Posted in July, 2025
Executive Summary

Most VC and PE firms assess sales performance through lagging indicators—ARR, win rate, CAC. While helpful, these metrics provide a surface-level view. They don’t uncover the execution gaps or early-stage risks that often lead to missed targets and delayed growth.

The MEDDPICC® Portfolio Audit provides a structured approach to identifying these risks early. By applying the MEDDPICC® framework at the portfolio level, investors gain deeper insight into pipeline integrity, sales maturity, and the scalability of revenue operations. This paper outlines how to operationalize MEDDPICC® beyond individual reps and turn it into a diagnostic tool for portfolio health.

The Problem: Strong Forecasts, Weak Foundations

Many Health IT startups secure early wins—a few pilots, a big logo, or a promising ARR spike. But as they transition from founder-led sales to a scalable go-to-market model, cracks emerge:

• Sales forecasts miss quarter after quarter
• Pipelines swell but deals don’t close
• Reps struggle to replicate success across new accounts

Why? Because sales success isn’t just about the product or the market. It’s about execution. And too often, execution discipline is missing under the surface of growth metrics.

Investors need a way to qualitatively assess the maturity and consistency of how sales teams qualify, advance, and close opportunities.

The Solution: MEDDPICC® as a Portfolio-Level Lens

MEDDPICC® (Metrics, Economic Buyer, Decision Criteria, Decision Process, Paper Process, Identify Pain, Champion, Competition) is a proven strategic framework used by high-performing enterprise sales teams. But it can also serve as a portfolio health assessment tool when adapted for investor use.

By using MEDDPICC® at the board level, investors can:

• Identify sales process weaknesses before they impact revenue
• Bring consistent language to sales performance discussions
• Align company goals with measurable buyer outcomes
• Assess deal confidence beyond gut feel

MEDDPICC® isn’t a script—it’s a lens for identifying risk and repeatability.

Operationalizing the MEDDPICC® Portfolio Audit

Below is a breakdown of how each MEDDPICC® element translates into questions investors should ask during portfolio reviews or board meetings:

Metrics

• Are sales reps anchoring value in measurable, hospital-defined KPIs?
• Can the team quantify the financial or clinical impact of the solution?

Economic Buyer

• Who controls the budget, and are they directly engaged?
• Are deals stalled in committees because the true EB isn’t identified?

Decision Criteria

• Do we know the hospital’s specific buying priorities?
• Are we winning on the criteria that matter most to the buyer?

Decision Process

• Is there a clear, mapped process for getting a deal through legal, IT, and procurement?
• How early is the sales team identifying the full approval path?

Paper Process

• Are procurement timelines understood and built into forecasts?
• What’s the average legal/procurement cycle time by customer type?

Identify Pain

• What business problem is driving urgency?
• Is the pain internal (revenue, workflow) or external (compliance, patient outcomes)?

Champion

• Who is selling on our behalf inside the organization?
• Do they have political capital and influence beyond their title?

Competition

• Who are we really competing against? (Status quo? In-house build?)
• How are we differentiating beyond features?

Patterns of Risk Across Portfolios

When applied across multiple companies, MEDDPICC® reveals common revenue risk patterns:

• 70% of late-stage pipeline lacks a named Economic Buyer
• Forecasts are driven by rep confidence, not buyer validation
• Closed-lost reasons lack detail or insight
• Legal and IT hurdles delay deals, but aren’t accounted for in planning
• Founders still lead most key sales conversations past Series A

These aren’t isolated issues. They’re systemic indicators of an underdeveloped sales infrastructure.

Elevate HIT Sales: Partnering for Execution Clarity

At Elevate HIT Sales, we help investors and portfolio companies apply MEDDPICC® beyond the sales team. Our services include:

• Portfolio-wide MEDDPICC® audits to assess deal qualification and execution rigor
• Advisory support to help founders operationalize sales process maturity
• Board-level coaching to improve pipeline visibility and forecast reliability
• Ongoing sales enablement, training, and playbook development for GTM scalability

Conclusion: Deal Volume Doesn’t Equal Pipeline Health

A healthy pipeline isn’t just about quantity. It’s about control, qualification, and alignment with how hospitals actually buy.

For experienced investors, the MEDDPICC® Portfolio Audit offers a new lever: a structured, repeatable way to uncover revenue risks before they hit the P&L.

Let’s move beyond counting deals. Let’s understand them.

Elevate HIT Sales is Built by HIT Operators