Danaher Corporation (DHR) Earnings Call Transcript & Summary

Good morning, everybody, and welcome to Washington, D.C. to our Diagnostics-focused Analyst Day here, and also welcome to everyone joining us on the webcast. I think we're going to have a really fun couple of hours here planned for you. I'm going to go through the agenda in a minute, but before we do that -- let's make sure -- Darren, I don't -- I'm not sure, it's advancing there. So I'll hold on a second. Do you have to mention that we will be making forward-looking statements today as part of the -- or may make forward-looking statements as part of the presentation today. As you see there, you can read the full text in its entirety on our website or in the binders in front of you. On to the agenda. We're going to start with a nice overview of the platform here. Julie is going to come up and talk about how we've built a really exciting and differentiated diagnostics business here. We're going to talk about our Specialty Diagnostics business with Leica and Radiometer a bit, go on to Beckman and finish here with Cepheid. We'll then bring everyone up for Q&A at the end of the day. Hopefully, you guys will get a sense of just how special these businesses are and really differentiated from a financial perspective, and really some exciting opportunities ahead from a growth perspective for these businesses. So with that, I will welcome Julie up here to start the day for us.

Hello, everyone. It's a pleasure to spend some time with you this morning discussing our Diagnostics business. Before I get into Diagnostics, I think it's important to note that Danaher's portfolio transformation has created a focused life sciences and diagnostics innovator. And this is a great ecosystem in which our Diagnostics business can thrive. It's very motivating for our talent. And basically, we have these 3 platforms: Biotechnology, life sciences and diagnostics, all committed to using the power of science and technology to transform human health. All with differentiated positioning, attractive end markets and really nice financial profiles. The Diagnostics business at $9.6 billion is the largest of Danaher's platforms. It offers Beckman Coulter, Cepheid, Leica Biosystems and Radiometer. All scaled and differentiated positions and some of the most attractive areas of Diagnostics. And building this Diagnostics platform has been a journey, powered by the Danaher Business System. It started in 2004 with Radiometer, our entry into blood gas testing in acute care. This year, Danaher celebrates our 40th anniversary. But in some ways, we're only 20 years old because Radiometer was our first operating company in the area of human health. And it was a great business for us to better understand the attractiveness of these secular growth drivers in Diagnostics, the attractiveness of the recurring revenue business model. And we'll discuss today how Radiometer has just been an excellent durable growth company for us regularly performing above the market. And then next, Leica in 2005. This is really a story of strategy dictating M&A. So the Leica acquisition starts as a foothold, an anatomical pathology and the core histology, really the workflow of the pathology lab. But understanding where the puck is going in pathology, we then moved into advanced sustaining as well as digital pathology. And we'll discuss today how we think our leadership positions in advanced staining and digital pathology really set us up well for the future of companion diagnostics in this space. And then in 2011, Beckman Coulter. So Beckman Coulter offers a very scaled position in the core lab. As Danaher diagnostics every hour around the globe, we offer over 1 million tests. And a big chunk of those are Beckman Coulter tests. So it makes us incredibly important to the health systems that we serve. And when we initially acquired Beckman Coulter, it was a 0% growth company. And we'll talk to you today about through the power of DBS, working on our commercial engine and innovation. We have brought that company to a mid-single-digit grower. And now that we have updated all of our instruments, filled menu gaps, we're really in a position for this next stage of Beckman Coulter growth that we think can be mid-single digits plus. The table has been laid for that. And then last but not least, Cepheid. So the initial investment hypothesis around Cepheid is we thought that the architecture, the point of care architecture of the Cepheid box was the best architecture for molecular testing. And that certainly panned out during the pandemic, where we saw a very significant increase of our installed base. It really was the preferred testing modality. And the Cepheid team continues to prove that out quarter after quarter, gaining share both in respiratory testing as well as nonrespiratory testing. So a story of acquiring leading positions and enhancing those positions over time with the Danaher Business System. And what that gives us today is a very comprehensive Diagnostics platform. So we are in the emergency room and intensive care with Radiometer. We're in the pathology lab with Leica Biosystems and the core lab with Beckman Coulter, and then the molecular microbiology lab with Cepheid. And you can see on this slide how these companies have grown over time, the nice profit margins that we've been able to attain, these are all scaled businesses across the hospital with differentiated financial profiles. And we really like the strong secular growth drivers in diagnostics. It starts with diagnostics being at the heart of predictive and preventative care. 70% of all health decisions start with diagnostics. And then when you couple that with the growing aging population around the world, and we forecast that the human beings over 65 is going to double between now and 2050. You see a significant increase in these critical health care decisions that need to be enabled by diagnostics. We also have a lot of room for continued expansion and penetration of new technologies, whether that's molecular or digital pathology or new companion diagnostics, there's room for greater penetration. In molecular, we have seen, helped by the pandemic, a 2.5x increase between 2019 and 2023 in terms of the penetration of molecular testing. But something that Vitor and Peter will talk about in the Cepheid section, is that excitingly, there's still lots of room to expand our penetration of molecular diagnostics. And then the other way we grow is by meeting the key needs that our customers have. And really, these come in 2 broad buckets. One is for improved workflow, the other for improved clinical solutions. Our customers have a skilled labor shortage. For example, over 15% of laboratory roles remain unfilled in the U.S. Every laboratory director I talked to, this is a huge part of what's on their mind. And we can help them with automation, which has been a real powerhouse of Beckman Coulter and with better designed instruments that are easier to use. So for example, our DxI 9000 instrument is the only immunoassay analyzer with zero daily maintenance. When you're looking at constrained lab techs in your lab, these things make a huge difference. And then, of course, at the end of the day, what we do is for patients and better clinical solutions. And we are entering an age of greater precision medicine. When you look at the pharma clinical trials today, over 50% are using biomarkers to inform enrollment. That means that we have an incredible responsibility and opportunity to use diagnostics to ensure the right patient is getting on the right therapy at the right time in a precision diagnostics context. So we really like these long-term secular growth drivers that underpin our strategy. And our portfolio is indexed to highly attractive areas of diagnostics. Cepheid is the leading molecular player with the largest installed base in test menu, and that has led to double-digit nonrespiratory CAGR between 2019 and 2023. Leica Biosystems and Radiometer offer scaled pathology and blood gas positions, each over $1 billion in annual revenue, each growing at a high single-digit CAGR. And then Beckman Coulter, a comprehensive portfolio with strong footholds in the core lab, now a mid-single-digit grower, and we'll talk about this room to make that a mid-single-digit-plus proposition. So how do we win in diagnostics? We think our competitive advantage comes down to 3 things. One is innovation. And this is innovation powered by the Danaher Business System. This has been a big focus of the platform, and we have seen an increase in new product launches the last 3 years, 2x the level it was the 3 years previous. And frankly, when we look forward, we see that cadence of innovation increasing again. The other is commercial execution, again, powered by the Danaher Business System. This is driving wins of new customers by focusing both on the operational efficiency that we can give those customers as well as our clinical value advantages. And then Beckman Coulter, we certainly have seen this play out. It's a big part of the Beckman story, a greater than 40% increase in competitive wins between 2018 and 2023. And then as we look to the future, we are establishing our portfolio to have a right to win in high-growth segments of diagnostics. We think that neurodegenerative disease, infectious disease, including the host response to infection and oncology are all going to be double-digit growth areas of diagnostics over the next 10 years. And you can see how the way that we go to market, the way we win, has resulted in a differentiated financial profile both in terms of our growth and our operating profit margins. I think our results speak for themselves and how we have outperformed our peers. I want to double click on this being positioned to win in these high-growth, high-impact areas of diagnostics. So I'll start with neurodegenerative disease, which we think will grow to a $5 billion Diagnostics market over the next 10 years. The clinical need here is for accessible, noninvasive diagnostic testing for early detection and ultimately monitoring of these diseases. Today, the standard of care to get put on one of these exciting new disease-modifying therapies that are now on market is either a PET scan or a spinal tap. So as you can imagine, patients usually undergo a PET scan or a spinal tap when their disease and their symptoms are quite progressed. And this is unfortunate because actually, the earlier that you detect disease the better these disease-modifying therapies work. So what allows noninvasive early detection because you have to be able to detect proteins in the peripheral blood that have escaped that blood brain barrier. Well, the answer is you need a highly sensitive analyzer. And the DxI 9000, our recently launched immunoassay analyzer has sensitivity that is 100x better than conventional immunoassay. I mean, conventional immunoassay is pretty good. It can detect the equivalent of a teaspoon of sugar in 1,000 Olympic-size swimming pools. Now we're talking about detecting that teaspoon in 100,000 Olympic-size swimming pools. That does not matter for every disease state, but we believe it matters significantly in neurodegenerative disease. And we have great partners working with us. Working with Fujirebio, who has the most extensive research portfolio of assays out there to put some of those assays on the DxI 9000 analyzer. Working with ALZpath, the great antibody supplier. And we also recently announced our partnership along with Fujirebio with Biogen to help them with their next generation of drugs and the biomarkers that will support them focused on tau pathology. We also think that infectious disease is a very exciting place. There's a rise in complexity in infectious disease management and an opportunity to do things better now that was scientifically, we better understand the host response to infection. And here, both the Cepheid GeneXpert architecture and the DxI 9000 have important roles to play. GeneXpert with ability to have greater multiplexing, you understand fuller the panels and what kind of infectant is actually at play here. And Beckman Coulter is working with partners in this space including MeMed, which offers an exciting assay that determines whether an infection is bacterial versus viral, and we're putting that on the DxI 9000 platform. We also have strong academic medical center partners in this space as well, such as the University of Oxford, where we're working on precision medicine for sepsis. And then oncology, so the treatments for oncology continue to advance. And when you look at the portfolio of oncology medicines in development, what you see is that these therapeutics are using an increasing number of biomarkers, things like antibody drug conjugates, and they're going to require more precise measurement. Frankly, better, more reliable quantification than the pathologists can get just from looking under the microscope. So this is where we really like our position in advanced staining with putting the biomarkers onto the stain as well as digital pathology because digital pathology is going to go beyond a workflow advantage. And yes, it's important that you can see these slides anywhere that the best pathologists focused on that disease state can view the slide due to digital pathology. But when we look at this therapeutic pipeline, we think digital pathology is also going to become more clinically important as well. So we're working with biopharma and we're investing to become an excellent partner because Leica hasn't traditionally played largely in companion diagnostics. And one of the ways we're investing is with our new centers of innovation. So this is how we are building CLIA labs with the full Danaher kit of instruments that can help support the development of clinical trial assays and support our biopharma partners through the clinical trial to develop companion diagnostics complementary diagnostics. So we're excited that we believe are helping solve some of the health care's biggest challenges with the high-resolution technology and workflow that we think is required to play a very meaningful role here. Something you also will hear us talk about more than we have in the past is harnessing the power of the Diagnostics platform. So let me tell you what this means and what it doesn't mean. So we aren't changing the way we go to market. We still believe in having strong brands, individual operating companies with great accountability for running those businesses with the power of DBS. But what it does mean is that there are certain situations where the platform can play a synergistic role and we'll be doing more of that. Commercially, especially after the pandemic, health systems understand in a different way than they did before the importance of partnership with their suppliers. And we have found that using the full breadth of the Danaher portfolio commercially can be very meaningful. And also in certain high-growth markets where we're investing and adding a lot of feet in the street and talent to gain share. In some cases, we'll even go to market as Danaher. When it comes to innovation, there are certain things that we can build at the platform more quickly than any individual operating company can do. And then all the operating companies can enjoy that capability that we have built and these new centers of innovation are just 1 example of how we can support our operating companies for innovation. And then lastly, partnerships. So when you think about the innovation ecosystem, academic medical centers, biopharma, they are excited to partner with our individual operating companies. They are even more enthusiastic about partnering with Danaher. So for example, one program that we started is our Danaher Beacons program. And so this is a way of getting access to early innovation, speeding up the time of innovation and the time to peak market adoption by working with academic medical centers. So you'll see this continue to grow. Two early examples are our partnership with Oxford University that I mentioned and precision medicine for sepsis as well as our collaboration with Johns Hopkins in the diagnosis of mild traumatic brain injury. So you'll see us strengthening our value proposition with these platform-level capabilities. And still, I would say our greatest competitive advantage of all is the Danaher Business System. And this is not only a series of tools that are very powerful in helping us execute at excellence that continue to evolve with us into the growth company that we are today, but it is our culture of continuous improvement. Just last week we celebrated the winners of the CEO Kaizen. This is something we do every year. And I'm reminded every year how amazing it is with the power of Kaizen, of these teams can come together and drive double-digit million dollar value results over a week of well-designed Kaizen. I think it really is an extreme competitive advantage for us that is enabling differentiated execution at scale. So that is the overview of the platform. So what else will you hear from us today. We'll talk about specialty diagnostics in a minute, Radiometer and Leica Biosystems. We'll then shift to the Core Lab and Beckman Coulter and how we've continued to drive commercial execution, innovation, execution to now be at mid-single digits and looking at mid-single digit plus. And then we'll go into Cepheid and the molecular diagnostics story there. So let's transition to specialty diagnostics. Specialty diagnostics, Leica and Radiometer. These are not small companies. Together, $2.6 billion in revenue with the great secular growth drivers that we spoke about for the Diagnostics platform as a whole with really attractive recurring revenue mix and geographic mix. Strong global brands with leading market positions. Where do we play? So Radiometer, you find principally in the emergency and intensive care. So blood gas is taking critical respiratory and metabolic measurements that are critical for making those critical care, rapid decisions. And then we also have our point-of-care immunoassay analyzer that's doing key cardiac, some infection immunoassay biomarkers at the point of care, where every minute matters. Then Leica Biosystems is in the pathology lab. So starting with histology in our Polaris system, a leader in tissue preparation preparing that sample. And then we have our advanced staining business, adding biomarkers for advanced analysis of the tissue sample and then our leading digital pathology business as well. So let's talk about Radiometer. Radiometer has been a fantastic grower for us, regularly performing 300 bps above the peers in the space. Current strategic focus areas for Radiometer include innovation and new products. We have new menu that we can bring to those instruments. The team has performed well launching new innovation. One of the things we recently have worked on is connecting our blood gas analyzers for better workflow, and we've seen a 3x increase in those connected blood gas analyzers between 2018 and 2023. Another is execution in high-growth markets, places like Southeast Asia, India, Saudi, here we're expanding our commercial capabilities and our direct sales channels to be able to continue to drive what has been low double-digit growth in these segments. And then reinvesting for growth. You can see a picture of our new immunoassay point-of-care analyzer. They're on the slide, that's under development, but this is running the Danaher playbook to fund growth investments and expand margins. And we are seeing low double-digit growth in that immunoassay segment. So outperformance driven by consistent DBS-driven execution and innovation. So now let's turn to Leica. And I mentioned that this is really a story of strategy driving M&A and creating an increasingly powerful pathology leader. Starting with core histology that was our foothold in the pathology lab. We've got a great position. I mean, all this work that the lab does preparing the tissue sample is very central to what they do. And then the advanced staining we added with the acquisition of Vision Systems. So these immunohistochemistry capabilities, which is a higher growth adjacency to that initial core histology play. And then now also digital pathology with Aperio, another double-digit growing segment. And all of this has come together to result in high single-digit revenue CAGR, flagship platforms in advanced staining and digital pathology. And as I mentioned previously, really setting us up extremely well for that next generation of companion diagnostics in oncology that we think will really require the use of advanced staining and digital pathology. Even post those acquisitions of Vision Systems in Aperio, the Leica team has done a fantastic job growing those franchises with new product launches. And here, it's about continuously improving the workflow for the customer. So our Aperio GT 450 scanner offers a 40% faster turnaround time than prior platforms. And the success of the scanner is one of the reasons that we're enjoying double-digit pathology -- digital pathology share gains. And then our BOND-PRIME, the advanced stainer high-speed advanced with industry-leading turnaround time. 2x faster throughput than the leading competitors. And this is driving greater than 10% advanced staining average annual core growth. So the team continues to offer innovation as increasing productivity for our customers, and as a result, driving market share gains. So putting it all together, how do we win in specialty diagnostics? We think we have attractive positioning, scale and leading positions in both acute care and the pathology lab. It's about DBS driven execution, commercial execution and innovation above market growth and financial performance and about focusing on innovation. And you can see we've had outstanding long-term performances in these businesses. I think the results speak for themselves. So now we're going to transition to Beckman Coulter. Now we have the Cepheid instrument here, you can see it's small and very cute and mobile. The Beckman Coulter instruments are a different game. And we actually really thought hard about getting all of you and to see a lab in the area. And then we work through the logistics of getting 150 people into a laboratory, and we decided that was a lot to ask of our customers. So we have prepared a brief video that you'll see in a minute just to give you a feel for what the laboratory really looks like and what kind of equipment is turning out over 1 million tests per hour around the globe. And then I will invite Chris Hagen to the stage to tell the Beckman Coulter story. So Chris is our Senior Vice President and General Manager of our Specialty business within Beckman Coulter. But he joined Beckman Coulter just right after I did back in 2017 and has been an instrumental part of this accelerating growth story of Beckman Coulter. So I know you'll enjoy hearing from him. So with that, we'll roll the brief video. [Presentation]

Good morning. It's great to be here with all of you. Thank you for joining us this morning at our Investor Day. Thank you as well to all of you that were able to join us last night for dinner. I trust you had an equally exciting conversations over dinner as we did after Mitch and Rainer's presentation. And between all the conversations, one of the favorite questions I received is, why did I think Danaher was choosing now in this particular meeting to highlight Beckman Coulter within the diagnostics companies that we're highlighting today. It was Elizabeth Jones that asked that. Thank you very much, Elizabeth. And I told Elizabeth, I think Beckman Coulter is one of the great Danaher and DBS stories and the turnaround of Beckman Coulter that because we're embedded within one of the platforms within -- in those platforms within the company that we don't always get to talk to you about. But today, we're really excited to share that exciting story and exactly what that's meant for us at Beckman Coulter. So starting with what you already know. Beckman Coulter is a $4 billion business with 90% recurring revenues in geography spread all around the world with strong core market leadership across multiple modalities and a very strong global brand. As you saw in the video that we just looked through, we enjoy the benefit of having modalities all throughout the core laboratory. So while some of the players in the market may have chemistry and immunoassay analyzers and they play in that segment, and others may have strong position in hematology, but perhaps lack chemistry immunoassay. We benefit from the fact that whether we're talking about chemistry, immunoassay, hematology, urinalysis, automation, IT, microbiology, we can go to the core laboratory with the suite of all of those solutions, and that enables us to partner with hospitals, with lab directors, with pathologists in meaningful and differentiated ways from that of everyone else. As we think about the journey that Beckman Coulter has been on, I would sort of break that into 3 sections. And that journey has been one of moving from at acquisition from low to negative core growth to low single digits by the time we got to 2018. We now are firmly in the mid-single digits, and we have our eyes set on high single digit, and we feel very strongly about our opportunity to get there. And the reason we feel strongly about that comes down to 3 of the areas that Julie referenced: a, the innovation and the products that we are bringing to market. And today, we enjoy 2x as much incremental new product revenue as we did on this journey back in 2018. Part of that journey then is a story of commercial execution. And I'll talk you through a little bit more about that, but the story of Beckman Coulter has been a story of commercial execution and the turnaround and the change in trajectory and the continued growth is a story of commercial execution. And then, of course, we're very excited about the DxI 9000 in some of the new disease areas that Julie referenced that we're going to be able to move into and that will become a part of that journey and that growth story as we look to move from mid-single digits into high single digits. So I'll start with the customer for Beckman Coulter and why that customer is so important and has been such a big part of the story of our change in growth. If we think about the core laboratory that we wanted to take you through today. It's generally led by a medical director or perhaps a pathologist. And they have a series of different responsibilities and key stakeholders that they have to manage. So they've got their lab. If you walked into that lab, it wouldn't feel much different perhaps than a manufacturing environment that you would walk into today. They've got their SKU dips on the Board where they're looking at safety and quality, right, in inventory and production. It's a machine like you noted in the video we showed you, they've got to worry about turnaround times. So they have all the day-to-day concerns that everyone that operates in that environment would have. But they have employees. They've got challenges with attracting and retaining that talent. There are 13,000 fewer medical technologists at any given point than there are open job racks within that position. So once they identify someone that they can bring into their lab and train, it's imperative to them that they drive retention and high employee engagement. And many times, they look to their in vitro diagnostic partners to help play a key role in that. And driving that engagement means removing some of the mundane and tedious in small tasks that they are -- that they would have to do in a manual-based workflow and enabling them to operate at the top of their skill level, and that's where Beckman Coulter can come along and play alongside them. Of course, they also have clinical, the medical directors and pathologists as they're operating within that lab. They have a clinical responsibility to the hospitals they serve. And they are tasked with moving outside of the laboratory into the emergency department, the other areas of the hospital in order to drive real clinical improvement and patient care and the way that, as a laboratory, they contribute to both treating patients in earlier diagnosing very costly diseases. And that, again, is a place that we are able to come alongside of them and they look increasingly to players like us to come and help them to take the communicate -- the story of the lab outside the lab and to those partners, and I'll talk a little bit about that. And then lastly, they operate within an environment that is consistently profit constrained. And when you look out across the hospital market today, specifically in the U.S., it's an ever consolidating environment. And so if you're one of those lab directors and pathologists, you are constantly thinking about not just what today's laboratory looks like, but you may be consolidating future laboratories in the future. You may need to think about the technology you have today and how does that become standardized across 5 to 10 are new laboratory sites that you're going to have in the future so that the patient result that takes place at one of those sites can be compared to a patient result at another site. And so that's the environment that our customers operate in today. So let's talk a little bit about how we, at Beckman Coulter approach that -- those customers. Well, we've divided our segments. You can sort of divide customers in hospital laboratories into 3 segments. You can think of them as small and small laboratories. You can think of them as sort of midsized laboratories, and then there are large laboratories that would have all of that automation equipment that you saw in the video. And those are the ones that would really feel like a manufacturing floor. And each of those segments and the customers in those segments, those labs, they have distinct challenges within their lab, but then they also have a set of common challenges that would span across all of those labs. And so generally, when a hospital is looking to go and bring new innovation into the hospital, they will put out what we would call an RFP, or request for proposal. And it's a bit like a -- America's Got Talent maybe where each site gets a vote. And if you're a small sized hospital and the in vitro diagnostic vendors coming in, you're going to be highly oriented towards their smaller volume solutions and what they can do to help you there. If you're sort of in a midsized hospital environment, you're looking for what solutions the vendor can bring to you in that midsize and so on with the large. And so we recognize that if we're going to come alongside and partner with these lab directors and pathologists, we need to be able to win the vote of each of those hospitals. We need to have a solution that can meaningfully impact their workflow, their employees within their site. The average IDN might be 15 hospitals spread across small, mid and large size, and you've got to win the vote of each of those 15. So historically, within those smaller hospitals, as we think about our automation for all and wanting to go with a solution for each of those, we've been challenged in our legacy portfolio to always solve that automation solution in some of those smaller hospital sites. The average small hospital that you will walk into today has what we would call a work cell. So in the processing of a lab sample, there's roughly 32 steps maybe from the time that lab sample comes into the lab, that patient sample, to when it works its way all the way through the laboratory workflow, and that patient result can make its way back to the patient, to the clinician. So in the smallest lab is where they are looking to begin automating some of those beginning steps of that manual workflow. And the work cell helps them to automate some very important steps and eliminate that from the workflow. And what I'm talking about there is the movement of the patient sample from the chemistry immunoassay analyzer of the chemistry over to the immunoassay analyzer. So without that connection, you can imagine the lab technologist goes and loads the patient sample onto the chemistry analyzer. They go back to do their work. They wait until it's finished. They go back, retrieve it from the chemistry analyzer, move it on to the eye analyzer go back, and do some other work and then they have to come back again and again and again for each patient sample. So when in vitro diagnostic manufacturers like Beckman Coulter can bring them a work cell, which automates the passing of that tube from one side of that analyzer to the other and prevents the back and forth, you can imagine how exciting that is that you're no longer having to do that back and forth. That improves employee retention, engagement. You can also imagine how difficult it is then to sell into that IDN if you don't have that solution. And up until the launch of the DxC500i this year, Beckman Coulter has not had that solution in the small volume laboratory, which means every time we go to that RFP and we're trying to get a vote, there are 5 to 10 of those hospital sites that are not likely going to want to vote to go back to a manual workflow or to stay in that manual workflow with the promise of that work cell. And so there have been points at which we've oriented our sales teams away from integrated delivery network works for where the small size hospital lab makes up too large a part of that, and we've oriented them onto the mid and larger size laboratories. We no longer have to do that with the launch of the DxC500i. For the first time, we can go after 100% of the hospital market with a solution that is scalable to meet all of their needs and receive the vote of every single hospital cyber regardless of size. In the midsized hospital in 2021, we launched the DxA 5000 Fit. That was game-changing for us then. It took -- I mentioned the 32 steps to process a sample that the large volume labs enjoy that we fully automated. It took that footprint, consolidated it down into something that could fit into the midsized hospital and solved 70% of those manual steps, which just happens to be where most of the labor is, most of the sample handling errors that take place and then also most of the employee injuries that take place. So we had already resolved that back in 2021 for them through our DxA 5000 Fit and a full 1/3 of our customers that order total lab automation solutions today, order the DxA 5000 Fit. And then in the large lab, we've always had that solution. Julie mentioned the DxI 9000. We couldn't be more excited about the DxI 9000, and since I've been talking about workflow, I'll start with its workflow benefits. This is going to be game changing again within the workflow of the laboratory. So you may or may not have ever read the instructions for use on your washer or dryer at home, but I promise you it has one. And from the fact that I don't know what it is, you can tell I haven't read mine, but it requires a certain maintenance schedule. And in the core laboratory, it's no different. Except that it's a regulatory environment and you're not allowed -- regulated environment. You're not allowed to not know the instructions for use when it comes to the maintenance. And that maintenance generally breaks into daily, weekly, monthly, annual. And every analyzer on the market has a daily maintenance. Now you can imagine about how much less excited you may be to do your laundry if you had to do maintenance on that dryer every single day. You can then imagine that it's -- fast forward today, and it's like table stakes, you don't do daily maintenance in order to be able to use that equipment. With the DxI 9000, it is the only IA analyzer on the market for which we have eliminated daily maintenance. It's very easy to see how appealing that will be to our customers. It's equally easy to see how 5 to 7 years from now when those customers become up for renewal again and someone else comes in and wants to introduce their immunoassay analyzer. And the first question is, well, is there daily maintenance? And the answer is, well, yes, of course, there is. There is no way you're getting rid of my DxI 9000 and taking me back to the days of daily maintenance. So as excited as I am about all of the benefits of the 9000 that we'll talk through. I suspect this is the benefit that our customers in the laboratory will be the most excited about. Now for us, of course, we're also excited because the DxI 9000 offers an opportunity for us to expand our menu. I mentioned that RFP in competing. Within each of those sites is generally a need to run infectious disease assays or cardiac assays like NT-pro. And up until we've launched this analyzer, we have not yet had those assays available to us on our IA platform. Now we've remedied that through partnerships to bring -- which bring in other analyzers and can place that analyzer in the equipment in order to meet what we've referred to as a menu gap within Beckman Coulter. But with the launch of the 9000, we no longer need to bring in that extra analyzer into the laboratory in order to fill that menu gap. In fact, we can eradicate once and for all the term menu get from the vernacular at Beckman Coulter, it's a meaningful difference in how we go to market now because we can now meet those customers and the lab space is already pretty constrained, introducing a new piece of equipment in there isn't the most popular idea. So to be able to go in and offer the full suite of assays on our analyzer is incredibly meaningful to them. Just that menu will open up $3 billion in new market segments for us between the infectious disease and -- or the blood virus, sorry, and the NT-proBNP. That is markets open to us on our already existing installed base at the call points with which we already call on with the personas that we already deal with every day. That's a very exciting opportunity for Beckman Coulter. And then lastly, we have the high sensitivity that the DxI 9000 now brings, and Julie referenced the 100,000 swimming pools and I'll talk a little bit more about that. In addition to innovation, we brought extreme commercial execution. We couldn't be more proud and excited of our commercial teams at Beckman Coulter. We've been able to go from low single digit to mid-single digit without enjoying any of the innovation that I just talked you through. Without the blood virus or the NT-pro, without the work cell, right, without the high sensitivity of the DxI 9000. And for the last many years, I've shared again and again with the commercial team, if we can focus on what we have in the bag now. And through repetitive excellence and extreme execution and sweating the small stuff, if we can learn to go and understand what our customers need from us in addition to just the technology and how we can serve other needs that they may have, while we look to innovate and bring these new innovations to market, and we can execute on all those small details. Then we'll become the kind of commercial machine that once we get this new innovation, we can drop it right on top of a very well-oiled machine that knows how to take those products to market and make the most of every opportunity. It will seem easy after having to sell into these spaces without some of the products I've talked about. And that's what we've worked on over the last several years, and it's paid amazing dividends. We now can see 50% more of the opportunities out in the market than we could in the past. Every year, we continue to beat the previous year's competitive wins and the amount of revenue that we take in from competitive wins. It's indicative of the type of commercial organization that we've built, and we're happy to hand them this new automation. One of the new capabilities that we built commercially was our performance partnership organization. I mentioned that in -- to commercial execution, a part of that was helping our teams to talk to the laboratory directors and pathologists about things beyond just the technology itself, right? Talking about the workflow, understanding the steps to process a sample, understanding the day-to-day challenges that they go through along those 3 pillars that we talked about. And in order to have those conversations in more meaningful ways, we added a performance partnership organization that is able to go into these hospitals with us and bring DBS to the hospitals. DBS is a part of our secret sauce. It's a part of what makes us successful as a business. We felt strongly that in the lab operating environment, it could also make a meaningful improvement for them. Many of these lab directors and these pathologists went to school for biological sciences, health care, service sciences, MDs. They're not carrying MBAs used to challenging some of the business-related processes that DBS equips us to address on every single day. And so when we put ourselves in the place of the customer though and say, "Hey, I'm willing to make your problem, our problem and not just in regards to the technology, but all of the challenges you face." We found it's made a meaningful difference to the relationships that we're able to have with them. You can see we now enjoy $45 million in annual revenue that we've added to our business as a result of taking this performance partnership solution out to many of the competitive accounts that we've been seeking to win while we await the coming of some of the new product innovation. I have no doubt that with the new products, the performance partnership and the commercial execution capabilities, that momentum will only build. And lastly, I'll close with -- now that we've talked a little bit about the innovation and the commercial execution. We're very excited about moving into new market segments within the core lab, right, leveraging an already existing installed base. And Julie talked about our excitement in neurodegenerative diseases. She talked a little bit about, and I'll add that today, as you think about a PET scan or a spinal tap, we're trying to measure plaques that have moved from or through the blood-brain barrier into the peripheral blood. It's at 100x more concentrated in the cerebral spinal fluid than that peripheral blood. So detecting those proteins in peripheral blood is exceedingly difficult. And so today, our customers are faced with sort of 1 or 2 trade-offs. They can turn to what we refer to as research grade sensitivity instruments, which have incredible sensitivity, but suffer from lack of workflow infrastructure. You're not going to find those analyzers generally spread already throughout a core lab. In fact, you won't find them at all spread throughout a core lab, connected to automation lines so that, you can not only test for maybe p-Tau, but in addition, several other biomarkers that may become relevant. So today, hospitals choose from I can have a highly sensitive analyzer not connected to automation without the existing installed base or workflow or I can choose an analyzer that's already plugged into the core infrastructure, plugged into the workflow of the normal laboratory but it doesn't have research-grade sensitivity. That's effectively what we believe most of the market has to choose between today. That trade-off no longer exists with DxI 9000. The sensitivity this brings them is the research grade sensitivity onto an analyzer that exists within an already built infrastructure within the hospital laboratories and an installed base that is much broader than what you would see with those research grade instruments today. As I think about where Beckman Coulter is today and that journey that we've been through, this market is, for sure, a market that will continue to evolve and change. We don't yet have all of the answers for it. But I'm exceedingly excited that Beckman Coulter is playing in a space with very exciting new and upcoming biomarkers at market formation. That's never been a conversation we've quite been able to participate in. We're really excited to be there. And with that, I'll turn it back over to Julie.

So thank you, Chris. So hopefully, this discussion has helped to understand why we're so positive about the future of Beckman Coulter. The opportunity to now have available the blood virus and NT-proBNP that we used to refer to as the menu gap and would rigorously segment our customers to make sure that we were targeting customers that could get around this menu gap, similarly with the lack of the workcell, all of that is behind us now. So a great reason to believe that we can go after the $3 billion market that is blood virus and NT-proBNP and really feel like the sweet spot is every integrated delivery network out there as opposed to rigorously targeting a subset that we think is a high fit for Beckman Coulter. That's an exciting time for a sales force that has shown that with the power of DBS, they can really execute and get us to mid-single digits. And now we believe it can go beyond that. And you couple that with the opportunity in these high-value disease states, neurology, which we talked about today with Alzheimer's, the play that we have moving forward in infectious disease and we talked about it last in this session, but we also think that there's a very interesting, albeit longer-term opportunity for us with our hematology business in hemato-oncology as well. And then we'll continue to use the DBS playbook at Beckman Coulter. We've done a lot to improve our margins over this time period with Beckman Coulter, and those opportunities continue to be there. So that's going to enable us to continue to funnel more investment into our R&D pipeline and make this an increasingly exciting business. So with that, I'm going to change gears. We're going to move on to Cepheid. And to tell this story, I'm going to ask Vitor Rocha, the President of Cepheid and then Peter Farrell, our Executive Vice President of Worldwide Commercial Operations, to join us. Thanks.

Thank you, Julie. Hello, everyone. Thanks for joining us today. I'm very happy to be here to talk about the exciting journey at Cepheid and my colleague, Peter Farrell is going to be joining me on stage here to share with you that story. Cepheid is solving one of the toughest problems in healthcare today, providing diagnostic tests near the patient at point-of-care in scale. We provide tests that are fast, accurate with the broadest menu in the industry in different care settings and in a platform that is easy to use and is scalable. Since the acquisition back in 2016, we experienced significant growth in our business, driven by decentralization of care, driven by the penetration of molecular diagnostics, among other factors. We surpassed $3 billion revenue mark. We're very excited about that. We now have 6,000 associates globally. We built a very strong global brand and a leading market position, and that is very exciting to see. Where we play as a company? We are a leading player in infectious diseases with a very broad portfolio of 35 tests covering a wide range of disease areas. Sexual transmitted diseases, virology, host associated infections, a small portfolio of oncology and of course, respiratory. Very strong portfolio. All of that is done in this architecture in one cartridge, which enables our customers to drive the standardization of care, enables them to drive consistency, enables them to drive compliance for their protocols, enabling them also to drive better financial and clinical outcomes. As a company, we built a very strong presence in the hospital space. We have a very large installed base that is growing, and we keep adding menu in that installed base. During the pandemic, this installed base that we have proved to be very efficient, leveraging the fast deployment that we have in terms of deploying assets in that network of instruments but also the extensive coverage that we have in our respiratory menu in our portfolio. And that led us to build this $1.6 billion franchise in respiratory. Now post-pandemic, we continue to see that our customers value our -- they really value our story. They continue to see the value of our portfolio. And what they are doing there, just leveraging their instruments to perform non-respiratory testing in their portfolio, in their instruments. And that is helping us to achieve $1.3 billion of revenue in non-respiratory testing, growing double digit, which is very exciting to see. Now I'm going to ask Peter to come here on stage to share with you how and why we're winning with our customers. So Peter, come on stage, please.

Thanks Vitor. So the Cepheid story is pretty exciting. I've been around for 10 years, so I was there before Danaher bought us. And Cepheid was always a company of innovation for you that followed it a long time ago. Innovation was at our core. When we got acquired by Danaher 8 years ago, things changed at Cepheid. Without Danaher and their support and DBS, we would never have been able to scale the business like we have. So it's been an incredible journey. And when I think about the technology, yes, we have our instruments. Vitor said, they're scalable. This is the GeneXpert 4. It has 4 modules. To run a cartridge, all you have to do is load the sample, put it in the -- put it in the instrument. And then press run. Just close that, and it runs. So when I think about that scalability, you could run a handful of tests, 4 or 5 in an urgent care center or you could run up to 1,000 tests on some of our bigger systems. So we have a 4 module system, a 16 module system, and a 48 and 80 module system. So we could run lots of samples or we can run small samples. The magic though, is the cartridge. And it's that cartridge that allows that test result to be given at any location where the patient is, right? So tuberculosis tests are done the middle of Africa in small villages, what we found during the pandemic is that this cartridge allowed decentralization of tests to be able to have the laboratory feel comfortable with what those tests were in a network of institutions. And so if you think about how molecular tests were done in the past, this cartridge has all the chambers where sample prep, amplification, detection and results were before. So it's pretty amazing what this thing can do. So this is really the magic. So then we get to what happened during respiratory. And so the endemic market for respiratory is about 5x larger than it was. And our sales revenue have grown from $250 million, here settled -- it went up to $2.7 billion, now down to about $1.6 billion is the endemic state. And we see now that the respiratory business is going to start to grow again like it has prior to the pandemic, at similar types of growth rates. But super exciting for us is because we went into this market and we made some really critical decisions. When the pandemic started, we had to make some decisions. We could not supply as much as our customers wanted. In fact, supply was probably about 1/10 of what our customers really wanted. So we had to scale up manufacturing. That's the beauty of working with the DBS system and with Danaher being able to do that. But what we're able to do is we decided to have the most impact on patients by going to those cities and providing tests for people that already had an instrument. Because they didn't need to be trained. We didn't need to ship them an instrument. We didn't need to send an engineer into those sites. So we really had a huge impact early on in the pandemic because all of our tests were used very quickly. In some of those big cities that were really under siege with COVID. But also what we were able to do as we came out of the pandemic was to focus on health systems. IDNs, health systems, those are large systems that have hospitals and outpatient clinics. And those are really our targets that really have driven a lot of our growth. And the reason why is this cartridge allows the same result, whether you're in a big hospital or in an outpatient clinic, okay? So we really made an effort and during the pandemic, you would have those customers that would really just try to have as much coverage with as many test types as they could for COVID because it couldn't get it all from one supplier. Things have changed in 2023 and into 2024. Those sites have now decided what is their vendor of choice. Who is going to be the primary provider of respiratory tests. It's a big reason why Cepheid is the market leader in respiratory. So what really evolved from the pandemic? I think we can all remember those days, whether you are in your car, getting a swab in a parking lot or in a car line to be able to then wait for 2 or 3 days before you got a result to either travel or go somewhere or understand whether you are sick because somebody in your family was sick. That was a pretty uneasy time. And the reason for that was the test were either not sensitive enough to know whether you are really positive or not, those antigen tests that get sent to your house, they're good when you have symptoms, but they're not so good before you have symptoms. And then there were a lot of tests, whether they be open systems or closed systems in laboratories that would run in a day or 2 later, you'd get your results and then you could figure out what you're going to do with your day. When the market was $30 billion, a small percentage of that was molecular point-of-care testing. So 3 years ago, that was -- that's the business we were in. Fast forward, the business model has changed for those clinicians, those laboratorians. And now it's expected, right? The laboratorians know they can get a quality result quickly, but most important, the patient knows that they can get a quality result quickly. People know what's the difference between molecular and EIA. They know an antigen test, they know molecular tests. So the change is dramatic. Yes, the market is 1/5 the size, but the amount of point-of-care molecular tests that are done today is really the way that test and treat is able to happen. No longer is it good enough just to detect, you need to be able to treat your patients and patients want to be treated for either respiratory, whether it's COVID or whether it's flu or whether it's RSV. So we learned a little bit about what an anchor assay can do. On the right-hand side, you'll see that our installed base grew from 20,000 systems to 60,000 systems during COVID. Many of those were in customers that we currently had business. But those 60,000 systems really translates into over 300,000 modules because each one of the systems that we have, the smallest one we have is with 4 bays, the largest one we have is with 80 bays. So that scalability is what our customers really, really were attracted to. So customers that had a 4-bay system would get to a 16 bay system. Customers that had a 16 module-based system would go to a 48 or 80. And then we were able to move into the CLIA-waived markets and the CLIA-waived markets are important because those health systems that I spoke to you about before, they wanted to move testing outside the 4 walls of their hospital. Okay? Most expensive place in a hospital is around where patients either going to the emergency department or get admitted into the hospital or come out and go into the ICU. So what they wanted to do is they wanted patients that were somewhat sick but not super sick to go to their urgent care centers that they owned. So they started buying up more of those. And they want respiratory tests and other point-of-care test to be done at those locations versus their hospitals, right? It makes good sense. I think the fact that our system and the cartridge is CLIA-waived, makes a huge difference because you've just probably read that we have our HCV fingerstick. It's the first HCV fingerstick test, whole blood test. In 40 minutes, you're going to get a result to be able to treat patients. So just like those patients that are suffering tuberculosis that walk for a day or ride their bike for a day to go to a village. If you cannot detect what they have and start treatment when they are there, they do not go on treatment. That's why GeneXpert has 95% of almost all of the TB tests that are done in the world, they're done on GeneXpert. For HCV is going to be the same. The drug addicts are the ones sharing needles that are causing the big spread of HCV. And it's treatable, curable in 12 weeks of therapy. When those patients show up to those clinics, they now can test them quickly and start them on therapy because those addicts will not come back. If they don't start therapy that day, they will not come back. So the fact that this system is that easy to use and can be used anywhere, we see a lot of opportunity for expansion because that's where the healthcare decentralization model is going. So about 75% of our instruments are in hospitals, 65% of the gain of those 40,000 instruments were in existing accounts. So that allowed us to really have a high rate of adoption, quick rate of adoption. And when I think about an example, here is a health system that is out west that started with us about 9 or 10 years ago. They started running MRSA and it's about $100,000 worth of business. They then added some systems, and they added some other HAI tests, C.diff was one of them. And then they realized that with the Flu RSV before the pandemic and Group A Strep, they could run those tests in their locations outside the hospital. And the laboratory felt comfortable about it. So then they added respiratory testing, and they were in 50 locations. And we probably had about $4 million worth of revenue. They started at $100,000 a year. Then COVID hit, and they went from $4 million to $12.5 million, and they're currently in about 100 gene experts in about 125 locations. So when you think about our installed base and what we can leverage, most of them being in the hospital or associated with a hospital does testing in outpatient clinics. This is the real opportunity for us. To add new tests. So not only the 35 tests that we have outside the U.S. and the 20 that we currently have in the market in the U.S, we're going to show as we develop 4 or 5 tests a year. This is the installed base that we're going to be able to leverage to grow our business. So the opportunity for us is huge. In my -- from my perspective, these accounts that are now $12.5 million, we probably have 50 of them, that big, 60 of them that big. And they used to be the size of a territory. That $12 million used to be what a rep used to handle as an entire territory. Now it comes with one health system. There's 225 health systems that are pretty vertically integrated that we target because the more vertically integrated a health system is, the more likely they are to be able to consolidate testing and be able to perform it on one system because that's what they want. They want the same results for their patients that are in the health system. So it's a super exciting story for Cepheid. I'm going to turn it back over to Vitor, who's going to talk a little bit about what our future looks like, but it really is exciting, and I appreciate your time today.

Thank you, Peter. So Peter talked about the past on how we're winning with our customers. I'm going to be talking about the future. In the future, when you talk about Cepheid, we talk about growth, it's about 3 things. First, on increasing utilization of our installed base, number one. Number two, it's about expanding the installed base. And then number three, how we can keep adding to our menu, so expanding our menu. And this page talks about this. So on utilization, we're super excited about the growth that we see in terms of non-respiratory testing that is being used more and more in our 60,000 instruments globally. So that's a major force of driving utilization in our installed base. Then number two, in terms of expanding the market, we see opportunities in the outpatient clinic in U.S. it's still underpenetrated with 10%, but we also see opportunities in the hospital space in Europe, particularly where we have a penetration that is under 50%. And then from an expanding menu perspective, we are super excited about our roadmap in the coming years as we move and expand our portfolio to multiplex panels. Which opens a whole new chapter of growth for Cepheid. We are super excited about that, and I'm going to go into details about those 3 areas in the next pages. So when you talk about utilization of our installed base, again, very happy to see the growth that we saw in non-respiratory testing over the years coming from low double digit to double digit. Now you might be asking yourself, why this is happening, right? And we saw -- we put here a couple of examples to share with you. Why that is happening? Well, it's happening because hospitals are back to pre-pandemic testing protocols that they had before the pandemic. They have to run ongoing tests inside the hospital for MRSA, like Peter just talked about, C. difficile and other tests. And we have a leading position in hospital-associated infections, and that's why we see that part of the portfolio growing 10%. Another reason why the non-respiratory is growing is because existing customers are adding new assays. So a customer who is running an outpatient clinic today and they have our 4-plex respiratory testing, it's natural for that customer to think, okay, I'm going to add our Group A Strep as part of my portfolio in my clinic. And that is helping us to drive Group A Strep to grow at 25% range as we did last year. And a third example here is just growing the utilization of recent added assays. So that same customer that is running a respiratory might decide to run sexual transmitted assays. And our portfolio that is growing about 20% as well. And you saw that growth last year. So super excited about how we are driving the higher utilization of our 60,000 instruments globally by those drivers. In terms of driving expansion of our installed base, it's all about increasing clinical adoption. We are extending deeper in the hospital by providing better patient management to our customers. And then longer term, providing faster diagnosis for patients with severe infections like sepsis. Which enable clinicians to provide life-saving treatments to their patients. We are also extending deeper in outpatient clinics with a test & treat protocol. And by having very selective assays, really going deeper in outpatient clinics, which again, is very underpenetrated. In U.S., we have a big opportunity in U.S. but also outside of the country. And then last, we're very excited about the menu expansion. As I said, we have a very exciting roadmap. And as we execute our roadmap in the next 5 years, we're going to be adding another 20-plus assays in our portfolio. That is very exciting. We're going to be expanding our assays to multiplex in respiratory diseases and also gastrointestinal infections. And that is going to help us to, as I said earlier, to open a new chapter of growth for Cepheid, in the hospital, but also by selecting their specific assays, we can also go deeper into outpatient clinics. Opening up $2 billion of opportunity for Cepheid in the coming years. So we're very excited about how we are adding our menu in the coming years and helping this business to grow. So putting all together, we built this $1 billion -- $1.6 billion franchise in respiratory that is growing on an endemic respiratory market that is 5x larger pre-pandemic. We're super excited about how we are leveraging our installed base, growing the utilization of that installed base and how our customers are using non-respiratory testing in that installed base and continue to add to their solutions. And then last, from an innovation perspective, we have a very exciting roadmap. We are building that roadmap and executing, really playing our DBS playbook to innovate at a faster pace moving to High-plex. And with that, we opened a new chapter of growth for Cepheid of about $2 billion of opportunity in the coming years. And we'll continue to do that, delivering outstanding performance. You saw the story of Cepheid earlier today coming from 0 profit back in 2016 to more than 30% profit last year, and we continue to do that and expanding our leadership position. So thank you. With that, I'm going to turn it over to you, Julie.

Thank you, Vitor. And thank you, Peter. We were all very proud of the role that Cepheid could play during the pandemic. But when we look at the opportunity that we now have before us, to continue to increase molecular penetration in the market, to add menu into a very strong installed base and to move into multiplexing, we think that Cepheid continues to have a very exciting future for us. So we've covered a lot of ground today. And we've talked about the continued growth of the portfolio from 2018 to now, a combination of strengthening our position with DBS rigor and strategic growth investments. And hopefully, you better understand why we believe the future remains very strong for the platform while we have a lot of conviction around this being a long-term, high single-digit growth platform for us, given all the opportunities we have between the secular growth drivers in the business, and the way that we have internally brought the right technology to bear to take advantage of some of these very attractive growth drivers moving forward. So with that, we're going to get ready for some Q&A. So I'm going to invite people to add some seating here to the stage. And while they bring that up, we have a little bit of a tradition here at Danaher of giving back in conjunction with these Investor Days. And so I'm really pleased that the way we've chosen to give back this time is through the Sepsis alliance. And if you're not familiar with the Sepsis Alliance, it's a fantastic organization. Obviously, very pertinent to our mission at Danaher Diagnostics but it is the leading sepsis organization in the U.S., working to save lives and reduce suffering for sepsis, providing education, support and advocacy. So -- we're excited about the donation that we're able to give to the Sepsis Alliance. So now I'll ask Vitor and Peter and Chris to join me here, and there's going to be microphones out in the audience so we can take your questions.

Great presentation. Michael Ryskin, Bank of America. Maybe just to kick it off, you talked about the evolution of the various platforms and the opcos over the years. Danaher, historically, has kept a very distinct and separate opco structure. But in the bioprocessing biotechnology segment over the last couple of years, there's been some merging between Pall and Cytiva. Just curious on your thoughts there, as you've taken each of these, Beckman, Leica, Radiometer and you've driven the initial improvements. What's the forward strategy? Is there opportunity to bring them closer together? Do you still see the distinct opcos is the best way to go?

Yes. We do see changes coming, but we see it as more of an end versus a change from our operating company-centric structure. So you won't see Danaher Diagnostics. There's no plan to make it look like Cytiva does at the moment. We think that there is tremendous power in our very strong operating company brands, and there's really tremendous power in the fact that we are calling on different parts, different laboratories within the hospital to have that operating company structure. What you will see change is we think that there is a more active role that the platform can play. And we talked about some of those areas in the presentation. That means there are commercial synergies when we occasionally approach customers as a unit offering the full breadth of our portfolio. In high-growth markets, there are some areas where we think we're underpenetrated today, we want to make some significant investment. And in some cases, the best way to scale that up is to go as a platform. And in terms of innovation, we talked about the centers of innovation. That's something that really makes sense for us to do as a platform. Our partners are really excited by being able to use the breadth of the portfolio there. And we'll see other capability investments that we can make -- digital platforms, AI, et cetera, to help innovation across our different operating companies. So something additive, expect to earn my keep in the platform position but not a wholesale change of how we go to market. Thanks for the question.

Julie, this is Doug Schenkel from Wolfe Research. I think this one is for you. So kind of building off of Mike's question, but just thinking about it specifically in the context of commercial strategy. How is your go-to-market strategy evolving as you think about opportunities to cross-sell the bundle products -- where are you in that process? And can you share more on sales structure? Is commercial leadership more integrated? Are you making changes in terms of incentive structure to promote broader platform, selling and cross-selling? Anything like that, I think, would be of interest?

Yes. Yes. So we haven't made any changes to our sales structure currently. But what we do find is that now that our customers are kind of catching their breath after the pandemic, I truly believe that they see a different kind of value and ensuring that they have strong partnerships. And so there is a segment of our customers who really want that relationship with Danaher. So right now, that's a little bit more ad-hoc as our customers ask for it. But you can expect to see more of that from us moving forward commercially. So early days, but I think ultimately powerful for us.

Patrick Donnelly from Citi. Julie, I know across Danaher, each segment has their own pipeline of opportunities on the M&A side. I'm sure the guys in the stage come to you with different ideas as well. How do you think about just the M&A landscape in Diagnostics, obviously, Diagnostics, I'm sure, in your view, is top priority, but there's a lot of different things across Diagnostics, whether it's the test makers who sometimes struggle with profitability obviously, again, kind of the boxes that you can scale up the way you guys did with Cepheid in terms of that margin performance going from unprofitable to incredibly profitable. I guess, can you just talk about how you view the pipeline, the landscape? Would you guys ever skew into kind of that core test making or you just buy kind of an isolated test maker and try to scale that to profitability? Just curious how you think about the pipeline and the key parameters that you look for?

Yes. I mean so as you know, M&A is certainly part of the Danaher playbook. And we have a lot of discipline where we pretty much look at everything out there. Over the last few years, we've been mostly focused on smaller deals, including technology tuck-ins that make us stronger, that move forward, our existing strategy. We also are looking at buying some distributors and things like that. But we remain very active to accomplish what we shared with you today and to get to that long-term high single-digit growth rate as a platform, we frankly don't see any major gaps. So we can do that without significant M&A but we'll always be active and cultivation is a big part of what we all do. So thanks for the question.

Vijay Kumar from Evercore. Thank you for hosting the Analyst Day and taking my questions. I had a 2-parter, if you will. One on -- you had the slide on historical CAGR, high singles. Is the conclusion those high singles growth rates are sustainable? And which of those, I think you mentioned a lot of different growth drivers, are you most excited? Is that neurodegenerative, et cetera? And then on that last question on M&A, are there any product gaps within your Diagnostic portfolio when we think about cancer monitoring, liquid biopsy. It seems like a pretty big gap. It's a pretty fast-growing market. What does Danaher intend to enter or participate in that market?

Sure, yes, I mean you asked about the long-term growth of the business. We think that, that high single-digit growth for us long term is very attainable for this platform. You asked me what I'm most excited about. I think it comes in waves, and that's what I like about our strategy is that we have some things that are going to take a little longer, and some things that are extremely immediate, right. So some of the immediate things, Cepheid has got this great installed base, they're adding menu to that installed base, growing share quarter after quarter. Beckman Coulter, it's hard to communicate how profound telling our sales team, that we can eradicate the term menu gap from their vocabulary and go after that $3 billion blood virus and NT-proBNP market that's sitting in our accounts. And often, frankly, we had to help the customers get around the fact that they didn't necessarily want an additional box in their account. But they were choosing Beckman because of our great automation and workflow and other things. And now we can make that much more efficient for the customers and enjoy this really nice market. So those are things that are very immediate. Neurodegenerative disease, you probably feel the passion of the team when we talk about that. I think that's an incredible opportunity, and it's one that's going to make a huge impact in the lives of patients. I mean this is a disease where people didn't used to think that there was anything that they could do about it. So why get diagnosed and live with the knowledge if you can't act. And now we have 2 disease-modifying therapies on market, many more, over 100 in clinical trials. So I think ultimately, it's going to become a market more like oncology, where there's many therapeutic options, and you need this unique high-resolution type instrumentation that we have that's going to help ensure that you get on the right therapy, that you're able to have the sensitivity to monitor that therapy over time. So that's really exciting. And we feel similarly frankly, about these opportunities in infectious disease and in solid tumor oncology that we highlighted. I think that our combination of high-resolution instrumentation, the sensitivity in the DxI 9000, the greater resolution of looking at a slide via digital pathology armed with artificial intelligence. So you can be more accurate than before. It's going to make a huge impact. So you can see I could go on and on, but I think that's quite exciting. Part 2, remind me, part 2.

Liquid biopsy?

Yes. Yes. We look at those opportunities. I think liquid biopsy in many ways, is complementary to what we do at Leica Biosystems. I mean you're going to ultimately want to get that definitive diagnosis. So it's something that we understand is out there, but -- and we watch and see how it develops, but not needed to implement this strategy. Thanks.

Dan Leonard with UBS. A couple of questions on the Beckman growth acceleration. First, on menu gap closure. Can you be specific about when you expect FDA approval for a couple of those additional assays in blood virus and NT-proBNP? And then secondly, as you aspire to accelerate growth towards high single digits, how are you thinking about the opportunity in China as it relates to that algorithm for Beckman?

Yes. Yes. So the clearances for blood virus and NT-proBNP are rolling out over time. And so we expect the last of those to be completed in 2025. Some of them we already have now, some of them will complete next year. And given the length of the sales cycle here, we're already sort of in the zone of customers understanding that this is going to be a complete portfolio for us. The China VBP is something that we are prepared for. And one of the things that we carefully looked at -- and we've gone really deep on understanding volume-based procurement. When it initially rolled out, one of the questions was is this going to be a mechanism to kind of put the finger on the scale for the local companies. And what we've discovered is that is not at all the case. This is simply about China, trying to do what's best for their people. And to have lower pricing in the market, more like what we get in other parts of the world. We understand that. This is going to mostly be a Beckman Coulter impact, roughly $150 million. The question is precisely how quickly that's going to occur, right? Will it happen over 3 years, 4 years? Will they pick up the pace, so we get over the majority of it next year. And that's something we closely monitor.

If I might just add with your NT-pro as well. We've received FDA approval for that within the U.S. So that was a very important cardiac marker. Typically, hospitals will use either BNP or NT-pro. And if they've already converted on to NT-pro you can imagine to go and win those hospitals, it would require converting clinically them back from NT-pro to BNP, that doesn't happen. So already having FDA approval now of NT-pro unlocks a whole new competitive segment for us that we can begin going in and meeting them where they're already at clinically. With technology we have.

Yes. I mean Beckman has just done a great job segmenting customers to understand where we can win and it's very freeing that we don't really have to do that anymore. Yes.

Jack Meehan Nephron Research. I had 2 Cepheid questions. The first is just the growth algorithm. Confirming double-digit expectations? Is it as simple as continuing to place over 1,000 boxes a quarter, [ $70,000 ] a box or so annually. I just wanted to get your thoughts on whether those were reasonable benchmarks. And then second, what's the timeline to unlock the multiplex opportunity and just confidence you can get there where honeycomb fell short back in the day.

Thanks for the question. Yes, long term, double digit, low double-digit growth. That's how we think about the company. We are putting, as I said, a lot of effort in non-respiratory core, and that's going to help us to drive double-digit growth. Also, as we move to multiplex, that is going to open up another opportunity for us in terms of growth. Look in terms of timing or looking in the next 2 years, in terms of launching assays that will have, let's say, higher plex than we have today. allowing us to get into upper respiratory diseases, gastrointestinal diseases and opening up an exciting chapter for us in terms of growth.

Puneet Souda at Leerink Partners. Julie, you talked about oncology being an important growth driver, and there was a question around that earlier, too. But just a 2-part question, 1 oncology, 1 Alzheimer's, 2 important growth drivers. So in oncology, just given the number of assays today that are on in germline and somatic that are running on a sequencer. So just trying to understand can PCR-based platforms in some ways is still positioned enough that they can continue to have a large position in the market? Or do you think you need a sequencer in order to continue to position into an oncology market. Just thinking about late-stage to MRD to screening as this market is developing and faster growth rates out there. And then on Alzheimer's, I appreciate all the details on how you're positioning into that market. that market has been slower to uptake or slower to ramp than expected, partly because of the drugs infusion centers and whatnot. But just what's your expectation on when that market can truly inflect?

Yes. So your question on PCR in oncology, of course, we watch the NGS space and follow it closely. A lot of that business is essentially hypothesis free testing. And we do think there's a role for PCR and aspects of that testing where the hypothesis is better known and you need a little bit less information. So we'll continue to have that as a thesis and go after select aspects of that market with PCR. And then, of course, we've got our other oncology plays Leica Bio and ultimately at Beckman Coulter as well. In terms of Alzheimer's, yes, I think that the market has developed a little bit slower than some people thought with the initial therapeutic releases. From the people I talk to, a lot of it is just a matter of time. There's a lot of infrastructure that health systems have to set up to manage these patients, whether it's ensuring that they have the MRI follow-up available that they're able to track that they've had the right pre-testing. And when I talk to health systems, they are all very clear that this testing is coming, that it's going to balloon and they're in the process of finalizing their plans to be able to handle diagnostic testing. So I think it's definitely coming. And as Chris mentioned, I think we're at the right time to take advantage of the opportunity.

If I can complement the first part of the question. We see an opportunity for PCR more into the early guidance, if you will, early detection in the LDT space. We see today the most successful test in the world today's, [ cologuard ] with a PCR test with only, I think, [ 8 ] targets. So it's not even high plex. But then we see less opportunity for PCR, if you think about therapy guidance and monitoring that because of the number of mutations, the number of genes that is growing every year, we see there more of an NGS player than PCR.

Luke Sergott, Barclays over here. Yes, I just wanted to follow up on that. And it's kind of as you look at the market opportunities from an M&A perspective, the market starts becoming a lot more consumer driven, especially on the oncology market. And if you understand you guys don't have a menu gap as you look at it right now. But if you're going to get an oncology, there's MRD diagnosis and then screening and screening is the biggest. And so as you guys kind of look at those opportunities in front of you, how do you kind of rank order those as to where and how you would start dipping your toes into those opportunities?

Do you want to comment on that -- PCR perspective.

Can you repeat your question, please?

Yes. It's kind of as you're looking at the oncology market as a major growth driver outside of the sequencing opportunity, it seems like PCR seems more in your wheelhouse. So as you approach it from screening to monitoring to diagnosis, how do you guys approach that going forward?

We have a small portfolio today in PCR with our tests. There's a lot of work that needs to be done still with this small portfolio that we have with our sales organization, primarily outside of U.S. we have an amazing bladder cancer that detects and monitor patients with bladder cancer. So there's a lot to be done outside of the U.S., we don't have the bladder cancer test. In U.S. today, we are focusing that in Europe. For U.S. particularly, we are reassessing our strategy long term. We have capabilities with our platform, with our cartridge, and we are looking at specific areas where we can grow in oncology long term.

The other thing I would add is the main oncology opportunity that we highlighted today is that Leica Biosystems, where when you look at this portfolio, the market for companion diagnostics is really expected to increase. And as I mentioned, really build on digital pathology to be able to assess those multi-biomarker needs that are in the pipeline.

Over here Dan Arias from Stifel. Julie, I just wanted to go back to the customer example that you guys gave where you took customer from $100,000 to $12.5 million by expanding the menu utilization there. Along those lines, are you able to give us a rough sense for how the Cepheid installed base breaks down when you just think about the number of labs or hospitals that are using 1 test versus 4 tests versus really taking advantage of the full menu. It seems like it's just a really easy way to drive utilization, but it would be nice to sort of have some numbers to sort of put to that?

We don't break down that number in terms of installed base, but we do have a lot of focus on our sales organization in terms of how they go about specific accounts. So they have very specific data per accounting sales force that tells them here's the installed base of this customer, the test that they are using today, what would be the next natural add to that customer from an assay perspective not looking only of what the customer has today, but also even the reimbursement in that state. If the reimbursement is favorable or not for that specific test. So that's how our sales organization is really focused on driving the high utilization and adding more menu to our customers. And that's how we're building stories like you saw earlier today.

I think just to add, if you have 3 tests, it's different for every type of account. So it doesn't really paint the full picture because somebody who's running respiratory could do hundreds of thousands or tens of thousands in their health systems, but if they're running an oncology assay or something of lower volume. So we don't really track it the way you're asking. But we do see a large opportunity because during COVID, that big expansion, many of those customers that we added were just starting to run respiratory. So that is the real big opportunity for us.

We're going to take one more question here.

This is Rachel Vatnsdal from JPMorgan. So I had a question here just on innovation and diagnostics and how you guys think about what you're doing on the diagnostics franchise potentially opening new markets for other parts of Danaher. So I think Alzheimer's is a good example of this. It's been very clear that Diagnostics is one of the bottlenecks in that workflow to then enable more prescriptions being used across the globe. And so given some of the innovation that you're doing in Diagnostics, I think one of the takeaways from dinner last night was that, that could potentially open up Alzheimer's for bioprocessing down the line. So can you talk about this pipeline of innovation in diagnostics, how do you talk with other areas across Danaher, whether that's bioprocessing or life sciences? And are there other opportunities similar to Alzheimer's that you could see unlocking given what you're doing in diagnostics?

I mean our businesses are certainly interrelated now, right? And as a focused life sciences and diagnostics innovator, there's a lot of reasons for the businesses to talk with each other. So -- we do that regularly. And when we think about, for example, the opportunity we have with antibodies was our latest acquisition. All of our biopharma partners are excited that we now can combine the strengths across the life sciences platform and what we do in diagnostics to hopefully give them a more streamlined process, where they don't need to make these handoffs, right? So they can develop the antibody in development phase and then know that Danaher is over the total framework, ensuring that there is nice ease of transition into a clinical diagnostic. So it's just one example of how we're able to partner together. Thanks for the question. Well, thank you all for your time today. We really appreciate it, and it's been great speaking with you. And thank you so much.