Exact Sciences Corporation (EXAS) Earnings Call Transcript & Summary
September 13, 2022
Earnings Call Speaker Segments
Thomas Peterson
analystEverybody, thanks for joining us here at the Baird Healthcare Conference. I'm Tom Peterson. I'm an associate on our life sciences and diagnostics list here at Baird. We're excited to have Exact Sciences presenting and representing the company today, we have CFO and COO, Jeff Elliott. Jeff, welcome.
Jeffrey Elliott
executiveThanks for having us. Thanks for the Baird crew for having me back. Good to see everybody in person.
Thomas Peterson
analystGreat. So Jeff, a lot of ground to cover. I'm sure we're going to get into the Cologuard setup in a moment, but I think we should probably start on the news on the multi-cancer early detection development. It's been a busy couple of weeks at ESMO. But for those of you in the audience and on the webcast who may not be familiar, can you just give us an overview of the data presented at ESMO on multi-cancer?
Jeffrey Elliott
executiveSure. And just take a step back here. The goal of our multi-cancer program is to help catch more of the 70% of cancers where to date, there's no current standard-of-care screening. And this is why cancer is one of the leading causes of death out there. If you can find it early, you can help save a lot of lives. So we've released data over the weekend at ESMO, as you mentioned. This is the first time that we brought together all the great work we had done internally, plus the great work from the teams that we acquired at Thrive. So this brought together different -- 4 different classes of biomarkers, given us many different shots on goal, and we're pleased by the performance that we showed. We showed we could find 61% of cancers in the study at a 98% specificity, meaning about a 2% false positive rate. Again, these are for cancers that many times, there is no way to screen for today. So we're optimistic that this approach, which again, it's multiple shots on goal, 4 different biomarker classes. We bring this together and we show very good sensitivity. Particularly within early-stage cancer, if you can find 3 or 4 out of 10 of early-stage cancers, again, early stage means it's very treatable, perhaps curable. You can find those in cancers where there's no current standard-of-care screening, you can have a major impact on human health outcomes. So we're thrilled by the data that we presented at ESMO.
Thomas Peterson
analystGreat. And you touched on the marker selection. There's a lot of curiosity, I think, around the data just because we had seen some Exact internal data. Obviously, you had the Thrive acquisition and then there was some implicit understanding that there will be some R&D sort of collaboration. So can you kind of speak to where each of those market classes came from? I thought the inclusion of [ antipode ] specifically was interesting, but you can speak to that development process in more detail.
Jeffrey Elliott
executiveSure. It's really all one team now, so I don't want to say it's us versus them. But if you look historically, the work that Exact had done internally and with the Mayo Clinic dating back over 10 years now, where they center around methylation markers, that class of biomarkers that is really the core foundation for many of our products, including Cologuard and Cologuard 2.0, our multi-cancer program relies heavily on methylation markers. The data we had shared back a couple of years ago now in multi-cancer before the Thrive acquisition included some protein markers as well. Thrive, dating back years ago, had started with mutation markers. So again, a different biomarker class looking at mutated DNA and also some protein. So we brought all that together, added in some [ antipode ] on top and then came up with what we thought were very good data. What also the data sort of help us drive home is the overall patient experience here, which is very important. And one of the key learnings from Cologuard, we've screened nearly 10 million people now over time over the past 8 years, when you look at the user experience here, both for the patients and physicians, it's very important. You don't want to send patients off on a diagnostic odyssey. It needs to be clear that after a positive test, what the next steps are. For Cologuard, after a positive Cologuard, it's clear. Go under colonoscopy, inspect the colon. If you find something, you could snip it out then. After a multi-cancer test, what we're proposing is after a positive test, you go as part of that test go to a full body imaging and find out right there if you actually have cancer or no. Maybe it was a false positive, you're in the clear. That's an overall better experience. And it's very clear for the patient and primary care doctor what to do after that positive test.
Thomas Peterson
analystGreat. Can you flesh out sort of the specificity profile that you put forward? Slightly higher false positive rate maybe than with prior data. But again, with that patient journey, how do you see that playing into the ultimate kind of performance profile of the assay?
Jeffrey Elliott
executiveThere's always a trade-off between sensitivity and specificity, and we want to make sure that we're doing the right thing for patients here to maximize the kind of the health outcomes and the economics of the tests. Potentially and we're open to this consideration, if you give up a little bit of specificity, that potentially could add a lot to sensitivity. And what you see here at the data at ESMO, specificity was 98% and change. Sensitivity, 61%. Again, for many of these cancers, there's currently no way to screen for them. So I think that trade-off, maybe giving up a little bit of like close to a point of specificity, is one that we are willing to make. Again, we have to finalize the assay and decide in a prospective setting the final prospective registrational study, what the specificity will target, but it's a trade-off we're willing to make. Ultimately, if sensitivity is high enough, perhaps you could space up the interval longer. Let's say, you do this test every 2 or 3 years, then a 2% false positive rate every -- kind of spread out over time means that an annual basis, it's less than 1%. So there's some trade-offs here, and we're willing to consider all those trade-offs.
Thomas Peterson
analystSo you don't necessarily think this needs to be an annual test?
Jeffrey Elliott
executiveIt definitely doesn't need to be.
Thomas Peterson
analystInteresting. You mentioned the prospective trial coming up. SOAR, I think, is the name of that trial. Is 80,000-plus patients still the right way to think about that from an overall size standpoint? And like what's a realistic outcome for enrollment?
Jeffrey Elliott
executiveThat's probably the right ballpark. It needs to be a large study because you want to make sure that you get a broad representation of the intended use population, and you see as many cancers as possible. There's different approaches out there. With Cologuard, our BLUE-C study, which is for Cologuard 2.0, there, we're going to roll 20,000 to 25,000 people. So you look at the incidence of colon cancer in a population, and that's about the right size. To cast a wide net and make sure that our FDA label and our study includes as many cancers as possible, you enroll a much bigger population. So it's a different design of the study. It's an interventional study. What I mean there is as patients are enrolled, they'll get the blood test. And the blood test will inform their next step, so they'll actually get the result. If the blood test is positive in the SOAR study, those patients would then go on to a full body imaging. With DeeP-C and BLUE-C for our colon cancer products, it's not an interventional study. All those patients, they provide a stool sample, they get a colonoscopy and they don't know the results. So a different type of study. It's one to really look forward to, to launching next year. Next year, we'll also launch our lab-developed test, or LDT, for multi-cancer. So the team is thrilled to really leverage the foundation we have -- we've built up over 10-plus years for Cologuard and for Oncotype, leverage all the people, the IT systems, the lab systems, leveraging that to pursue multi-cancer, which again we'll launch that next year. We're thrilled to have that in the market.
Thomas Peterson
analystGreat. And alongside SOAR, whether it's through the LDT or a second trial, do you have any planned studies around for the patient journey, patient anxiety throughout the process? I think that's going to be key for how this market ultimately develops in the next couple of years.
Jeffrey Elliott
executiveIt is important. I would point back to the DETECT-A study that Thrive ran several years ago. That was the first and still the only fully prospective study in the intended use population, 10,000 people. Part of the intent of that study was to understand the user experience, both for patients and physicians, and to understand how this will fit into the current standard-of-care screening. So this is something that is really important to get right. You want to make sure that it's acceptable, both from a performance standpoint and the overall user experience. So we've got multiple studies ongoing and planned to help make sure we really get that right.
Thomas Peterson
analystGreat. And then maybe just more broadly, as we think about the Exact portfolio, you kind of spoke to or have spoken to in the past on the cancer continuum and serving that entirety of the market. Where do you think multi-cancer fits within that cancer continuum play? Obviously, it's more on the screening side, but how does that ultimately deepen relationships throughout that cancer value stream?
Jeffrey Elliott
executiveWell, the thesis has been for us that it would be very additive. We've got current standard-of-care screening mammography, colorectal cancer, cervical cancer. Those all stay put. There's room to even drive those adoption rates higher. Cologuard has something to do with that. Multi-cancer is a new paradigm that layers on top of that. It won't replace current standard-of-care screening. It's really meant to help pursue earlier detection for the 70% of cancers where there is no screening today. Oftentimes, cancer is found in the OR, ER. Somebody shows up with pain, and that's how they diagnose it. Well, that shouldn't be the case. I'm sure everybody in this room, I don't even need to ask, everybody here knows somebody who has been diagnosed with cancer, typically at late stage. It's a really tough journey they go on. And journey is really a bad word. It's not fun. The journey is really not fun. It's a continuum of care that we need better screening options, so the multi-cancer test will help pull screening and detection earlier, then we've got a whole portfolio of tests to really help through that whole, again, journey, all the way from early detection. We can help diagnose the cancer. We can help understand the prognosis of cancer. We can help understand recurrence and optimize therapy later stage. So it's a whole suite of tests. The reason why we're doing this is because hospitals are asking for it, patients are asking for it, and it's the right thing to do for patients.
Thomas Peterson
analystGreat. And maybe last one on multi-cancer. You mentioned the LDT launch. Who do you think that initial customer set is for an LDT? What kind of level are you seeing from health systems and partners you already have in kind of the Cologuard space?
Jeffrey Elliott
executiveWe are seeing significant interest from health systems. A few years ago, I'm sure we -- I probably said here on stage that our penetration with health systems for Cologuard was suboptimal. It had been a lagging part of our business. When you take a step back and look at this market, health systems are a really important part of the market. It's probably at least 60% to 70% of primary care doctors, either employed by or affiliated with the health system. And we have been lagging there. It is always a longer selling cycle in the health system. It's a harder group to penetrate. And if you were launching a new product, you don't have a base of revenue, it's hard to get their attention. But we worked -- the team did a nice job over time finding ways, finding the right person to communicate with, finding the right way in the door. And we've built up a good base now. Now it's over half our revenue, and we've done a good job there. It helps now having the base. If you look at Cologuard, it's the biggest diagnostic, still the fastest launch ever. Oncotype, the second big diagnostic around, having that base of revenue, about $2 billion of revenue this year, helped us get into the conversations in a way that we couldn't before. Other companies often can't. Now we can build upon that. So the relationships we have with all the leading health systems, we can have conversations top down about the pipeline of our company. And we're seeing significant interest. Companies -- health systems, they want to bring more patients in. They want to help in earlier detection. And for them, being part of both our SOAR study and the LDT launch is something that they are kind of lining up to be part of that.
Thomas Peterson
analystGreat. That's good to hear. I think we'll call it on multi-cancer there for now. Probably more to come. But let's get into Cologuard a little bit, maybe starting with kind of where we are today. Last quarter, you flagged that rep access was still 50% to 60% of kind of pre-COVID levels. But unlike prior quarters, where it was maybe COVID that was getting in the way, you spoke to some physician office staffing shortages. I guess what's the current update on that? And how long do you think it kind of takes to work through some of those office shortages?
Jeffrey Elliott
executiveYes. I think we're on track for a good year. I mean, we guided the year initially to about $1.3 billion of revenue, raised guidance after Q1. I think the team did a nice job of executing. We restructured the sales force in Q1 in part to address some of the changes in the marketplace with COVID. We had assumed at that time that the rep access would continue to improve. And look, relative to last year, it has. There was a big part of the last 2 or 3 years with the pandemic where reps were entirely shut out of offices. And we and our partner at the time, Pfizer, had pulled reps out of the field. So our access then was zero or close to zero for a lot of the pandemic. So it's better now than it was. However, I had -- we had previously assumed that throughout the year, things would start to normalize, things would continue to get better. What played out in the second quarter is we really still -- stable access. So not worse, not better, really stable. What had been a limitation from COVID before where doctors would say, look, it's -- COVID is still too prevalent, please don't come in here, shifted to COVID isn't really the concern. It's more staffing. Still, if you look at the latest employment numbers, there's still 3 million to 4 million people who are disappeared from the workforce. I think they're home watching TV. Hopefully, they're seeing Cologuard ads, but they are out of the workforce. And what that has meant is fewer nurses, office staff. Hospitals are busy, they're back to kind of normal volumes, but they don't have the same amount of staff to meet that demand. So if our reps try to go in there, we do what's called a total office call. We talk to the doctors, the nurses. And then they all can help grow the business. They can all move the needle. And now because of these staffing challenges, our rep's ability to go in there and educate that whole office is limited somewhat. They've been really creative. They found ways around it. So you can see even looking at the back half of the year, we still guided a 22% growth for Cologuard. So still with $1.3 billion of revenue, it's still very strong growth. It's just -- there is some headwinds in the market now that hopefully, as people come back to the workforce, those -- that will abate.
Thomas Peterson
analystAnd new ordering conditions were still strong in the quarter. I think it was slightly above where we were modeling. What kind of tools -- you kind of alluded to some of the alternative methods you're talking about kind of getting in front of docs. Are these marketing converts? What's driving still what seems to be sustained new ordering growth?
Jeffrey Elliott
executiveYes. I can think back to my time when I was at Baird years ago that I thought longer term, maybe at some point, we get to 100,000 order providers. That was back in maybe 2013, 2014 I assumed that. I wasn't a very good analyst. Here we are, it's almost 300,000 so I was way off on that. The strength in the number of new order providers -- I've been pleasantly surprised for years on that. If you think back pre-pandemic, the most recent data, again, pre-pandemic, 90% of the new order providers, we have never called up. We haven't called them. It was the TV ads, so the marketing team, which that team has done a phenomenal job driving awareness. And so this is really the patient pulling the doctor in saying, "Doc, I saw this ad. I want that. I don't want the scope," and that had been a big source of growth. And it still is a big source of growth. Now our reach has gone up. So I think the percent of truly marketing converted is down a bit. But still, 8 years into launch, still be adding 9,000 new initial order providers in the quarter. I'm blown away by it. We'll take all we can get. We continue driving that. But the bigger source of growth is orders per physician. The potential there is huge. We could probably grow our business 10x just by increasing orders per doctor. So that's where the reps typically focus. It's really still the marketing ads, the TV ads that drive the new doctors to Cologuard.
Thomas Peterson
analystGot it. Great. That's helpful. On that rep -- orders per physician, I think there's probably a couple of drivers there. Let's start on rescreening. Where are you on the rescreening journey relative to your expectations? Kind of what's compliance here? And any particular benefits you're seeing as you get kind of more electronic ordering into the system?
Jeffrey Elliott
executiveWe continue to make really good progress on rescreens. Last year was the first year we broke out the revenue contribution. It was $100 million. We beat that expectation. This year, we said $220 million, $220 million. I feel very good about that number. I think we'll beat that one this year, too. So overall, the team has done a good job. What's happening here is 2 things. One, the pool of patients who are eligible for rescreens, what I mean by rescreens is the guidelines in Medicare recommend that you repeat Cologuard every 3 years. The pool of patients who are eligible continues to grow, so you've got this growing and growing population. At the same time, our success rate at converting those patients continues to grow. The team has done a nice job putting in new tools. I'll give you an example here, putting new tools to help make sure people are aware that they're due, make it easy for doctors to order. The big win that we had in the second quarter and what we're kind of just getting going on is what I call our advanced order workflow. The advanced order workflow allows a physician to order, up to 12 months in advance, a repeat order, a repeat test. So what happens in the real world, people go and get a physical and it may vary the time of year they go. Maybe in 1 year, you go in January. The next year, you go in March, and it could vary. Well, if you're not due the day you go in for a physical, historically, the doctor often wouldn't order. You're not due that day. Well, what we realized is that the patients may often be due in a month or 2 months. So we now allow a physician to order up to a year ahead of time. We hold that order and then when the patient actually becomes due, we send out the collection kit and test the patient. So it's a convenience factor. It's more convenient for the physician and for the patient, and we keep people up-to-date with screening more effectively. Well, today, when I look this year alone, we've had over 100,000 advanced orders. So we've made meaningful progress here. Still a long ways to go, but making good progress here. Why rescreens are so exciting is that it's a recurring source of revenue. Let's say, we test somebody at age 45. We've got 30 to 40 years to keep them screened. It's part of the beauty of Cologuard. We can keep people screened, get more people screened and keep them screened longer. It's a recurring source of revenue for us, which as a CFO, I love that. It's also a higher-margin source of revenue. It's higher margin because when somebody does Cologuard for, say their second or third time, I've done it 4 times, by the time you use it the fourth time, it's really easy to do. Every time you do it, the compliance rate goes up. You enrich it to somebody who understands it, satisfaction rates are high. So that patient compliance rate is about 20 points higher on the second go round. So over time, it's a recurrent source of revenue that grows. In a few years, it's probably $500 million of revenue. It's a higher-margin source of revenue because the compliance rate is higher. And the OpEx required to reengage that patient, sometimes, it can be pennies to a dollar. Because if you just send that patient a text message, that's inexpensive to reengage them. So this is a really good source of revenue. It's probably our biggest source of growth for the next few years, and one the team has done a nice job of executing on.
Thomas Peterson
analystGreat. And from a patient perspective, in that case, you walk out your door, there's a Cologuard kit on your front porch. You don't have to do much, but send it in. Is that sort of the patient workflow there?
Jeffrey Elliott
executiveYes. I mean -- and we would engage with the patient to make sure they understand the process. So we would engage with them, that kit would arrive, convenience of your own home, get out the Sunday paper, read that, do your business, and send the kit back in. Easy, it just takes a minute. And yes, so overall, like in this environment where people are working from home, want to control their own care and they're used to ordering things off Amazon, well, look, I mean, Cologuard arrives at your front door. This is part of normal business, right? It's different than like a blood test, for example. The majority of people never get a blood test in a given year. So we're appealing to a much broader market than blood ever will be able to, and you can do it in the convenience of your own home.
Thomas Peterson
analystGreat. And the other thing driver that comes to mind in terms of bumping up the orders per physician is you've talked about last quarter, sort of that top 40% of Cologuard orders pre-COVID still sort of remaining below where they were pre-COVID. They haven't kind of recaptured their typical ordering pace. What's the outlook there? What kind of efforts are you making to reengage with those physicians? And what do you think is the biggest impediment to them getting back to that pre-COVID level?
Jeffrey Elliott
executiveThis is a trend that really stood out. When you go back a year or 2, when we try to understand kind of what was happening in the business, something that really surprised us was we segmented the market based on the top ordering physicians, ones that had truly -- they had bought into Cologuard, the true believers. We call them the most frequently with our sales force. A lot of them had ordered Cologuard even into the hundreds of times over the course of history. And these -- again, these doctors truly believed. Their orders were down, I think, at that point, probably down 20% or so, down relative to the start of the pandemic. Well -- but we were still growing. Where the growth was coming from was the doctors that before the pandemic represented the bottom 60% of orders, the ones that just kind of dabbled. They would order for a patient who asked for it, but they hadn't truly bought in. And we, for the most part, didn't call them. So we've been watching these trends as they unfold quarter to quarter to quarter. For a long time, the top ordering, again, they represented the top 40% of orders, that segment, the true believers, they stayed down. The order trends stayed down, kind of down 20%. Well, in the most recent quarter, they were down 9%. So making progress there. It's important, again, because that's a huge part of our orders. Equally as important is the dabblers. They've been accelerating sequentially for, I think, over a year now to the point where now, they've almost doubled since the start of the pandemic. So massive growth coming there. What that means is that our ordering base has broadened. It's deep and really an important new category. Again, we hadn't normally called on the bottom 60%. We are doing that more now. But the docs at the top, they're coming back. They're coming back as access has improved over the past year. They're coming back as their patient flow had improved. So that's something that I watch closely. Again, that's our core ordering base, and they're starting to come back.
Thomas Peterson
analystGreat. Let's get into BLUE-C a little bit, Cologuard 2.0. I believe you've completed enrollment around stool. Still waiting on blood. I think it's maybe 10%, 20% behind just from an enrollment standpoint. So maybe one, do you think that phenomenon is particular to the trial itself? Or do you think there's inherently something about a blood-based test that makes it less likely to be compliant? And then just generally remind us sort of time frames around the 2.0 re-up.
Jeffrey Elliott
executiveYes, take a quick step back. Cologuard 2.0 is an enhanced version of already a very good test. The primary goal is to improve the specificity. Secondary goal would be to improve the false -- the pre-cancer detection rate. Both really important things. The team has done a nice job doing that and also added some operational enhancements in to help bring down the cost per test pretty meaningfully and also drive more revenue. So Cologuard 2.0, I think, will be a home run product. BLUE-C is our registrational study for both Cologuard 2.0 and our colon blood program. People often forget we've got this program. We've been working on this for over 10 years. So we've been at this a long time. And the team has been really thoughtful about the approach to colon blood -- and realistic, realistic in terms of where the blood test is likely to fit in. I think it can help save a lot of lives, but it's going to serve a different niche in the market. And that's based on, again, the kind of nearly 10 million people that we've tested, not just based on survey work. So we've tested a lot of people. And the blood test, likely to fit in, in a similar part of the market in FIT test. Again, there's 10 million FIT per year, so it can serve an important role, just going to serve a different one. BLUE-C, where we're again running the study for both of these, we've asked all patients, please collect a stool sample for Cologuard, please do a FIT test, which is an important normalizer within the study, and give a blood sample. As patients do this, they get paid to do it. It's part of the study. They get paid if they give each one. We've actually been kind of surprised that 10% to 20% fewer patients, again, patients who were enrolled by a physician, not by Exact Sciences, enrolled by a physician, who are -- have agreed to be part of the study, have collected stool, 10% to 20% fewer are willing to give blood. Does that play out in the real world? Well, you ask the big labs. 40% of patients, when asked to go down the hall or through the lab in a different building, don't do it. So blood compliance rates are lower than people probably realize. Again, 40% of patients decline to do it. We've seen this play out with Cologuard. It has, by far, the best compliance of any on-market test for colorectal cancer screening. So will it play out? I think time will tell what will happen with our blood tests. But overall, I think this study of over 20,000 people that we're not even involved with -- again, physicians enrolling, is showing far fewer people are willing to give blood.
Thomas Peterson
analystGreat. Let's touch on the Precision Oncology side of the business briefly. We've got about 5 minutes left or so. Last quarter, you announced the divestiture of the Genomic Prostate Score asset. I guess what was behind that decision? Why do you feel like that is a more optimized portfolio going forward?
Jeffrey Elliott
executiveYes. We've committed to being profitable in '24, and we've committed to always doing the right thing for our shareholders, which means that looking at parts of our portfolio and making sure that, hey, are we the right owner of that portfolio or that part of the portfolio. And what we came up to the conclusion on with the prostate test is that there was a better home. MDxHealth, another public company, really strong management team, has an established presence in the urology space. We came to the conclusion that they were the better owner for it, so we divested the product. They're up and running with it now. They've got multiple products on market. They've got a pipeline of other products coming. To win in this space longer term, I think it helps to have more than one product. When we looked at our road map of new products, we were only going to have one, maybe 2 products there. So again, I think this is the better owner for it is MDxHealth. And look, it helps improve our margins and help improve our growth over time.
Thomas Peterson
analystGreat. Let's touch on profitability a little bit. Kevin, I believe, yourself, have said that you don't think that Exact will conduct any additional equity raises. Can you just give us an overview of the thought process behind that, kind of current cash balances, facility -- financing facilities you might have available, et cetera?
Jeffrey Elliott
executiveThis dates back to early in the year. There was a competitor conference you may have heard of. We were getting ready for that one. And at the time, we looked at our model for the next couple of years, and our model showed us getting profitable in '24, really for the full year, being adjusted EBITDA positive for the year. And our thought was, look, we saw this sentiment shift. And we said, look, to get ahead of that, let's make sure we articulate the path between here and there and commit to publicly that we'll be profitable for the year, and we stand by that now. So we started talking more and more about it. Obviously, since then, inflation has spiked, the world has changed, and we want to make sure that we're doing everything within our power to get there. We're firmly committed to it. To do that, it involves prioritization. We need to make sure we're investing in the projects and programs that drive the highest return on investment. And again, we're the rightful owner of those products and programs. So we've made some tough decisions, but I think the team has done a nice job. I think we're going to deliver on a really strong year, both in terms of revenue and EBITDA. You look between Q1 and Q2, we basically have their EBITDA loss in one quarter and there's a lot more exciting stuff ahead there. There's even a chance that we pull in profitability until later next year, too. So I think the team is on a good roll. As of last quarter, we had over $700 million of cash on hand. We also put in place 2 credit facilities, both about $150 million. One we tapped into, about $50 million, so got a lot of liquidity available. And we're looking at possibly monetizing our main processing lab in medicine. Over the last 3 or 4 years, we've put in several hundred million into that lab. We still find it's the whole thing. There's no reason why we have to keep all that financing to ourselves. We can get a mortgage, we do a sale leaseback on that land. So that's something we're looking at now.
Thomas Peterson
analystOkay. Great. And with regards to that adjusted EBITDA profitability target, can you just kind of walk us through sort of underlying assumptions around OpEx growth, relative to the revenue growth? And maybe an overview of sort of between each revenue line items or the cash contribution? I don't want to get that granular but the profiles of...
Jeffrey Elliott
executiveYou want the whole model or something?
Thomas Peterson
analystYes, please. That would be great.
Jeffrey Elliott
executiveWell, for us, it starts with growth. We're a growth company. So it has to start there. I typically -- I'm a conservative CFO, so I typically don't include growth from products that aren't on market yet. So it primarily relies on growth from Cologuard and Oncotype. And there's a lot of room for those products to grow, so I feel good about that. Gross margin, there's some major projects we have to drive efficiencies in our lab. In fact, the biggest efficiency gains we've ever delivered in our lab are coming over the next year to 2. So I feel good about those programs. I think most of the improvement you'll see is in OpEx. You've started to see it within sales and marketing. If you look over the last couple of quarters, sales and marketing is kind of flat to down, even when the top lines are growing nicely. G&A, another big area of efficiencies that are coming. Our teams have done a really nice job identifying discrete things that we can chase after. A big one is we pulled ahead some IT investments, IT investments that will cost us some money now. Overall IT investments by end of year, cumulatively, will be over $800 million. So we've invested heavily there. The reason why, because it drives growth. It drives growth and efficiency. So this advanced ordering workflow we talked about will be a nice contributor to growth. That required some additional IT, so we pulled ahead IT investment to make sure that foundation is solid. And then I think you'll see some nice cost takeout there over the next couple of years.
Thomas Peterson
analystGreat. Well, I think we just ran up against time. So we'll leave it there for now. But Jeff, thanks again for joining us, and enjoy the rest of the conference.
Jeffrey Elliott
executiveThanks for having me. Thanks again to Baird.
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