jefferson, Penn Medicine, and Children's Hospital of Philadelphia; payer leadership from Independence Blue Cross and Highmark Blue Shield; pharma partnership leadership from Eli Lilly's Gateway Labs; the Medical Device Innovation Consortium; Drexel's College of Medicine; growth-equity and diagnostics perspectives; and the Science Center's own team.
Three themes surfaced fast.
In healthcare, the person who benefits from an innovation is not always the person who pays for it.
As one council member put it, a haircut is simple: you get the service, you pay the barber, and you're done.
Care doesn't work that way. The patient receives it, the clinician delivers it, and someone else entirely, whether an insurer, an employer, or the government, covers some or all of the cost. Each of those players wants something different, and that split sits at the root of why so many promising ideas stall between the lab and the bedside.
This came up from nearly every seat, in nearly every framing.
As Andrew Fish of MDIC described it, a systemic mismatch exists between who realizes value from health interventions and who pays for them. A life-enhancing or life-saving therapy or device is valuable in different ways for the patient, their doctor, and the health system that delivers it, but is typically paid for by an insurer applying a utility analysis that assesses value differently than the patient, physician, and health system.
Each actor in the system calculates value differently and applies distinct metrics to decide whether to receive, deliver, or pay for a specific intervention (recognizing that health systems may choose to pay for various interventions or technologies regardless of reimbursement because they save money in the care setting or are judged to be an imperative for patient care). These disconnects compound across a complex health care ecosystem and impede innovations that would improve outcomes and save lives.
“There’s the difference between the customer and the payer. Being two different things with very different sets of incentives. There's a lot of value that someone else isn't going to pay for, can't recognize, or that value isn't high enough to offset the cost of doing the thing,” said a clinical expert on the council.
Timing makes it worse. Even when an insurer and a health system agree to share the savings from keeping people healthier, the payoff can arrive a year later, by which point the patient may have changed insurers or providers, leaving no one eager to pay now for savings a competitor might collect. The web is also more crowded than it first appears, with employers and government each shaping the flow of money in their own ways.
Health economics, one investor argued, belongs in phase one. The counterargument is obvious and also the problem: who funds that?
Technical innovation has outrun business-model innovation.
The council was largely aligned that the constraint is no longer whether the biology, chemistry, or engineering works. It is that there is no corresponding invention in how the thing gets paid for.
Science has raced ahead while the way we pay for it has stood still. Independence Blue Cross’s Mike Vennera noted that extraordinary advances in biology and genetics have not been matched by innovation in how care is financed. Traditional payment models were not designed for treatments that may require a significant investment today but deliver benefits over many years or even a lifetime.
“When I got into the space 15 years ago, it was about manufacturing and technical challenges. Now it's much more what's the commercial market and asking the question, are any of these products really making a return?” explained Tom Wilton, Senior Vice President of Innovation Ventures of the Children’s Hospital of Philadelphia.
"There are a lot of things that are technically very good, but they add massive cost to the system. When we ask why health systems or insurers are losing money, it often points back to these great innovations. They can be really expensive [to implement],” said Highmark Blue Shield's Dan Tropeano. They noted that ambient AI note-taking—intended to make doctors’ jobs easier and free up time—can also have unintended impacts. For example, in an appointment where a clinician might typically assign eight reimbursement codes, an AI tool, lacking certain nuanced understanding, may ascribe 24, resulting in a more costly visit.
Evidence expectations are real, divergent, and mostly invisible to the innovator.
FDA wants one thing. CMS wants another. Each private payer has its own flavor. Health systems want to know it works in their population, not in a highly motivated pilot cohort.
As a result, reimbursement thinking arrives too late to matter. Repeatedly, and from both the device and therapeutic sides: by the time a company is seriously asking who pays and how much, the answer is already constrained by decisions made years earlier — in manufacturing design, in trial design, in target product profile.
One health system leader described the pattern precisely:
“Sometimes startups come to us, and they have data and are backed by venture capital and have traction. They'll say, ‘We reduced the blood pressure with this AI app’ - and you dig a little bit deeper to get a closer look. They gave it to 1,000 patients and only 200 people actually engaged with. So you're already dealing with a highly motivated group without control group to compare against,” said Penn Medicine’s Kit Delgado. “And it’s a study population that doesn’t face the same socioeconomic challenges as the one we serve in West Philadelphia.”
“Most innovators don't think about health economic studies. I think health economic studies should be included in phase one clinical trials. Who's got the money to do that? But if you don't do that, then by the time you get to your phase three, it's too late,” noted a health system representative.
Meanwhile, founders are being asked to price and plan for evidence requirements they did not know existed when they set their use of funds. They don’t know what a health economic study is or how to navigate it – things that other people in the system take for granted have a steep learning curve, and early-stage companies that don’t have access to vetted subject matter experts are struggling to account for these unknowns.
Actor problems and system problems.
Underneath all three ran a distinction Andrew Fish, President and CEO of MDIC, the Medical Device Innovation Consortium, drew that reframed the conversation: the difference between actor problems and system problems. Actor problems are solved by helping a founder understand the terrain better. Useful, bounded, and no reflection on anyone's competence.
A founder who has not identified who signs the purchase order has an actor problem. A founder whose evidence package satisfies the FDA, puzzles CMS, and means something different to each private payer does not — that friction sits in the space between institutions, and no amount of coaching relocates it. The clinician who sees value and the patient whose life improves are not the party paying, and nothing any individual actor does resolves that.
System problems are structural — the actors are behaving sensibly inside a misaligned system. A program pays off in eighteen months, for a member who may have switched plans by then: both the payer and the provider can see the benefit clearly and still can't rationally sign. If you gave every actor perfect information and perfect competence, would the problem go away? If yes, it's an actor problem — solvable by coaching. If no, it's structural. And it’s one this group can work to frame and address.
This is not another ecosystem map.
The commitment is narrower and more testable: identify three to five specific points of systemic friction, and reimagine them — a workflow, an evidence pathway, and a vetting process. Some of those attempts will fail. We intend to document the failures alongside the successes, in a set of case briefs the council will review and publish.
Parallel work is already underway. A Healthcare Innovation Supply Chain Council, convening senior supply chain leadership from Penn, Jefferson, Temple, Christiana Care, Cooper, Main Line, Penn State Health, and Geisinger, met for the first time this spring and surfaced a striking piece of common ground: those systems are so inundated by early-stage outreach that they know they are missing things worth seeing. There is genuine appetite for a regional vetting function and a shared playbook.
A third council, focused on medical device strategics, follows. And thanks to Genentech's support, we will fund a small number of scholarly awards on translation topics in priority disease and community health areas.
Why this region, and why it matters beyond it.
There is a reason this is worth attempting in Philadelphia specifically. The concentration of assets here is not just large, it is diverse — multiple health systems with genuinely different populations, payers with both insurance and provider arms able to tie clinical data to claims longitudinally, a patient population that looks like the country rather than a selected slice of it. That combination makes this region something closer to a living laboratory for translation than almost anywhere else.
And the stakes are both clinical and economic. An innovation only produces jobs, investment, and mobility for this region if it becomes a company that can scale and stay. If more predictable adoption pathways could take even three to six months out of a sales cycle, that changes the investment case for building here rather than leaving.
“This is a way we can leverage the power of Philadelphia to learn something, if not make a little more impact than we would otherwise,” said Science Center’s Senior Vice President, Ecosystem Engagement, Tracy Brala. “That is the wager. Get the right leaders in the room, be honest about where the system breaks, and do more than just talk about collaboration – move on to producing outcomes.”
The council will continue convening through December and we’ll continue reporting what we learned. Watch this space.
