ImpediMed Ltd

ASX:IPD

Thank you for standing by, and welcome to the ImpediMed Limited Q2 FY '25 Results Call. [Operator Instructions] I would now like to hand the conference over to Dr. Parmjot Bains, CEO and MD. Please go ahead.

Thank you. Good morning, and thank you all for joining us to discuss the Q2 FY '25 results. I'm pleased to be here with McGregor Grant, our CFO and COO. Today, we'll be referencing the 4C quarterly activity report and presentation we lodged this morning with the ASX. The presentation is a more detailed summary of the more detailed 4C. After our remarks, we'll be taking questions.

I'll begin on Page 3 and quickly go through the agenda for today's call. So Page 3. Consistent with the previous quarter, we will start today with a brief strategy recap. Then we will cover on the key highlights and financial performance for Q2. We will touch on other key metrics in the business. And to finish, we will cover the outlook for the next quarter before commencing the Q&A session.

Now turning to Page 4. I always think it's worthwhile to start with a reminder of what our immediate strategy is. It's to execute to breakeven and profitability with a focus on sales, marketing and clinical execution in BCRL. We've come a long way and made a lot of changes in the 12 months that I've been here. The team has done a lot of work, and we're really proud of the achievement that was made.

When we assess our achievements against the goals we set in Q3 last year, it's frankly been a bit of a frustrating quarter with delays in U.S. orders coming through despite our pipeline growth. We are focusing now on how we can accelerate this pipeline conversion. In the historical context, this is a good result. We saw record results in terms of revenue and cash receipts with good cost control and operating cash flow. We will continue to make good -- we continue to make great progress with reimbursement, which is still the key success for BCRL and the focus on sales process is driving significant lead generation. Everything is heading in the right direction.

But as a Board and management team, we still don't accept this current status quo. The business is not quite where we want it to be in terms of U.S. sales, and we're challenging all aspects. I've just, in fact, flown back in from the U.S. this morning after conducting a very detailed quarterly analysis of our pipeline with a granular -- at a granular level with every part, which are basically comprised of our individual sales reps, clinical program specialists and reimbursement teams.

This coming quarter, we've got 15 trade shows in the next half year to continue to generate leads, and we're looking at all the initiatives we can take to accelerate our lead conversion. When I look at the progress that's being made, the results being delivered from the processes we have put in place and when I talk to our customers and potential customers, I continue to be very confident that we will execute on the opportunity.

Turning to Page 5. Let's talk about what's going right and why we have confidence in the business model. Firstly, we have a very strong foundation. The strength of the ARR business model is that it builds on itself with every contract. The quality of our customers. Even with the list of the new and renewing customers this quarter, it's a who's who of quality world-renowned institutions, NCCN centers like the Cleveland Clinic, Memorial Sloan Kettering, Vanderbilt and Mass General. Large IDNs like Sutter, Baylor Scott & White and Northwell. We have inclusion with the world's -- with the most widely guided guidelines, NCCN and recently NAPBC.

Last quarter, we were recognized as a technology market leader by Frost & Sullivan. Secondly, we are seeing the pipeline expanding responding to our marketing and sales prospecting efforts. The clinicians are excited by the ability of SOZO to improve cancer patient survivorship. Critically, we see reimbursement is reaching a tipping point. In today's post-COVID environment where hospitals are still struggling financially, it's more important than ever to have high levels of reimbursement, not just for financial sustainability for the system, but also to reduce the administrative burden as they have to manage reimbursement. This is one of our key learnings.

But that understanding gives us the confidence to further allocate resources into sales, and we want to see an acceleration of the conversion of the opportunity pipeline that our team has diligently built in the last 12 months. Finally, our cost discipline is critical and is now providing us with the runway to invest and reallocate where we are spending our resources to underpin this growth.

Now turning to Page 6, we'll touch on the key highlights for Q2. As I mentioned, there is a lot to like in the result. In the financials, we reported record revenue and cash receipts. Operating cash flow reduced significantly quarter-on-quarter even after you adjust for the R&D tax credit. And we continue to have a healthy cash balance and have actually increased our runway quarter-over-quarter. On the reimbursement front, we continue to see growth in payer coverage. And with everything the company has done, the clinical trials, the guidelines submissions, the CAP programs is all about getting coverage for patients. So they can receive the SOZO measurements to prevent breast cancer-related lymphedema and help support financial sustainability for health care clinicians.

Institutions differ. The markets differs depending on what state you're in. So there's no hard and fast rule, but we believe that our reimbursement is now reaching a level where we should see it start to make a meaningful impact on sales and in doing so, ultimately, patient health.

And finally, to sales. The revenue trend is positive. For devices, there was a 75% increase quarter-on-quarter, but it's really not where we want it to be. As I mentioned, we're not happy with the U.S. number yet, but we are confident that we have all the components and processes in place, putting us in a position to capitalize on this opportunity. Internally, we can see we're at the point where it now makes sense to invest more into sales, although keeping our cost discipline in mind, and we are reallocating existing resources into more frontline roles.

I'll now turn over the presentation to our CFO, McGregor Grant, to go through the financials.

Thanks, Parmjot. Starting on Page 7. As Parmjot mentioned, it was a positive quarter financially. We achieved record quarterly cash receipts of $3.4 million. Headline operating cash outflow reduced to $2.5 million from $4.8 million last quarter. Major drivers included receipt of the cash, the R&D tax credit and lower administration costs. As we have mentioned at the time, the last quarter's operating cash flow was about 10% higher than budget, mainly due to timing. And as the timing issues reversed, operating cash outflow was expected to decrease to under $3.5 million this quarter. We did, in fact, see just this.

Once you add back the R&D tax credit, the operating cash flow was $3.4 million, in line with guidance. Cash and cash equivalents at 30 June '24 was $17.7 million. We've got the opposite effect from exchange rate movements compared with last quarter. This quarter, there is a notional FX benefit affecting the balance. And as with last quarter, this is largely unrealized.

As a result of the cash balance and the reduction of the operating cash outflow, the result in today's 4C is showing 7.2 quarters of operating cash flow. When you adjust for the R&D credit, it comes in at 5.2 quarters, still a good improvement on last quarter's result.

Over to Page 8. Last quarter's revenue was the only slightly disappointing aspect of the result. This quarter it bounced back -- this quarter it bounced back nicely. And as with the cash flow case, the factors that caused the disappointment last month reversed this month. Revenue came in at $3.3 million, up 24% versus quarter 1. Last quarter, although Rest of World sales continued at anticipated levels, the timing of distributor inventory restocking, which is reported as rest of world sales was smaller than anticipated. This quarter, we saw reordering from the distributor, resulting in a higher Rest of World figure of about $400,000, as you can see in the graph.

The second factor was the strengthening of the U.S. dollar versus the Australian dollar. Importantly, you can see in the revenue chart that the trend line is positive. We've included a longer-term revenue graph to further illustrate this point. There is a definite upward trend in the core business. You can look at an even longer-term graph and it tells the same story, a business that is incrementally improving, and this is prior to full reimbursement.

Looking at Page 9. Firstly, to ARR. Again, a nice upward trajectory as TCV gains translate in annual revenue. TCV contracts in place at 31 December '24 are expected to generate core business annual recurring revenue or ARR of $12.5 million for the 12 months to 31 December '25. That equates to a 23% rise year-on-year and with ARR at December 31, '23 of $10.1 million. Looking at TCV, the value of new contracts signed during this quarter, which we refer to as total contracted value or TCV, was $3.2 million compared with TCV of $4.8 million signed during quarter 4 FY '24.

The reduction reflected 2 factors. The largest factor was the reduction in the number of units due for renewal compared with the previous quarter. As we called out at that time, last quarter included the renewal of one of our largest customers with a large number of units. The second factor was the reduction in the number of units sold during the quarter. On a positive note, we continue to be pleased with the quality of accounts initiated or renewed in the quarter, together with continued strong price increases on renewal, averaging 23%.

I'll now hand back to Parmjot to continue through the remaining slides.

Thanks, McGregor. On to the reimbursement slide on Page 10. So reimbursement remains the main key to accelerating sales growth and clinician uptake. Importantly, it's not just about covered lives, although that's albeit a great proxy for reimbursement traction, and we're now at 73% across the country. It's also necessary to have high percentage coverage in individual states so that as many patients as possible can be covered for each clinician. Now being under certain levels, the administrative burden in hospitals is critical and high coverage enables a significant reduction in administrative burden. And in states that have high percentage of reimbursement, we are seeing a traction in sales.

We did see growth in payer coverage in the quarter and importantly, a high percentage of patients covered in more states. SOZO now has above 80% coverage in 25 states in the U.S., up from 16 reported in Q1. It's also worth noting that most of the major payers -- we have most of the major payers now reimbursing patients with 11 of 15 top payers now covering SOZO testing, including 4 of the top 5 U.S. payers.

Over to Page 11. Over the last couple of quarters, we've spoken about the processes being put in place to generate leads. The effectiveness of these programs is driving our lead generation and building the opportunity pipeline that has clearly been demonstrated. As I mentioned last quarter, and we've been focusing a lot on this quarter, the task is now to convert that opportunity. High levels of reimbursement are clearly a big piece of the puzzle, but we can't just rely on that. Not the same solution across all the states. Some states are dominated by IDNs and others aren't. As an example, California has -- Kaiser has a big influence in California and has a different model of care.

We're working on how we can maximize the opportunities with the IDNs where we already have programs in place and master services agreements with. And how do we approach those IDNs and physician practices like ASA that operate over multiple states where we have some coverage is high and some are lower. We are challenging all aspects of our sales process.

The good news is the pipeline contains several multi-order opportunities and sufficient opportunities to reach our goal -- our initial goal of breakeven. We have grown reimbursement coverage, and we have some of the answers. Most importantly, as a team, we are continuing to work hard to unlock the full potential of this device in BCRL. And as I said at the opening, I am convinced that as a team, we are convinced of the opportunity and that we will execute.

Over to Page 12. So I want to quickly touch up on a key point on this slide. I've already mentioned about the quality of the renewing accounts, and that gives us a lot of confidence as does the price increase that we are achieving with those renewing accounts. The new stat that we included this quarter across the 23 NCCN institutions have 88 SOZO.

So that's, on average, just under 4 SOZO per institution, and that number is growing. That should be the base model for all major hospitals and enables an effective lymphedema prevention program to be put into place. NAPBC is a significant opportunity, and we've only just begun ramping up activity with these centers and are seeing positive early signs and clinician interest. And as I've mentioned, with the growing level of reimbursement, we are looking at increasing our investment in sales to accelerate the conversion of our pipeline.

Moving on to Page 13, which is our patient testing. In the U.S., our clinical program specialists closely monitor customer testing levels and work very closely with all of our accounts. The U.S. patient utilization continues to grow. The rest of world is managed by distributors and has shown a small decline. Most of this is from a revision of some high-level testing levels in Q4 and Q1 from the U.K. and Asia as well as the expected seasonal effect from the start of the Australian holiday season. It's not an issue, but we do continue to monitor to ensure that patient numbers remain unchanged and are really working to support our distributors as part of building out our rest of world strategy.

Turning to Page 14. We added this slide at a very high-level scorecard. What did we say we were going to deliver last quarter and what were the outcomes. As you can see, we did manage to achieve almost all of our goals, improvement in leads, contract renewal increases, expansion of payer coverage, improvement in key business metrics and a focus on cash with operating cash flow to under $3.5 million. The one that we didn't get a tick on was improving U.S. sales. The business metrics did improve as did overall sales. But as we've stressed, we need to see this acceleration in our U.S. sales pipeline.

This takes us to Page 15, this quarter's goals. Our extension of quarter 2, executing on the strategy with a focus on, number one, sales and converting the pipeline we have faster; two, increasing activities that increase our lead generation; three, extending private payer coverage; and four, controlling costs.

Finally, over to Page 16, the value proposition. We started talking about the value proposition and created this slide for the AGM. It's very easy to get focused on the details in this business as we provide a significant amount of information each quarter, but I find it useful to remind us of what this company has achieved to date and why I believe we are so well positioned.

Starting with SOZO. This is a platform technology with multiple clearances that can provide a significant upside over time. This year, we have been recognized in 2 awards with the most recent being the Frost & Sullivan Award for technology leadership in our space. The focus for the business at the moment is BCRL and has a TAM of around $600 million.

We have a successful global randomized clinical controlled trial, demonstrating the efficacy in reducing lymphedema. It's been recognized in the NCCN guidelines now with the NAPBC standard inclusion. We've got over 1,000 devices deployed globally and within some of the most highly regarded institutions on the planet. We have a rapidly growing pipeline that exceeds the number of devices needed -- required to reach breakeven. We've grown reimbursement with 11 of the top 15 U.S. payers covering 75% of the U.S. population. At our stage and market cap, we believe that's hard to match. And on that note, we'll open the call now for questions.

[Operator Instructions] Your first question comes from Shane Storey from Wilsons Advisory.

My first question just relates to the increase in covered lives that you reported. And I know that you won't really want to talk about individual payers, but could you help us understand some of the biggest sort of tranches of covered -- some of the bigger sort of pieces that sort of came through in the quarter that might sort of help us think about who those payers might be?

Yes. So we had a lot of -- we've kind of gone through historically 4 of the 5 large payers. But across the United States, there's a significant number of smaller payers within each state. So as an example, I think, last quarter, we quoted California has up to 48 different payers within their state. And so we found -- we actually now have conversion of a lot of these smaller payers. So that cumulatively, we're reaching up to 75% critical coverage across the country.

Yes. And then on the states, I mean, there's also some really great progress there going to 25 states from 16. Did I hear you say in your comments that California was one of the new states that sort of went into 80% and above coverage or not?

No, no, not yet. But they're very close, but not yet.

Okay. Is it the same for Texas?

Yes, Texas is not yet there either. So California and Texas, still not at critical mass.

Your next question comes from Tom Godfrey from Ord Minnett.

Can I just sort of start on your U.S. pipeline. Parmjot, I think, you mentioned there's a selection of multi-order opportunities in the near-term pipeline. Are you able to just sort of help us characterize sort of what's pushing out the sales cycle there or what's holding them back? Is it still figuring out adoption of workflows, medical practice kind of acceptance? Or is it just a situation where you're looking for that final payer to come on board and have critical mass coverage and have the ROI?

Honestly, Tom, it varies. I think each kind of state is different and each institution is different. So in some instances, it is just getting through kind of financial and IT and other approval processes within IDNs. It can take time. And that's why having the master services agreements in place is critical and -- because it helps us accelerate sales into these ones.

There are some where they have been waiting for payer coverage. And so that's been a factor. But I think a lot of it is really just at the moment for us is working through the time lines and their own internal processes within these systems. We do have some systems where we know that they've indicated they would like to ideally have larger systems in place, but they're starting with smaller pilots as well. So really, it varies and what we're trying to do is really trying to accelerate all of them and pull all the levers that we can.

Got it. That's clear. And I mean maybe just a follow-up to Shane's question just around -- like you've got 11 of the top 15 payers in the U.S. now reimbursing. But clearly, there's 4 left there, and there are some large regional insurers like Kaiser in California and then HCSC in Texas. I mean, do you have a sense for where some of those bigger guys or bigger dominoes are out and what's holding it up?

Yes. So Kaiser already covered. So they actually -- we do have coverage with Kaiser. But the other ones are still under review. So the key ones and with the market access team, we continue to do what we can do to support them. So probably not a lot of visibility for us at the moment on that one. But given the extent of coverage, we are hopeful that existing coverage and the insurers that have come on board, we are hopeful that they will continue to look and review these policies positively.

Got you. And so in California, is that Blue Cross Blue Shield that's sort of the last...

I think -- so we still don't have a couple of the biggies. So I think Aetna, I think, you guys are aware, is not -- we don't have coverage with Aetna yet. There are some Blue Cross Blue Shield policies there. So there's a couple still that we are looking at, hopefully, as they review their coverage, hopeful to get coverage.

Got it. No, that's clear. Last one I had was just around price increases on renewals. It's good to see the strength coming through there, but you're getting 35% on that top 10 client renewal, but the average renewal is only 23%. Like just wanting to understand what is driving the variance in some of the lower price increases across other contracts?

Yes. It's a variety of factors, Tom. It will depend on the levels of reimbursement in the state, the prices that are currently being paid by those customers. It is a range of factors. So yes, I mean that is about the -- that, of course, that is the average.

Got it. Okay. And McGregor, maybe one more just for you while I've got you. I mean this slow increase in investment around sales focused or front office staff that you're going to start building out, does that impact the 10% reduction this year in OpEx?

No. We are maintaining our guidance on that, and we expect H2 overall cash flows to be consistent with the H1 numbers.

Yes. And Tom, as I noted, we're actually reallocating some resources towards that frontline side as well.

[Operator Instructions] Your next question comes from [ Peter Gregory ], private investor.

I'd like, first of all, to ask a question about the immediate strategy page where you referred to actionable insights at point of care. Can you describe what that means? And also how it increases value and return on the investment to SOZO purchases and insurers? And also, how does it increase the motivation of caregivers to test and improve the testing experience for patients?

I think, [ Peter ], you've kind of outlined what these points do, exactly to your point, right? So actual insights at point of care is we're just optimizing the analytics that our clinicians see when they look at SOZO. So both the analytics that they see, but also the analytics that our clinical support team shares with the customer in terms of letting them know what their patient utilization is, how healthy their lymphedema prevention programs are, patients that are tested and so -- and those that are treated.

So it's really helping our customers understand the impact of these programs. Why it's absolutely critical is it drives expansion of the devices across the health care system. It also helps drive the renewals. So if a customer is getting a good success with the program, then it helps drive that renewal, both price increase, but also keeps the churn low.

Does it provide additional information for patients that gives them a better understanding of what's happening with their body?

Yes, absolutely. So the patients can see the results. So when they go in to get the testing, the patients will see what their Albex measurement is. And so they can see -- and if there is change of the standard deviation above the baseline, if they're triggered above that, then the patients can kind of see that they made an impact.

The other piece of analytics that our SOZO system shows is not just Albex, it is around their body composition. So the patients can have a look as they go through their cancer survivorship program. What's happening in terms of their muscle mass, fat mass, are they kind of maintaining health and survivorship. So it gives a lot of information for the patient to improve their care and survivorship.

Okay. No, that's great to hear. That sounds really positive. I'd also like to ask on Slide 12, the sales focus slide, you referred to adding 2 new KAEs. I see in the past few months that you've been advertising for key account executives in North Carolina -- North California, Chicago, Gulf Coast and New York. Are those 2 positions that you referred to in those 4 or is there some turnover happening with the sales team? Can you just fill me in a bit what's happening there?

Absolutely. So the 2 new ones are in the Northern California and Chicago region. So the Northwest territory is now developing a significant number of pipeline and market reimbursement to go and recruit in those 2 territories, in Northern California and that Chicago region. The Gulf Coast, we are changing over the reps there. So we are recruiting in that region. And we did have a rep leave in the New York state. So we are -- we've filled that role. That person has been in place now for a little while.

Any explanation of why you're losing a couple of people?

One left -- one left on his own accord, and one was just part of -- kind of monitoring outputs and performance.

There are no further questions at this time. I'll now hand back to Dr. Bains for closing remarks.

Well, thank you. Thank you again, everybody, for your participation and ongoing support for this organization. And just to kind of reiterate as a team, we are very confident that we will see execution. And we are seeing -- as I said, I've just flown back in from the U.S. this morning and gone through a very detailed review of our opportunity pipeline. And I am very excited by the opportunities that we have and really are seeing a significant change in the way U.S. clinicians are looking at cancer survivorship and around lymphedema, supported by the NCCN guideline. It was over a year ago. The NAPBC centers are really increasing awareness of that. So just thanks to the investors and also many thanks to the team. I know a lot of my team does dial into this call and just want to just give thanks to that, all the work that's been underway in the last 12 months.

Thank you. That does conclude our conference for today. Thank you for participating. You may now disconnect.