The questions people actually ask.

What does a fractional CRO for a healthcare company actually do?

A fractional CRO builds the commercial function a company doesn't have yet, rather than carrying a quota inside one that already works.

In practice that means defining who you sell to, what you say, how the process runs, what the CRM tracks, how sales hands off to operations, and what the compensation plan actually rewards — then hiring and coaching the people who take it over.

Unbound's version explicitly excludes carrying a bag. That is written into the scope of work, not just implied.

What's the difference between a fractional CRO and a sales consultant?

A consultant usually delivers a recommendation. A fractional CRO delivers working infrastructure and a team trained to run it.

The practical test: at the end of a consulting engagement you have a document. At the end of a fractional engagement you have a defined ideal customer profile, a documented sales process, a configured CRM, a compensation plan, hiring profiles, and someone on staff who can run all of it after the advisor leaves.

Why do health tech and healthcare AI companies struggle to sell a product that works?

Because the product being good and the business being viable are different problems, and technical or clinical founders are usually excellent at the first and blind to the second.

The gaps repeat: no defined targeting, no consistent messaging, no documented process, no CRM, no handoff from sales into operations, and nobody who has spent a career inside healthcare's buying process.

The gap is widest in healthcare AI specifically, because founders there build brilliantly in the domain they can see and the commercial layer is invisible to them. The technology works. Commercially, that turns out to be almost beside the point.

When should a startup hire a fractional CRO instead of a full-time one?

When you need the commercial system built but can't yet justify — or successfully recruit — a full-time executive.

A full-time CRO in healthcare costs $250,000 to $400,000 in base salary plus equity and benefits, takes three to six months to hire, ramps for another six, and fails often. A fractional engagement builds the same foundation in a defined number of weeks for a fraction of the first year's cost, and leaves a documented system behind either way.

The other signal: if you are about to hire your first salesperson, build the system first. Hiring into a vacuum is the expensive way to find out what doesn't work.

What is commercial due diligence, and how is it different from financial diligence?

Financial diligence asks whether the numbers are real. Commercial due diligence asks whether they will keep happening.

It examines a target's commercial function, pipeline quality, sales process maturity and the credibility of its growth assumptions. The central question is whether revenue comes from a repeatable system or from a founder with good relationships — those look identical on a spreadsheet and behave completely differently after close.

What is Foundation First?

Foundation First is Unbound's methodology: ten commercial domains assessed and built across four phases — survey the site, pour the foundation, frame the house, bring in the crew, make the house run.

The premise is that commercial gaps are scale-invariant. The same six or seven things are missing at a seed-stage startup and at a $600M enterprise, so the same sequence works at both ends.

How much does a fractional commercial engagement cost?

Unbound prices every engagement as a fixed fee against a defined scope, quoted before any work begins. No hourly billing and no open-ended retainers.

For market context: fractional CRO retainers generally run $10,000 to $25,000 per month, and standalone go-to-market strategy projects commonly run $10,000 to $30,000 at the generalist tier. Healthcare-specific work prices above generalist work because the buying process is more complex.

Specific numbers come in the first conversation, not off a web page.

Do consultants take equity instead of fees?

Some do. Unbound doesn't — cash engagements only, no exceptions.

Performance upside is available in cash: a percentage of closed contract value, a success fee on a raise, or a milestone bonus. Equity-for-services arrangements misalign incentives at exactly the moment a company needs honest advice.

Why are independent physician practices losing money in 2026?

Many are, and most don't know why, because the 2026 Medicare Physician Fee Schedule looked like good news.

The conversion factor went up — to $33.57 for qualifying advanced APM participants and $33.40 for everyone else. But CMS also applied a 2.5% efficiency adjustment reducing work RVUs across roughly 91% of physician services, and cut practice-expense RVUs for facility-based services by 7% while raising office-based services by 4%.

The net effect depends entirely on specialty and site of service. Procedural and diagnostic specialties are down: 81% of infectious disease physicians face cuts of 5% or more, and the American Medical Association estimates reductions of 10–20% for more than a third of oncologists. Office-based cognitive specialties such as family medicine and rheumatology received an increase.

The headline rate went up. Actual payment often went down.

Sources: Centers for Medicare & Medicaid Services, 2026 Medicare Physician Fee Schedule Final Rule; American Medical Association summary analysis, November 2025. Figures as published and current as of August 2026. *Subject to change by CMS. Confirm against the current final rule before relying on these figures.

What is a Practice Strength Index?

A structured assessment of an independent physician practice's commercial and operational health, delivered through management services organizations (MSOs) and practice networks.

One interview with practice leadership, then a written findings document within five business days covering five domains every time: reimbursement reality, payer contracting, revenue leakage, missed opportunity, and technology fit. Every finding carries a dollar figure or a range.

It is explicitly not a chart audit, a coding or compliance review, or a valuation.