Butterfly Network, Inc. (BFLY) Earnings Call Transcript & Summary

Thank you so much for joining us today at our Healthcare Conference. It's a real delight to have you. Maybe just given your background, I think it might be very helpful just to get a little bit of context around what brought you to Butterfly? Some of the things that you saw in terms of the opportunity and ultimately, what you see kind of going forward from here?

So thank you very much for having Butterfly here, having me here. I appreciate it very much. What brought me to Butterfly was -- so my last company was InTouch Health. We had sold the company to Teladoc Health, which was a great deal for us, it about a $1 billion deal, and I thought I wouldn't be working anymore after that. I took a year off and became Chairman of Caption Health, which is an AI ultrasound company and one of our partners was Butterfly. Caption Health had an AI algorithm for cardiac echoes and they needed a device to be able to deliver that algorithm on, and that was Butterfly. Subsequently, we sold Caption Health to GE. And being "retired" after Caption had sold to GE, Butterfly was in the midst of a CEO transition and they gave me a call. And my wife pushed me out the door and said, "Look, you're not really retired, you're still working, you might as well get paid for it." But what interested me very much in Butterfly is on the headline, people would say it's an ultrasound device, what's special about an ultrasound device? When you look under the hood, it's not just an ultrasound device, it's a complete revolution in imaging, not even close. And it is a harmony and synergy between cloud-based imaging, cloud-based storage, data, health care, data management, image acquisition and then the ability to democratize imaging and health care. 2/3 of the world today doesn't have access to medical imaging. Medical imaging is big, it's bulky, it's expensive. And the founders of Butterfly discovered that they are able to use a semiconductor to deliver energy. And I think for anyone new to the story, it's really important to understand how that semiconductor works. But after -- and I can go into that later, but once I understood the crazy incredible technology that this company had and also understand that it had this kind of fast start and then this fizzle, one of the things I've done in my career is, I've been able to align myself with undervalued -- not understood assets. And I have been able to create value from them. Computer Motion. I spent 10 years at U.S. Surgical which is where I did my medical residency, let's say, as an executive. And if you know anything about U.S. Surgical, Maverick's CEO, incredible technology and commercialized minimally invasive surgery and surgical stapling changing surgery in every operating room in the world twice. Then I went to Computer Motion, which was a medical robotics company that none of you know of. But if you -- we merged with Intuitive in 2003 and my investors in Computer Motion today own a 1/3 of Intuitive Surgical. So if you want to figure out the value of that transaction, it was pretty substantial. And that was a very not understood company. I went to Rita Medical, I went to Smith & Nephew, Andrew Dynamics. Each of those had a great experience with and then InTouch. So when I look at the future of imaging and I look at digital, Butterfly is right in the center of it and we're leading it.

Super, super helpful context. Thank you, Joe.

Maybe if we could also talk a little bit about when you think about what Butterfly is doing from a platform perspective, what's the secret sauce as you think about it? What really makes the platform, the technology so special?

And again, if you're going to look at Butterfly and invest, you have to understand this core dynamic. And it was manifest in other industries. Digital over analog; this is not the first industry that has seen digitization. And the best analog that would explain where Butterfly is well, first of all, Butterfly created a semiconductor that has MEMS technology married to it. It's a double wafer. And the MEMS technology has on our semiconductor chip, we have 9,000 little sensors. So think of those sensors as a pixel on an LCD screen. You control the color of 1 pixel, you then control all the pixels, now you have an image. A standard ultrasound device has a crystal or a lens. So imagine having a camera and you want to see far, you have to put on a lens to that camera. Now it's not adjustable because it's a piece of crystal. And so in order to see different parts of the body, you need different devices. If you go into the hospital and see a big ultrasound device, they'll have 4 handles or 4 probes attached to that device. What's core to Butterfly is they created a semiconductor that can deliver all the energy on demand. So you have 1 device, you tell it I want to do an abdominal scan, it automatically tunes it for that abdominal scan and you go. You want to do a cardiac scan, you just say cardiac, it tunes it and goes. So it's this complete dynamic array within the semiconductor that allows you to dynamically change it. Now why is that important? Well, a cart -- an ultrasound cart costs $30,000 to $200,000. Not very mobile and it's very expensive. Well, what Butterfly is doing is it's following this digital trajectory to power and miniaturization to help democratize care. And so that is the core essence is, what makes our platform unique is we're the first ones to do ultrasound digitally. Now the analog to that is remember, some of you are old enough, some of you aren't in this audience, I can see. But in 1995, the first digital camera was launched. Remember -- anyone remember Kodak launching a digital camera? And at the time, the big question was will digital overtake film. And everyone got so excited. You mean I don't have to develop film. You mean I can store it, you mean I can delete those bad photos and keep the ones I want. But it flopped. And it flopped because the image wasn't good. It was a 1 megapixel image. The moment you zoom in, it pixelates. And people said, "I can't really depend on this as my camera." Two years into the development, Kodak shut it down -- famously shut down the program. Well, a lot of other people said, "Wait a minute, there's way there. And Fuji and Toshiba and Canon and others, what did they do? They continue to develop the processor. They continue to develop the semiconductor. And what happened in the late '90s and early 2000s. We got 3 megapixel images, 5 megapixel images, 7 megapixel images, until in 2003, the market sold more digital cameras than film and has never looked back. That is what's happening with butterfly today. Butterfly has a processor and we went out with a lot of fanfare early on because the opportunity to have digital photography was so captivating, just like it was for Kodak. But fortunately, Butterfly stayed the course. And we just launched our third generation probe with double the processing power. We have Moore's Law on our side. We can double our processing power every 18 months, and that's been consistent for the last 60 years. and it will be consistent going forward. So what makes Butterfly special is the other 2/3 of the world are going to have access because we sell our device for between $2,000 and $4,000 depending upon which device, not $30,000 or $100,000. And in the next 3 to 5 years, the next processors we have coming out will be as good as a $200,000 devices. So if you think about it, supercomputers used to be huge, right? Massive. And now everyone carries one in their pocket. In the future, every doctor in the world, every nurse in the world will have a butterfly in their pocket. And that's what brought me to Butterfly.

Super interesting. Thank you, Joe. Thank you so much. Look, just pivoting to commercial progress, huge huge congratulations on the iQ3 launch. It seems like it's going very well. Can you talk a little bit about the launch? And also as you Joe, you're out in the field talking to customers getting feedback, what's resonating most with them as they try and use and buy the technology in your conversations with them?

Just as I just said, our customers say to us today, you did it. That's what they say. I've heard 2 people say this independently that with your iQ3, Butterfly today is everything we hoped it would have been. Because anyone following Butterfly was a SPAC, went public at $10, stock went up above $20, and now we have a below-dollar stock price. It's excruciating when you think about that evolution and because people got very excited about the vision, just like everyone got excited about digital photography in Kodak. But we went too hot too fast. Now we have a runway. We've launched our third-generation chip, that's double the power. We have our fourth generation chip, which is the next major leap in development that will be out at the end of '26, beginning of '27, and then we have another chip that's in development that will be 20x the power of what we have today. How does that change imaging if I have that kind of power in your pocket? Well, a lot of you on your phones right now are your iPads. That's how every single person is going to have it. And no one is even close. No one is even close to where we are. We've invested $300 million in this technology. We have 600 patents. Our moat is huge, and everyone is starting now to wake up because before we were a novelty, oh that's cool. You have 1 probe that can do every image. Tell that to the 1,000 Medics in Ukraine right now. They have it on their hip. Tell it to 600 caregivers in Israel and Gaza, they have it on their hip dealing with that crisis. They don't want to have a cart with 4 probes. They want to be able to get a decision like that to all the EMS services in the U.S. who are using it, tell it to the midwives in Kenya who are using it, we're democratizing imaging. Everything that our founder, Jonathan Rothberg envisioned and would hope would have happened is happening now. And so our sales are taking off. Our first quarter was great. We're at the end of our second quarter, so I can't really I can't really say much, but our customers are telling us that you did it and now they're taking notice. And I think the big change for us today is most of the imaging that our second-generation technology did meets the needs of general practitioners, EMS, and [indiscernible], et cetera. but we couldn't crack cardiac. And cardiac is probably the biggest ultrasound imaging segment out there. And we compete against GE and Philips and other independent companies. And what they do is they just simply sell their 4 probes as individual 4 probes. Why? Because they use crystals and crystals can't be modified. So if you want this signal, you have to buy this probe, this signal, you have to buy this probe. It is not a true point-of-care ultrasound application because you have to know what you're going to do before you take the image. And what we've learned is specialists like a cardiologist, wants to be able to do an MSK scan if they want to or they want to be able to place a needle if they want to. So just because they're cardiac, doesn't mean they want to look at the heart all day long. If they want vascular access, they don't want to have to go pick up another probe. So I feel right now, and it's so frustrating because the market doesn't get it yet, they still look at Butterfly and look at the -- what's happened to the stock price. There's a lot of muscle memory in where our stock is. But boy, anyone who's wise enough to get in now is going to be rewarded greatly because it's happening in the market, and you just have to look and just -- we did, before we launched a product, we surveyed 470 clinicians. We did a blind -- we showed the images blind. They didn't know who the company was. We just said, "which image do you like, A or B?" We took the exact same image, ourselves and GE, and the vast majority picked our product. So if I'm better than GE in cardiac imaging on my handheld based upon not me sensationalizing it, but based upon that survey data, and yet I have the ability to give cardiologists around the world, the opportunities to do an abdominal scan, to be able to do a pulmonary scan, to be able to do a peripheral vascular scan or be able to look at scan very superficially or musculoskeletal, why would you buy a one-trick pony that's not as good. And that's happen -- people are realizing that now. So what's happening for us is hospitals are starting to say, okay, this is no longer an individual product. We would see -- and they're now saying, let's talk about standardization, medical schools are wanting; 60%, 70% of medical schools today are training on Butterfly. So when those kids come out of school, they're going to know ultrasound.

That's super, super helpful. And maybe just double-clicking you talked a little bit about this in terms of the product road map and the innovation and where you're going. Is it kind of the next-generation platform? Is it capabilities and modules and kind of ability to hit different areas clinically that you're going towards? How would you talk philosophically about where that product road map is going, what you're trying to penetrate into as you think about that future innovation road map?

100%. So I told you that we are developing our fourth and fifth generation chips, and so we're going to continue to go to processing power and imaging capability. We're starting to reimagine what ultrasonography will look like. If I had a device that was as powerful as a cart, what would ultrasonographers do? Would they stay in a room with a device? Would they have a handheld device and make the patients come to them? Or would they go to the patient? I still think there'll be carts in the future, but I think the workflow dramatically increases because we have been now creating software. Not many people realize, but 65% of the ultrasound images that are taken in hospitals aren't reimbursed. Or let me change that. They're not submitted for reimbursement. So someone will do a scan and then they'll put the probe down, and they don't go through the effort of capturing the image and then filling out the documentation. So we've created a method there that allows us to plug into the EMRs that when someone goes in and then selects an abdominal scan, it gives them the codes for abdominal scans right there on the iPhone. And they click on the code right before they do the scan. So they have the patient in the phone that's linked to the EMR, they select the code. Once they're done with the scan, they submit the record. And when that record is submitted, it goes into the EMR and then it goes over to reimbursement to approve and submit. So now we're seeing hospitals have a massive ROI by deploying point-of-care ultrasound. And the University of Rochester, first hospital to put 800 devices out. And their revenue over -- more than doubled on ultrasound within the first 14 months. So in our developments, we are trying to -- now that we have the device that can capture the image better than anyone else, we are now looking to manage the data better than everyone else. So think about our data play. I have 150,000 devices around the world. I have 20 million images in my cloud. Name any other entity in the world that has 20 million images. And oh, by the way, I have 30,000 images a day streaming into my cloud.

Impressive.

So when you talk about AI. AI, what's the biggest challenge of AI? It's not the development of the algorithm, it's access to data. That's why Elon Musk talks about Tesla being a data company, not a car company because there's a massive amount of data coming in that they can use for intelligence. Well, so now we're going to monetize that data by developing new AI applications. So we -- but we learned that there's an industry of over 200 companies out there today, that are developing units -- just like Caption Health that are developing unique clinical applications of AI and ultrasound. Why? Why are there so many people developing AI for ultrasound? Because it's a hard image to take, and it's a hard image to capture. It's like being in a completely dark cave with a spot with a flashlight. You have to know exactly where to point that beam [Technical Difficulty] And then you have to be skilled enough to know what the hell you're looking at. That's ultrasound. But if I now can make it easier for people to capture an image and easier for people to understand that image, then now I can democratize it and so nurses and so doctors who weren't classically trained. The kids who are in medical school today, this generation are all going to do ultrasound. They're going to take their stethoscopes and they're going to put it to the side. Every one of them are going to scan somebody. The other day, I heard a story of a man about my age went into -- who had a difficult time urinating, went into the general practitioner. General practitioner, the typical symptoms for -- when you're not completely voiding your bladder is you have an infection, so they gave him antibiotics and then sent him home. But fortunately, for this patient, this doctor had a Butterfly, it scanned the bladder and found the tumor. I mean are you nuts? You imagine now, doctors have the capability. If you want to rule out abdominal pain, oh, you can have an appendicitis, you can have a bowel obstruction, you can have a AAA. That's how it presents as abdominal pain. Now your GP can just look inside your body and see what's going on right away. This is a medical revolution. And it is going to completely change the complexion of care. And every doctor is going to walk around with one of these devices in their pockets. And it doesn't stop there. There's so much other -- but when we talk about our road map, we're going to continue on imaging. We're going to continue on our middleware, so we can capture and make this really easy in its workflow. But then we realized, I can't compete with the 200 companies developing AI. No matter what, I already spend almost too much in R&D. We were -- we guided to $75 million to $80 million this year. I'm spending $45 million in R&D. It's well spent because of the semiconductor and everything else that we're doing, but it's still a lift. So I can't compete with those 200 companies. And you know what, we said fine. I don't want to. So we developed an SDK, and we created something called the Butterfly Garden. And the Butterfly Garden is an AI marketplace, where all of those 200 companies can have access to our software development kit and then put apps in the App Store or the Android store or the Google store, where someone purchases their app in the App Store, and we just launched the first one of these -- we launched Garden at the end of last year and the first partner has just commercialized their product, and they're called ThinkSono. It's an education DVT app. ThinkSono puts their app in the app store, customers download the app on their iPhone. When they open this ThinkSono app for Butterfly on their iPhone, they just plug their Butterfly into the app. And then now all the information from Butterfly populates ThinkSono's DVT app. And when they do the scan, then all the magic that ThinkSono does in its app occurs. And so instead of Butterfly having to compete with all these companies, we amplify them. And why do they want to work with Butterfly, because I've sold more of these devices than GE and Philips and the other companies combined, where we are the biggest install base in the world of handheld devices. And so we're the market. So people want to sell their software to our customers. And our customers want to buy their software because every new company that comes into our ecosystem makes Butterfly more valuable, just like your phone. You want something you just download an app. The phones killed all the other devices that used to have all these individual devices for these different applications. Now I have a thermometer, I have a calculator, it's all here. Well, that's now Butterfly. So Butterfly Garden is a massive development that allows us to focus our AI development, specifically on unique things to our semiconductor. For example, a flashlight -- Think of a flashlight, think of the beam that comes out of the flashlight. That's how ultrasound works today, straight beam. Well, because I control those 9,000 pixels on my semiconductor, I can do anything I want with the beam. So I can actually move the beam completely through the organ. So instead of being in that dark cave with that flashlight, I can actually just automatically scan the room and see each one of those images individually. You know how you have a burst on your iPhone, you press that, you hold that button while you're taking a picture, it gives you like 10 different images. We can just have a nurse going to the home, take the Butterfly and put it over your kidney, press a button, and it will take 42 images right through it, which is very similar to a CT scan or an MRI, CT or MRI are easy. The technician is not an artist or the technician is trained to put the patient on the table. Anyone here having an MRI done or CT? So you're on the table, they tell you to not hit your head as you get pushed into the magnet. And then the magnet goes [ dut dut dut ] and it cuts you up in fixed slices of images. And then a doctor then takes that file and goes down the elevator and goes through the organ and then chooses the right image in order to make the decision on. Well, Butterfly, because we have this dynamic chip, we can scan through slice the organ, but now without the sliced static ultrasound images and then present those 42 images to the doctor to then choose which images they want. So we -- so our development is focusing on how do we amplify our core technology and how do we amplify our chip, not how do we make a better DVT app, or a better echo app. We'll let the clinical companies do that and come into our environment.

That's very, very helpful, very thorough answer. One of the things that strikes me about Butterfly is just the breadths of applicability and the number of growth opportunities that you have. And so you spoke a little bit about medical education, everything that you guys are doing there. Obviously, international is a huge opportunity to touch on that a little bit. But then also even thinking about the partnership models and that being a core part of what you guys are also thinking about. What's kind of the framework with which you're thinking about deploying your resources, especially in this environment, what are you focusing on? How are you deciding what to focus on in running the company?

Well, that's a very good question. So we're maintaining our commitment to the semiconductor evolution. I saw -- I found a clip of Jensen Huang talking to Stanford students about 2 years ago. And he had said in the early days, we didn't know what our chip would be used for. We didn't have this business plan that said as we launched this next chip. Here are all the applications. And as we launched this next chip, here are the applications. He said, we just committed to build the fastest, most powerful AI chip. And then after we did it, we did it again, and we did it again, and we did it again. And there's a certain blind wisdom to that. Now Butterfly hasn't been able to capture the type of resources yet that they have. But we are committed to the advancement of our semiconductor technology. So we are developing our fourth and our fifth, and by seeing the reception of where we are with our third now, we know that there will be an insatiable appetite for the type of power that will be in that device in the future. So we're continuing to do that. We're continuing to invest in our middleware and we're continuing to invest in our Garden. Our Garden just makes us so much more applicable and allows -- the other part of the development is, going back to the camera story. So in 2003, the digital camera outsold film and then film fell off and the digital cameras accelerated. Well, how many of you today have a digital camera? Do you walk around with a digital camera? Where is your digital camera? I'm sorry? Oh, you carry a digital camera! Obviously, you must -- so you have probably something with a very high power and fantastic? The mass majority of people have a camera on their phone that occupies about 10% of the real estate of the phone, right? So it's not just processing power. It's miniaturization. So now imagine a device that's about this big. I'm holding up an AirPod [Technical Difficulty] Imagine a cardiac [Technical Difficulty] of congested heart failure patient. [Technical Difficulty] I think 70% of hospitals were penalized last year for too many readmissions. Imagine this now strapped onto a patient or imagine putting a temporary tattoo on the patient and just placing this in a certain area. They don't have to go search for that flashlight in the cave. They just press a button because I can go, boom, and I can scan through the body now, just like Star Trek, just like the Star Trek Tricorder, I can scan through it. So as we miniaturize home health and the ability to do image acquisition comes into play. And so we are working with partners today on finding ways to continue to not only miniaturize, and by the way, this semiconductor that we make is at [Technical Difficulty] the best chip fab in the world at TSMC; they're our partners. They're the ones who find that specific to our MEMS technology and they're the best partners you can have in the world. They are committed to our development. And when we talk about the future, and where we will be going, the future will be to liberate image acquisition, automate image acquisition, have miniature devices that can be worn as a wearable or a sensor or a home diagnostic tool that then allows the image to be automatically captured, sent to a remote caregiver and then they can determine how to modify people's medications. Say for congestive heart failure, really the symptom is pulmonary wetness, fluid in the lungs. And so today, they send patients at home with a scale and a pulse oximeter. And if they're gaining weight, that means they're retaining more water, and it's more an analogy -- analogous to heart failure increasing. So they'll then prescribe a diuretic in order to reduce the fluid in the lungs and that's how they balance. Can you imagine if a doctor at a moment can just say, "I want to scan you in your home without being there, getting the image and then making a clinical decision." It's insane.

Super powerful. Thanks for sharing, Joe. I think maybe turning just a little bit to financials. One of the things that you have very directly addressed since joining the company is [Technical Difficulty] and thinking about extending that. Can you talk a little bit about [Technical Difficulty] as well as kind of where you want to be and how you think about some of the trade-offs from that perspective?

Yes. It's probably the thing that's keeping our stock price down today. As everyone's -- we have about, as of last quarter, $116 million of cash, and we're consuming about $60 million a year in cash. Our revenue last quarter grew 14%, and we guided to a 15% to 20% growth for the year. So that would assume you're going to see accelerating revenue [Technical Difficulty]. But that revenue growth and that expense, the expense necessary doesn't get to breakeven on our own. So everyone is saying, you're going to raise money, you're going to dilute the shareholders and they're pricing it into our stock today. It's just where we're at. And it's hard to avoid that math. Because math is math. There's one X factor that I'm working on that I'm doing everything possible to avoid that happening. When I was at InTouch Health, we developed a secure private cloud that allowed you to talk to devices in hospitals without going through a VPN. We can ping directly to our -- we solved some secret sauce that allowed us to penetrate the firewall and get into the hospital. And just like AWS for Amazon, we solved the problem for ourselves that we then realized everyone else has. So we created an OEM business, and we started to sell software. Intuitive Surgical, back -- coming full circle, gave us $50 million for access to that cloud. That gave me nondilutive financing to then get to our exit and I never diluted a shareholder. So wait a minute, we just spent $300 million in 600 patents to create a moat with semiconductor-based ultrasound. We've decided to do something called Powered by Butterfly. And our Powered by Butterfly program is what my goal is to create nondilutive financing for the company. What does that mean? Well, we've done 2 deals so far. We announced we're doing power -- and what Powered By is, we will make our semiconductor available to a noncompetitive company in a noncompetitive market, so they can reach their ultrasound dreams without having to figure out a way around our patents and have to find $300 million to create a semiconductor. We've signed our first deal with Forest -- with Mandaera who is an ultrasound robotics company to do peripheral vascular access. If you look at it, it is the coolest thing you'll ever see. And they're going to be commercial in a year. They've paid us fees, development fees, and we have -- for every robot they sell now in the future, I'll be getting revenue. We have Forest Neurotech, which is a brain computer interface. They do an implant in the skull. And they use our ability to scan the brain with the moving of the beam where they can scan a segment of the brain, they can see vascularity and they can then deliver therapy. We are talking to about 15 other companies right now, And my hope is we could license our technology to constantly improve our balance sheet, which on one side is going to help us with our future revenue, but the more of these deals we do, the more it can help our balance sheet. And I'm hoping that with our accelerated revenue performance as well as with monetizing our investment that our shareholders, if I do this well and our team delivers on our strategy, we won't dilute shareholders. But -- if we don't, then we will.

Very helpful and sounds like very creative, thoughtful kind of strategy as you think about pathways forward for the company. Maybe just to close out, as you think about the next 12, 24 months, what would you leave investors with in terms of key things, a couple of things that they should be thinking about as they follow on and watch you?

We have a good team. we're executing. In the year that I've been here, we've done everything that we said we were going to do. And if you are shorting our stock, thinking that we're going to fail, and we're going to have this wild dilution, and we're going to go out of business, I'll prove you wrong.

Well, thank you very much, Joe. it's been a real [Technical Difficulty] everybody for listening in.