Exact Sciences Corporation (NASDAQ:EXAS) Q4 2023 Earnings Call Transcript

Exact Sciences Corporation (NASDAQ:EXAS) Q4 2023 Earnings Call Transcript February 21, 2024

Exact Sciences Corporation beats earnings expectations. Reported EPS is $-0.27, expectations were $-0.53. Exact Sciences Corporation isn’t one of the 30 most popular stocks among hedge funds at the end of the third quarter (see the details here).

Operator: Good afternoon, and welcome to the Exact Sciences Fourth Quarter 2023 Earnings Call. Please be advised that this call is being recorded. All lines have been placed on mute to prevent any background noise. After the speakers’ remarks, there will be a question-and-answer session. [Operator Instructions] Thank you. I would now like to turn the conference over to Mr. Nate Harrill, Vice President of Investor Relations, you may begin your conference.

Nate Harrill: Thanks, Jeanne. Thank you for joining us for Exact Sciences fourth quarter 2023 conference call. On the call today are Kevin Conroy, the Company’s Chairman and CEO, and Jeff Elliott, our Chief Financial Officer. Everett Cunningham, our Chief Commercial Officer, and Brian Baranick, our General Manager of Precision Oncology will also be available for questions. Exact Sciences issued a news release earlier this afternoon detailing our fourth-quarter financial results. This news release and today’s presentation are available on our website at exactsciences.com. During today’s call, we will make forward-looking statements based on current expectations. Our actual results may be materially different from such statements.

Discussions of non-GAAP figures and reconciliations to GAAP figures are available in our earnings press release and descriptions of the risks and uncertainties associated with Exact Sciences are included in our SEC filings. Both can be accessed through our website. I’ll now turn the call over to Kevin.

Kevin Conroy: Thanks, Nate. 2023 was another record-breaking year for Exact Sciences and our fourth quarter results set the tone for an impactful year ahead. A special thanks to our team for testing a record number of people during the quarter with our established brands Cologuard, Oncotype DX, and PreventionGenetics. We’ve built an unrivaled platform that will allow us to achieve our purpose to help eradicate cancer. We’re hosting today’s call from our San Diego R&D Center. Our talented scientists are harnessing the power of DNA, RNA, and proteins. They are developing a range of new tests that will change how cancer is diagnosed and treated. We’re set to gain momentum as we bring these new tests to physicians and patients at regular intervals over the next few years.

Highlights in 2023 include testing a record 4.1 million patients for cancer and rare diseases, growing core revenue by 24% to $2.5 billion, improving adjusted EBITDA $362 million year-over-year, turning free cash flow positive, submitting next-generation Cologuard for FDA approval, launching Oncotype DX in Japan on a reimbursed basis, accelerating our molecular residual disease or MRD program, launching OncoExTra, our solid tumor therapy selection test, and adding OncoLiquid, our liquid therapy selection test and advancing our multi-cancer early detection. The Exact Sciences team is laser-focused on five things this year. Further embedding Cologuard as standard-of-care, increasing Oncotype DX adoption internationally, advancing key pipeline programs, deepening relationships with health systems, and delivering experiences that patients and providers love.

Jeff will now focus on our financial results and our outlook for 2024.

Jeff Elliott: Thanks, Kevin. Fourth quarter revenue of $647 million grew 17% or 18% on a core basis excluding COVID testing, FX and M&A. Screening revenue of $487 million increased 21%. We continue to see broad-based momentum in Cologuard adoption by healthcare providers with an all-time high 172,000 ordering Cologuard during the quarter. This expanded base of [ordering providers] (ph) supports our long-term growth outlook. Precision Oncology revenue of $160 million grew 12% or 11% on a core basis. Growth was led by Oncotype DX, which expanded 48% internationally. Fourth quarter GAAP gross margin was 70%. Non-GAAP gross margin, excluding amortization of acquired intangibles, was 73%. Net loss was $50 million, and adjusted EBITDA was $50 million, an improvement of $45 million driven by better-than-expected revenue and continued operating expense discipline.

Free cash flow was $35 million, an improvement of $55 million. We ended the year with cash and securities of $778 million. Turning to guidance, we expect total revenue between $615 million and $630 million for the first quarter and between $2.81 billion and $2.85 billion for the year. This assumes screening revenue between $460 million and $470 million for the first quarter and between $2.155 billion and $2.175 billion for the year and Precision Oncology revenue between $155 million and $160 million for the first quarter and between $655 million and $675 million for the year. Annual guidance implies 13% core revenue growth, with 16% growth in screening and 6% growth in Precision Oncology. We expect to generate between $325 million and $350 million of adjusted EBITDA for the year.

We also expect CapEx to be around $150 million. We expect first quarter screening revenue to be down sequentially because of typical seasonal trends. Primary care utilization is lower in December and early January because of the holidays. This impacts screening revenue during the first quarter due to the normal timing between a Cologuard order and a completed test. We expect first quarter screening to be about 22% of full year revenue, consistent with the historical average. In Precision Oncology, we expect steady Oncotype DX growth in the US and strong double-digit growth internationally this year. Exact Sciences acts as a reference lab and process a test for other lab customers. Starting in the first quarter, we’re assuming a $20 million headwind or 3 points of revenue growth for Precision Oncology as various agreements related to whole exome sequencing and prostate cancer testing are transitioned in-house by those ordering labs.

The team did a great job implementing automation within our state-of-the-art labs, which will drive gross margin expansion this year and beyond. We’re also expecting continued OpEx leverage this year, especially within G&A. Sustainable double-digit revenue growth and industry-leading gross margins are powering adjusted EBITDA and free cash flow as we continue investing in growth and efficiencies. Priority areas of investment this year include reaching more people through new digital and TV averaging campaigns for Cologuard, further improving the patient and physician experience through our technology platform and advancing our MRD program. Back to you, Kevin.

Kevin Conroy: Thanks, Jeff. Brand awareness and loyalty are fueling Cologuard adoption and helping reach 60 million Americans who are not up to date with colon cancer screening. The number of healthcare providers ordering Cologuard and the number of Cologuard testing order have consistently grown. Cologuard is an essential part of their screening tool kit in part because patients prefer and ask for it. During the fourth quarter, Cologuard brand awareness reached 89%, an all-time high, and our market research showed people who have never been screened prefer Cologuard 2 to 1 over colonoscopy. We’re building on this momentum by helping health systems achieve positive clinical and financial outcomes, designing innovative ways to get more patients rescreened and partnering with federally qualified health centers and healthcare providers that serve diverse communities.

Our Precision Oncology team has guided treatment decisions for more than 2 million cancer patients around the world including a record 230,000 last year. Oncotype DX recently celebrated its 20th anniversary. During those years, Oncotype DX has become the global standard of care for patients diagnosed with early-stage HR-positive HER2-negative breast cancer, the most common subtype. We’ve received Oncotype DX orders from more than 120 countries and 98% of US oncologists have ordered. Oncotype DX has helped spare over 1.3 million patients from unnecessary chemotherapy. Increased international adoption led by Japan will be a key growth driver in Precision Oncology this year. We also plan to move our Precision Oncology portfolio onto our proprietary IT platform, making prior authorizations, billing and reimbursement highly efficient.

This will also enable rapid scaling of future tests, including Oncodetect, our MRD test, and OncoLiquid, our blood-based therapy selection tests. We are using our deep scientific capabilities and regulatory expertise to advance impactful pipeline programs, including multiple colon cancer screening initiatives and MRD. In colon cancer screening, we shared data from the prospective BLUE-C study demonstrating next-generation Cologuard will raise the performance bar in noninvasive screening. We submitted our premarket approval application to the FDA in December and expect to make the test available to patients in 2025. Most BLUE-C study participants also provided a sample for evaluating our novel blood-based colon cancer screening test. This year, we plan to announce top line results from BLUE-C or our colon cancer blood test.

In MRD, we plan on sharing several sets of data this year, including evidence that will support reimbursement in colon cancer. We’re excited about the performance of Onco Detect and look forward to integrating it into the powerful technology we licensed from the Broad Institute. Our mission is to help eradicate cancer by preventing it, detecting it earlier and guiding personalized treatment. Our unique platform, deeply embedded standard of care test and pipeline of life-changing diagnostics will power years of growth and continued profitability, helping us achieve our mission. We’re now happy to take your questions.

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Q&A Session

Operator: [Operator Instructions] And your first question comes from the line of Brandon Couillard with Jefferies. Your line is open.

Brandon Couillard: Hey, thanks, good afternoon. Two-parter for Jeff. First, on the first quarter revenue guidance, can you just unpack the $20 million headwind, I think, in the Precision Oncology business that you referenced, a little more detail on that? And then secondly, as you think about the guide for ’24, what do you pinpoint in for kind of OpEx and gross margins for the year? Thank you.

Jeff Elliott: Sure, Brandon. On the $20 million, this is an annual impact. Like I said, we, Exact acts as a reference lab for others in the space. And some of those contracts — we’re not surprised by some of these are rolling off as those labs take that work in-house. So that’s over the year, expected to be a $20 million headwind, probably hurts Q1 a bit more than Q4, but that’s the annual impact. On what the true growth drivers for Oncotype over time are going to be continued uptake in the node positive indication, international, which had an awesome quarter in Q4 grew 48%. And then over time, this serves as a perfect foundation for new product launches like MRD and therapy selection. So the business is very healthy. We have a comparison item this year.

On the margin side, you’ve heard me talk for years about gross margin expansion. This year, we expect continued progress. We’ve put in lab automation. The team did a fabulous job there of automating those labs. Many of you have seen it. If you haven’t, you’re welcome to come and tour facilities, they are state-of-the-art. Automating those labs further will help. We expect as we grow this year, leveraging that fixed cost is a big deal. Broadly speaking, gross margin improvement. OpEx leverage, another hallmark. We’ve built a strong foundation. And you’ve seen the impact over the last couple of years, we’ve had significant adjusted EBITDA and leverage. We expect that to continue again. Probably the highlight this year will be within G&A. I expect that to be our biggest source of leverage.

However, I do expect leverage across all three lines, G&A, sales and marketing and R&D.

Operator: Your next question comes from the line of Catherine Schulte with Baird. Your line is open.

Catherine Schulte: Hey, guys. Thanks for the question. I have a two-parter for you. Maybe first on the screening guide, you’ve been clear in the past to expect 1Q to be down sequentially. But can you just talk through phasing for the rest of the year and what gives you confidence in the ramp there? And then second, and Kevin, I know you have a fairly big chunk of options that are expiring, I believe, later this week. Any comments on what you’re planning to do with those? Thanks.

Kevin Conroy: Let me start with the second first. Yes, I have options that are expiring their 10-year grants. So they were granted in 2014. And I plan to exercise and hold while selling just enough to pay the cost of exercising and the taxes. But the goal is to hold the difference. And I will just say before handing it over to Jeff, we came off a great year in 2024. The momentum is something that is generating enthusiasm across internally and also our important customer and patient base that we take care of, there’s still 60 million people out there still this year, like there was last year that are not up to date with screening. And we have a huge opportunity there, and we’re making incredible progress with health systems, payers, the brand awareness of Cologuard.

It’s an exciting time with Precision Oncology continued growth and node positive internationally and then just a number of new product launches over the next two years. So we couldn’t be more excited. Jeff, why don’t you take the rest?

Jeff Elliott: Sure. Catherine, on your phasing question, we’ve talked about this many times before, but as a reminder, primary care utilization typically impacted around the holidays. So basically, we lose about two weeks of the quarter around Christmas and New Year’s, two weeks for patients and physicians take off, go on vacations. So that’s the fact that there’s fewer office visits during that time. I mean, there’s fewer Cologuard orders then. That means about 30 days later, when we complete that test, there’s less revenue we recognize. So the holidays really impact Q1, so I would continue to expect a sequential step down Q4 to Q1 as you model out forever. Think of our screening business down sequentially. This is very similar to what you see in Precision Oncology.

The Oncotype brand continues to grow, but you do see that step down. It’s related to physician office visits around Christmas and New Year’s are slower which hits — hurts Q1 revenue. So from a phasing standpoint, typically, we expect pretty strong growth in orders for Cologuard throughout the early part of the year up until May. Things typically flatten out over the summer months and then a steep ramp again from Labor Day through Thanksgiving. That’s what we expect this year. From a revenue standpoint, I would — again, I said in my remarks, 22% of Q1 revenue for screening this year. That’s consistent with the historical average. When you look at a growth standpoint, from a growth standpoint, we’re expecting 23% on a two-year stack basis, so a two-year compounded growth in Q1.

So as Kevin said, very strong trends here, you just have a phasing dynamic in Q1 to keep in mind.

Operator: Your next question comes from the line of Doug Schenkel with Wolfe Research. Your line is open.

Doug Schenkel: Hey, good afternoon, guys. Thanks for taking the questions. My first one is just a guidance clarification question. I think you guided to 16% screening revenue growth for the year, as I think you talked about back in January. Just keeping in mind a bigger opportunity for repeat orders this year, which I think — I don’t have my model in front of me, but I think could be between 250,000 to 300,000 tests. What does this imply for first-time orders in terms of the growth there? It seems like it’s a moderation there. And if that’s the case, I just want to make sure that, that is conservatism versus anything else. And then my second question is just a competition question. Obviously, some big readouts expected from blood-based competition coming up soon. As we head into that, I’m wondering if you’d be willing to share what you think the bar should be as we look at key data like advanced adenoma detection as those readouts come in. Thank you.

Jeff Elliott: Doug, this is Jeff. I’ll take the first one on screening. So yes, we did guide to 16% growth for the year coming off of a year, just a tremendous year in ’23. Kevin talked about some of the highlights there. We’re comping against 31% growth. So 60% feel good about that, and there’s a long runway ahead here. One of the slides we shared today showed the broadening of the ordering base and the deepening of the ordering base. This has continued for nine years, and we expect that to grow for many years to come. Rescreens this year, to frame this, last year rescreens at three-year repeat customer was about 20% of screening revenue. This year, it’s going to be, call it, a couple of points higher. So it is growing rapidly.

It is one of our biggest growth drivers. The reason why it’s growing really twofold. One is that the pool of new patients becoming eligible accelerates this year, it’s up to 1.6 million. It was at 1.2 million new patients becoming eligible for the last couple of years, and also, our success rate at getting those people back to Cologuard continues to grow. The team has done a nice job executing there. What this implies for first-time users, we typically think of that age 50-plus first-time users is still double-digit growth. That’s one of the beauties of this business model is that because this is such a massive market, 110 million people in total, you can expect predictable sustainable growth, double-digit growth from that key ordering group, Doug.

And then, Everett?

Everett Cunningham: Yeah, Jeff, let me just add a couple of things, Doug. As Jeff said and Kevin said, we’re coming off an incredible year in ’23. I’ve recently just participated in our global sales meeting and I’m just telling you our — to ahead, everybody feels that we have an incredible opportunity to continue this growth to fulfill our mission. As we’ve said, Cologuard has grown by 31% last year. And the one thing that we’re continuing to do is to smartly invest in areas where we know we can grow profitably. We’re looking at our core business, our sales leaders, and marketing leaders, we’re understanding the trade-off between investments and growth. And a couple of things that I feel really, really confident about is how we’re getting at this.

Marketing, as an example, we’re being very smart at the way we’re taking advantage of key growth levers like rescreens, our 45 to 49 segment, which is fantastic opportunities for growth. And then secondly, in sales, we are investing wisely in areas that we know we could put additional heads in the marketplace to talk to the right customer at the right time with the right message. We’re going to continue to do that. So 2024 can be another incredible year.

Kevin Conroy: The second question, Doug, on competition blood tests, what’s the bar? I mean first, just reiterate what Everett said, like this is never a straight line. We’re always sober, there are always opportunities for improvement. That has been every quarter since we launched Cologuard almost 10 years ago, and it’s going to be every quarter this year and next year and beyond. But the team is focused and we’re really excited about the path ahead. In terms of blood tests, we talked about this many times, so I’m not going to add a lot here. The final arbiter of whether a blood test would be widely adopted is the main guideline group USPSTF. They do sophisticated modeling. Their modeling nets out at two key factors. One is life years gained, 83% of life years gained in their model comes from precancer detection.

And then the second factor comes from — is the question of unnecessary colonoscopies generated per 1,000 people screened. And what you see there is that, that model is the bar, not anything we believe, it’s very objective. And it’s very difficult to get into the guidelines with the performance characteristics of what we see today in this category of tests. So I think you really do the digging into the USPSTF guidelines. Anybody investing, anybody studying this space, that’s where all roads lead to long-term commercial traction and impact.

Operator: Your next question comes from the line of Dan Brennan with Cowen. Your line is open

Dan Brennan: Great. Thank you. Thanks for taking the questions, guys. Maybe first one would just be on 45 to 49 Everett, you mentioned it. Just wondering kind of where that finished up for the year and kind of what you guys are baking in for further traction in ’24. And then, B, Kevin, if I could just go back to the question on blood-based, I appreciate exactly what you said, which is completely fair, but it’s hard for us to untangle we’d have to build the model to kind of untangle that, which some of us have tried to do. Is there a way to think about just bluntly when that data hits like how kind of, you’ve been pretty open about the biological barrier for blood, but I’m just wondering, assuming 90% specificity, where do you still view like the most likely outcome for that data? And is there an upside case that would kind of make you worry? Thank you.

Kevin Conroy: Well, so if you take a look at the FIT test, the reason that the FIT test models well is because it detects 24% of precancerous polyps. And it only has a 5% false positive, right? Not a 10% false positive rate like most of the blood tests. You have a 10% false positive rate. As you can imagine, you do that test every year, generates twice as many unnecessary colonoscopies as a FIT test. It also — if a blood test, let’s say, it detects in the teens in terms of precancers, it doesn’t drive the life years gained. So you’re in this difficult place to get onto this efficient frontier as it’s called. So you can do the rough modeling by comparing it to the FIT test. And what you’ll see is these blood tests generate a lot of false positives.

They also generate not enough life years gained, and the cost of them is significantly more than a FIT test. And certainly, the guideline group considers these broad parameters when they look at including or not including as an ARB-rated test, it’s hard to become an ARB-rated test. And so I’ll go back to the real value that we’ve created for Cologuard is because we set the bar for the test that we were developing based upon these inputs from the start. That’s the way we designed Cologuard, was to make sure that we would be at that efficient frontier of that modeling exercise. And that’s why we feel very confident that for years and years to come, colonoscopy and Cologuard will be the two leading tests and you’re seeing that today as Cologuard takes share away from the FIT test, colonoscopy volume, screening colonoscopy volumes haven’t changed in a meaningful way in a decade.

Right around 5 million to 6 million screening colonoscopies per year, it’s not changing now, but backlogs are growing. And so our challenge is to get to the patients. Our challenge is to make this — to hit the easy button. Our challenge is to make sure that every patient who turns 45 thinks about colon cancer screening and then thinks about Cologuard. And these are difficult challenges. And fortunately, we built a team, a technology platform that is built for purpose to achieve our goals.

Jeff Elliott: Dan, this is Jeff. On 45 to 49, this is one of the many ways that Exact is competitively unique is that we’ve had now almost three years of working to build awareness and penetrate this younger population. And what that means is it’s approaching 20% of our screening revenue today. So it has been a massive growth driver. I expect that to continue when you look at the need here, as Kevin said, there’s a relatively limited capacity for colonoscopy in this country. So when you add 20 million more people into the screening pool like the guidelines did three years ago, Cologuard is the best option. So we are taking significant share there. It is above growth rates, above the overall base of business. And I think that will continue for many years to come. Add anything?

Everett Cunningham: Yeah. And I’ll add just maybe some field entail around the 45 to 49 segment, our field organization knows this is a great opportunity to grow Cologuard, and we’re helping our customers. I’ll give you two examples around health systems. There are still some health systems that don’t have the new guidelines in their health maintenance systems. And as Kevin said, the easy button, we know where these health systems are. So we’re targeting these health systems to make sure that they have it in their health maintenance system. The second is this is the data that our sales representatives have. Our sales representatives know by individual prescriber which health care providers are ordering Cologuard for the 50-plus audience but are not ordering it for the 45 to 49.

So then they will gear their message to making sure that they know the new guidelines to making sure we get our fair share in that younger cohort. And then lastly, as I mentioned earlier, we have specific marketing campaigns for the younger segment, 45 to 49. We’ll continue that in ’24.

Operator: Your next question comes from the line of Vijay Kumar with Evercore ISI. Your line is open.

Vijay Kumar: Hey, guys. Thanks for taking my question. I had a two-parter. Kevin, on the life years gains here, I’m just curious with your sensitivity for advanced adenoma being, I think, 43%, 44%, if the blood-base is around 25% or 30%, I’m curious what the life years gained differential would be? And Jeff, on adjusted EBITDA margins, it looks like the guide implies 300 basis points expansion year-on-year. That’s a little light. I think it implies OpEx showing high singles. Perhaps, I think when you go back to your longer-term model, maybe there was a little bit more leverage expected. So curious if this is just conservatism on the OpEx assumptions?

Kevin Conroy: So on the first question, you are testing my memory of the ranking. Cologuard has the best ratio of any screening test. Cologuard has the best ratio of life years gained to unnecessary colonoscopies. Colonoscopy has the highest life years gain. Some of that is simply because of the assumptions in the model. It also has the highest number of unnecessary colonoscopy. So colonoscopy that is performed that doesn’t find anything, which is the majority of colonoscopies. Between the FIT test and Cologuard, the fit test done every single year, which, by the way, only about three people in 1,000 due to FIT test every year for a decade. But if you model it that way, compared to Cologuard every three years, the FIT test detects about, just like maybe 7% or 8% more life years or it saves 5% to 10% more of life years than Cologuard.

[You see] (ph) blood falls off by like 25% because of the lack of sensitivity of refining precancerous polyps. And this is the challenge. So I’d go back and reread this part of the script, and reread it again. This is the challenge, to getting an A or B rated test. They don’t hand out As or Bs very easily at the USPSTF. This isn’t like great inflation in some US colleges. This is — there is a standard and it’s driven off of this model. Pre-cancer detection matters.

Jeff Elliott: Vijay, this is Jeff. On your EBITDA question, look, we gave the guidance last summer. We ended last year a lot further along towards our long-term goals. Remember, our long-term goal is for at least a 20% EBITDA margin in 2027. Last year, we’re at 9%, we’re way ahead of plan here. This year, we expect another 3 points improvement. Over time, we expect continued increase every year. That’s what we built here. We’ve built a foundation, our customer technology platform, our labs, our sales teams, you name it, to scale very effectively. When you look at the numbers this year, I do expect to see leverage again across all three major OpEx lines. Sales and marketing after the last two years where that had come down in absolute terms.

Everett’s done a really nice job of leading this team, but we see such strong return on investment there that we are going to raise some investment there. Just it makes sense to is the right way to build business is the right way to take care of patients and add value to the system. So we will invest in all three. We talked about last year, midyear, we accelerated investment in our MRD program given the near-term opportunity there. And as some of the bigger programs get towards market, the investment dollars do increase temporarily. And then G&A. G&A, I think the biggest source of leverage. We’ve got major initiatives there across our customer care teams, our customer experience teams and IT that over time will not only help accelerate growth further, but also help us run the business more efficiently.

Kevin Conroy: Yeah. And let me add on to that what Jeff just emphasized about continued investments. As we’ve mentioned, we’ve taken our sales and marketing spend down by over $100 million over the last two years. We believe that if we were investing more, we would be growing even faster. This isn’t sub position. We have very sophisticated modeling that shows the responsiveness of marketing and sales activity to the output. And during that same period of time, we have grown $870 million from a revenue basis. So it’s judicious, it’s prudent for us to make additional investments so that we can grow faster and grow profits faster so that we can reinvest and move forward. Ev?

Everett Cunningham: No. And I’m glad we’re at the point that we are because our data and analytics get better as I speak. And that matches really nicely with our market structure to where the data and analytics just don’t sit at my level, but they go all the way down to the local level so we can invest in resources smartly, and that’s driven by our local leaders. They make the call in terms of where that opportunity of growth is, where we can grow our business and continue to be a real value to our patients and customers.

Operator: Your next question comes from the line of Dan Arias with Stifel. Your line is open.

Dan Arias: Good evening guys. Thanks for the question here. Kevin, I too wanted to go back to the blood-based assay development topic, which I’m sure you don’t love, but hopefully, you can appreciate just how much that’s playing into the stock conversation for you guys right now or at least for us anyways. My question is really, though, on process rather than performance. You mentioned the importance of USPSTF. When we think about that, can you just talk to the confidence that you have when it comes to getting everything squared away in time for consideration there? In other words, if the data reads out midyear and the guideline folks want everything to them by, say, early 2025, is there any reason why you wouldn’t make the cut off there for whatever they need for their evaluation?

Kevin Conroy: No, we will make that cutoff. We will make that cutoff.

Dan Arias: And is that the right timeline that you are assuming plays out on that by the end of this year, USPSTF is ready to accept data and have what they need in front of them in order to do this thing?

Kevin Conroy: So if you look at this historically, the last cycle was, I believe, five years in between updates. The cycle before that was eight years. It’s a group of volunteers. They do dozens and dozens and dozens of guideline updates every year. They have limited resources. So they are due to have the final update by ’26. Does that get pushed out? We don’t know. We would expect in the nearer term to see something from USPSTF where they lay out what’s called their study plan. The topics they review, the essential timing, et cetera. And we haven’t seen that yet. But it was eight years, and then it was five years. We’ll see if is it five years? Is it six years? Is it longer? We don’t know.

Operator: Your next question comes from the line of Andrew Brackmann with William Blair. Your line is open.

Andrew Brackmann: Hi guys, good afternoon. Thanks for taking the question. I want to go back to some of the comments on health system efforts. Obviously, it sounds like you guys are providing these systems a lot of value with some of the things that you’re doing internally. But can you maybe just sort of talk structurally about those partnerships? Is there anything in those contractually or sort of what you guys are — have with those partnerships that can potentially ward off competition if that does come in over the next handful of years? Thanks.

Everett Cunningham: Yeah. It’s less about contractually and more about the value that we’re bringing to health systems. Health systems, we’ve seen this over the past couple of years, they’re coming to us and they’re coming to us to solve healthcare problems and issues. One is around screening. And so we find that — and then I also have health systems tell us on a daily basis, we need to go beyond the product. So the one thing — many things that we bring to health systems are great products, outstanding customer support, of which they’re looking for. We have an outstanding medical organization that partners with them and so they love [our surround them] (ph). And this Cologuard, Oncotype DX, OncoExTra. And what’s also exciting is our portfolio that drops right into our bag, and we can sell a portfolio to them.

So it’s all about partnership, and it really separates us from the competition in terms of our products, our portfolio and all the surround sound that we can partner with them and helping them have better healthcare for their patients.

Kevin Conroy: Yes. It’s incredible. This technology stack that we’ve developed that creates a competitive uniqueness. And that investment has been well over $1 billion. It’s about 100 different applications internally built, externally sourced that lead to this compliance engine that Everett referred to, the ability to automate things like reimbursement, prior authorization, campaigns to remind people to get screened, population health initiatives. And so this is a contractual based relationship. It’s a relationship based on real value for health systems patients. And it ends up leading to significant growth and profitability.

Brian Baranick: I’ll layer in one additional comment. This is Brian, by the way. We are having very meaningful conversations with a number of health systems just to reiterate what Everett was talking about around the portfolio. So while it’s not walling off the competition, a lot of these vendors are looking at us as a one-stop shop and thinking about preferred vendor agreements. They’re realizing the benefits of transacting with one company, talking to one customer service rep calling one service number, sending samples to one company for testing. So we are having very meaningful and real-time conversations around this preferred vendor agreement type of structure with some of our key customers.