Cochlear Limited (COH) Earnings Call Transcript & Summary

Okay, good morning, everyone. And thank you for joining either here at Cochlear or online, all right, to be able to have another one of our Capital Markets Day. With COVID, it's been a little while, but it's certainly good to be back here. So today, I want to start with an acknowledgment of country before we get into the detail of the presentation. So on behalf of Cochlear: It's a pleasure to acknowledge the Wallumattagal people of the Darug Nation, who are the traditional custodians of the Macquarie Park area; and we pay respects to elders, both past and present, and to leaders emerging. We always start presentations with our mission because our mission guides us. It's clearly the purpose of the company. It guides us in terms of the outcomes we want to achieve but also guides our strategy. And hopefully, as we go through the strategy today, you can see clear links to each of the parts of our mission that we have here. And today, I'm going to start with an overview of corporate strategy. I'm going to do that pretty quickly. You'll see the slides actually have quite a lot of detail on them, so you can take them away and read them. I'm not going to go through that detail. I'm going to keep quite high level, so I think better today to hear from Jan, Dean, Lisa, Greg. And also with Jan, we have Adi and Roger, who will be presenting parts of our technology. For afterwards too, we have all of our executive team here and other members of Cochlear, so there's a chance to -- over lunch, to talk to us a bit more. And we have some manufacturing tours there as well. Between each of the sessions, we'll have time for Q&A. If that's sort of going too long, I'll jump in and say let's hold for the end because we do have time at the end to have more detailed questions, but let's get started. So I'm going to spend a bit of time on our growth opportunity, leading into the strategy. And then [ I shall move ] quite quickly through the strategy so you can hear more from other executives in more depth, but underpinning our strategy is this enormous growth opportunity that we have. And there's 5 aspects to why do we have such a significant growth opportunity. And the first of those is hearing loss is prevalent, one of the most prevalent, medical conditions; and way under-treated, one of the least treated in the world as well, so that creates enormous opportunity not just for hearing implants but actually for all forms of hearing solutions. In our segment, in implants segment. Cochlear implants are cost effective for all age groups, and there is more and more data emerging to show how cost effective they are. It's sort of blindingly obvious for children. Now there is very good data for adults and for seniors, on the cost effectiveness. And that obviously supports reimbursement and supports health care budgets allocating money towards hearing care. We think about hearing aids or implants when we get into indications for an implant, and those indications are expanding. Implants give a significantly better hearing outcome, so that again underpins the huge opportunity, but despite that opportunity, we've only got about 4%, maybe 5%, penetration of people within indications. Again that underpins the potential for long-term growth. And indications are expanding. And that's sort of recognition of the improvement in outcomes and just growing recognition of the need to treat hearing loss because of the consequences, other health consequence, economic consequences, of not treating. And then finally: good hearing, an essential part of healthy aging. And obviously that's very clearly closely linked to expansion of funding, and we'll talk more about that as we go through today. So those are the 5 pieces to really underpin the growth opportunity for us. Then we think about the growth opportunity. We think about it when we segment the market. We think about it in 4 segments: children in the developed markets, which we've talked a lot about over time, very highly penetrated; obviously significant lifetime value, significant for recipients, for children, to be able to hear versus not being able to hear. High penetration means we don't need to invest too much in driving awareness there. It's -- there's already a standard of care. Children in emerging markets. The reason to act is as compelling as it is for children in developed markets. What's needed is awareness, infrastructure, training. In our emerging markets strategy, we work to provide those things and do so in a paced manner because of the need for the whole [ life of care ]. You can't just do surgery. You've got to make sure the after care is in place, so that paces the rate of our investment and rate of growth. Adults and seniors in developed market is the one we talk most about. It is the biggest opportunity for growth for us over at least the next 10 years. There are far more adults and seniors with hearing loss than there are children, significantly more, but the penetration, and we'll talk to that, is very low, so that's the core of our strategy and where particularly Dean and Lisa today will spend most of their time. It's talking about what are we doing to activate that segment. And then acoustic implants. So acoustic implants, a really important opportunity for us, and we'll talk a bit more about that as we go. Okay, so our strategy. We set out our strategy across 5 pillars of -- and ways we can create value, and for each of those, we've got targets. We got -- we're clear on the stakeholders and on the benefits we deliver, so as we step through the presentation, we're going to do it in terms of those 5 pillars. And starting with a healthier and more productive society. This is where Dean and Lisa will spend most of their time talking today, so I'm going to move through this quickly, but the strategy here, you can see what are our priorities. What's our target? And who benefits? And how do they benefit? Being -- linking back to how do we create value for all stakeholders. So getting referrals for adults and seniors. Lisa and Dean will talk to this, about developing standard of care, so I'm going to move quickly through it. And we have Adi Nilson, who's our vice president for Acoustics product portfolio, with us today, going to talk about Osia. What I do want to say on acoustic implants is we have a huge opportunity here and I think we're going about it the right way. If you go back to the start of Cochlear in the early '80s, one of the things -- a couple of things that the company got right, the people in the company got right, at the time were the technology choices. And that technology choice of a titanium implant and a system that used low power enabled us to lead the market early, which enabled us to invest in the development of the market. If we look at acoustic implants. We've shipped over 750,000 implants in total over our history. It's a couple hundred thousand Baha implants, only 12,000 Osia implants in that total, but we've got the technology right. And we have made a different choice to our competitors here. And Adi is going to talk to this, but the piezoelectric technology gives us 3-Tesla MRI compatibility. It also gives us higher power output at higher frequencies. Those 2 things, we think, are an unmatchable competitive advantage. So [ same as ] 40 years ago with cochlear implants, I think we've got the technology right to enable us to lead and invest in growing the acoustic implant market, which is a huge long-run opportunity. Reimbursement and indication, clearly critical. You can see in the [ packs ] changes each year we are working hard at this right around the world. It's a critical piece of the strategy. And we make small steps in a lot of places over time, but all of that builds to more awareness, more funding. And Jan will talk about why those indications are broadening. Emerging markets, we're not going to talk about today, [ but as I say ], it's 20% of our revenue comes from emerging markets. It's also been, in terms of the number of implants, a good area of growth. There's significant opportunity, about 10% penetrated for children in emerging markets at the moment, but the -- and we know the steps to take. And we're pacing our investment in the steps that we need to take to grow those markets, around awareness, building funding, building our presence, people on the ground and making sure that professional capability and the infrastructure are in place to give good outcomes because it's good outcomes that lead to repeat funding obviously. So on -- from emerging markets -- so that's the first of the pillars. Second of the pillars is a lifetime of hearing solutions. And Jan is going to talk in depth about this, but it's clearly 2 parts. It's making sure we have technology leadership, a leading product portfolio and delivering the customer service and experience that our customers expect. Those 2 things give us the market leadership and give us -- we have access to more patients over time. So our investment in R&D has been significant and consistent over a very long period of time, and that enables us to have the portfolio that we do. It also means that we invest, and Jan will talk to this, across the entire portfolio. And why is that important? It's important because what people -- what our customers obviously want is hearing. They get through -- that through the entirety of the system and the professional experience that delivers those hearing outcomes and convenience, so by investing in the entire system, we both improve hearing outcomes. We improve the convenience of getting care and we lower the cost of care. So it's only through doing all of those things, investing across the whole system, can we deliver that holistic outcome, which we see as key to our market position but also key to market growth. And as part of that investment is the ability to offer upgraded technology to our growing recipient base. So over 48,000 people upgraded technology last year. That was lifted by Nucleus 8, and you'll hear more on Nucleus 8 this morning. And service and support, and part of that is connected care. And Jan is going to talk to our connected care solutions as we go through today and -- but really 3 pieces to -- or 3 outcomes we're looking for, for connected care. The first of all is this convenience in care and the creation of capacity. Second one is to reduce costs. Again, as we will compete for a larger part of health care budgets as we grow, we need to demonstrate that we're doing that efficiently. And part of that is taking costs out of the system. Connected care is an opportunity to do that. And we start to generate a lot of data from our customers from the connected care solutions, which we think we'll be able to use them to get better outcomes and to give us insights into future product development and better ways to streamline care and deliver better hearing outcomes into the future. And very importantly obviously with the implant is the reliability. And again the choice of a titanium implant back in the early '80s of Cochlear was critical to underpinning our reliability, which enabled us to continue to invest in market growth. And so 22 in there, which as you can see on the chart, with 35 years, 90.49% reliability is a sign of the great technology decisions that were made early on and the care taken in manufacturing. And there you can see each generation of implant gets more reliable over time. We're very rigorous in the reporting of our reliability. There are standards that we rigorously adhere to. We also report all of our generations of implant, whether they are on the market or not. And Greg will talk later to some of the aspects of ensuring quality in our manufacturing process because that will link to -- between R&D and manufacturing and the quality controls in manufacturing which underpin the long-term reliability of our implants. Okay, on to people. And as a technology company and a company that is very dependent on strong professional relationships, our people are absolutely critical to our success; and hence a lot of attention and investment on our part in making sure that we have the best people and that we have a culture which enables those people to thrive and deliver for our customers, so a significant amount of work on our culture and on talent. And just a couple of aspects of that is really thinking about enterprise leadership. So again, as our customers want and demand more integrated and streamlined solutions, whether they're professional customers or recipients, we need to make sure our organization is well connected globally to deliver that. And that is fundamentally about culture, how people work together and interact around the world, so we spend a lot of time working on our culture. We measure that in part through anecdotes and in part through our engagement survey. And our engagement is at 80% and it's been at 80% for several years. And when we look -- and we're very happy with it being at 80%. When we look underneath that, we see more indicators of our culture. And one of the ones that stand out is that 94% of people understand how they contribute to the satisfaction of our customers. And that's, when you think about a lot of our employees in Australia, most of our customers are outside of Australia, but people still see that very direct connection. That speaks to our mission and elements of our culture [ that absolutely ] drive us to continue to do better in terms of servicing customers. And pretty clearly, having that culture, it enables us to attract the very best people to work for Cochlear; lots of examples I could give for that. One is just the number of engineering applications we get from graduate engineers. And it's actually -- the exact number, I think, is heading for somewhere between 10% and 20% of all graduating engineers in Australia want to come and work here, so it's that on its own is a significant indicator of what -- the opportunity we provide and the sort of access to talent that we have. And an advantage of being in Australia, I mean, clearly from an engineering perspective is [ we're able to attract ] people like that. Clearly we have that sort of similar level of talent around the world. [ I mean an ] important part of attracting that level of talent is to make sure that we have a very diverse and inclusive culture. Clearly our customer base is incredibly diverse with customers in 180 countries around the world. We are trying to reflect that within the organization, and we have a number of ways in which we do that in terms of sort of broad aspects and dimensions to diversity and inclusion. One of the ones that is the most measurable and most focused on is gender diversity. And we've made some pretty significant process -- progress there over the last several years. And then from the -- all statistics there, the key one for me -- or for us, sorry, is senior placements. If we get senior placements at 50-50, we will end up with a -- with proper gender diversity across all levels of the organization. And we're making good progress on that front. Okay, environmental responsibility. We need to do this. We are a small carbon emitter. We have a small environmental footprint, but we still need to improve it, so we are working through our scope 1, 2 and 3 emissions. We've quantified scopes 1 and 2. Most of that comes from our manufacturing sites and through energy consumption. We've converted them over to renewable energy, 96% converted to renewable energy. That's led to a significant reduction already in our scope 1 and 2 emissions. We are at the moment quantifying scope 3 emissions. We think the biggest part of that is air travel, not surprising for a global company. And we've committed to reduce carbon emissions from air travel both by reducing travel per person across the company; and buying offsets because there is no other way to reduce carbon emissions from travel at this stage, buying offsets to reduce that impact as well. And then finally on to sustained value; and a couple of parts to this, obviously our financial returns [ then ] how we go and conduct business. We have a very long track record of growth. And these charts are on our website. They're in the annual report, long-term history of growth in implants, of revenue growth, of investment in R&D and in OpEx; and consequently that flowing through to profit and dividend. And given the growth opportunity, we obviously expect that to continue but know that we need to invest and keep investing to get that opportunity. That's why we've been really clear on the P&L that we're aiming to get 10% top line growth. Obviously it's not going to be like that up. And they will move around a bit, but that's our long-run growth. We've been growing faster than that actually more recently, committing to 12% of sales into R&D, a gross margin of 75% and a net profit margin after-tax of 18%. I often get asked, can we get leverage? Yes, we can. And we do, and we reinvest it. And the way to think about that, you'll hear from Dean and Lisa, we are investing significantly in building awareness and building access for adults and seniors. The way we think about that is that we're building an asset. And we want to invest in that -- as much as we can in that asset while maintaining our level of profitability. When we've got 5% penetration, it clearly makes -- and we've got a great product, it clearly makes sense to make that investment. As that asset is built, we'd hope, at some point in time, the maintenance CapEx or the maintenance on that asset is less than the costs to build. [ Then we want to see ] leverage in the P&L, but at 5% penetration, that's a long way out into the future, from what we can see and the opportunities we have to invest. And then on the balance sheet, we want to keep that conservatively geared in all senses. Greg will talk about inventory later. We want to carry a lot of inventory to buffer supplier risks. We want to be, and we are, cash positive; and have debt facilities so that we have significant liquidity should we need to call on it. And clearly we've got the buyback going on because we've got more cash [ than that ] at the moment to step our way down to these targets. And then in terms of being agile and efficient. So we have said we're going to come under our 18% net profit margin the last couple of years and the next few years while we spend about $150 million on reworking our global processes and our global platforms. We've made good progress here. We have in the last quarter implemented Workday and Salesforce Health Cloud. We've done those successfully in that there's been no [ operational ] interruptions from doing it. We've moved smoothly over to the new systems. We now have consistent processes around those systems around the world and we're starting to get and see consistent data. Next -- the next steps here are to replace our core finance system and our supply chain systems. And it's not just about putting these platforms in because that's -- well, that's really important. And we're already now looking with, for example, Salesforce Health Cloud, how can we use some AI add-ons that Health Cloud provide to streamline our customer service, but it's also about our operating processes and operating mechanisms around the company and how we get consistency and clarity yet to those so that we can actually move faster. We're not only going to get more efficient but actually be able to change faster because we have more consistency, so good progress here. These are really important steps in terms of building an organization that's capable of supporting a much larger customer base with the level of customer experience and customer service that's now expected from -- our customers. We don't compare us to our competitors but compare us to an Amazon or another -- or an airline or an -- actually an airline is the wrong example. An online store in terms of the service that they get. And then Greg will talk to manufacturing and how we work to maintain that 75% gross margin by getting and continually finding ways to improve processes there. And clearly we want to do this responsibly in terms of corporate governance, in terms of making sure as best we can our supply chain and our suppliers adhere to modern slavery and -- or avoid any sort, forms of slavery. There's very clear modern slavery guidelines out there. And cybersecurity, clearly we invest in that; and in data security as well, as you would expect. So in summary, this is our sort of strategy on a page, thinking about the ways we create value, our strategic priorities, our targets for each of those priorities and being clear on how we provide value for all of our stakeholders. So I'm going to finish up there. I'm just going to move pretty quickly because I want to get on to more depth from the other executives, happy to take a question or 2 on the strategy now but suggest it might be better to wait until the end because the questions are probably going to be answered -- a good chance they could be answered by the coming presentations. Okay, no questions, so I'm going to hand over to Jan Janssen. Jan is our Chief Technology Officer. And he has been with Cochlear since 2000, came to Cochlear through the acquisition of Philips' hearing implant business, so a very long history in cochlear implants. Jan has been responsible for our R&D since 2005, so clearly very deep knowledge of hearing implants and the technology; and here to talk about our approach to R&D, some of the things we're working on. And also [ I'd be ] joined by Adi Nilson and Roger Smith, who Jan will introduce part through the presentation. Jan?

Thank you, Dig. And thank you for your kind words in introducing myself. So in this session, I really would like to give you a perspective in how Cochlear is thinking about future innovation of our products and services, so I'll deliver this together, like Dig said, with Adi Nilson, who is our VP of the Acoustics product Portfolio; and Roger Smith, who is a product manager working in our sound processor area. I'd like to start actually with a small anecdote, if you want. Or this is a letter that we received a few months ago in our Denver office from a recipient called Ophelia, who is I think 9 years old. It says, "Dear Cochlear corporation, I would like it if you could make a cochlear implant that is waterproof with no case." And today, you have to put the processor in a little case to make it waterproof. "And I think it will be very good to have one. This is what I think it should look like." And this has a picture and has an LED in there. And then she explains why she wants to have it. She says, "I do not like it when I have to put on a case because other people go in the pool before me," yes, "And I hope you can help." That's what she wrote. As in -- why we have this and why we include this letter. Because I think it shows that, for her, hearing again with cochlear implant, she's taken for granted now, yes. It's now about living her life and getting in the pool before her friends do, so I think it is a good illustration also for adults where we are today. Cochlear implants do provide tremendous benefit, but there's still a lot of opportunity in how we can make the product easier, more convenient for people to get on with their lives. So it's always an interesting letter to start with. So -- and today, we find ourselves in a strong position with our portfolio. And I think it's fair to say that, in many aspects of the product portfolio that we're offering, we are setting the benchmark. Cochlear is setting the benchmarks with our cochlear implants in terms of reliability, as you saw from Dig, but also in terms of size, in terms of the electrode technology. In the acoustic implant area, you're going to hear more about that. We created a complete novel offering with the piezo-based transcutaneous bone conduction devices. We, for a long time, have had [indiscernible] products for sound processors in terms of size, in terms of connectivity but, of course, also in terms of hearing performance. And then over the last few years, we've continued to build out our portfolio of software and apps that make it more convenient for recipients to manage their hearing; for clinicians to have better tools, including in the operating room, and I will talk about that, so that we continue to build, yes, opportunities to facilitate and simplify the aftercare through our technology, including telehealth solutions and, of course, what we provide for our customer service, but there's still a lot of opportunity, we believe, to do better. And the way we think about future innovation and the key pillars where we continue to focus our R&D investment dollars have to -- relate to hearing outcomes, yes, so I'll talk about each of those in the session today, but then also -- like the letter from Ophelia indicated, also about how can we help people with our technology to make life even easier, use technology to really simplify and streamline the aftercare. And so we put that under the banner of connected care. And then we're always on the look in how we can continue to expand the portfolio of options that we provide. Like Dig indicated, 40 years ago, Cochlear provided, started to provide cochlear implants. In 2005, Cochlear acquired a company in Sweden to have a second product family with our bone conduction with our Baha bone conduction devices, which are percutaneous devices, but over the last few years, we've expanded our portfolio with the transcutaneous, through the skin, yes -- or across-the-skin, excuse me, instead of through-the-skin, bone conduction solution. And Adi will elaborate more on that towards the end of the presentation. So first, in terms of hearing outcomes. Now I do appreciate that a few of you are hearing professionals, so I'm going to try to make it as easy as possible for you to understand what is it that we're actually trying to achieve with our R&D efforts in hearing outcomes. So let me start by illustrating how hearing outcomes have evolved over the years. So what you see here on the slide, to your right-hand side, is the outcome from 3 large studies, yes. That is, in our world, a study of 50 is a large study -- that we've done over the last 20 years, so 2005, 2010 and 2017. And we measure hearing -- one of the measures of hearing outcomes is how well people can understand words in a quiet environment, so we play a list of 20 words and we just check how many words that people actually understand correctly. And so that's what these green bars show on the graph here, yes. So you see that in 2005 -- there is a group of people that we would call star performers who get like 7 out of 10 words right, yes. There's a larger group, however, that even with a cochlear implant still doesn't get more than 3 out of 10 words correct. Now I have to mention that, before people get a cochlear implant, they typically have about 1 in 10 words correct, yes, so their hearing performance is about 5% to 10% in this test. So as you see that -- as time has progressed and as technology has progressed, you see that the group of people who do really well with a cochlear implant is growing. You can see now, about 1/3 of people, we would call star performers with a cochlear implant. And equally important is the group of people that actually do not achieve the outcomes that we would seek with the device is shrinking and shrinking to about 10% or 15%. And so that's a combination of the technology that has improved over the years, better electrodes, better sound processing technology but also the fact that, over the years, the indication has expanded. Now when I say indication expansion, it comes in 2 forms. So 1 is that, formally, reimbursers have accepted for -- people to reimburse cochlear implants, for people that have, let's say, more levels of hearing than we had, say, 20 years ago. So that's kind of the -- if you want, the formal expansion of indication [ criteria ]. The second one is actually what is clinical practice, yes. So if you look 25 years ago, people that would receive a cochlear implant, for example, in Melbourne in Australia would have about 115 decibels of hearing loss. If we look today, that has dropped down to about 90 decibels of hearing loss. Our indications actually go down as low as 70 or 60 dB of hearing loss, yes, so we still have a lot of opportunity for more people to be treated. And often there is a lag between what is reimbursed, if you want, and what's formally allowed, if you want, through the regulatory and reimbursement system in a clinical practice, but it's those 2 combinations. And the fact that people get implanted earlier, yes, is also a driver of better hearing outcomes. We [ started ] with children. If children of -- are born with severe or profound hearing loss, if they get implanted, say, before the age of 12 months old, they will have near-normal development typically. The same is true for adults. The earlier that adults are implanted, the more likely is it that they will get a -- that they will get better hearing outcomes with a cochlear implant. So we have great progress in terms of how people hear, yes, but still opportunity because ultimately, of course, we'd like to -- people to have 100% hearing in a quiet environment at least, but of course, we live in a noisy world. And when we talk about hearing outcomes, we talk about also -- excuse me, about things like hearing in noise, telephone use. Typically one of the things that people struggle with big time before they have a cochlear implant is using the telephone. And Roger will probably talk to that. But also binaural hearing, hearing in 2 ears. And so if you look at the -- if you want, the block diagram [ or ] schematic of a cochlear implant which picks up the sound through microphones. It then passes through a stage where we do what we call preprocessing. That is where we try to remove as much noise from the microphone signal as possible from other speakers or fans or things like that before it then goes into a step where we analyze the sound, break it down, in our case, into 22 frequency bands that are then delivered through the electrode to the auditory nerve. And then in the block diagram, there is the user, who has a level of control over the device; as well as the clinician, who will during the fitting set a number of parameters. So if we look at where have we made most progress over the last 20 years in terms of hearing in noise, it has to do with these front-end steps here. We went from -- one, from a single microphone to dual microphone. And that, we can then connect with technology that will be similar to what you use potentially when you're on an airplane, noise-canceling headsets, yes. It's similar type of approach where with using 2 microphones we can do smart processing and really improve that hearing in noise. And I'm sure Roger will also talk to that. And importantly, over the years, we've also automated that type of sound processing because we know that it can be difficult for people to know, "When should I switch on this algorithm versus that algorithm?" So we have a type of artificial intelligence actually build in already into the product that does that based on the auditory scene classifier to make that change. So these are the areas where we've made a lot of progress in terms of hearing in noise; still a lot of opportunity left there to do better, however. And then of course, a big step forward since 2017 for cochlear implants when we could achieve connectivity, direct connectivity, between a smartphone and a cochlear implant sound processor. Because that opened a complete new world for our recipients, to connect through their phone for phone calls, for video conferences; watch movies; et cetera, but if we also think about other aspects of hearing outcomes -- and then I'll talk about things like listening effort. A lot of people that -- with hearing loss will often say at the end of the day they're completely exhausted because the brain has to work a lot harder to listen, to hear. Music appreciation, sound identification, speaker identification. So that's the ability to tell 2 speakers from each other, something that we can do very easily, yes. People with cochlear implants -- for people with cochlear implants, it's a hard task, yes. If we also want to drive further enhancements in those areas, then we need to turn our attention also to the -- what I would call the back end of a cochlear implant system. That is how do we process the sound. How do we deliver it to the hearing nerve? And how is it programmed in the clinic? And I'll elaborate a bit what our philosophy is in that respect. So our philosophy to improve, if you want, the back end of the -- of a cochlear implant system is, first of all, to deliver the electrostimulation as close to the nerve as possible, yes. And I'll explain what I, what we mean with that. So that's the first part of our strategy to drive hearing outcomes, to the blue part of that -- of the graph. Secondly, it's important also that, while the electrode array is inserted into the cochlea -- the cochlea is a very delicate organ. It's the inner ear. It's Greek word for inner ear -- is that that's done in a as atraumatic way as possible. Because we know there's more trauma that actually will negative correlate with future hearing outcomes. The third pillar of our strategy there is to improve the quality of the stimulation of the nerve by being more precise, and I'll explain that as well. And then the last very exciting pillar that's really gaining traction over the last few years is the combination of drugs, yes, of pharmacological solutions, together with a cochlear implant. And I'll elaborate on each of those. So first of all, in terms of the electrode technology. So what you see on the graph there, here is a schematic picture, if you want, of a cochlea. And we can see that there's kind of 2 ways -- or 2 places where the electrode could be placed. It could be placed to the outside of the cochlea that's called the lateral wall. Or it could be placed closer to the inner side, to the inner wall, if you want, of the cochlea. Why is that important? That's important because the neural elements, yes, so the hearing nerve that we are stimulating, is present in the center of the cochlea. So by putting the electrodes closer to the cochlea, yes, we can reduce the stimulation current. It means better battery life, for example, but also, and I'll explain it a bit in more detail in later slides, that also helps us to minimize cross talk, if you want, between the 22 channels that can be present. So there's a lot of very strong rationale why it is -- it makes a lot of sense to deliver the stimulation as close to the hearing nerve as possible. Now Cochlear offers both types of electrodes, yes. Often, there can be a physician choice, preference for one versus the other, but we do believe strongly that -- in the longer term, that a -- perimodiolar electrodes will be an important stepping stone to optimize hearing outcomes for recipients. So as I mentioned, it is important or we've shown through research that it is important that we can minimize trauma during insertion. Now we do that in many different ways that we try to achieve that; the most important one, in fact, by having an atraumatic electrode, yes. And so our electrodes that we developed that we have currently in the market are a lot thinner and more flexible than the devices we had, say, 20, 30 years ago; and have been designed really with being atraumatic, yes, in mind, but we also know that surgery and -- well, routinely can still play an important role in the insertion process. And so we've now -- we are in the process to introduce a new tool in the operating room called Nucleus SmartNav so -- already rolled out in the United States. We are rolling in -- out in other parts of the world as we speak. That uses -- that's iPad-based, so it's an iPad. It has then a small what we call a surgical processor which takes care of the communication from the iPad to the processor and from the processor to the implant. And SmartNav delivers, yes, in a wireless fashion, real-time actionable insights that help and provide assurance to the physician yes, during and after the insertion process. So it will provide a range of diagnostic measures to confirm that the device is working properly, that the nerve is responding. Because that's it's definitely a peace of mind for the surgeon to know, "Okay, when I stimulate while the patient is still in the OR, the nerve is actually responding." So cochlear implants can not only stimulate the nerve. We can also measure back from the nerve. And also, SmartNav, we've taken the opportunity to also facilitate and streamline some logistical steps, if you want. In fact and the bottom right here, you can see that with SmartNav we now can automate the implant registration, something that used to be paper-based in the past. And often there was a long lag between the surgery, where people have to fill out then all the details, send it through a paper document to us. That's also one of the feature we've integrated into SmartNav, together with a range of other measures, diagnostic measures that we provide. I won't go into detail, happy to talk about those if you'll have any specific questions on that, but I can tell you that the tool has been extremely well received, yes. And it is for us [ really also ] a springboard to continue to develop more and more novel measures that we can add to SmartNav, given it's a software-based solution, for future use. So I mentioned about having an electrode close to the nerve, having an atraumatic insertion, but also about how can we further build on that precise stimulation. And so this is an illustration, if you want, if the electrode is further away from the nerve. So you can see here that's the electrode. Imagine that we have now rolled off the cochlea, so as a linear representation. So if you have what we call a lateral wall electrode, then the electrode -- the electrical current that occurs during stimulation, yes, will actually spread out quite broadly in the cochlea. The cochlea is a very conductive medium. It's a bit like seawater, yes, so the ions kind of will kind of [ wave out ] quite broadly, which means that there's fair amount of, if you want, distortion or cross talk across the 22 channels. Ideally we'd like each of these 22 electrodes to target just [ 1/22 ]of the hearing nerve, yes, but because that's high conductive medium, that's not the case. Nevertheless, with lateral wall electrodes, people can hear well, yes. It can get -- still, people can get good outcomes, but if we want to enhance that, then of course, it makes a lot of sense to bring the electrodes closer to the nerve. And that's really what we have done with our perimodiolar electrodes. We started pioneering in this already in the 1990s, had our first product on the market in the early 2000s. And it is absolutely a differentiator for Cochlear, to have a perimodiolar electrode. One of our competitors also have something that's somewhat perimodiolar. The other competitors actually don't -- have not been able to deliver similar technology. So as we bring the electrodes closer, that allows us to reduce the stimulation current because we're now closer to the neurons that we target, yes. And that helps us, yes, to a certain extent, to limit that cross talk, if you want, between the 22 channels, but we don't want to stop there. And so we are working now, in -- still in a research fashion, to other ways that could further focus that stimulation. And so we're looking at electronic means in combination with the perimodiolar electrodes to further deliver that stimulation more precisely and with less overlap, if you want, between the 22 channels. And what we've seen from early research is that, that should contribute to improvements in the -- on the blue aspects of hearing outcomes, sound quality, music perception, hearing in noise potentially, et cetera. So you can see where we're trying to go with this. And then you can think, also further in the future, if this is indeed an effective way to be more precise in the stimulation, perhaps, one day, we can also then increase the number of channels from 22 to 32 or 64, whatever that might be in the future, but the first step is to make sure that 22 can actually work more independently from each other, yes. So again this is still in clinical research, and often, these things, of course, take many years in our world to try these things out; also because, when we try out these ways of stimulation, the brain often needs time to adjust to the new way of stimulation, yes. So the brain has to learn how to hear with electrical stimulation. And when you make a change in how we stimulate, the brain doesn't respond immediately. It needs time to adjust, often, and then readjust to that. And only then we'll know whether one way is better than the other way. So that's one of the reasons also why it can take a while for us. And then the last aspect of our strategy to continue to drive hearing outcomes is the drug-device combination. So we've already shown in a feasibility study a number of years ago that embedding a steroid, yes, into the electrodes, so that's the part that goes into the inner ear, can help actually to reduce the electrode impedances. You can see that to the right here. So in the feasibility, you see here the black dots is a standard electrode. The open dots were the patients -- were the impedance of the patients that received these drug-eluting electrodes. And basically what the drug is doing, it's helping the body to deal with the foreign body reaction. As soon as you put something in the body, the body is going to want to fight it. And by bringing steroids into the cochlea, the steroids will be there for a number of weeks before it's completely -- if you want, before it's eluted out to a level, [ such ] therapeutic level. That really helps, yes, over a long time. You can see, for up to 2 years, yes, where we really see a lowering of impedances, which we believe has to do with the fact that there's less fibrotic tissue that's developed in the cochlea. So we are progressing our dexamethasone research now to where it's more commercial solution in a number of years. That does take time because -- to develop these devices, to make them manufacturable, to adjust our quality system, to get to the pivotal studies and then to the regulation does take time; also because in medical devices the combination between a drug and a device is not all that common. So also from a regulatory pathway perspective, we actually have to, if you want, break new ground often and get regulators onboard with this type of space -- of device, but we don't stop there, yes. So we already continue also to look what can happen even after our drug-eluting electrode, the dexamethasone-eluting electrode. We are in a collaboration with a French company called Sensorion for a different type of drug, an anti-apoptotic drug that can be taken orally -- or that, at the moment in its small study, is taken orally; and maybe also have the potential to be integrated in a device in the future. You may think having even almost like a cocktail of drug-eluting electrodes. And then at the bottom here. This is really futuristic. We are supporting a study that's actually running here in Sydney, where prior -- just prior to the insertion of the cochlear implant, a neurotrophic factor, a growth factor is actually injected into the cochlea, with the idea to actually resprout part of the hearing nerve. Earlier, I explained to you that -- what we try to do with the perimodiolar electrode. We bring the nerve -- sorry. We bring the electrode close to the nerve. What we try to do in this study, we bring the nerve to the electrode, yes. And that's based on preclinical research that we support a number of years ago. The clinical research is still running. It's too early to talk about this. This will be a long term because it's kind of a gene therapy. It will take a long time before this will become mainstream, we believe, because of the different hurdles that we'll have to go through, but it's an exciting prospect in how we can use drug-device combinations in the future to improve outcomes. Then in terms of lifestyle and ease of use, yes. So we heard from Ophelia. She's not complaining about her hearing. She's complaining about the fact she cannot -- she has to put on an accessory before she can jump in the pool. And so that, I think, is a good metaphor, if you want, yes, for us to continue to think about how do we support our recipients with their device, yes, day to day. Because we take it for granted. Some of us will use ear pods or ear buds for a few hours a day, but with a cochlear implant, today, if you don't wear your external processor, you basically are deaf typically, yes, and won't be able to communicate at all. So we made a decision a number of years ago that, as the first step, we want to provide choice for our recipients. We have the choice between what's called a behind-the-ear processor, yes. So that's a device that rests, if you want, on the pillar -- on the ear. And our Nucleus 8 processor is our latest generation of behind-the-ear processor, but since a number of years, we also provide what's called an off-the-ear processor. With the off-the-ear processor, both the transmit coil that you see here lying flat and the processing unit are both integrated in a single piece, so it's more convenient, yes. And a number of recipients really prefer that way to hear, but we won't stop there, so we'll continue to search for even better ways that we can provide external -- the external part of a cochlear implant to our customers. We will continue to -- we are continuing to look to ways to shrink the processor because we know size matters and not only because of cosmetic factors but also because of retention, particularly for children. The smaller the processor is, the easier it will likely stay on the ear, for children, but also for people to live their life, making it smaller is better. And of course, we're also continuing to work towards the option to have an implant that could be even used without an external processor. And I'll talk more about that in a moment, but I think this is a good opportunity for me to introduce you to Roger Smith. Roger is a product manager at Cochlear and will talk to you a bit more in depth about our portfolio of our hearing -- or sound processors. Over to you, Roger.

Thanks, Jan. Good morning, everyone. So I think it's really clear to see there are some exciting, new future innovations coming from Cochlear, but I think today it's also important to talk about the products we have available right now for our patients and for people with severe to profound hearing loss. And so as Jan mentioned, the -- our premium sound processors come in 2 different form factors, the Nucleus 8 and the Kanso 2 sound processor. And they both deliver the proven hearing performance benefits that comes with our products, using dual microphones and SmartSound iQ with SCAN 2 and ForwardFocus technology to enable people to hear their best in any situation. We also have a bimodal partnership with ReSound hearing aids to enable people who have a cochlear implant on one side and a hearing aid on the other side to be able to hear well and stream from compatible devices and really elevate their hearing experience to the next level. Both our sound processors deliver direct connectivity with Apple and Android devices. And connectivity allows also the use of a Nucleus smart app to give them control and fine-tuning of the product to help them really manage their life and their hearing experience. And from a lifestyle perspective, we offer a range of wireless accessories to -- like the TV streamer and the wireless mini microphone to help people hear better in different situations and enjoy their life there. And with lifestyle, our 2 processors are IP68 rated, which is the highest level of water protection available in a sound processor on the market too. And we also offer a range of retention accessories to make sure that people who wear our products don't have to worry about the safety and security of their products while they're living their life. An exciting, new development in our sound processors is that in the U.S. we've introduced the Nucleus smart app bimodal functionality. And so that means that patients who have a compatible -- a cochlear implant and a compatible hearing aid on the other side can now control both devices from the Nucleus smart app from one location on their mobile device. And that really just goes a step further and simplifying their lives and enabling patients and users to be able to manage their situation and enjoy their life in an easier way, so that's really exciting. So maintaining that streaming capability and now introducing that bimodal control. And a unique feature that's with the Nucleus 8 sound processor and really exciting is it is the only sound processor on the market today that's ready for the next generation of Bluetooth audio streaming technology called Bluetooth LE Audio. And Bluetooth LE Audio is really going to be the next generation that's expected to replace the current Bluetooth classic audio streaming. And it's going to open up the doors for both manufacturers and users of audio devices because this new technology uses lower power and efficiencies and also better quality of sound delivered, but what's really -- sorry. The LE Audio protocol is going to take some time to be adopted around the globe. And while that's happening, there's a lot of excitement building now for this particular profile within LE Audio called Auracast. And Auracast is about the ability to broadcast stream any sort of audio experience. So if you've got, like today, I'm speaking with a microphone, they would be able to send the signal acoustically but also broadcast my voice digitally. And so there's -- it's going to open up the doors and lots of different activities that will be possible. So imagine 2 kids who are watching a video and -- sharing the iPad and watching a movie or something. And one of them might have off-the-shelf wireless headphones and the other one might have Nucleus 8 sound processors. They would be able to sit and share that movie and watch together. And it's something they can't do today, so that's exciting. Another activity is actually, if you imagine, at the gymnasium, when you're working out, or at the doctor or a reception area, where they always have the TVs but they're muted to keep things quiet. You could select that TV and the one that you wanted to watch, catch up on news or whatever; and stream that directly to your ears, so a very exciting capability there as well, but I think what really resonates most with our patients and customers is this ability to hear your best. So streaming in situations, locations. So think about lecture halls and presentations like today; at the airport or the cinema, theater; anywhere where there's an audio experience that, that location would be able to send out the audio experience acoustically but also broadcast the signal digitally. And anyone in the audience could be able to pick up that signal. A classic example that I think really resonates is at the airport where some people are very nervous about flying because they're afraid they're going to miss an announcement at a gate. The gates changed or delayed. Now that person will be able to sit in the airport and select gate 17 Qantas. And any time there's an announcement made, it would stream directly to their devices, hearing aid, sound processor or even headphones; and they would be able to hear that announcement as if it was spoken right next to them, so really exciting technology there. And then Nucleus 8 is the only sound processor available today that's ready for next-generation LE Audio, so I think that's very exciting to point out. I want to change gears slightly now; and tell you a story about a recipient, a cochlear implant recipient, because I think it's important for you to understand just what these products are doing for people and improving their lives and how much of a change it is. And that person I want to tell you about today is actually in the -- so I don't know. Most of you can -- probably can't see, but I'm a bilateral cochlear implant recipient. And I have 2 Nucleus 8 sound processors on today. I was first implanted in the United States, in 2009, on my left side. And then I moved to Australia and began working for Cochlear. And I got my second implant in 2021 and became bilateral, so I was bimodal for a time and now bilateral and it's been a life-changing experience for me. I was born in the U.S., in Iowa. And I had mild hearing loss at age 5 and that continued to progress and my hearing got worse. And I was given hearing aids as a teenager, and you can imagine that didn't go very well. I didn't wear those too often, but by the time I was in university, I was really struggling to hear. And I knew that I needed to use hearing aids if I was going to get a university degree and get a career in my life. And I got really good hearing aids and they helped me, but I still needed to have note taking service and study buddies and do things like that to help me really get through the experience. I did graduate and I moved on, and I started my career as a physiotherapist. And I think, like many people with chronic hearing loss, over time, their world -- my world adapted with me, so my friends and my family, my job sort of adapted with me. And I got more powerful phones and they spoke louder, so I was doing okay. I knew that I was missing out, but my friends would cover for me and help out. But I got the sense just I was missing something. And then I had children. And when I had kids, it was so hard for me to hear what they were saying as they began to talk. And I just started to feel more and more like I was really not living my life to the fullest. And so that's when I met someone with a cochlear implant. And I think the experience that we hear very often here is that someone had the catalyst, something that gets them to take a step and move in the direction of getting a cochlear implant, whether it's to accept that they have hearing loss and they have a problem, they need to do something about it to realize that their hearing aids are not helpful enough or to maybe think a quick implant really is something that I would -- I could use and would benefit me. And it's fun for me to tell this story because my catalyst is actually my older brother, -- and so Marais 4 years older than me, and he had the same trajectory of hearing loss and progressed very much the same way as I did, but he was always kind of taking the first step, getting new hearing aids and telling me about the experience and doing -- using a system of devices or whatever it may be. And then one day, I got a call that he was going to get a cochlear implant. And I was really surprised by this, but secretly very happy because I knew now he was going to -- this person that I knew and trusted was going to be able to tell me what it was really like and would it be something that I would want to do. So 3 months after he got his implant, I went over to -- he was having a birthday party for his kids and I went to his house, and I was excited to ask him all these questions about what's it like? How are you doing? Can you hear better? I didn't even have to speak to him. I walked into the party and I could see him across the room and he was a changed man. It was so incredible to see the confidence that he carried himself with and the happiness that he exuded and his interaction with people, and it was just I didn't need to talk to him. When we did, and we were chatting and he was -- his girls could too and he's talking to his little 3-year-old across the backyard, and I could barely hear their voices and he was having a conversation. It was so incredible to see that transformation. So I said, how do I get one of these. And of course, 6 months later, I had my own cochlear implant and happy to say the experience was life changing for me as it was for my brother. So I'd like to tell that story because I think it's so important for you all to realize just how life changing and how amazing these products are and what it can do for people with severe to profound hearing loss. So I thank you for listening. I'm happy to share my story. And now I think I'm going to hand back to Jan, who's going to talk a little bit more about how we're working to improve our products to help people live their lives. Thanks.

Thank you, Roger, and it's also fantastic to hear and have the -- hear from firsthand what the impact is that the technology makes. So as we -- as I alluded to, we have 2 options for the external sound processor, but we also keep looking for a way that people could use their implant in a what we call totally implantable fashion. So that means that, that device needs not only to have the traditional functionality of the electrode and the electronics to stimulate. It also needs a microphone. It needs an implantable battery, and it needs a sound processing capability, all built into the implant. So that's quite a challenge. And to tackle that, we had our first attempt with a first-generation research device all the way back in 2005, 2006, when 3 patients were implanted with a very first generation of totally implantable device. There's a few things we learned from that. One is people really appreciate the fact that they can hear even without a sound processor because I have to explain that these 3 patients can use a device either with or without a sound processor. If they put on the sound processor, it works like a traditional cochlear implant. If they take it off, it works by the implanted microphone. So they can kind of have both options. So people really appreciate that they have the option to hear without an external device. But at the same time, they told us that the presence of body noise, eating, swallowing, chewing, things like that, was extremely loud. And that really gave us pause to think, okay, we do need to come up with technologies that make that, if you want, more acceptable, particularly if we think about the commercial device. So we ran the way and looked at solutions that we can tackle that. But our big takeaway was is how valuable this invisible hearing aspect is. So -- at the same time, it gives a lot of motivation. So we started then to work on a second generation. So you here see a picture of the second-generation totally implantable research device. You recognize that the microphone is now separate from the implant. And this microphone actually does have the capability to suppress the -- or eliminate part of the biological or the body noise. And so again, like in the first generation, recipients can use it with an external system, and they also have a charger that they can use to charge the implanted battery. And here you can see the 2 wearing modes. So either the people wear it with an external processor, look similar like Roger with the look today or without and they still have the option to be able to communicate and to hear. So 10 patients were implanted with this research device a few years ago. Important to point out that preoperatively, so before getting the device, these patients had about 3% sentence understanding. So this is just an indication how poor people hear of typically before they receive a cochlear implant. And then after 6 months of receiving the device, they actually score now around 80%, even with the invisible hearing mode. So it's a fantastic improvement between pre-op and post-op. Still a little bit of difference. So the gray bars -- the gray box here is what people hear where they're in the external processor versus the invisible hearing in yellow, and we expect that there will be a bit of a difference there. But the main comparison, of course, is with what we heard before they had cochlear implant, which was all the way here. So of course, this gives us a lot of encouragement to continue this development like a point of that is still a research device. They will have a lot of compromises that we had to accept for this device. But of course, with this positive feedback, we are very motivated to deliver this type of technology to our recipients into the future. So let me now introduce you to Adi Nilson, who will talk about the last pillar of our innovation strategy -- sorry, sorry, sorry. I'm ahead of myself, Connected Care, do my slides. Excuse me. Yes. So the third pillar of our offering relates to Connected Care. So this is how through the journey from what happens in surgery, what happens in the hospital, what can we do remotely and what can we do by providing control in hands of our patients in simplifying and supporting patients at every stage of their journey. And our goal really with our Connected Care portfolio is to provide this convenience and confidence to all of our customers. What I mean all our customers, it's to the recipients, it's to the surgeons, the physicians as well as to the audiologists. And so we do that by the real-time surgical guidance that we're now providing with our new SmartNav solution by more convenient care delivery options that we have. So the follow-up care can happen either in person in the clinic. But since a few years, we also have options for the professional to deliver care remotely from the comfort of the recipients home. And importantly, is that through this -- of course, we also get a lot of insights that help us also to improve our products going forward. So it's about convenience and confidence, but also by clinic efficiency. We know as we continue -- see the continued growth of cochlear implants that is putting pressure on the aftercare in hospitals. And Dean or Lisa also may talk about that. And so it is important that we do make it aftercare also more efficient, and of course, evidence-driven. And then the data that will be collected as we provide these more modern ways of providing that care will support us by generating better evidence also from a payer perspective, and it will also allow us to likely in the future, optimize the stimulation and the processing more to the individuals or form of more personalized care that we can provide in the future. And now it's time to hand over to Adi Nilson to talk about the expanding portfolio. Sorry about that.

Don't worry. Thank you so much, Jan. And hi, everybody. Great to be here today. My name is Adi Nilson, and I'm based in Sweden, been with Cochlear for more than 12 years, working mainly with the acoustics portfolio. So my job today is to briefly tell you a little bit about the Osia system, which is the latest innovation we introduced in this portfolio. So the Osia system was developed to remove boundaries to bone conduction. Bone conduction implants being in the market almost as long as cochlear implants, but for various reasons, haven't been as appealing to both patients and professionals. So Cochlear has begun the development of the Osia a few years ago, and we've been introducing it to the market 4 years ago. And it's powered by unique Piezo Power technology, which enable improvement in hearing in the high frequencies. And why do you want the improvement in the high frequencies because that's where everything good happens, as one of our surgeons said. It's the voices of babies, children. It's the bird, it's whispers and all those kind of things. So very important improvement for bone conduction patients. It's also discrete and easy to use. Since we introduced, we actually have implanted it in 14,000 patients. I know Dig said 12,00, but actually watch the numbers, and it is 14,000, very proud about that. And it actually makes it the most preferred bone conduction implant system in the world. And also, we usually say it's the fastest-growing hearing implants ever introduced. So very proud about that. And of course, it's also thanks to the fact that it's discrete and easy to use. So in the spirit of always bringing meaningful innovation to the market, we recently also introduced it with a 3T compatible magnet. So that's the OSI300 implant that we've introduced in the U.S. We got an FDA approval or FDA clearance at the end of August and introduced this in the beginning of September. And that makes Osia the only bone conduction active implant in the market that enabled 3T MRI scanning. And I think we all know, I don't need to talk to you people who already know that we have it with our CI technology, but we all know that 3T scanners are becoming now the standard of care for MRI technology and great additional improvement also for bone conduction patients now. So how is that technology really work? So already mentioned some benefits with the Piezo Power transducer but it's also very suitable for implantable solution because that it has no magnetic material in it. It means there is no material that attract to the strong power magnetic field in the MRI scanners. And that's why it makes it more suitable unlike other. So if we talk about the competition, they have today an electromagnetic transducer that is implanted and that doesn't make it as suitable for MRI scanning in the same way, definitely not up to 3T scanners that are now, as we mentioned, already standard in the market. And the new addition to that technology is the new magnet that we have now introducing with the 3T magnet and I'll show you a little bit about how it works. But basically, it's align itself to the direction of the scanner so where the magnetic field of the scanner is working. And lock itself there and stay in place, so there's no risk for dislodgement or any other things that can happen during the MRI scanning. So back to what are the benefits for the patients. And in what way the Piezo Power is really beneficial. So it means that we don't need to remove the implant which sometimes is needed. So no need for unnecessary surgeries. There is a minimal image artifact because many of our patients sometimes need to undergo MRI again if they have diseases in that area. So with the piezo, there's no need for that. And like I said, because there's no risk for using and moving parts, so there's no performance degradation and it will withstand the exposure of the strong magnet field. And this is just an illustration of how that magnet works once it gets into the MRI machine, it's lock itself, align itself to the direction of the MRI field and stay in place. An additional feature that I would like to mention is just the -- as you can see, there is a simple magnet removal if needed, depends on the patient's condition. There is still a possibility to do that. So that's conclude my presentation on the Osia, and I'll hand over to you, Jan, to conclude that session.

Yes. So I hope that we've been able to give you a good overview of Cochlear's philosophy and strategy in terms of future product innovation. So we continue to invest around 12% of sales revenue in research development. Now that does include also clinical studies, regularly clearances and things like that, which I hope that you could see that a strong pipeline of products and services that we continue to work on to continue to drive hearing outcomes. It's -- cochlear implants do provide a life-changing intervention to many patients, but there's still a lot of opportunities to do even better there and then particularly to make life easier living with a Cochlear implant through what we do with our processors and totally implantable devices, simplifying that aftercare to make it convenient, efficient both for customers, end users as well as for clinicians. And we continue to look also for further ways we can expand our portfolio. I think Adi shared with you what Osia has done for Cochlear in terms of creating a new fast-growing segment, and we continue to look for other opportunities, too early to talk about today to broaden our portfolio of offerings. So I think that -- we pretty much stalled of the time, but maybe still some time for questions. Yes, if any questions you might have. Yes, I can hear you now.

Craig Wong-Pan from RBC. Just a question on your TICI. You kind of mentioned there's a bit of still sound sort of body noise there. And I think you mentioned that on the slide that says finalization of product development. Does that mean there's going to be another generation before you have that commercialized?

Yes. So what we showed here was a second-generation research device and what we often try to do with our research devices is to make sure we understand the key aspects and the key challenges that we need to overcome. And that was the purpose of this device. So the device, as you see it here, we indeed I think is not suitable yet for commercial introduction. So we do want to refine a number of aspects as we often do after these studies. And similar to what I mentioned about the drug-eluting electrodes. Given the novelty of this technology, we will have to also indicate significant clinical studies and also the regulatory approval pathway for a novel device like this, we expect to be quite significant compared to what we usually do as a mirror, if you on generation improvement of a product. But like I said, we're very encouraged by the results there, including the recipient's feedback about the body noise cancellation. It's clearly working and clearly doing a good job in making the sound quality acceptable for the recipients in the study.

And one of your competitors has another TICI that kind of uses the ear as like a sort of microphone. Could you make any comments about what you think about that as -- I mean, how does that compare to yours?

Yes, yes. So when we think about the total implantable device, you need to find a way to pick up the sound. There's a few different ways that can be done. The solution that we are going for with this generation is called the subcutaneous microphones, so there's a microphone beneath the skin. Another type would be a middle ear microphone, microphone, a microphone that picks up the sound in the middle ear, so where the ossicles move. And there's even the option to put up the sound -- pick up the sound in the cochlea. It's called an inner ear microphone. And so we deem that at this stage, the trade-offs are most favorable towards a subcutaneous microphone. It's surgically definitely simpler than any of the other types that are there, potentially serves also broad age category. Now whether we get regulatory clearance for broad age category that's yet to be seen. And we do see actually very good performance with it. But typically to Cochlear, we always keep working. We don't typically put all our eggs in 1 basket. So we also continue to build a portfolio of technologies that will give us other microphone options in the future as well.

Sorry, it's Andrew Goodsall from MST. Just interested in any advances you're making with robotic surgery. I know that's quite an issue and some of your competitors are making some advantages there?

Yes. Yes. So when we talk about robotic surgery, there's 2 aspects that come to mind. So 1 is the placement of the implant and the access to the cochlea. That's 1 part, if you want potential area of robotic surgery. The other 1 is the insertion of the electrode into the cochlea, which is this kind of delicate step where you kind of typically manually the physician will insert the electrode. To date, I would say most of the research has been focused on the second aspect. There's been some work on the first aspect, which is getting access to the cochlea, which is actually quite deep into the head, it's probably the same depth as your eyes. So it's a few centimeters deep. That aspect, I'll leave that aside at the moment. So the focus today is really on that robotic insertion of the electrode array where the hypothesis that if you could do that in a very controlled potentially slowing and very smooth way that, that might contribute to the preservation of any residual hearing. So none of our -- most of our competitors are not directly active in that themselves, but typically work with other parties to do that, and so are we. So we are collaborating with a few of these robotic insertion companies to look for options to see if indeed this -- the combination of a robot with the device is worth it because it does at time cost to the procedure. And as we want to streamline this, given the huge growth, of course, we always need to think, is this improvement actually going to -- is this addition to the procedure actually going to deliver a better outcome, but we are actively working there with the companies in this field.

David Stanton from Jefferies. You've been talking to clinic of -- improving clinic efficiency for some time. I mean, I wonder if you could talk to what you've seen in terms of some metrics in terms of that improvement over the journey? And where do you think it will get to going forward in terms of basically seeing more patients in the clinic, please?

We like to hold that one to Lisa's presentation because she's going to talk to that one.

Can I just ask you a question about signal processing? I mean how much bang for the buck can you get out of that just in terms of ongoing miniaturization, better algorithms, that kind of thing? I mean you've talked quite a bit about the miniaturization of the mechanical components, getting those closer to a device, that sort of stuff. But what about post-processing of information, is there anything more to be gained from that, do you think?

Yes. So where we -- perhaps I'll answer my throughout my question, your -- my answer in 2 pieces. So this is what we call the pre-processing stage, where we use -- so far done most improvements based on the dual microphone technology and using the spatial selectivity to focus the speech on the direction where it's coming from and then suppressing any noise comes -- that comes from other directions. And that's proven to be very efficient. You might have heard in the video at the beginning, someone talked about this algorithm called forward focus, which kind of basically suppress the background noise by about 6dB, which means it's half as loud as it would be otherwise. And there's still a lot of -- if you want fuel in the tank in that space, we believe, particularly as we think about AI, deep neural networks, there's still a lot of opportunity there. One of the challenges in our world is always, can we deliver that for an acceptable power budget because we want to keep the processes small. And so a lot of investment actually is in the microchip technology that gives that processing capability at an affordable power consumption. But the second part is under the back-end stimulation. And that's really the combination of the electrode technology with the stimulation processing. And so when I showed the graph there or the picture with the blue bars that further focus the stimulation, that, in combination with different sound processing algorithms we believe has the potential to further improve hearing outcomes when we think about sound quality, music appreciation, things like that, but those things like speaker segregation is to be able to tell 2 different speakers apart, which is a really difficult task for CI patient today. But it goes hand-in-hand with the technology and the stimulation strategy. But we have quite a significant research program on that still running as well.

There was a question for Jan. But come back to this at the end, if that's all right. And then because Jan will still be here. So we can keep going with the presentations because some of these questions may get answered on the way through. Thanks, Jan. So after Dean who is going to present now, we're going to have a short break. But I do want to introduce Dean Phizacklea. So Dean is our Senior Vice President of Global Strategic Marketing, been with Cochlear for 7 years, been over 7 years now in this role. Prior to Cochlear, a long history in medical devices and pharmaceuticals working in Europe, in Japan, in the U.S., in both P&L roles, country management roles as well as in Global Marketing -- Head of Global Marketing roles, a very broad experience. And Dean's going to talk about the pathway and standard of care. And one of the great things Dean brings to us is experience of bringing standard of care about in other therapeutic areas.

Thanks very much, Dig, and good morning all. I think Jan has done an eloquent job in describing the wonderful product portfolio and the change that brings to patients. And Adi has done the same from an acoustics perspective. And then the very personal story that Roger shares of what this does to individuals. And I guess my presentation is aware of how do we join those 2 together? How do we bring this wonderful technology that we know it changes people's lives to those people who most deserve. And certainly, we've got some success in pediatrics, the bigger challenge we have is in adults. And so as I go through the presentation today, sort of 3 big chunks in that presentation. One is around, well, why is this important? Why do we think there needs to be a standard of care or a more efficient effective referral pathway. A second part of the presentation will cover elements of what are those big barriers that are preventing that pathway to be established. And then the third piece is, give some high-level views of some of the activities, strategies that we have in place to help close that gap and build that referral pathway. And I'll keep it relatively high level because I think Lisa as well in her presentation is going to give some real life deep dive of what that looks like at the country level. So why do we think it's important to have a referral process for adults? I think Dig touched on the significant global health burden net hearing losses. So the latest World Health Report or the World Hearing report coming out from the WHO talks about 20% of people across the globe have some form of hearing loss. That's even more acutely felt in that age group of adults and seniors, where 1 in 3 have hearing loss and almost all of those over the age of 60 would have a form of severe to profound hearing loss, which is very much where our technologies play. What you also see in that space is a growing base of evidence to say there are other implications for hearing loss, some things that are not always considered as long-term implications. And this increasing relationship between hearing loss and dementia and cognitive decline, increasing evidence coming to the fore that there is a direct link between those 2. And we know that the global cases of dementia are going to triple by the time we get to 2050. We know that the number of patients with hearing loss is probably going to be around 2.5 billion by the time we get to 2050. So there is a compelling need to address what is a real public challenge. From, I guess, opportunity for the company. That's a significant addressable market that provides huge opportunity for growth, not only in the quantum, and you see on the top left-hand table that quantum of patients is increasing and particularly in markets where we have well-developed reimbursement structures in Europe, more than 30% of patients are going to be the age of -- over the age 60, and those patients are going to be living for a lot longer than those patients would have had historically. So that problem is -- that opportunity is big and is only going to get bigger. On the bottom left-hand chart, the bubble charts, while those bubbles might look small in terms of profound, severe and complete deafness, if you just have a look at the quantum of patients, that's a significant opportunity. And we're seeing that demographic shift in the sales of surgery mix today. And so that pie chart gives you a sense that right now is as of the end of the last financial year, 70% of our surgeries are coming from adults and seniors. So we're seeing the demographic shift happening within the own business. So clear compelling public health need, we have a solution for that need and therefore, the opportunity exists for growth. The next slide is I wanted to give you a sense of what -- when you develop this referral pathway, what does good look at. And we've done this as an organization before. We've done this in pediatrics. And this is the U.S. and starting back in '95 going through to 2010, you can see that, that journey of standard of care, which is now well established in pediatrics. Three sort of key insights from this slide. One is the crucial role that public health care policy does in unlocking standard of care. So you see newborn hearing screening as a critical first element in unlocking that standard of care journey. And so public health policy and its implications is something we're going to talk about a little bit later on. The other piece you see there is this relationship with good, robust clinical evidence that is supporting reimbursement. And if you're supporting reimbursement, you're also then of course, providing access. And so clinical evidence and the importance of that is a key unlocker here. And the third piece you see in here is the sustained effort over time. It wasn't just 1 level of dB or 1 level of access. We've built that over increasingly lowering the hurdle to get access to these products. Age is a second piece that you can see. And the third important insight is there's a ton here. This is not a sprint that gets you across the line. This is a sustained effort, in the case of the U.S. 16 years before you get to some level of standard of care. And I think that's a mindset we need to take into the building of this pathway in pediatrics. And that evidence has translated into a broad adoption across the globe. So reimbursement for many of our developed markets is not a significant barrier. There are opportunities to expand that. But in principle, it's not a significant barrier. And what you do see, for example, there's no age limits now in the case of getting reimbursement in pediatrics. In the years, we're right down to 9%. That's on the back of that evidence. That's on the back of proving its health economic benefit. And so reimbursement by and large, is not a significant barrier to, I guess, access to cochlear implants. And we see this reflected then in the penetration rates across the globe. This is a selection of key developed markets, reflecting hearing loss, this is 0 to 18. But as you go down the age groups, it's a very similar profile that we have a significant penetration and reflective of standard of care for pediatric patients. So we have a history of being successful. We, I think, understand the key elements of that. So as we tackle the challenge of an adult space, many of these are going to resonate. There are different barriers or challenges which we'll unpack in a moment. And so contrast the pediatric penetration rate with adults, and this is a subset, this is seniors, and you can see this vast disparity that reflects a nonstandard, very dispersed, very disorientated customer or patient journey to get access to the technologies. And so this is the challenge, I guess, we face. And this is really why we are significantly investing in developing a referral pathway that's effective. So then if this is the case, why are we not there? What are those barriers to access care. And probably a significant barrier that's both at the patient level but also at the physician level or the health care professional is it's not seen as an important thing to address. It's not seen as a priority within the health care space. On the left-hand side, that's a survey done in the years over 1,000 patients and asking them to rank in the next 12 months, what's the most likely health intervention they would take or the most likely important lifestyle intervention that they would take in. You clearly see where hearing loss stacks in that space. right down at the bottom. On the right-hand side, this is a survey with 400 health care professionals, nurses and primary care physicians, GPs asking them the question of how -- what's the priority for you for hearing health in your engagement with your patients and less than -- or around 1% of those individuals said that this was an important piece to discuss. So whether you're a primary care physician -- and I'll show you some data around specialists, it's not an important piece and the same on the left-hand side, not an important piece. And we'll talk about why we think that's the case. Again, 2 pieces of patient feedback. Left-hand side, this is a survey of 15,000 adults across the U.S. age 50 to 80, asking them a series of questions. One of those is have you had a discussion with your physician around cochlear-implant? So this is awareness of cochlear implants. 80% of patients have never had that conversation. Either they don't know it or their hearing professional is not aware of it and hasn't had the conversation. When asked when last did you have your hearing tested? For most of these responders, it's been 10 years since they've had their hearing tested. Again, not an important or seen as an important piece. On the right-hand side, when you ask these individuals, what would be the choice or the modalities of treating your hearing loss. Again, you see cochlear implants is very well -- very underrepresented and not seen as something that is front and center at a patient or the primary care level. So we've got an awareness of hearing health and its importance, probably on the back of not fully appreciating any long-term implications. And then you've got this very low level of awareness of what a cochlear implant is and its role potentially in addressing the hearing loss. And so that's from a patient perspective. If you flip this over to providers or health care professionals, this is a summary of some research we've done with ENT. So these are not treating cochlear implant physicians. These are ENTs, primary care physicians, audiologists, Think of those as retail audiologists or audiologists in primary care practice or in hearing aid practices across Germany, U.K., the U.S., Japan is a very consistent theme of the barriers across any one of those countries. And again, not surprisingly with providers, awareness is an issue. It's just not top of mind. I don't think about it. I may not see these patients. I may be seeing them, but I don't recognize who they are. I don't have a lot of exposure, either in my training I've never been exposed to what a cochlear implant is, I don't engage in a health care environment where cochlear implants are in use. And remember, there are ENTs in this space -- in this provider panel. I don't know what would qualify for -- see our patient, what they would qualify for, what are the criteria. And so because of that, I don't refer them. There are some secondary barriers that do surface. So aversion to surgery. This is the physician's view, not the patient's view, that I don't think this patient is suitable for surgery or would want surgery. High levels of satisfaction with hearing aids. When you do research with patients who are on hearing aids, they have a perceived high level of satisfaction that there's no need to move to something else. And it's the same with many of the audiologists. They think their patients are well satisfied. Their patients are telling them they are well satisfied and so you don't get this referral piece. There's a lack of evidence of how well a cochlear implant would be to a hearing aid. You've seen from Jan's presentation, there is significant evidence to demonstrate that impact, but it's not visible and they're not aware of it. There are some elements of, I guess, financial barriers here. In certain places, there's a financial incentive to keep those patients and not refer. But it's not a primary barrier in many of these places. So again, consistent with what you see in patients, this awareness and top of mind is a significant barrier across a whole range of people in the space. And so this is reflected at a very personal level when we did the living guidelines projects. These were 2 quotes that sort of resonated with many of the people involved in developing those guidelines. And you're seeing this from a -- on the left-hand side, a user and on the right-hand side an audiologist that this challenge of different professionals inconsistent or no information the messaging around hearing health care makes it very, very difficult for individuals to seek care. In many of the research, some of those journeys are 10, 12, 15 years long, before they line up in a CI clinic. And on the right-hand side, there's this view that it's either surgical or technology. It's not patient centered in our view. There's no consistent referral, not just within the space, but even between 2 centers in the same state, there is inconsistent referral patterns. And so there is this real desire to pull together a universal view of how we would move these adult patients, very similar to what we have in pediatrics. So there are a number of other barriers, but these are the big ones of just awareness, understanding and then the referral of how to get to a clinic. So if we understand why we need to do it, and we understand some of those key barriers, then I think according to our mission, our job is to make more people hear and be heard. What are we doing to help build that? And if not just us, this is a collaboration with a whole range of stakeholders of how we might build that more effective and efficient referral pathway. And trying to sort of make this easy to grasp and get our heads around. We sort of bucket into 4 key areas. On the top left-hand side, a critical element in developing a standard of care is the creation and dissemination of key elements of evidence. And that's not just clinical evidence that supports why you would use a cochlear implant and what that does to a patient's hearing performance and their quality of life. It's also increasingly we're going to have to demonstrate the cost effectiveness of this product. As we grow the marketplace, you can imagine, payers are going to be demanding a level of cost effectiveness for the intervention. So that's an ongoing piece. And the more we can generate good quality evidence we're using that to inform guidelines. And so we call them living guidelines because they need to be real-time changing as we get in clinical evidence. You can't wait for these 5-year interplays, which used to happen in many other therapeutic categories, you'd wait 4 or 5 years, you gather with evidence that's taken place, you'd review the guidelines and then you would issue. I think there's a real acknowledgment that this needs to be something that is very current. And so as we get new evidence, we're informing those guidelines. And those guidelines are right from identification through the referral, through the surgery, including the aftercare, because we know that is a critical element of outcomes, but it's also a key element of growth with capacity constraints. Enabling those guidelines, you need some sort of health care policy to endorse or enable that structure. And so a lot of work helping shape our health care policy at a global level, but most importantly, at a country level. And then you need advocacy. In many other therapeutic categories, the patient's voice is powerful. The patient's voice demanding access to the therapy because it's their health, that is the most important piece at risk, that patient advocacy piece is an important element of how we're thinking about building that pathway, and we'll dive into that in a moment. And again, you can have great evidence, good guidelines, a policy that endorses and supports it, but unless people take action unless somebody refers or a patient demands, it doesn't change. And so a core part of what we're doing is how we're driving that behavior change. How we're instilling the action with many of these professionals and patients to make the change. So key 4 building blocks of how we've structured our investment in our time and energy in building that referral pathway. I'll dive into one of the -- into each one of these in a little bit more detail. So of course, creating evidence, there is significant evidence today. Some of that is reflected in the broad reimbursement we have, but that's not sufficient. We're going to have to continue to strengthen that evidence. And you're seeing elements of that on the -- this is an extract from The Lancet publication, which starts to talk about the link between hearing health and dementia, identifies that hearing health is -- or hearing loss is the single most modifiable risk factor for dementia. So starting to shape some of the public policy piece. On the right-hand side in the bottom, this is continued demonstration of the health economic benefits of cochlear implants, particularly in adults, in multiple countries. This is our own research that shows when you use a Nucleus 7 with one of our implants, you get the significant shift in quality of life patient -- quality of life outcomes for patients. And that's what we want. We want to see patients embrace and feel that they are engaging with their life. And then there's an important change in our space. Jan spoke about big studies being 50 or 60 people. These are large prospective randomized controlled study. So the highest order of evidence that are again starting to influence this referral path and I'll touch about those in a moment. So trying to harness the evidence that's collected because it needs to support the guidelines. And so quick deep dive into 2 of those studies. The one on the left is the COACH study. This is a randomized prospective study being done in the U.K. taking patients who are currently on hearing aids as a control arm and comparing those patients -- of that same demographic of patients getting a hearing -- cochlear implant and comparing speech outcomes between you're getting a hearing aid versus getting a cochlear implant. That's certainly going to be the largest and most robust prospective study to position the role of cochlear implants relative to hearing aids. And on the right-hand side, that's just most recently published in the last 6 or 8 weeks. This is the ACHIEVE study. It's a hearing aid study, but it's done in patients with mild to moderate hearing loss. And what that's done is compared that group of patients who would then receive hearing education or health care education and the intervention arm giving you a hearing aid and understanding whether or not the hearing aid reduces the risk of cognitive decline based on all of those research coming out. And what you see for a patient population at risk, there's a 48% reduction -- a 48% reduction in the risk of developing dementia. That's the first piece of evidence that's starting to show if you don't take action early on in treating your hearing loss, not only don't you hear, but for the first time, you're starting to see other implications to hearing loss. And this is an important piece because this is how diabetes and hypertension get visibility, is because you die of a heart attack or you develop atherosclerosis or you develop with diabetes, blindness, amputations, there are real consequences to not treating it. Up until now, that's not been the case with hearing loss. You're going to go deaf, you're going to hearing aid, people are going to speak louder. Now if I'm telling you that this is an impact on dementia and cognitive decline, that's a compelling reason for a patient to take action. There are massive costs associated with that from a public health care policy. There is an incentive for health care policy to change based on those implications. So while this is a hearing aid study, and it's in a different level of hearing loss, it's a significant piece in shifting the dialogue around the importance of hearing health. So that's the ACHIEVE study. I gave the results of that in the slide. But there, you can see that there is a significant impact over 3 years for a patient population who at risk for dementia, significant shift in how we would frame hearing health and hearing loss. We getting out evidence. We've got to put that into guidelines. There has historically been no global set of guidelines, which there are in places like hypertension, diabetes, rheumatology, asthma. All of these, there are global guidelines. And so we've started on a journey in doing that. What you can see is we published an international consensus paper where we gathered a small group of clinicians in our space led by our clinical team in developing a consensus paper. But it was just that, it was a consensus paper. It wasn't guidelines. And so we initiated a project to -- whoops, but we -- can you go back 1 slide? Thank you. We initiated -- whoops, sorry, go back from -- there we go. We initiated a study in developing living guidelines where we gathered 50 individuals from across the globe, audiologists, surgeons, patient advocacy in building what we think -- what we know is the very first global set of guidelines from early identification right through to treatment and rehabilitation. That's just rolled out. And I guess the important piece here is it's great to have a document. It's great to have a group of people who have built that. The change only happens at a country level. And so what we're seeing right now is a number of our key countries, then utilizing that document and driving some of those changes and discussions at a country level. I'm not going to go into a deep dive here, but this gives you a sense of what the different types of actions some of the key countries are taking in bringing these guidelines to life, shaping policy, shaping their own guidelines, driving awareness, engaging consumer or patient advocacy groups. So that third piece around patient advocacy, you have some high-level focus areas. So we're obviously working with the WHO at a high level. but we have some key countries where we're actively using WHO to drive policy change resolution, and that's an ongoing relationship we continue to have. Over the last 3 or 4 years, we've been actively driving members or patient advocacy groups to unite and have a single voice. There are a lot of patient advocacy groups in CI. The problem is they're very diverse, very discrete, very decentralized, and there's no powerful single voice deck and shape. And so we've worked with a few individuals to develop this TICI, which is really a collaboration of a number of different patient advisory groups to drive the voice of customer much, much more louder. Importantly, we've got research collaborations on a product and technology side, but we do have these 2 key relationships with public health academia. So we've got a group here in Macquarie that are working on a number of longitudinal epidemiological studies. We've got Professor Franklin in John Hopkins, who, of course, is a key architect of the ACHIEVE study, but is also looking at driving changes to public health policy. So that academic relationship is important for credibility, but also because they are public health policy drivers. And then we've got a number of versions of collaborations, pulling together different groups. So this is an example, and I'm sure Lisa will dive into this in a moment, where we've got policymakers, hearing aid people, CI surgeons pulling together, and in this case, in the U.S. called the Hearing Health Collaborative in pulling together a united view of hearing health and helping to shape policy, that has to be driven by professionals and individuals, but we certainly play a role in helping enable that. And the variations of that across the world, there's one in Australia that is up and running as we speak. So very high level and a very quick view of some of the key areas we're helping shape advocacy. I mean as I said, it all doesn't happen unless people make a change. And so there's some really tactical elements of working with individuals around hearing aid partners where we're working with them and helping identify who would be, how they would refer, who they would refer to, revolving educational elements that we can go into. This is an example in the U.K. where we're working with the NHS in training, the hearing aid audiologists in the NHS of what does a cochlear implant patient look like? What is that? What's the surgery involved, who could you refer to and hoping that starts to accelerate referral. And then we've got a number of platforms where we use those platforms to disseminate the latest information sharing of the activities across the globe so that there's a transparency and access to information. And the adult hearing platform is just 1 example of that. So those are the 4 key elements of creating evidence, putting guidelines together, ensuring that's enshrined and supported by advocacy and policy and then driving behavior change. And if we get those 4 right, then we should to the right-hand side, have a development of standard of care. And again, the call out being a sustained effort that has some short-term wins, but mostly sort of pay off for the medium and long term. And I'll stop there and take any 1 or 2 questions. Yes.

You spent most of your time talking from what I call the top-down approach, the research, innovation, The audiologists, the professionals, et cetera. I'm very keen to hear the speaker from the U.S. because the previous Head of U.S. and Cochlear in the United States, who became a short-term CEO. Talked about developing groups of CI recipients who then would talk to potential CI recipients and explain to them the benefits and your colleague with his double cochlear demonstrated that very well. I wonder the degree to which Cochlear can, should, whatever, start working from the bottom up approach. People who are my age, who are suffering a noticeable deficiency in hearing, who go to an audiologist who says, I've got the product for you, but having been aware of Cochlear for 12 years, I'm a little bit dubious about jumping into that realm. And I'm now going to go to my GP and get a referral to somebody who knows more than just how to sell a product. But the question I'm asking you is what can Cochlear do to increase, to motivate the hearing impaired who don't know and are not getting any advice on where do I go now?

Yes. And a very good question. 2 responses to that. So one, you can imagine there's a whole range of things we're doing, and it's hard to capture them in a single slide. So we've got 2 pieces. We have broad awareness strategies in place, and I'll call them consumer strategies in place. And that's not a strategy to connect you directly with the clinic, but it's inform you of the various options in hearing health. Why Cochlear implantation is an important piece, and we're about to embark on a pilot in fact in the U.S. what I would call broad-scale consumer awareness. And there are variations of that across different countries. The other piece that's not reflected, but is an integral part is a volunteer network. So we are I think, Roger, clearly articulated the impact his brother had but not everybody has, I guess, access to that intimate piece. So we have, for a long time, initiated out of the U.S., but is replicated in many countries. A volunteer network. We work with a group of passionate CI recipients. And we actively match those to people who we feel would be in a similar space, reflective of their journey and get them to engage. And we see that has a significant impact at that last page. So it's really at a different time in the space. I've come through. I'm now fairly ready to go, but I really want to understand what that is. There's a real synergy and impact in that personal relationship. And so that's a piece that's reflected in many other places.

Okay. Thanks, Dean. We're going to take a break now tili 5 past 11, and then we'll come back with Lisa and Greg and Q&A to do finish up. [Presentation]