Why the best U.S. entry point may not be the biggest one
Everyone starts with the same shortlist. Boston. New York. San Francisco.
It's not a bad instinct. These are visible, well-capitalized markets with global name recognition and the kind of institutions that look right on a pitch deck. If you're explaining your U.S. strategy to a board back home, those names land easily.
But here's the thing about U.S. healthcare: it doesn't function as a single market. It works as a collection of regional ecosystems, each with its own institutions, priorities, and (critically) its own logic for how decisions are actually made. Knowing that changes how you think about where to start.
For many international life sciences and medtech companies, the smartest first move isn't the biggest name on the map. It's the place where you can actually figure out how the system works, where the right conversations are accessible, where people have time to be useful to you, and where early mistakes don't cost you your reputation before you've built one.
That's the argument for Philadelphia as a home base. And it's what makes Minnesota such a natural next step.
Philadelphia doesn't always make the shortlist, but it probably should. The density is real: Penn Medicine, Jefferson Health, Temple Health, and ChristianaCare anchor a region with exceptional clinical depth, while major pharma players, including GSK, Merck, and Eli Lilly (which just opened a new innovation hub in Center City), have made substantial commitments here. But what often gets underestimated alongside all of that is the navigability. For a company entering the U.S. for the first time, that's not a small thing. You don't just need meetings. You need to understand what those meetings mean, how decisions move through the system, who actually has influence, and how to position your technology so it resonates with American customers and investors.
Philadelphia tends to give you room to figure that out. It's a market where you can build real relationships, learn how to operate in the US market, and establish a foothold without being swallowed by the noise of a larger coastal hub. For companies serious about expanding across the full U.S. market, it's often where the foundation gets laid.
Once that foundation is in place, the question becomes: where do you take it?
Minnesota is a different kind of argument, but just as compelling, and for companies that have done their early groundwork, it tends to be a logical place to go deeper.
It's one of the most significant healthcare hubs in the country, and it's systematically underestimated by international companies that haven't spent time there. We saw this firsthand during a March 2026 visit with ten WorldUpstart alumni companies. Over the course of the trip, they met with Greater MSP, Destination Medical Center, Medical Alley, HealthcareMN, and the State of Minnesota, as well as senior leaders from Solventum, BlueCross, Allina Health, and HealthPartners. The trip ended at Mayo Clinic, where conversations ranged across innovation, business development, and how major institutions actually evaluate new technologies.
What made those conversations matter wasn't prestige. It was proximity to real decision-making. The people in those rooms understand how their systems work internally, where a new solution might fit, what must happen before anything moves forward, and which questions a company needs to answer before it'll be taken seriously.
That kind of access is hard to get. And it's only useful if you've done enough groundwork to make something of it, which is exactly why the sequence matters.
So when you think about your U.S. expansion strategy, don’t just think about the destination. Think about the sequence.
The companies that got the most out of the trip to Minnesota were the ones that arrived with context, knew how to read a room, and followed up in ways that actually move things forward.
Boston, New York, and San Francisco still matter. But they're not the only places that matter, and they're not always the right starting point for a company still figuring out how to navigate a U.S. healthcare conversation.
That's what WorldUpstart is built around: not just opening doors for many ecosystems, but making sure the companies in our program, and our growing alumni network, are ready to walk through them.
