NeoGenomics - Q3 2023
November 6, 2023
Transcript
Operator (participant)
Welcome to the NeoGenomics third quarter 2023 earnings call. Third quarter 2023 financial results conference call and webcast. At this time, all participants are in a listen-only mode. Please note, this call is being recorded and an audio replay will be available on the company's website. Kendra Sweeney, Vice President of Investor Relations, you may begin your conference.
Kendra Sweeney (VP of Investor Relations)
Thank you, John. Good afternoon, everyone, and welcome to the NeoGenomics third quarter financial results call. With me today to discuss the results are Chris Smith, Chief Executive Officer, and Jeff Sherman, Chief Financial Officer. Additional members of the management team are available for Q&A, including Vishal Sikri, President of Advanced Diagnostics, Warren Stone, President of Clinical Services, and Melody Harris, President of Enterprise Operations. This call is being simultaneously webcast. We will be referring to a slide presentation that has been posted to the Investors tab on our website at ir.neogenomics.com. Starting on slide two, during this call, we will be making forward-looking statements regarding our anticipated future performance. We caution you that such statements reflect our best judgment based on factors currently known to us, and that actual events or results could differ materially.
Please refer to our most recent forms 10-K, 10-Q, and 8-K we filed with the SEC to identify important risks and other factors that may cause our actual results to differ materially from the forward-looking statements. The forward-looking statements made during this call speak only as of the original date of the call, and we undertake no obligation to update or revise any of these statements. During this call, in order to provide greater transparency regarding our operating performance, we refer to certain non-GAAP financial measures that involve adjustments to GAAP results. The non-GAAP financial measures presented should not be considered an alternative to the financial measures required by GAAP, should not be considered measures of liquidity, and are unlikely to be comparable to non-GAAP financial measures provided by other companies.
Any non-GAAP financial measures referenced on this call are reconciled to the most directly comparable GAAP financial measure in a table available in the press release we issued this afternoon. I will now turn the call over to Chris Smith, Chief Executive Officer of NeoGenomics.
Chris Smith (CEO)
Thanks, Kendra, and welcome everyone. Thanks for joining us this afternoon to go through our third quarter financial results. As always, I want to begin with our mission and our vision statement because it's what motivates our company and teammates on a daily basis. Our mission at Neo is to save lives by improving patient care. Before we dive in, I also want to thank the 2,200 teammates for the impact they're making on patients' lives every single day. Now, let's move to slide four and get into third quarter highlights. As you can see, we had another very strong quarter, growing revenue 18% over prior year. Clinical services revenue increased 20%, driven by strong volumes across our modalities and an increase in revenue per test.
As a highlight, NGS grew in excess of 35% and now represents approximately 25% of our total clinical revenue. Advanced diagnostics revenue, which includes pharma services and informatics, increased 8% from prior year, driven by continued growth in informatics and a ramp in RaDaR. As we continue to execute on the transformation of the business, our progress has outpaced our internal plans. We started the year with the outlook that we would be adjusted positive in the fourth quarter. However, in the third quarter, adjusted EBITDA significantly improved 129% as compared to Q3 of last year to a $+3 million. Adjusted gross profit was $67 million, representing a 25% increase over the prior year, or 44%. For the 10th consecutive quarter, we saw an increase in revenue per test versus prior year.
NGS growth continues to be a driver of improvements in revenue per test and is growing well above the estimated market growth. In addition, revenue cycle management and pricing initiatives also are contributing to revenue growth per test. In terms of other key quarterly business updates, we completed three submissions to MolDX, including one additional breast application, as well as two new indications, 1 in lung and 1 in head and neck. Slide five demonstrates the consistent performance with third quarter, delivering sustained improvement in revenue, gross margin, and adjusted EBITDA. We are proud of this year-over-year accelerated growth because it's a direct result of the strong execution by our Neo teammates and the growing demand for our products from existing clients as well as new customers.
Our operating and revenue cycle initiatives, implemented in the second half of 2022, continue to enable accelerated growth, and we believe they have the ability to continue to drive improvement in the business through the end of the year and beyond. Let's move on to slide six. We've kept a narrow focus on our strategic priorities laid out at the beginning of the year: profitably grow the core business, accelerate advanced diagnostics, drive value creation, and enhance people and culture. Our new teammates are the foundation of the company, and continuing to enhance this team and our strong mission-driven culture is critical to our long-term success. This afternoon, I'm going to focus on our other financial priorities. We continue to profitably grow our core clinical business as we execute our commercial strategy, which is protect, expand, and acquire. This has helped us deliver strong volume and improve mix.
Our continued improvement in turnaround time has allowed all modalities to grow faster than the market. In addition, the mix shift towards more comprehensive panels has supported the delivery of yet another quarterly improvement in revenue per test. Clinical adjusted gross profit increased to $13 million, or 28% versus the prior year. Our newest NGS CGP panel for heme malignancies, Neo Comprehensive - Heme, was launched a few weeks ago and strengthens our leadership position in the heme oncology services. We also launched a therapy selection panel, providing comprehensive overview of biomarkers for detecting early-stage lung cancer. Finally, we continued our sales force expansion that we disclosed in Q2. Within Advanced Diagnostics Division, which includes pharma services, informatics, and R&D, we continue to focus on innovation. As mentioned during the third quarter, we submitted three RaDaR applications to MolDX. Collectively, we now have 27 studies in progress utilizing RaDaR technology.
Some of these are interventional trials, including MERIDIAN in head and neck, CAN, HER2 in breast, and a randomized ctDNA lung trial. In December, additional RaDaR breast cancer data will be presented at the San Antonio Breast Cancer Symposium, and we also have three posters featuring other Neo heme modalities accepted at ASH. We hired a new head of R&D, who will implement a new structure focused on accelerating new product development and driving innovation that will benefit both our clinical and our pharma customers. While it's still early days with RaDaR, we are very pleased that our technology is detecting low, positive clinical samples, highlighting the value of sensitivity for RaDaR. We have focused on driving value creation from a financial perspective and are pleased that we've delivered even further margin expansion from Q2, and have generated significant operating leverage as revenue favorability fell through to the bottom line.
As we continue to optimize our lab operation, we achieved approximately a 20% improvement in turnaround time over Q2. Because of several key acquisitions over the last 5 years, we have been operating under multiple LIMS systems. To further enhance operating efficiencies, we launched a key initiative to move the organization to one LIMS system. This project will provide a new system, which will become the backbone of digitization of our labs, allowing for tighter integration between our CRM system, ordering systems, and ERP back-end, and allow increased efficiency across our entire enterprise. We'll start to see the benefits in 2024. To further reduce costs and improve margins, we've completed the consolidation of our international labs into one lab in Cambridge, U.K., and have improved processes on procurement and supply chain. We expect to see these benefits continue in 2024 and beyond.
Before I turn the call over to Jeff, I want to take a minute to address the FDA's proposed unilateral regulation of lab-developed tests as medical devices. Given the substance of the proposed rule is in draft form, and the agency has requested public comments on the topics, that includes grandfathering, it is important to note that many instances around this topic are still hypothetical. That being said, Neo has a strong history of complying with CAP and CLIA regulatory standards, and we have also been working with MolDX on coverage determination. We believe these factors, taken together, give us a head start over many other reference labs and providers performing similar testing. We have operated our business in preparation for regulations for some time now and have executives and teams in place who have experience with the FDA approval process, including quality, regulatory, and R&D.
Furthermore, our assay development over the last 12-18 months has been incorporating FDA design control in preparation for future submissions. As a member of ACLA, we will work with the association to ensure the continuation of patient care with limited business impact. Now, let me turn the call over to Jeff to review our financial results in more detail. Jeff?
Jeff Sherman (CFO)
Thanks, Chris, and good afternoon, everyone. I'll begin with a little more detail on our operating results for the quarter. As Chris said, we continued the year with revenue experiencing accelerated double-digit growth over prior year. Third quarter revenue was $152 million, an 18% increase over the prior year and a 3.4% increase from Q2 of 2023. Revenue growth was driven by growth in clinical test volumes, a continuing shift to higher complexity tests, and improvement in revenue per test, driven by business mix and revenue cycle improvements. Adjusted EBITDA improved 129% from prior year to $+3 million. Q3 marks the fourth consecutive quarter that adjusted EBITDA increased from prior year. We generated significant operating leverage as revenue favorability fell through to the bottom line, with over 60% of revenue growth flowing to adjusted EBITDA.
Looking at slide eight, clinical services revenue of $128 million was an increase of 20% year-over-year, driven by a 7% increase in volume and a 12% increase in revenue per test. Higher volume is driven by growth within our existing client base, as well as newly acquired customers, and demonstrates that our sales force optimization strategy is enabling us to reach the oncologists, pathologists, and other physicians and providers we serve. Turning to slide nine, average revenue per clinical test increased by 12% over prior year to $440, representing an improvement for the 10th consecutive quarter versus prior year, as we maintain our focus on higher-value tests and revenue cycle management initiatives.
As we previously noted, NGS growth is a focus of our sales team, with NGS revenue approaching approximately 25% of our total clinical revenue for the year. As a result of our strong performance in NGS and the expansion in our sales team, we continue to see accelerated growth in NGS. On slide 10, as we noted on our Q2 call, advanced diagnostics revenue growth slowed in Q3 with an increase of 8% versus prior year. ADX revenue grew slower in the third quarter due to macroeconomic conditions and pharma R&D spend, as well as our decision to rationalize our global testing sites and low-margin business. This is expected to continue into the fourth quarter and early 2024.
However, the focus on profitability and margin growth is driving performance, with adjusted gross profit for ADX improving by $6.4 million, or 32%, and adjusted gross margins improving by 440 basis points on a year-to-date basis versus prior year. Looking at the income statement on slide 11, adjusted gross margin was 44.2%, and an improvement of 247 basis points over the third quarter of last year. Adjusted EBITDA was $+3 million, a $15 million, or 129% improvement over the third quarter of 2022. These significant improvements were driven by both higher gross profit and lower operating expenses and highlight the operating leverage in the business. Regarding operating expenses, sales and marketing expense was $17.6 million as we continued to invest in the expansion of our sales force.
G&A was $61.5 million, and R&D expense was $5.3 million. We did have a favorable R&D tax credit related to fiscal year 2022 of $1 million in the quarter. In addition, there was $2.1 million in restructuring costs in the quarter related to the previously announced organizational restructuring and footprint optimization, which is part of our value capture program to gain operating leverage. We have revised our original restructuring plan costs and timing of projects, and as a result, now anticipate these costs extending into 2024. These charges will ultimately result in enhanced operational efficiencies as we continue to optimize our geographic presence. Turning to the balance sheet on slide 12, we ended the third quarter with cash and marketable securities of $402 million.
We continue to make good progress in diligently managing our cash burn and are focused on accountability and disciplined oversight of operating expenses. Cash flow from operations improved $11 million, or 66% from Q3 2022. On a year-to-date basis, cash flow from operations improved by $43 million, or 68%, and the year-to-date cash burn improved by $36 million, or 50% over the first nine months of 2022. Our strong financial position provides us the financial flexibility to continue to invest in the business and achieve our strategic and financial objectives. Given our Q3 financial performance and continued progress executing on our strategic priorities, we are revising our revenue and adjusted EBITDA guidance for the year. Turning to slide 14, we previously had revenues of $565 million-$575 million, representing 11%-13% growth in 2023.
We are revising that range upward and now expect total revenue between $585 million and $592 million for the year, representing 15%-16% growth. Adjusted EBITDA was $-13 million to $-10 million, and is now $-4 million to $-1 million, and at the midpoint, represents an improvement of $46 million, or 95% from year-end 2022. We continue to see strong revenue growth and an increase in NGS product mix, and are very encouraged by the opportunities for RaDaR and other newly launched tests, which provide accelerated leverage to the bottom line. As we stated at the beginning of the year, our year-over-year comparisons will be more difficult in the fourth quarter, but we believe we have a strong foundation and dedicated teammates to deliver financial results.
While we continue to be focused on driving operational efficiencies, we will also continue to invest in the business to capitalize on our future growth opportunities. Our strategic focus remains to deliver long-term, sustainable growth. With that, I'll turn it back over to Chris.
Chris Smith (CEO)
Thanks, Jeff. As you can see, we are very pleased with our year-over-year progress, including strong revenue growth of 18% and significant improvement in adjusted EBITDA. We now have three pending submissions for RaDaR with MolDX, and we are generating additional data that will support expanded coverage in the future. We saw meaningful progress in the execution of our strategic priorities and therefore are raising our guidance for the full year results. We are well on our way to becoming the leading cancer testing information decision support company.
We'll continue to build on the foundation we have laid out over the past several quarters to deliver long-term, sustainable growth. I'm excited for our teammates and our customers, but for most of all, the patients that we get to serve on a daily basis. Thanks, and we'll turn it back over to the operator to open the call up for questions.
Operator (participant)
Thank you. At this time, we will be conducting a question and answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you'd like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. Once again, that's star one if you have a question or a comment. The first question comes from Mark Massaro with BTIG. Please proceed.
Jeff Sherman (CFO)
Hey, Mark.
Vidyun Bais (VP of Equity Research)
Hey, this is Vidyun on for Mark. Thanks for taking the questions and congrats on the strong quarter. I'm just wondering what key data points should we be keeping an eye out for on RaDaR out of the 27 clinical trials? And specifically, when might we be able to see a head-to-head comparison with a competitor, MRD tech? Thanks.
Chris Smith (CEO)
Yeah, why don't I let Vishal take that? He can talk a little bit about some of those key trials that we've got ongoing.
Vishal Sikri (President of Advanced Diagnostics)
One of the trials will have some initial data coming out at San Antonio, which is the TRACERx clinical trial. The other ones will see data readouts throughout the year in 2024. In terms of head-to-head, you know, that's still something that we are considering. It's not something that is a main focus for us, where our focus is developing our own clinical data to get published and also to get MolDX approval.
Vidyun Bais (VP of Equity Research)
Okay, perfect. Yeah, and then, what levers could be pulled from here, with respect to operating leverage and OpEx management? Should we think about most of the improvements from here to be a drop-down on revenue growth? And, what are some areas you might be looking to optimize from here on, taking out any additional costs, if any?
Jeff Sherman (CFO)
Yeah, I think, you know, as we've said in previous quarters, I think from an operating lever standpoint, we continue to see a lot of different opportunities that can continue to drive results. We've seen good progress on the volume front this year and continue to see opportunities to drive volume growth. We've seen good growth in pricing as we focus our attention on a higher complexity test. We talked about NGS growth, you know, represents only about 25% of our total clinical revenue today, and it's growing faster, you know, much faster than the overall market growth. And so that area is going to drive performance as well. We continue to see opportunities to grow the ex-ADX business. And we've talked about a few things for the margin perspective.
You know, implementing a new LIMS system is going to help us be more efficient to drive more improvement on the adjusted gross margin line. Better procurement and systematic buying will also help us drive performance there. And then below the line on the OpEx side, you know, we're continuing to look for opportunities to get more efficient there as well. You see our year-to-year OpEx expense is down year-to-year, you know, both in the quarter and on a year-to-date basis, and that's before even taking into account your restructuring costs that we're hitting this year. So I think as we think about our drivers, we see a lot of opportunity to continue to do what we've done this year.
And we'll talk more about 2024 when we give our Q4 guidance in February, but we still see a lot of runway to drive improved performance.
Thanks.
Chris Smith (CEO)
John, can we move to the next question?
Operator (participant)
Absolutely. The next question comes from Andrew Brackmann with William Blair. Please proceed.
Chris Smith (CEO)
Hey, Andrew.
Andrew Brackmann (Research Analyst)
Hi, guys. Good afternoon. Hey, Chris, how you doing? Thanks for taking the question. Maybe if I could start on the durability of growth for that revenue per test metric, can you maybe just sort of talk about how you're thinking about some of those drivers or sort of some moderation in that rate over time? Just trying to figure out how much.
Chris Smith (CEO)
Yeah
Andrew Brackmann (Research Analyst)
How much juice is left to squeeze just from internal initiatives. Thanks.
Chris Smith (CEO)
So I'll hit it high level, but I'll let Jeff kind of walk through, because there are, like, really three main levers. But I think, look, one of them obviously has been mixed around NGS, and this is the first quarter, as you know, we've kind of come out and disclosed the growth on NGS, and the amount of revenue. And look, it being only 25% of clinical revenue, it gives us lots of runway because of where the ASP is. And so that mix, we're able to continue to manage, especially as we expand the sales force and continue to expand our presence with the oncologist versus just pathologists in hospital. But Jeff, do you want to kind of talk through the levers and the way? Because I know you, you and the team and Warren spent a lot of time there.
Jeff Sherman (CFO)
Yeah. If you go back to 2021 and 2022, you know, our revenue per test was growing anywhere between 2% and 7%. You know, we've clearly seen an uptick in 2023 with our revenue per test, with our NGS growth now, you know, averaging almost 10% for the year. So I think we're going to continue to stay focused on growing NGS and expect to continue to see growth over time in revenue per test. I'm not sure I would extrapolate 12% in one quarter over time, but I think we continue to expect to see growth. And then I think there's two other areas that we have, you know, focus initiatives on. The first is our revenue cycle, just collecting more for the work we're currently doing.
We've seen good improvements in that for the year, and I think we actually have, you know, a multi-year opportunity there. And then the last area is just price. You know, we are seeing price increases with our direct client bill contracts, and we're working on taking a more coordinated approach with our managed care pricing as well. And this is an area where we think dedicating some resources and some talent is going to help drive that revenue. So I think as we stand back and look at, we've had very strong growth this year, but we still see, I think, a multi-year opportunity to see revenue per test grow over time.
Chris Smith (CEO)
Yeah. So I think from a durability perspective, we see that continuing to run for the next several years.
Andrew Brackmann (Research Analyst)
Okay. That's perfect. And then, I appreciate you guys actually giving that color around sort of the NGS mix here. I wanted to ask on the non-NGS side, because I think by my math, you guys put up growth, call it in the low teens, the mid-teens in the quarter. Can you maybe just talk about the durability of growth in that category as well, just as we.
Chris Smith (CEO)
Yeah
Andrew Brackmann (Research Analyst)
Look at those more traditional tests? Thanks.
Chris Smith (CEO)
Well, I think, you know, look, I would say that a couple things are, are impacting that. One is, look, I would say, and we've shared this pretty publicly, starting at the end of last year, that we are winning much more now than we're losing. So we're moving share, and moving share is obviously helping move modalities. And I think when you think about those modalities, they would grow, I guess, anywhere from probably 2%-4% would be normal market growth rates. We're growing faster than market in every single one of our modalities. But in addition, what Jeff just talked about, this whole strategy that we're having around revenue cycle management doesn't just help with NGS, but it helps across the board. And so that's helping us from a revenue perspective in all those modalities. So we're seeing really nice growth there.
And I think that's, you know, look, the—we still, when you look at the whole market, there's still lots of runway where, from a market share perspective, where we believe that we can, we can only not only win new accounts, but also expand. And I think Warren, and he's here, so we can throw it to Warren. But Warren, is there anything else you want?
Warren Stone (Divisional President of Clinical Services)
I think that's probably the high level, Chris, is that you know, ultimately, it's our commercial strategy that we're executing again. So, we're losing less than what we have in the past. That's a fundamental for us to build on.
Chris Smith (CEO)
Winning more.
Warren Stone (Divisional President of Clinical Services)
Expanding share of wallet is obviously significantly easier with existing customers. And we've actually been really, really effective there. That's been probably our area of largest growth. And then lastly, it's obviously winning new customers, which is, as we've expanded our, our sales resource, that's another area that we've focused in on, and we feel that a lot of the wins that we've secured in 2022 will annualize into 2024, which obviously provides some, some tailwind as we move into next year. That's really effective execution of the strategy, which is driving above-market growth of these other modalities.
Chris Smith (CEO)
And then I think that, you know, we clearly see a correlation between improved turnaround time and sales growth as well. So as our operational efficiencies continue to improve, you know, it's helping us drive incremental volume.
Andrew Brackmann (Research Analyst)
Okay, that was great. Thanks, guys.
Chris Smith (CEO)
Thanks, Andrew.
Operator (participant)
The next question comes from Alex Nowak with Craig-Hallum. Alex, please proceed.
Chris Smith (CEO)
Hey, Alex.
Alex Nowak (Senior Research Analyst)
Okay, great. Good afternoon. Hey, good afternoon, everyone. Really strong NGS gains, as we've talked about here so far in the call. You know, the company lost market share in NGS in the molecular business over the last couple of years, really before the new team has joined. So is this really taking back market share from those gains that were lost, or is this better penetration of NGS into your existing customers that maybe haven't used NGS to the full extent?
Chris Smith (CEO)
I would say yes. I mean, it's really both. I mean, I think we have the market growing 15%-20%, so when we're growing 35+, not only are we growing with the market, but we're moving share. So it's really a combination of both.
Alex Nowak (Senior Research Analyst)
Okay, got it. And then the next MolDX resubmission here, is that going to be to grant a broader MRD and recurrence label versus the five-year recurrence label we have today?
Chris Smith (CEO)
Let me let Vishal kind of take that one and talk about what's going on with our products in MolDX.
Vishal Sikri (President of Advanced Diagnostics)
Yeah. So that is correct. It's going to be an expansion to our current approval that we have from MolDX, both in the recurrence and surveillance space.
Alex Nowak (Senior Research Analyst)
Very easy. Excellent. Thank you.
Chris Smith (CEO)
Thank you.
Operator (participant)
Up next, we have David Westenberg with Piper Sandler. David, please proceed.
David Westenberg (Senior Research Analyst and Managing Director)
Hi.
Chris Smith (CEO)
Hey, David.
David Westenberg (Senior Research Analyst and Managing Director)
Thank you. Hi, guys. Thank you for taking the questions and congrats on a really good quarter. I mean, I appreciate all the commentary on the NGS growth. The ASP lift, I mean, it was really big, and so I want to actually just cut in a little bit more into that lift, revenue cycle management piece. I mean, I don't know if you can quantify it, but kind of help us frame the size of that lift. How much meaningful wood is there to chop in terms of revenue cycle management?
Then just maybe even in this quarter, was there any one time in this quarter from that revenue cycle management, just to be aware of as we're modeling ASPs, because I think you beat the street by, like, $40 or something like that in the quarter?
Chris Smith (CEO)
Yeah, let me maybe take it a couple of ways and let Jeff kind of get into the details. So we haven't disclosed how much the opportunity is, but when we built, you know, the way we've thought about the business over the next, you know, several years, there's opportunity to continue to move that out. And David, I think we may have even talked about this when we met in San Francisco, that being new to the industry, I'm incredibly surprised at just generally how bad the industry is getting paid for the work that we do. And I think, you know, we believe that reimbursement and billing should be a core competency of the company, so we're spending a lot of time, resources, and energy, I would say, doing innovative things that we think will significantly improve our ability to get paid for what we do.
Jeff, do you want to give more?
Jeff Sherman (CFO)
Yeah.
Yeah.
From an overall NGS perspective, look, I think roughly 60+% of the revenue per test is driven by just NGS mix and price within NGS, and then the balance would be revenue cycle initiatives and other modalities that we're seeing growth in. And so again, with that relatively low penetration percentage as a percentage of our total clinical revenue and our continued focus on driving that, we do see an opportunity to continue to drive that. Again, I wouldn't extrapolate one quarter, but we've got 10% revenue per test year to date, and it has clearly stepped up from where we've been, you know, the previous 8-10 quarters before that.
David Westenberg (Senior Research Analyst and Managing Director)
Got it. And just a quick one. Well, maybe it's not really that quick, but just thoughts on PAMA, if and when it returns, how we should think about that for 2024 or 2025, in terms of our model. Thank you.
Chris Smith (CEO)
Do you want, do you want to take that, Warren?
Warren Stone (Divisional President of Clinical Services)
Yeah, I mean, if it, if and when it returns, I mean, it's difficult to actually understand exactly how it will impact. Certainly, some of the, the lower value modalities is, is certainly where some of the cuts are, are slated at the end of the day. As we look forward into the future, we don't see that as a material impact to our performance. Certainly, it'll be a. If it does materialize, it will be a marginal headwind to, to AUP, but nothing too material because it is with the lower value modalities that are in focus.
David Westenberg (Senior Research Analyst and Managing Director)
Thank you.
Chris Smith (CEO)
Thanks, David.
Operator (participant)
Okay. The next question comes from Tejas Savant with Morgan Stanley. Please proceed.
Madison Pasterchick (Equity Research Associate)
Hi, this is Madison Pasterchick on for Tejas. Congrats on the strong quarter. Just looking at the guide and what it implies for fourth quarter, could you maybe give us some color on why you think the conservative, like, flat sequential growth for top line is a fair assumption for the quarter? And is there any conservatism baked into the guide, and what are you assuming on the budget flush there for pharma at the midpoint?
Chris Smith (CEO)
Yeah, I lost you in the middle part of your question. Can you say that last—Jeffrey, did you get it all? Are you good? I, I lost you in the middle. Can you, can you say that again? You're talking about the, the conservatism in the guide, but.
Madison Pasterchick (Equity Research Associate)
Yeah. Yeah, just wondering, what kind of conservatism is built into the guide for the fourth quarter, and if you're assuming kind of any budget flush. Just looking at, it looks about flat sequentially from third quarter to fourth quarter, so trying to parse out some color there.
Jeff Sherman (CFO)
Yeah, I mean, the midpoint is roughly flat, but it is a range, you know, of performance for Q4. So, I wouldn't call out anything, you know, unusual in Q4. You know, we expect to see, you know, continued improvement as we have throughout the year. But clearly, as we think about, you know, guiding for Q4, wanted to give a range that we thought made sense.
Madison Pasterchick (Equity Research Associate)
Gotcha, that makes sense. Anything you're assuming there on the, on the budget flush?
Chris Smith (CEO)
On the what?
Warren Stone (Divisional President of Clinical Services)
Budget flush.
Jeff Sherman (CFO)
Flush. I'm not sure what you mean by budget flush.
Madison Pasterchick (Equity Research Associate)
Okay, it just was in biopharma.
Chris Smith (CEO)
On the business?
Jeff Sherman (CFO)
I'm sorry.
Madison Pasterchick (Equity Research Associate)
Sorry, I don't know if the breakout.
Jeff Sherman (CFO)
Can you say that?
Madison Pasterchick (Equity Research Associate)
Yeah, I'll just move on to the next question.
Jeff Sherman (CFO)
Okay.
Madison Pasterchick (Equity Research Associate)
Just can you talk a bit about any conversations you've been having with biopharma customers and any feedback you've been getting from them? And I know you talked a bit about the tougher macro environment in ADX, so any color there you've been seeing?
Chris Smith (CEO)
Vishal, you want to take that?
Vishal Sikri (President of Advanced Diagnostics)
Yeah, I can take that. So we do hear from our pharma customers that there is consolidation in terms of the number of clinical trials that they're running, number of compounds that they're focusing on. A lot of it was earlier on in the small biotech, but we're hearing this a little bit on the larger pharma companies also. So based off that, I mean, that's why we saw a little bit of a slowdown in Q3 compared to the previous quarter, and we do expect it to continue a little bit going into Q4 and early 2024. But we're hearing consolidation, especially when it comes to the programs that they're focusing on, the limited number going into 2024.
Chris Smith (CEO)
I think our broad menu of testing does help us.
Vishal Sikri (President of Advanced Diagnostics)
It does.
Chris Smith (CEO)
You know, soften some of that impact because we're not just focused on a couple of different single modalities.
Vishal Sikri (President of Advanced Diagnostics)
It's a small percentage of our overall.
Chris Smith (CEO)
Yeah. Yeah, we talk a lot about the importance of a portfolio effect. I mean, having informatics and pharma and radar and clinical, you know, if, if one of those slows down a little bit in a quarter, even though you see good long-term opportunities, the other's covered, and I think that's what you really saw here in the quarter.
Madison Pasterchick (Equity Research Associate)
Gotcha. That's really helpful. Thank you.
Chris Smith (CEO)
Thanks.
Operator (participant)
The next question is from Mike Matson with Needham. Mike, please proceed.
Chris Smith (CEO)
Hey, Mike.
Joseph Stringer (Senior Analyst)
Hey, everyone. Hey, this is Joseph on for Mike. Congrats on the quarter. Maybe just a couple around RaDaR. I'll try to just put this all into one. But for breast, looking just, you know, at the expanded coverage, do you think that timeline could be a little bit quicker than the other two submissions, just given that you've already had, you know, dialogue with them and a previous submission? And then just a reminder, I know you guys said it before, but, you know, under the current reimbursement profile for breast that you guys have, about what percentage of that, you know, potential MRD volume for breast cancer patients, is there with that, you know, current reimbursement?
And then just, you know, looking at the other three submissions that you guys announced, can you maybe just talk about your confidence on those submissions, you know, if you have enough evidence with those. I know you guys, you know, didn't necessarily get awarded for colorectal. You're looking at more evidence for that. Maybe could you put a timeline of, you know, when you're expecting that submission, if it could be by the end of the year?
Chris Smith (CEO)
Okay, that's a lot of questions.
Jeff Sherman (CFO)
Yeah, a lot of.
Chris Smith (CEO)
In one there, so
Joseph Stringer (Senior Analyst)
Yeah, my bad.
Chris Smith (CEO)
Good way to ask one question.
Vishal Sikri (President of Advanced Diagnostics)
So, I would say that we do expect a faster timeline on the breast—on the expanded breast compared to what we saw with the colorectal, as an example. We were able to go out and get the initial breast indication, and we believe that we have a relatively good handle on what is expected by MolDX now. In terms of the, you know, number of MRD coming from breast cancer patients versus our current submission, we haven't broken it down by type of cancer so far, so I think we're going to leave it at that. But, you know, we obviously focus a lot on breast cancer because of our high sensitivity value proposition that you need in breast cancer.
Confidence in the other submissions, I think, you know, for head and neck and for lung, as we've mentioned, we have submitted. One of the big things that we did not have with colorectal, that we do with these submissions, are publications that we feel are strong and feel will add a lot of value, especially when it comes to patient care. So we've utilized those as part of our submissions. And in CRC, at this point, we're probably looking at something for CRC in 2024 and not in 2023. I think I captured it all.
Joseph Stringer (Senior Analyst)
Okay, thanks. Yeah, yeah, that was, that was everything.
Chris Smith (CEO)
You just remembered the quarter. Thanks.
Joseph Stringer (Senior Analyst)
Yeah, thatwas, that was great. I'll just do one more quick one then on RaDaR, and it'll just be a single question. I guess just looking into 2024, you know, maybe this time next year in 2024, you, you could have, you know, RaDaR clinically in, in multiple different cancers. I was just wondering if you could kind of frame up, you know, maybe the gross margin for those, or I guess the, the high bar or the, the low bar of what type of gross margin you could- gross margin improvement you could see from these tests as they, you know, start to ramp clinically.
Chris Smith (CEO)
Yeah, I don't, yeah, I admire you trying to get that question, but we obviously haven't given guidance for 2024. And look, it's early days with RaDaR. So I think. Look, I think what we believe it's important to get coverage, and the way to get coverage is to make sure you're running the right clinical trials and getting those published. So look, this is the first time we've ever talked publicly about how many ongoing clinical trials we have. To give color, there's a lot going on with RaDaR. So I think as that starts to come to fruition, we'll update you, but we're not giving any kind of financial guidance around gross margins or anything on RaDaR for next year.
Joseph Stringer (Senior Analyst)
Okay, sure. Fair enough. Well, congrats on the great quarter, you guys.
Chris Smith (CEO)
Thank you.
Operator (participant)
The next question comes from Tom Stevens with TD Cowen. Tom, please proceed.
Tom Stevens (VP)
Hey, all. Massive quarter. Congratulations. I just had a quick one, again, just to kind of beat the dead horse on your kind of CGP portfolio and kind of just where you're winning there. I mean, you talked about operational efficiency, you talked about, you know, more specialist sales force. Is it as simple as fast turnaround times and being in front of clinicians, or is there something more going on?
Chris Smith (CEO)
Well, I think there's a lot of things at play. I mean, I think a lot of these fit under our sales optimization strategy and our focus. And as you know, we started adding field people towards the end of last year and then into this year to start to focus more on community oncologists, because we had been pretty heavy on, you know, the pathologists in the hospitals. I think that's definitely making an impact. You know, we were really a non-player in solid till we launched a product in March. Takes the time to get the product moving, and look, we continue to be the heme leader, and we continue to bring new innovations out on the heme side. So I think it's multiple things, but maybe let me give. Warren can maybe give even a little more color around.
Warren Stone (Divisional President of Clinical Services)
I think the multiple things is exactly it. It's a lot of number of things acting in concert, and I think one of the first things I want to call out is the work we've done operationally from a turnaround time perspective. And we spoke about that in the call, but obviously, with the importance of the NGS to our overall performance, we give that extra focus, and we've done really well there from a turnaround time. I think the added resources in the field is the second factor here that's really contributing to the success.
And then thirdly, is the execution of the sales strategy that I spoke about earlier, coupled with new products that we've brought to market, not only the CGP panel that we brought to market in March of this year, but also the new Heme Neo Comprehensive that we launched earlier in quarter three. Those all contributing. So there's a number of factors in concert that are sort of compounding one another that's driving the performance.
Tom Stevens (VP)
Wonderful. Yeah. So I guess I'll follow up with a two-parter there. I guess, just on the back of that, going into next year, you know, should we expect these kinds of growth rates going into 2024 within the NGS portfolio, given the number of launches and the sequence you've had this year? And then just the second one, a bit unrelated, is kind of: have you guys thought about or outlined kind of the net gross margin benefit you get from this LIMS reorg?
Chris Smith (CEO)
So internally, we have. I mean, I think this LIMS was a huge project, and to give you an idea, even the planning of it took us several months to really get to a place where we felt good about it. We carved it out of the business, so and given it dedicated resources to ensure that we're able to get the focus and the execution. But when you've done, you know, five acquisitions over the time history of the company, and running on multiple, multiple LIMS systems, the inefficiency from a gross margin perspective is significant. As you know, when you put one of these in, it's like doing an ERP project. It takes time, so you're not going to see this, you know, starting January first, right?
We believe we'll get some positive impact starting in H1 of 2024, but it really is an ongoing that we think we'll see, you know, a 4.5, take it, to say, over a two-year period, we'll see, continued impact on that. And then do you have anything else?
Jeff Sherman (CFO)
Just on the NGS growth. Look, we continue to expect NGS are going to grow next year, but we'll give more color on that as we give our guidance going into next year.
Tom Stevens (VP)
Wonderful. Congrats on the quarter. I'll get back in the queue.
Chris Smith (CEO)
Thank you.
Operator (participant)
Once again, if you have a question or a comment, please indicate so by pressing star one. Up next, we have Matthew Sykes with Goldman Sachs. Matthew, please proceed.
Chris Smith (CEO)
Hey, Matt.
Prashant Kota (Healthcare Equity Research Senior Associate)
Hey, guys. This is Prashant Kulkarni for Matt. Congrats on the quarter, and thanks for taking the question. So, could you clarify on the additional breast MRD submission? I know it's been talked about, but is that for triple-negative breast cancer?
Chris Smith (CEO)
Prashant, go ahead. Hey, Matt. Yeah, it is for triple-negative breast cancer.
Prashant Kota (Healthcare Equity Research Senior Associate)
Got it. Okay, thank you. And then, how much market share do you see RaDaR capturing over the longer term, given the competitive landscape?
Chris Smith (CEO)
Well, look, I think the way to think about, you know, a lot of y'all, you know, right, in the market, the analysts have been writing that it's a $20 billion market and, you know, less than 1% or 2% penetrated. So there's a lot, a lot of runway. I mean, obviously, there's a company in front of us. There's multiple companies coming out. But look, I would not say that we publicly disclosing, you know, what the share is. I would say, look, what we're seeing is our sensitivity is significant, and we're seeing that really makes a difference in disease cancer states where sensitivity matters, places like breast, you know, lung, et cetera. So I think it's just too early to try to speculate how the share will all work out.
But look, big, big market with lots of opportunity.
Prashant Kota (Healthcare Equity Research Senior Associate)
Got it. And, just and lastly, any color on the sales force expansion?
Warren Stone (Divisional President of Clinical Services)
Yeah. So we continued to expand our sales force in the latter part of Q3 and into Q4. A lot of the work we're doing in full transparency really culminates into a sort of redeployment that we're kicking off very early in 2024 that will position us to continue the momentum that we've experienced in 2023 thus far.
Prashant Kota (Healthcare Equity Research Senior Associate)
Got it. Thanks, guys.
Operator (participant)
The next question comes from Mason Carrico from Stephens. Please proceed.
Jacob Krahenbuhl (Equity Research Associate)
Hey, guys. This is Jacob on for Mason. Thanks for taking the question. Congrats on a strong print. So appreciate all the color around the NGS growth. Lots been covered there, but maybe just digging a little bit deeper in there. Could you talk about how the growth trended during the quarter in NGS across heme versus solid tumor?
Chris Smith (CEO)
So we build all our NGS kinda together, so we don't break out what's heme or solid. So I think we've been pretty open publicly that we were really a non-player in solid till we launched our new panel in March. But we don't disclose which. How much is heme or how much of it.
Jeff Sherman (CFO)
And, we don't really talk about interquarter, you know, performance either.
Chris Smith (CEO)
Yeah.
Jeff Sherman (CFO)
So we prefer to just talk about in quarterly increments.
Jacob Krahenbuhl (Equity Research Associate)
Okay. Yeah, thanks for that. So on.
Chris Smith (CEO)
It's really for competitive reasons. It's not that we don't wanna give any color, but look, it's a highly competitive place, and I think we're really pleased with where things are going, and we just, from a competitive perspective, don't disclose that.
Jacob Krahenbuhl (Equity Research Associate)
Yeah, no, that makes sense. So on that new test you launched, Neo Comprehensive, it's been out there in the market for a little bit now. Could you maybe talk about how adoption trended? And maybe more specifically, do you think you're converting docs away from competing offerings that have been on the market for a little bit, or do you think the majority of the growth is just coming from broader market expansion?
Warren Stone (Divisional President of Clinical Services)
Yeah, it's a combination of both. There's certainly many cases that we could cite where there's been conversions that we've managed to accomplish. In other cases, we have broader market expansion because of the growth in the market that we're actually benefiting from. So it's a combination of both. And again, I reiterate the fact that the investment from a sales team perspective is really what's helping out.
Chris Smith (CEO)
I think that's helped a lot. You know, one of the things that's always been a strength of Neo has been the community setting. So think about the community oncologists, and a lot of them, there's a lot of our competitors who are living primarily in university or research institutions. And so our ability to continue to penetrate the community oncologist is a key factor to our growth. I mean, lots and lots and lots of treatments going on in the community.
Jacob Krahenbuhl (Equity Research Associate)
Got it. And then, if I can just squeeze in one final one here. On your commercial sales team, you talked about how you're continuing to expand in Q3 and Q4, but I think you previously mentioned that you really didn't plan on materially scaling that team in 2024. Is that still the plan, or have your thoughts changed there?
Warren Stone (Divisional President of Clinical Services)
Yeah, I think most of the investments that we're gonna do from a commercial expansion perspective are happening at the very back end of this year. And they may. Some of it may roll into Q1, but it's all part of a larger plan for 2024. And those resources are really focused in terms of customer facing, but also putting, investing in the back office to ensure better enablement, because this is where we're gonna drive the productivity improvements of the sales team, which is gonna allow us to sort of do more with the existing team that we have. So that's gonna help to negate the need for further investment, certainly in 2024, but we'll reevaluate that later, probably this time next year, in terms of what we wanna do for 2025.
Jacob Krahenbuhl (Equity Research Associate)
All right. That makes sense. Thanks, guys.
Chris Smith (CEO)
Thank you.
Operator (participant)
The next question comes from Puneet Souda with Leerink Partners. Please proceed.
Puneet Souda (Senior Managing Director of Life Science Tools and Diagnostics)
Yeah. Hi, guys. Hey, Chris, thanks for taking the question. So, maybe at a high level, and I apologize if this was covered, but I wanted to get your view on the revenue cycle management has been a big focus. Obviously, you're seeing improvement here in AUP that is remarkable. So maybe can you talk about where you are in that revenue cycle management transformation process, how far it's done, and sort of what's left to go? Maybe just talk about that at a high level, if you could.
Chris Smith (CEO)
Yeah. Puneet, I know it's a busy day with the markets closed. We did cover some of it early, but we'll—we're happy to jump back into it. Look, I think one thing we talked a lot about is our mix, and by NGS being, you know, only 25% of the clinical revenue, lots of runway, and so obviously higher ASPs, et cetera. But what Jeff did kind of dive into a little bit more were the other levers. Do you wanna talk about it? We, I mean, we did talk about revenue cycle as a multiyear strategy, as we kind of looked at it, but do you wanna give.
Jeff Sherman (CFO)
Yeah. I would say we're still in the early phases of capitalizing on the opportunity and revenue cycle, Puneet. What I said earlier on the call was, you know, roughly about 60%+ of our improvement in revenue per test was driven by NGS mix, and the balance was pricing, revenue cycle improvements, and some mix in our other testing volume. But as we think about what we're expecting to get paid and what we are getting paid, we still see room to improve there, and it's not a one-quarter or two-quarter process. I think it's a multi-quarter process. We wanna use technology more efficiently to make sure we're being efficient, making sure we're getting prior authorizations, making sure that we have a medical necessity covered, medical records covered.
So there's a lot of different drivers, and it frankly varies by payer, where the opportunity exists. But I think we have a good, good handle on where we're not being paid and, and have plans in place to close that gap.
Puneet Souda (Senior Managing Director of Life Science Tools and Diagnostics)
And do you want to talk a little bit about contracting? Like, we have, like, 200 payer contracts, but how you thought the managed care runway?
Jeff Sherman (CFO)
Yeah, so managed care was another area, just pricing. We also have a pricing lever, which is from our direct client bill, where we can do pricing, and that's about 65% of our clinical revenue. The remaining third is managed care contracting, and we've added resources to really go after, in a more coordinated, sophisticated way, pricing improvements on our managed care side of the business. So it's multifaceted, and that's why we think we have, you know, we still have room to run over the next, you know, couple of years in this area.
Puneet Souda (Senior Managing Director of Life Science Tools and Diagnostics)
Got it. Super. That's, thanks for all the insights there. And then one more on, you know, labor, inflation was a bit of a concern early on, and then cost of goods was a concern, continues to be a concern for some of the labs. But just maybe just talk to us overall about labor costs and inflation that you're seeing. And do you see, you know, the layoffs among the biotechs and some of the diagnostics companies out there, potentially giving you an opportunity, in the hiring landscape, to address some of those concerns, in the market? Thank you.
Chris Smith (CEO)
Well, look, I definitely think when some companies have gotten out over their skis and they do some type of change from a financial perspective, we definitely look for great teammates. I mean, I think it. Our people are our greatest assets, so I think anytime we can add there. I think the other thing that's really helped us is we're pretty diverse on where we are. I mean, we have wet labs in Houston, you know, in Orange County, Fort Myers, and Raleigh. And so I think that we feel incredibly good about the labor pools in those markets and our ability to attract and keep great talent. So we have not seen a big impact.
You know, look, I will say that, you know, our view is that we want to make sure that we hire the best, and we pay them fairly, but I wouldn't say that we've had a big impact. The one thing, and again, this came out in my pre-remarks, is that we really. You know, Neo didn't really spend a lot of time around purchasing and procurement, and we spend, as you can imagine, you know, millions and millions and millions of dollars. And so one thing that has changed over the last six months is bringing in a chief procurement officer and our ability to put some systems in place that we think allows us to do a much better job of managing the purchasing side of the business.
Puneet Souda (Senior Managing Director of Life Science Tools and Diagnostics)
Got it. Okay, super. I think all the radar questions are covered, so I'm good. Thank you.
Chris Smith (CEO)
All right. Thanks so much.
Operator (participant)
Okay, we've reached the end of the question-and-answer session. I will now turn the call over to management for any closing remarks.
Chris Smith (CEO)
Okay, so for the folks that are still on, look, we really appreciate you taking the time. It was a busy day in our sector and the market, so thanks for hanging in there with us and learning a little bit about what would happen in the Q, Q3. And look, we'll look forward to coming back to you with the Q4 results sometime after the first of the year. Until then, take care.
Operator (participant)
Thank you. This concludes today's conference, and you may disconnect your lines at this time. Thank you for your participation.