So, A lot of health systems are actually, they’re blinded to a lot of data that they need to get at. So we actually go in with accurate lists that need to be screened first time or rescreened, or we have a 45 to 49 population that they need to actually detect. When we provide that data and analytics to them, again, we’re helping them broader than just the product, and that’s where we’re seeing these partnerships increase quarter-over-quarter.
Operator: Okay. Your next question comes from Puneet Souda with Leerink Partners. Please go ahead.
Puneet Souda: Yes. Hey, guys. Thanks for taking my questions. And Kevin, a bigger question for you. It appears that the relationship of Cologuard test to Cologuard reps and the leverages is similar to what you had a few years ago. Simply put, more reps means more Cologuard orders. This is the first time you had slowed down investments in a decade on the reps. So the question is, if the lesson here is that you will need to continue to scale the sales force as you penetrate the market further for Cologuard in the next few years. Is it safe to say that scaling has to continue and the investments into the business have to continue? Or is there an improved leverage that you will continue to get as we get into our penetration numbers for Cologuard?
Kevin Conroy: I think the answer to that is and. We will increase investments and we will get more leverage. As we become a $2, $2.5, $3, $4 billion category, we will continue to make additional investments. And it’s the right thing to do. It’s the right thing to do for patients. It’s the right thing to do for our customers. They actually want us to come in and help educate their physicians, their nurses, their physician assistants. So we will have the ability to do this. We’re talking about a pretty modest investment in terms of sales force growth relative to the impact. It takes three to six months to get a return on the investment that you have made because the number of Cologuard orders per office visit is high. We haven’t I think laid out what that number is, but it’s 50% higher now than it was two years ago.
So it continues to grow and it just makes sense. You would be disappointed and our investors would be disappointed in us if we didn’t make continued investments in our sales force.
Everett Cunningham: And I’ll just — this is Everett. I’ll just add one other thing to that is, as we unlock new opportunities in the field, and I think about our relationships with health systems, our relationship with payers in terms of care gap opportunities, we’re doubling down in terms of our federally qualified health centers and challenged geographies and zip codes. I talked about the new providers that we generated in the last year. As we unlock these new segments of growth, we’re going to need sales reps, account executives, multicultural approaches to driving this business. And so, it’s not just adding reps for the sake of adding reps, but adding reps to get at these new opportunities of growth.
Puneet Souda: Helpful, guys, thank you.
Operator: All right. Our next question comes from Matt Sykes with Goldman Sachs. Please go ahead.
Matt Sykes: Hi, good afternoon. Thanks for taking my questions. Apologies up front, I’m going to ask another marketing leverage question, but mine’s focused on the shift and mix towards larger health systems and whether that creates more leverage, either from a centralized call point or the fact that some of the health systems, once adopted, kind of do some of the marketing for you within the system. I’m just wondering if that will allow you that operating leverage you’re talking about in terms of increasing marketing spend leading to ever-increasing revenue. Just how do the health systems play into that dynamic?
Kevin Conroy: You know, there is no doubt that you’re seeing that leverage just going back over the last couple of years. And Jeff can provide the details in terms of the dollar of Cologuard growth, I believe, around $800 million over the last couple of years with the sales force that is smaller than it was two years ago and a marketing spend that was smaller than it was. The leverage is obvious. The question is how much do you keep that up? And we’re eating it up less than the 2022 spend. So, the leverage we’re getting out of health systems, the leverage we’re getting out of payers, the payer leverage is incredible, because that is a very small team that is executing on those relationships. And then, our IT team and a small group of people around customer experience, and really delivering that impact. So this is – the payer segment is a huge opportunity as we look out over the next five to 10 years.
Jeff Elliott: And the leverage gets even better over time. Today, here, we are talking mainly about Cologuard. But as we add new products, as we launch new products with this sales team through this electronic origin channels to the same customer care team the leverage gets even better. So, we’re still building some of the foundation here and getting leverage. And over time, I think things get a lot more attractive.
Matt Sykes: Thank you very much.
Operator: Your next question comes from Dan Brennan with TD Cowens. Please go ahead.
Dan Brennan: Great. Thanks for the question Jeff, obviously – good luck. Great working with you. Kevin, so I thought I heard you mention earlier to Doug’s question, maybe something about the quarter off to a good start. Maybe there was some comment. I just wanted to clarify that. You’ve talked about these payer programs in the back half of the year, it sounds like it could be notable. Could you just help frame how we think about those, like size and anything of that? And then Jeff, you talked about these out-of-period captures that you had last year. Would you be – could you kind of share with us out of the 1.8 million Cologuard test in the first half last year? I know those grew 34% year-over-year, like any sense, or can you help us think through just what percent of those kind of we’re at a period.
So, we can kind of normalize things, and get a better sense of underlying growth rate? And then any color on 45 to 49, I haven’t heard it come up like in terms of kind of contribution or anything in the quarter. We had 105 million and I’m wondering if we were in the right zip code? Thank you.
Kevin Conroy: We’ll try to keep track of all those questions. I think the first one, what I said was just based on the marketing investment alone, the increased marketing investment in Q1. We have seen accelerated growth in Q2. So, we have confidence with the guide that we’ve given for Q2. And then when you have the sales force adds and we have even more confidence. So in terms of payer programs in the back half, I don’t think we’re prepared to size that right now. Last year, it was in the tens of millions of dollars total. And we think, it will be significantly more than that in the back half of this year. So, we’ll probably provide more clarity as time goes on, but that’s about as much clarity as Jeff will allow in his last earnings call.
Jeff Elliott: Dan, thanks. A couple more here. You asked on 45 to 49. Still very strong growth here. When you look at the size of opportunities, about 20 million people, about 4 million people turn 45 every year and essentially all of them are on screens. So Cologuard fits in really well. It’s a huge opportunity. And it’s approaching 20% of revenue of screening revenue today. So very strong growth. It did – volumes grew double-digits in Q1, even with that tough comp. We expect strong growth to continue. Kevin talked a bit about upping some of the investment target of the re-screen population. There’s still a long ways for this to run. You asked on the sequential kind of last year, what was the impact? We have given some clues here.
We haven’t sized it, but I’ll kind of reiterate that in a normal year, you would expect Q4 to step down and then the Q1. Last year, we saw the opposite. We saw Q1 up. I think it was up almost close to 10%. A few things happened. One was the abnormal flu season last year, very light, very earlier this year, more of a normal flu season. The other were the IT upgrades – upgraded the billing systems and the patient compliance system. So that whole delta is not out-of-period revenue. Some of that is the impact of flu.
Operator: Okay. Your next question comes from David Westenberg with Piper Sandler. Please go ahead.
David Westenberg: Hi. Thank you for taking the question. And congrats, Jeff, and have a good next chapter of your life. So I just wanted to – investors were a little bit concerned, I think, with some of the implications for the back half of the year ramp. I actually think you did lay out the comps in the front half of the year, were pretty challenging. And I know we’re kind of laboring the question, this kind of Doug question and Dan’s as well. But can you give us any sense of trends in terms of hospital utilization in March? And how much maybe that flows through, give us a reminder of how long it takes to kind of flow through the P&L? And see some of that impact maybe in April and May. And I know you’re not in the habit of giving kind of a month-by-month play, but I just really think that maybe a little bit of color on why that’s – again, that second half of the year step up is not that ridiculous?
