There is small learning curve for getting to know rpm-ostree and toolbox tends to be a hindrance if you want IDE integration. Also you have to reboot after installing packages to the core OS, that's mainly why they recommend using flatpaks, but it's optional.
Note that it's still beta but pretty reliable as you can always downgrade and wait till they fix stuff that may be broken after an upgrade.
When it comes to actual setup needed it's not much different than a regular distro. No language to learn, no additional setup required.
Initially I played around with toolbox, wrote a 30 line bash script for initial setup for it and eventually ditched using it.
You can still use RPM Fusion and install regular .rpm's.
One thing to note is that they recommend to use the default partition layout as custom ones can (and do) break.