July 29, 2026

The study is still a design choice. For now.

“As we are planning our clinical study in the US, we have an opportunity to design the study in such a way that will basically address the needs of not just FDA, but also CMS and private payers.”

Gil Senesh, on the call

Everything on the four surfaces ahead serves that sentence. Work through them and you will have corrected what we heard wrong, named the one challenge that matters most, and co-authored the record on Commit. That record is the first pass of the work.

Ten cards. Roughly twelve minutes.
Two things we don’t know

When the US study’s design decisions actually need to be made. And whether the reimbursement consultant should review the discussion guide before the interviews run. We would rather find these out with you than guess at them.
Listen

Ten things we think we heard.

Correct anything that isn’t right. Card ten is our read rather than your words, so it is the easiest place to push back.

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Whose words
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An eleventh card
Frame

Six ways to see this. One that matters most.

We leave this page with one sentence: the challenge that, once solved, untangles the rest.

Our diagnosis

BeCapio has strong momentum on multiple fronts at once: completed study, MedTech Innovator, strategics at the table, consultant introductions live, and a US study taking shape. The risk is not lack of motion. It is that the fronts are on different clocks, and the quietest clock, the study’s design window, is the one that matters most.

Our read, in one sentence

Convert momentum into structure before the access gets spent.

Everything below is how we got there, and where you can disagree. Four candidates are weighed against each other; the sentence we settle on is at the foot of the page.

3A

Six ways to see what these interviews are for

Each traces to your own words. Reorder by importance, by dragging a row or using the arrows.

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3B

Four candidate cruxes

Each one carries the critique against it. Adopt the one you believe, or write your own below.

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Adopted frame

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The fuller read

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The crux we agree on

Our read is preloaded. Adopting a candidate replaces it. Edit it into the sentence you would defend. This becomes the spine of the record.
Envision

What this looks like when it works

Keep only the outcomes you actually want. What you keep becomes the destination the work is held to.

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State A · momentum, structured

The next three weeks

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State B · the evidence

End of the effort

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State C · beyond

The options this opens

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The future state taking shape

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Next three weeks
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End of the effort
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Beyond
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For which we will give up
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Nothing kept yet. The destination assembles here as you choose.

What we are not aiming for

A destination is only credible with its boundaries named. Edit these, or add your own.

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The trade-offs that earn it

A vision without a named cost is a wish. Finish these three sentences.

If we want this, we will have to give up
Commit

The record we co-authored

Only what you affirmed or wrote. Nothing we added on our own.

Dark Horse Works × BeCapio · session record

What we heard, how we framed it, and what we are aiming at

Date & place

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Present

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The frame we agreed on

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Adopted crux

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What we affirmed hearing
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Nothing affirmed yet. Go back to Listen.
The future state we chose
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Nothing kept yet. Go back to Envision.
Trade-offs we accept
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The question we answer first
What we will test
By when
Who owns it
Not committing to
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Dark Horse Works · Demand Discovery
Send yourselves a copy of this record
A PDF of exactly what is above. Nothing else attached.
Where this goes next

The natural next step is a short working session: lock the decision map the study design must answer, and put a guide skeleton under the conversations already in motion. The conversations are live, so the guide is the thing that cannot wait. Everything above travels into that session as the starting material, and what you flagged gets corrected first.