Hologic, Inc. (HOLX) Earnings Call Transcript & Summary

Thank you, everybody, for joining us today. Welcome to the JPMorgan Healthcare Conference. My name is Casey Woodring. I'm the Life Science Tools and Diagnostics team here at JPM. I'm pleased to be joined here by the team of Hologic, CEO, Steve MacMillan; CFO, Karleen Oberton and COO, Essex Mitchell. So I'll turn it over to them for a second for the presentation, and then we'll jump into Q&A. So with that, Steve, take it away.

Great, Casey. Thanks for having us. As I was coming out to this, I realized it was 20 years ago this month, I presented at my first JPMorgan as a new CEO. So still I have a lot has happened through those years. And about 10 years ago, we had just welcomed Mike Watts back to the organization. I was about a year into Hologic. For those of you who tracked the journey at that point in time, we were just coming off about 5.5x leverage. My best friend at work, Carl Icahn -- if you owned over 10% of Hologic had 2 members of the Board. It was not the easiest of situations. And 5 years ago at this conference, we said we were poised to make a big difference in the world. And if you recall, this little thing called COVID was just starting to be heard about over in Asia. And certainly, the way our team responded in that time has fundamentally helped strengthen and transform Hologic. So let's go through -- we could read every word of the safe harbor, but we will spare you that. And we'll get right to our presentation today, which is really a quick overview of who are we today? And then talk about that track record of dependable growth, transforming our core franchises. Give you a little more insight into the competencies we've really built and finish on the financials. So overall, when you think about what are we today and I think about a company you'd want to invest in, and I think about who we are, and I tend to think these are pretty good things, which is a company that's proven very solid revenue and EPS growth, with market-leading brands and many, many very strong market-leading brands, still with multiple growth platforms ahead of us, early-stage growth opportunities through both organic innovations well as some acquisitions we've made over the last couple of years, strong operating margins, exceptional free cash flow. And today, unlike a decade ago, what we would call a fortress balance sheet, that track record of dependable growth. When you strip everything out and you look at what was Hologic in 2014 and where are we today, we have averaged 4.8% top line growth through that time period. By the way, in that base on the left, the $2,511 was over $220 million of Blood Screening, which was highly profitable revenue and we did divest that years ago to Grifols. So the core growth rate actually being a little bit higher than that. But all in, if you own Hologic back then and you own it today, you've witnessed a 4.8% CAGR, not always in an exact straight line, obviously. Nothing is that perfect, but overall, very solid mid-single-digit performance. Our double-digit EPS growth. When you look at our non-GAAP EPS through both capital deployment through accelerating that growth rate, everything else, we're very proud that over this decade, we have delivered double-digit, almost 11% compound annual growth rate in that earnings per share. And we think that puts us in a relatively rare air. Now how have we done that? Because quite often, people are looking for sort of the one big sexy thing? Is it a particular product or a particular geography? What I want you to realize as we go through this is, it has been fundamentally through lots of actions through our various businesses. And let's start with our Diagnostics business. And this business has been all about placing Panthers and then expanding the menu. And here, as you see, going back to 2014, we had about 500 Panthers placed globally. The bottom is the United States, the top bar is International. By 2019, we had more than tripled that. So we were doing an incredible job of placing those Panthers through those years. And then as COVID hit, we more than doubled again off of that big base to almost 3,300. So when you look at it globally, about a sixfold increase in our Panther placements over that time in the United States, more than a fivefold increase internationally about an eightfold increase to where today, we're fairly well balanced around the world. And the other magic of our -- this business, it's all about Panthers. It's machines placed, and then it's menu. And this is what we've also been doing through those years. You go back to 2014, we only had 4 assays approved on Panther. By 2019, that was up to 16. Currently, it's at 23 and continuing to grow. So the magic of our Diagnostics business, and you see it coming through in the numbers, is more Panthers, more menu, more customers adopting that, and it just keeps building on itself. And so what does that look like overall over that decade -- it's been a 6.4% growth business for our Diagnostics business. And the interesting thing to look at this here is cytology and particularly with all the USPSTF and lengthening intervals, everything else through the last few years, especially a lot of focus on that. And at the end of the day, you see our Cytology and Perinatal business today is roughly the same size that includes Perinatal, which has actually declined. Our cytology business is marginally bigger than what it was, but we've added this incredible growth driver of our Molecular Diagnostics business, which has more than doubled during that time, and it continues to grow at a very, very healthy rate. Shifting to Breast Health, kind of a similar story where over the last decade, we have shifted from just over 2,000 3D units really helped transform the market, to a 3D market where today, we have more than 15,000 3D units installed around the world with a big chunk of those in the important United States market. And underneath the surface, when you look at our Breast and Skeletal business, it's been about a 4.5% grower. So it tends to be slightly on the lower end of our growth rates of our businesses. But the magic that we've been doing with this business over time is, as you look at those buckets and to bring some clarity to what those buckets are, the bottom dark blue is the actual gantries. That's the capital. Everything else on top of that, we've been shifting to more and more recurring revenue. So that next blue bar is our Service business. As you can see, just the Service revenue alone now significantly larger than the gantry business itself and even our Interventional business is now growing and getting close in size to our gantry treat as well. And again, that's a lot of recurring revenue. And on top of that, the accessories and equipment. And then the very top part of that, that little gray bar is the Skeletal business, which is effectively a flattish business over that time frame. So the core Breast Health business actually growing a little bit better than that 4.5% through that time period. And we like the way we've been transforming that business over time as well. And then we shift to our Surgical business, which doesn't always get as much attention. This is the one that my good friend, Carl Icahn want to sell off early on. But I would tell you, it's really kind of been the hidden gem of this company, in that it's higher margin. And as you can see here, the CAGR over that time period, north of 7.5%. And the fascinating part here is we've gone from that NovaSure business which was really the key franchise way back in 2014, even though that business has effectively declined modestly through the years, what we have done with the MyoSure business and our Fluid Management business that lighter blue, has become a major growth driver for this business and then adding in through some of the recent acquisitions, starting to build out a Laparoscopy business here as well. So overall, this business is thriving and also really in the very early innings of our international expansion, which has really been fueling some growth here for the last couple of years in this important franchise. Now we'll shift here to our competencies, to try to give you a little more feeling for who we are, what we've done. And that is, we tend to think we've got a pretty unique culture, very purpose-driven about trying to make a difference in the world, particularly for women's health. And in a world where, frankly, rights for women are not necessarily going in the right direction, having Hologic out there and fighting for better women's health, better rights, we believe, is a very motivating force both for us to make a difference in the world, but also incredibly unifying and empowering for our employees as we know we're making a difference, whether it's for ourselves, our families, our friends or everybody. And a deep passion there for women's health, highly engaged workforce. The very first year, we had done this engagement survey back about 9 years ago. We came in at a whopping 36th percentile. We had work to do. And so we've continued to move up, and we're now quite proud that we're at the 97th percentile, never patting ourselves on the back, always figuring that there are areas to keep getting better at. And we've gotten some nice recognition. In simple terms, we call this our virtuous circle on the right. The way we look at it is the more that we innovate, the more we sell, the more we sell, the more we can invest. And it's -- as we keep getting bigger, we can invest more in R&D. We can invest more to grow our categories, make a bigger difference for women. And then the cycle starts all over again and very, very motivating for our employee base. Now we get a lot of questions always around, well, what about market share, what about growth rates of categories. And I think the harder part to fully understand, and it's a hard one for us to fully articulate is that largely, we have created markets. So the sizes sometimes are of the markets and the shares have been hard to figure out. And if you think about it, going back really to our legacy company, Cytyc, really created probably the first modern day branded diagnostic product in ThinPrep and created one of the first physician sales force that carried on to this day and really transformed the traditional pap smear into the modern day ThinPrep pap test which had made a major impact on taking cervical cancer as being one of the very leading killers of women around the world over the last 20, 30, 40 years. Now really shifting to where cervical cancer has gone so far down. The same we did with the transition from 2D to 3D mammography and inventing 3D bringing that to the market around the world, a game changer in mammography. MyoSure to treat uterine fibroids. Remember, getting questions early on, could it ever be a $100 million business? We didn't know how big can it be? It was hard to define the size of the market. And today, it's not only over $100 million, over $200 in that $300-ish million range become a huge business and continuing to grow, because when you're pioneering new categories, bringing new products to market, you start to find more opportunities over time. Same with our Vaginitis Testing, our BV/CV test, we brought to the market in the molecular world. It was largely LDTs, very hard to know how big that market was. That has now become our second largest assay in just a few years. While it was technically launched in 2019, because of COVID, everything else, it's really caught steam just in the last few years. And so we've historically been innovating in ways where it's not necessarily going after a clear market or a clear competitor. We're going after a medical need and a medical opportunity, that our unique relationships by being deeply entwined in women's health, we get ideas from the KOLs or we see things happening and then our teams innovate in those spaces. And so again, in any given year, no one of these products is necessarily breaking out or driving things hugely. But collectively, each of them just add up with this inexorable force that just keeps building over time. The other hidden gem that we've had, and we've really started to get very serious about this over the last 6, 7 years, has been international and we were going back and we'll get some highlights or actually headlines, I guess, from about a decade ago. And international for us at that point, was largely a distributor-led business. And what we have done, particularly since Jan Verstreken came on in really 2017, we've transformed our International business from largely working with dealers in an indirect model, to having our own people and then the market access and building out reimbursement capabilities, everything else to where our international business has been accretive to our total growth rate through that time. And if anything, has been stronger over the last 5 years than even the previous 5 years within this, but a total CAGR of over 6.5% during this time. So what does this really look like again as you start to stack these things. We've got these great market-leading brands. Think about our business in this way. We have ThinPrep and Panther in our Diagnostics business, these rock solid, market-leading brands that can be grown upon. In our Breast Health business, we have our 3 Dimensions and the incredible base that we have from our 3D Mammography and in our Surgical business, both NovaSure and MyoSure as these market-leading brands that we're then building out the International side. And then where we start to get excited those top 2 buckets through organic innovation, and we've touched on a few of those between BV/CV, fluent, which is our Fluid Management System in our Surgical business and more recently, even our Genius digital cytology. So we're taking ThinPrep and moving it from frankly, where cytologists have still been looking through microscopes at slides to digitizing it, putting it on screens and then being able to start to work the AI algorithms of reading the tests and really being able to provide huge workflow advantages for the cytologists. So that's all good. And then the other part that we've really achieved, I'd say, more over the last 5 years and starting to accelerate here of late is building the tuck-in M&A muscle. Candidly, that was a muscle that did not exist in the company. And so as we sit here today, we've gotten much better at identifying, integrating and really making great use of our cash on the acquisitions by having the internal capabilities. Because having the balance sheet is great, but if you don't have the internal capabilities. It's not much. And what we're really pleased with is, if you look at these last ones, Biotheranostics is a deal we did in Diagnostics, what 4-ish years ago, Karleen. And that business has more than tripled for us, since we brought it in. So about $30-ish million up to north of $100 million. Acessa and Bolder, a couple of deals that we did in the surgical business that have been double-digit growers. They're still small, but double-digit rates. So it's kind of a nice year 1. It makes a little difference, but really driving for things that are going to be accretive to our overall growth rate. Endomagnetics a deal we did last summer for our Breast Health business that's off to a very nice start for us. And just what, 1.5 weeks ago, Brandon, we closed the Gynesonics deal, that we've been working on last year for our Surgical business. So that's just going to be coming to the franchise. Had our kickoff meeting last week, and more meetings this week. So really liking what we've got for this combination organic and inorganic opportunities to grow. So to wrap up on certainly Karleen's favorite, but I think all of our favorites are the financials. And certainly, we start with what is an incredible best-in-class operating margin. We're in that 30-ish low -- very low 30% range and very proud of that. While we continue to bring in some deals that might be slightly dilutive to that, but finding additional efficiencies within the organization to continue to drive great margin structure. Also the cash flow, and this has been a tremendous piece. Over the last 5 years, you can see our free cash flow conversion rate of close to 100%, and you can also see on the right side, just effectively kind of what I call pre-COVID up to the new scale that we're at today in a post-COVID world through our growth becoming closer to $1 billion of annual free cash flow. And what that's led to is a very different look at our balance sheet. You go back to 2014, we were 4x levered and 2 years earlier, it was 5.5x levered. So we've made tremendous progress on that front while also deploying a fair amount of that cash, both on M&A but also on ourselves. We have continued to believe that, frankly, we are a great bet. We've done a lot of due diligence ourselves. We like what we saw, and we decided to buy some more of ourselves as well through the years. So as we sat at year-end, which was basically September 30, we had about $2.4 billion of cash and cash equivalents on the balance sheet, which gives us that ample fuel power to -- or ample firepower to fuel the additional growth. So far this year, we just did the Gynesonics deal in that roughly $350 million range. Our Endomagnetics last year in the $300-ish million range. We kind of love that size of deal that's bringing revenue that we can drop into our sales forces and immediately start to get additional growth and leverage. So here's how we wake up and think about the business overall. At the end of the day, we've delivered over the last decade, double-digit EPS growth, and that is something we continue to aspire to do. And the way we get there, every company can get there a little differently. For us, it's probably in that mid-single-digit revenue growth. Ideally, right? What we want to keep doing is moving that on up. But the pragmatic reality of where we've been has been in that range and ideally getting a little bit better. Very modest operating margin expansion. We're already world-class. We don't want to drive off the cliff, but there's still always opportunity. We're consolidating facilities. We're always looking at ways -- I think it's hard for any of us to look at anything and say, golly, we're operating perfectly. So there are always opportunities. We find them -- we wake up every day ourselves and thinking that there's so many things we can still do better. And so we're always looking there. We like the idea of trying to get into this regular acquisition, part of what we articulated last year. If we could do -- my dream would be we could do 3 of these $300-ish million deals a year, drop one into each of our franchises. We have one Diagnostic, one Surgical and one Breast Health deal every year, that will be accretive to the growth in that year, but really accretive as it becomes organic, that would be ideal and use what's left over to continue to buy back our own shares at a minimum offset dilution. But we do have that ability to also do more than offset dilution through some more meaningful buybacks if we want. So there's so much focus on the middle of the business and exactly no given year is going to be exactly always within the range as we've said. But we feel really, really good about our long-term goals, what we've achieved to date and continue to try to thrive in that environment. So with that, Casey, will wrap up, and I'll join my team here for questions.

Awesome. Yes. That was a great overview. I guess starting where we left off, just to touch on that last slide first since we've gotten a number of questions on it the last couple of days. You referred to mid-single-digit revenue growth. Is that an intended change from the existing 5% to 7% revenue growth LRP? And how should we think about that?

Yes. We remind you that the 5% to 7% was not an LRP. It's kind of become acronym. We put that out in the middle of COVID when people are trying to figure out what are we, and we saw that we're growing faster. So we put that out for a 3-year period through 2025. We will have absolutely achieved that. We did not anticipate that in the first year of that, we grew 15.4%, just organic strip out COVID. So that obviously put a much higher base on that number, than we ever imagined. So we are viewing it at mid-single, that can be slightly lower than 5%. We obviously continue to aspire in that range, but we think there's become an inordinate focus on that type of a range. And I think as, frankly, my good friend, Marc Casper says all the time, right? Any given year, you can be above below any given quarter, you're going to be above and below but where are we aspiring to and ultimately, to be the higher end of that, but we are putting that out there.

Okay. So maybe thinking about that mid-single-digit range -- or that number moving forward. Can you break that out between the 3 segments between Diagnostics, Surgical and Breast Health, how should those...

Yes, we're not going to give specifics to that end. But I think what you should expect is Surgical and Diagnostics are at the higher end of that range, and Breast Health at the lower end over time. So, Karleen, do you want to add to that?

Yes. No, I think it's probably relatively consistent with the performance we've seen over the last 10 years that in Diagnostics, you have Molecular that's clearly going to lead on the growth rate, but you have Cytology, which Steve highlighted is more flattish. So that net diagnostics high-end surgical as we demonstrated over the last 10 years at the high end and Breast at that lower end.

Okay. And Casey, probably the higher level piece, I'd say, is if there's a year where we grow 8% or 9% right? Because you're going to have years where you're not necessarily in that range. That will be a year with probably less operating leverage because we've got the ability to drive back. And I think what this company has is so much more flexibility to achieve that double-digit EPS growth than what is fully recognized in value? I would argue a lot of people probably haven't realized that's what we've done over the decade. And so we've got more firepower and ability to play those cards to deliver that double-digit growth.

Okay. I guess following up on that, any more color you can provide on that modest operating expansion piece.

Modest?

Modest. Yes. Yes, just curious if you have like an annual target we can anchor to or anything like that?

Yes, I'll start with that, Steve. As Steve talked about in wrapping up is that we aspire to double-digit earnings growth rate. And so it starts with the top line, but we're going to use the whole P&L, Casey, to achieve that. So it's not just margin expansion, it could possibly be tax rate, it's going to be share repurchase, et cetera. But I think giving the peer-leading best-in-class margins that we currently have. We always want to make sure we're still investing back into the business in things like R&D. So we're driving that innovation and keeping that top line where it needs to be.

Okay. That's helpful. Maybe turning to the first quarter pre-announcement from the other day. You did close to 1% ex-COVID organic constant currency growth. It came in slightly below expectations. I think it was 1.8% to 2.8% growth. So just curious relative to expectations, kind of how the quarter played out. I think Breast Health came in a little below [ Street ] expectations and you might have had a bit more COVID assay revenue. So maybe just walk us through the puts and takes there?

Yes. I think if you look at the midpoint of our guide, you take out FX, we kind of hit the midpoint. But to your point, from a performance perspective, Diagnostics had an exceptional quarter. If overall Diagnostics grew 9%, excluding COVID Molecular growth -- definitely grew double digits. Surgical came in solidly despite some headwinds that we worked through on the IV fluids shortage situation. And Breast Health was probably a little disappointing. What I would say is that if you looked at '24, was probably still a recovery year on the gantry piece of that business as we work through the elevated backlog we had talked about that built up through the supply chain challenge. So as we enter '25, we entered into, what I would say, a normal capital environment for us where we are really in this 3D to 3D conversion, if you think prior to COVID and prior to the supply chain challenges, we were still in a 2D to 3D, where you had outside factors such as higher reimbursement driving that conversion. Now we're in a 3D to 3D factors. And so as we approach this year, we did change comp plans to address that. And we probably didn't have the best execution that we would have liked to at the start of the year, but we've addressed that with some changes in leadership and think we'll see improvement as we exit the year.

Okay. And then just on the bottom line in the quarter, you were able to deliver at the high end of your target EPS range. Can you give us color on how margins trended relative to expectations? And if those drove adjusted EPS in the quarter or if there was more below-the-line benefits anywhere?