Karina Sotnik spent the 1990s helping Silicon Valley tech companies expand globally. Two decades later, she's flipped the script: now she helps international life sciences and healthtech startups break into the US — the world's largest and most complex healthcare market.
The gap she's filling isn't small. Every year, hundreds of these startups arrive in the US with strong science, local traction, and US Food and Drug Administration (FDA) approval in their sights. Most of them stall. This happens not because their technology fails, but because they misunderstand what the US market actually wants: proof of payment as well as proof of concept.
That's the core problem WorldUpstart solves. Since launching its US Market Gateway Accelerator four years ago, Sotnik's team has supported more than 90 companies from 23 countries. Roughly 42% have established a US presence, 10 have secured FDA approvals, and alumni have raised more than $300 million in follow-on funding — all stemming from a two-month program that runs twice a year.
Why the US Market Breaks Most International Startups
The problem isn't science; it's strategy.
"US buyers don't just ask “Is it safe?” " Sotnik says. "They ask: ‘Who pays, why, and what changes in the clinic?' Without a plan for coverage and reimbursement, adoption stalls."
Many international teams pursue FDA approval first, and then expect hospitals and health systems to line up. But US buyers want different proof: workflow impact, economic benefits, and a return on investment (ROI). They want to know if this offering will save time for nurses, if it’ll reduce readmissions, and what the ROI will be for the payer..
The other trap is aiming too high too fast. In the US, sales cycles are long, procurement is layered, and privacy and security reviews can take months. If your story, evidence, and integrations aren't tuned to how American hospitals and payers actually evaluate new tech, you burn through time, money, and investor trust.
From Silicon Valley to a Global Accelerator
The lessons learned during her time in Silicon Valley enabled Sotnik to understand the growth potential when companies understand local markets and what breaks when they don't.
In 2012, the University of Pennsylvania asked her to build an accelerator — back when "accelerator" wasn't yet in everyone's vocabulary. That work taught her how to turn promising research ideas into companies and scale them with the right structure, teams, mentors, and milestones.
"Those threads braided into WorldUpstart," Sotnik says.
The two-month accelerator program takes a hybrid approach that includes live online sessions with experts, in-person immersion in the United States, and curated introductions to doctors, entrepreneurs, and investors. A typical participant already has momentum at home — revenue generation, funded pilots, clear adoption, and/or strong clinical data. What they need isn't more theory; it's US-specific guidance, proof, and relationships.
What Separates Success From Stalling Out
Not every company makes the leap successfully; in fact, one in five usually fails, but WorldUpstart has seen clear patterns in what works.
The companies that succeed show up coachable. They move fast on feedback and adapt their approach for the US market rather than trying to replicate what worked at home. They focus their story on a clear problem, a decision-maker, and one setting where the need is urgent and the economics make sense.
They also build the right proof. They move beyond simply saying, "our science is great," to also saying, "here's the clinical outcome, here's what changes in the workflow, and here's why a US hospital or payer would pay for it." Their regulatory steps line up with a realistic path to coverage and payment. In addition, they collect champions: US clinicians or operators who will vouch for them.
Finally, they're operationally ready. Someone senior from the company spends real time in the United States. They follow through after meetings, measure what matters, and conserve runway for long sales cycles.
By contrast, teams that spread themselves too thin, chase prestige logos instead of real opportunities, or try to raise capital before showing proof usually lose momentum.
Building the Bridge
At its core, WorldUpstart is about creating pathways where none existed. For international founders, breaking into the US market takes more than strong science or traction abroad. It requires strategy, proof, and the right connections delivered at the right time — in the right sequence.
By focusing on those fundamentals and refusing to let companies waste time on the wrong priorities, WorldUpstart has become a trusted bridge for global life sciences and healthtech companies ready to make their mark in the United States.
What Comes Next: Global Expansion and Women’s Health
The Fall 2025 Global accelerator cohort included companies from Ecuador, Brazil, and New Zealand for the first time, alongside a dedicated Japanese-Korean cohort — demonstrating strong momentum across Asia and Latin America. These expansions reflect the program’s core mission: to continue to help globally proven companies scale successfully in the U.S.
WorldUpstart is deepening its international footprint while launching a bold new initiative through its nonprofit arm, WorldUpstart Impacts - an effort focused entirely on commercializing women’s health solutions. The need is urgent: many women’s health conditions remain understudied, data is fragmented, and even breakthrough innovations often stall due to lack of clear clinical or reimbursement pathways.
The team believes its model is uniquely suited to close those gaps—just as it did in building the Knight Foundation–funded HiveBio Accelerator, where 70% of underrepresented early-stage founders in Life Sciences and MedTech secured funding during the program. That proven approach — tailored mentorship, real-world commercialization insights, and deep ecosystem connections — will now also be applied to drive women’s health innovation forward.
For Karina Sotnik, this dual expansion reflects a single mission: building bridges where none exist. “Whether it's supporting a founder in São Paulo, Seoul, or Philadelphia,” she says, “we're here to help breakthrough ideas find the path — and the partners — they need to succeed in the U.S. and beyond.”