ImpediMed Limited (IPD) Earnings Call Transcript & Summary

Thank you for standby, and welcome to the ImpediMed Limited Half Year Results Call. [Operator Instructions] I would now like to hand the conference over to Ms. Parmjot Bains, Interim CEO and Managing Director. Please go ahead.

Thank you. Good morning, and thank you for the opportunity for us to present and discuss the first half year results for ImpediMed with you. As you will have seen with the release of the financial results for the first half, we also released an investor presentation, providing more granular detail about the business and the progress being made. We understand the need for greater transparency regarding key data and believe that this presentation provides us and will be the basis for future presentations. Because this is the first time we have released this presentation in this format, I will take the time to walk through key points on the slide. I will then hand over to McGregor to talk through the financials. And after that, we will open the line for questions. So just as an overview. The SOZO revenue for the first half was disappointing and well below our expectations, considering the March 2023 inclusion on the NCCN Survivorship Guidelines and increasing payer coverage. However, reimbursement does remain a fundamental driver for provider uptake and critical mass coverage has gained momentum in the most recent quarter, with 15 states, now a critical mass, following the recent inclusion of North Dakota and, as of this morning, Maryland. Lead time for SaaS revenues is currently 6 months from lead generation to execution due to the need for customers to synchronize with budget approvals, contracting and IT security assessment. The company is actively working through customer opportunities and the sales process to identify areas where we can streamline in order to shorten the time from lead generation to contract execution and revenue; and accelerate revenue generation in breast and other reimbursed lymphedema users, reducing cash burn while we increase revenue as a critical focus for management. I commenced as Interim CEO on the 8th of January this year, and McGregor is Interim CFO in March. And we have expressed to the Board our desire to move to permanent positions. We are excited to have Christine step into the role of Chair, and McGregor remains on the Board as an Executive Director. As previously mentioned, the Board is in the process of recruiting for additional directors. Looking at the slide, Slide 5 sets out the investment thesis for ImpediMed. SOZO is a unique technology platform with extensive clinical trial evidence and definitive clinical guidelines supporting BIS, which deliver significant clinical benefit to patients. Increasing payer coverage enables acceleration of the breast cancer-related lymphedema device penetration, both within the existing early adopting sites and into new sites of care. The up to $2 billion market opportunity or TAM is based on capturing all cancer-related lymphedema. Focus historically has been solely on breast, and we're accelerating the go-to-market model for the reimbursed and FDA-cleared pelvic and melanoma-related cancers. There are multiple future growth opportunities that could be delivered through accelerating partnerships in oncology-related indications. However, right now, our activities are focused on achieving breakeven. These activities include having a laser-like focus on sales, marketing, medical and operations teams, and high priority states and IDNs with breast cancer opportunity; implementing productivity metrics for our field force to improve lead generation and accelerate sales; enhancing our customer implementation. We are piloting new pricing models to capture a greater share of that total addressable market and support multiple clinical settings across accounts. We are managing the business with stringent metrics, and we're reducing costs. Slide 5 sets out our goals and priorities over the next 12 months. These include: one, ensuring every new breast cancer patient in the U.S. accesses early lymphedema prevention through focused sales execution; number two, delivering a world-class customer experience and rapid implementation; doing so supports growth in our existing user base and keeps our churn low; third, we are going to expand and accelerate reach for all cancer patients who are at risk of leg lymphedema. As I noted, this hasn't been a focus for the last year. So given the uses in leg and larger market opportunity and existing reimbursement, this is a priority. Underpinning all of this is the need to reach breakeven through acceleration of revenues and management of expenses and maximizing shareholder value. Finally, we are looking to develop innovative partnerships to accelerate patient impact into existing and new patient populations. This is a lower focus and my priority focus is on the 4 above. However, given time to reinvestment and execution, this needs earlier concurrent evaluation. Slide 7 just highlights that the foundations of this business are strong and strengthening of payer coverage increases. In many states and accounts, procurement will not proceed without reinvestment, other than in some of our early adopting sites. There are now 15 states that have achieved critical mass, which the company has defined in having greater than 80% of the population covered through reinvestment by either Medicare or private payers. We are prioritizing our activity among the 11 top states, which we believe are all likely to achieve critical mass within the next 2 months, and as well as our IDNs. Our focus is now on execution at the account level. Slide 8, 9 and 10 provide an overview of our unique technology. Our SOZO Digital Health Platform is one device which is effective across multiple indications. There is an increasing wealth of data and publications supporting SOZO. The use of SOZO in lymphedema and heart failure are the 2 key indications towards reimbursement. Bioimpedance Spectroscopy, or BIS, SOZO non-invasively measures, monitors and manages its fluid status and tissue composition. The L-Dex score, only available from ImpediMed, is designed to detect lymphedema-related fluid changes within the arm. This is a trademark and now within the MASCC guidelines specifically referenced. Slide 11 is just a reminder of the importance of the PREVENT trial for patient care. As we all know, breast cancer rates in the U.S. population have declined over the last 20 to 30 years due to advancements in early detection and treatment. However, within this increasing population of patients who have been treated for breast cancer, there's an increasing population at risk for treatment-related complications. Breast cancer-related lymphedema is a condition that results from the disruption of the lymphatic system by breast cancer treatment, is one of these complications. While this may initially present as a transient swelling in the ipsilateral arm, breast or trunk, it can chronically progress to irreversible fibrosis and interstitial hypotrophy. Breast cancer-related lymphedema further compromises quality of life of breast cancer survivors via associated symptoms of pain, heaviness, disfigurement and functional impairment, as well as being associated with increased rates of infection and lymphedema-related hospitalization. I have to emphasize the PREVENT trial was unique. It provides clinical evidence for significantly large progression to chronic lymphedema with early detection using L-Dex and intervention versus the standard of care and tape measure. Slide 12 highlights the wide guidelines for the SOZO the technology. BIS is now included in multiple guidelines. Most recently, as of March last year, the NCCN Survivorship Guidelines recommending regular screening from lymphedema by symptom assessment, clinical exam and, if available, bioimpedance spectroscopy. Slide 13 just shows how ImpediMed-built technology compares with other lymphedema detection methods. Historically, in clinical practice, many centers continue to use the alternative of objective volumetric assessment: circumferential tape measure and perometry. BIS had received favorable assessments within a number of these [ practice ] guidelines, including NCCN for survivorship and now, reimbursed. Slide 14 shows the states that have reached critical mass, which have been achieved since the start of the beginning of this financial year. We had 14 states on here. And as I noted, as of this morning, [indiscernible] Maryland came on board, so there's now 15 states. It is important to emphasize reimbursement remains critical for uptake. We have potential customers with multisystem requirements who are waiting on reimbursement in the state. As part of our prioritization efforts, we are deeply focused on those top 11 states that are at critical mass and with large patient populations as well as IDNs. As announced on November 2023, UnitedHealthcare, the largest private payer in the U.S., updated its policy to state that those for lymphedema assessment, CPT code 93702 no longer requires clinical review. The removal of this requirement for clinical view is referred to as silent coverage, and this policy came into effect in January. Medicare in the U.S., along with now 40 other payer providers, currently provides silent coverage for CPT code 93702. In addition, there are 14 private payers that have published positive medical policy, with North Dakota just publishing and reaching 95% coverage. As mentioned in our second quarter results call, the company estimates approximately 85% of private payers will be providing coverage of CPT code 93702 by the end of the financial year. On Slide 15, I'll summarize some of my insights since I joined the company 7 weeks ago. In that time, I have been to 8 states, spent time with our sales clinical support team and visited over 18 customers to understand -- to gain an understanding of their needs and how this device is being used. And my insights are: SOZO is used primarily in the preventative care of breast. However, there is multiple use cases outside of this; there's an opportunity to grow the leg lymphedema indication. Reviewing our data, globally, 14 % of measurement is now on legs, 9% of this in the U.S. In the U.S., 80% of customers are measuring legs and plastics, pelvic cancers, melanoma for treatment and prevention. There is a very high customer interest to implement and extend. There's strong buy-in from doctors. However, as I've noted, reimbursement and matching the clinical flow remain critical factors for sites to implement. The lead sites and providers are now extending their device numbers from 1 to 2 per site and into other specialties as lymphedema prevention programs are established. 21% of our sites have more than 3 devices, and we need to build on those. There is an opportunity to broaden our product offering through a provision of body composition data, which is already available, to support broader care and customer retention and growth. As I've noted, our SaaS sales lead times are long, up to 6 months from lead identification to execution, driven by pricing and budget approvals, contracting and IT assessments. There's also an urgent need for us to build the lead pipeline through marketing and medical education. Slide 16 reinforces that our immediate focus is on executing BCRL. As a result of my time in the field, we have prioritized our activities both on the 11 key states and IDNs. We have segmented and prioritized the customer list and aligned on action to accelerate lead and execute on sales. The team has been working very hard. The following activities are completed or underway. We've realigned our key account manager territories to prioritize states. As I noted, we segmented our customer accounts, updated contact lists, focused marketing, medical and sales activities towards these targeted account. We are trialing and implementing a SaaS volume-based pricing and product strategy to increase customer retention and support new customer acquisitions, particularly supporting those larger customers and enabling device placement along the clinical flow. Commencing in April, we're organizing our sales team into regional pods with cross-functional customer sales, reimbursement and clinical implementation team. We believe that this will support and accelerate the sales and reinvestment process. We're implementing an all-hands-on-deck approach, increasing lymphedema PREVENT segment and SOZO awareness across doctors and health care providers through sales, clinical program support-lead, marketing and medical affairs targeted account education. Finally, we're also adding productivity metrics into our teams to support -- to measure productivity and ensuring that we are increasing our customer reach. The marketing team has done a lot of work and have done an incredible job. Two examples of the marketing initiatives that are: new sponsorships to drive awareness on lymphedema and targeted provider decision maker -- targeting provider decision makers at reimbursement summits with new partnerships. Slide 18 confirms there's significant market opportunity for the business. As we know, the market opportunity for all at-risk cancers for lymphedema is significant and estimated to be up to AUD 2 billion. Previous estimates of the TAM were based on a range of monthly license fees for SOZO and the number of sites of service. We consider a more accurate estimate of the TAM will take into consideration the actual number of procedures conducted in the company's target share of the economic benefit. We will continue to refine our assessment of the overall TAM, but the indications are that for all TAM for all at-risk cancers is up to $2 billion, dependent on coverage, which is the reimbursement amount per TAM, procedures and the share of the overall economic benefit ImpediMed will obtain. The TAM of BCRL is estimated around 35% of total. As I mentioned earlier, we are trialing new pricing models to capture a greater share of the TAM and support multiple clinical settings across accounts. Shifting to a patient-based SaaS pricing model is expected to increase our ability to capture opportunities in breast and other cancers. As I noted, the opportunity for leg lymphedema is greater in BCRL due to the volume of surgeries conducted that are also covered by most payers. Given the signs of the opportunities in leg, current use across sites, reimbursement and clinical guidelines, clinical marketing and sales trends are helping accelerate this. Finally, the last, Slide 23, just highlight the value of SOZO beyond lymphedema. There is an immediate opportunity to add value to clinicians managing oncology patients with our unique SOZO body composition and segmental data. As a starter, we can support broader use beyond surgeons into radiation oncology, medical oncology through provision of this data pending any reimbursement. This supports an increasing use case for lymphedema by providing this clinician for the opportunity to more holistically manage patient care as well as lymphedema. We are now working on analyzing existing data on SOZO to determine the opportunity to expand and grow reimbursement in other oncology-related areas. Slide 25 highlights the opportunity in oncology-related indications in the U.S. not only by the number of diagnoses but also the disproportionate size of oncology drug pipeline. We will evaluate potential partnerships in this space. Finally, from my side, once BCRL and leg lymphedema execution plans are in place and being executed, we will evaluate opportunities beyond lymphedema. This will likely be in partnerships given the need for speed and for cash management. I would like to conclude by saying that we remain confident that the adoption of the world-class technology will accelerate as reimbursement continue to expand across all states in the U.S., supported by effective pricing models, clinical education, awareness and focused execution. I will now hand over to McGregor.

Thank you, Parmjot. As you will have seen, revenue for the half year was $4.8 million compared with $5.7 million in half 1 FY '23 and $5.7 million in half 1 FY '23. The reduction was largely due to the foreshadowing end of the clinical trial program conducted by AstraZeneca, which generated revenue of $0.1 million in the current half period compared with $0.9 million in the previous half and $1.2 million in half 1 of FY '23. As we mentioned in the investor call earlier this month, for this period and going forward, the company will report all revenue associated with each contract as revenue from contracts with customers, recognizing equal monthly installments over the term of each contract. We can see this approach reflects the contracts being established with customers. And this change had no material impact on the current period results. During the half year, the company sold a total of 57 SOZO units, of which 32 units were sold in the U.S. This compares to 71 units in half 2 FY '23, of which 46 units were sold in the U.S. and 64 units in half 1 FY '23, of which 32 units were sold in the U.S. The core business total contracted value signed during the half was $4 million compared with TCV of $7 million signed in half 2 FY '23 and $6.2 million signed in half 1 FY '23. The existing contracts in place as at 31 December 2024 are expected to generate core business annual recurring revenue of $10.9 million for the 12 months to 31 December 2024. This compares with the ARR at 30 June 2023 of $9.3 million and $8.2 million as at 31 December 2022. Operating expenses for the half year was $17.1 million compared with $15.6 million in half 2 FY '23 and $17.1 million in half 1 FY '23. The increase in operating expenses compared with the preceding half was driven by costs associated with the general meeting in December -- in September last year and the departure of the former CEO and CFO. During the half year, the company had net operating cash flows -- cash outflows of $6.8 million compared with $5.9 million in half 2 FY '23 and $12.2 million in half 1 FY 2023. The increase in operating cash outflows compared with half 2 FY '23 was primarily driven by increased costs associated with staff, including recruitment fees and short-term incentives that are paid in the first half. These increases were offset by cash receipts associated with the federal government's R&D credit and the U.S. government's employee retention credit. Cash and cash equivalents at 31 December 2023 were $36.9 million compared with $45.7 million at June '23 and $26.2 million at December 2022. As Parmjot mentioned earlier, reducing the cash burn rate while we increase revenue was a key focus for management in the near term. The company has commenced introducing measures to more tightly manage cash flow, establish greater cost discipline in the business and is targeting a 10% to 15% reduction in annualized operating costs by the end of FY '24. So with that, I'd now like to open up the call for questions. Thank you.

[Operator Instructions] And our first question comes from Elyse Shapiro from Canaccord.

Just on your commentary around reaching breakeven. Do you have an update on your timing expectations for that?

So the time to reach breakeven, Elyse, is going to be a function of the rate at which we place new units into the market and the -- and of course, the monthly license fees that go with that. Clearly, we are seeking to do that as quickly as possible. As to the precise -- and of course, whilst in doing so, seeking to manage our cost base. So it's hard to put a precise time frame on it. But we're obviously clearly wanting to drive the top line as quickly as possible.

Got it. And then just in terms of how the installed base has been going, I guess, half year-to-date. Have you started to see the benefit of those critical mass states come through yet?

They are -- the reimbursement from -- as a percent has come on really in the last 6 months. So when the results presented at the end of the year, there were no [ percent per state ]. They're now coming over. We are starting to see opportunities come through. So just right now, the lead pipeline, all these opportunities work through around 300. I clearly want to double that number, but we are getting pickup in terms of lead. What we work on now is trying to execute those into rapid sales given that 6 months lead time.

And just around the new kind of TAM updates, looking at a kind of per scan approach. Does that imply that you're kind of thinking more of a volume-based approach in the longer run as an option for SOZO versus straight monthly fees?

Yes, we'll still be pricing on a monthly fee basis, but looking at setting those contracts up based on the volume of patients going through our system, so trying to capture the TAM that way.

And our next question is coming from [ Reuben Brock ] from [ Atticus ].

Just on the leg addressable market. What's the number of cancer diagnoses and the percentage of lymphedema, please?

So on the slide, the breast cancer is [ 300,000 ] per annum in the U.S. The TAM is 300,000. Of those, 80% are at risk of -- for breast cancer, a general risk of lymphedema. And then of the other types of cancer types, about 55% to 60% are at risk for lymphedema. It's on Slide 18.

And how many diagnoses for the leg?

For the non-breast cancer-related, 820,000. So they'll be surgeries like colorectal, genital, melanoma, head [ and skin ] lymph nodes, urinary cancers.

Okay. Just so I can properly understand. So that's the immediate focus. What does that mean in terms of market size, I guess, relative to breast and what we can see or some sales numbers we might be expecting from that leg area?

Yes. So breast is about 30% of what we think is the total TAM, or 35%. And so clearly, the rest is in that broader leg-related space. What we're working on -- and it hasn't been a focus for the last year is really working on making sure we've got clear clinical guidelines and then a plan of action to address those. As I noted within the customer base, around [ 9% ] of U.S. measurements is already in that leg space. So we're getting organic growth into that area, but we need some focus on medical and clinical sales and marketing activities on those.

And our next question comes from [Miriam Lee] is a private investor.

On rather churn. Is it definite that the 2% to 3% is per annum, not the quarter?

That's correct. [Miriam], it's the number of units where the contract has not continued expressed for year, expressed as a function of the average installed base for that period.

Right. Okay. Good. Now on to the extra things that you try to make, the package seemed more -- saying that very well, it's going to make the package seem more attractive if you can add in things like the protein calorie malnutrition, I think. Now a couple of those things are FDA cleared, but they don't actually have a CPT code, do they? So you can't charge for them. It's just an idea that the institutions might be more interested in having them as extras -- is that the case? And are they interested? When you've approached and talked to the institute -- hospitals about it, are they actually interested in all these extras that you can offer?

Yes. No, absolutely. I mean, you're right. As noted, they're not reimbursed. And so therefore, it's really about offering that holistic management of patient care with those body composition, segmental. And looking at our user base, about 80% has access to that. The company has made a decision not to offer that [indiscernible] retain last year. And so we're just revisiting the offering of that given the kind of widespread use of customers into that space and into that area. And while we do that, concurrently looking at how we can get reimbursement indications, but we need to analyze the data that exists in order to understand what the opportunities are there.

But I didn't catch that very well, maybe my line isn't very good.

Sorry. [indiscernible] interested. About 80% of sites will use that body composition and will be looking and using that data.

All right. Great. Okay. And can I have one more? Sometimes if we have companies that just sell shoes or something and you can say how the sales are going up till now for the third quarter, which is really nearly the January and February. Are you able to give any updates on sales, they area perhaps not very encouraging yet. But did I hear you say that -- did you mention the figure for the pipeline and I just didn't catch it?

Yes. No, I said right now, the team is working around 300 opportunities recently. They do take time to execute. So -- and it does take time to pick up. And so we remain positive and encouraged with the need to focus and accelerate our sales lead time.

Well, that will be very positive. If it's starting to show benefit in 6 months, that would be a huge increase.

It will take time.

And can I ask about what role is Dr. Chen playing in the promotion?

So Dr. Chen is our Medical Affairs Lead. The medical affairs drives medical education and our clinical support activities. So really around targeted education to doctors, KOL, somebody to drive awareness and [outcomes] promotion-related activities that was the sales and marketing teams.

Got it. So does he go to conferences, I mean, what does he...

Absolutely, they go to conferences. We've got plans where we are hosting webinars and dinners with doctors to drive the [wins] within our critical parties [indiscernible]. So a number of forums in which Dr. Chen and Medical Affairs team go down and drive the education. We also use some of our advisors, [Walton] and other doctors to also help support us on our medical education programs.

Right. And does he retain his private practice as well? Are you allowed to say that?

Yes. I think he got to do a minor amount of work on the weekend.

And our next question comes from [Bryce] Hamilton from Hamilton Family Trust.

Yes, I've got 2 questions. So the first one is, there was a tangential reference in the last phone conference about competition. So I guess the question is, do we see any viable competition starting to weave its way through? Or how are we managing that risk?

Yes, absolutely. So on the slide, we've kind of listed out the competitive platforms that are [indiscernible] to attain, one that's probably most they're trying to act to compete against us is InBody, that's a Korean company that's got a BIA, which is a slightly different technology. We have only one frequency where we're trying to [indiscernible] frequencies. They are trying to compete in that space, but don't have the reinvestment on CPT codes. So -- but they are competitive and we do kind of actively work to manage them and the messaging into the marketplace.

Okay. And second question was just tying into the interest around sales. So obviously, you're highlighting the 6 months lead time, which is perfectly understandable. I guess the question is, are there, I guess, any significant opportunities coming through from previous works? I know that there was a previous multiple facility deal that was signed. But is there any potentials coming through in the shorter term that don't sort of have a 6-month lead time starting now?

Absolutely. Look, the team has been working very, very hard. So they have worked in the throughput team and they have the marketing team. So everybody has been working very, very hard on driving opportunities. So we -- and we do track them on a most daily basis and try to help support the team to execute those. I think the ramp up will take a little bit of time as we really try to focus and help execute on those. But there are opportunities in the pipeline that will come up.

And now we have a question from Peter Gregory who is a private investor.

First of all, Parmjot, I'd like to congratulate you on the content of the presentation you've just shared with us. The very clear understanding that you appear to very quickly go over the business and also the fact that you are taking absolute direct control over the whole go-to-market process. So I think that's a very positive step forward. I'd like to comment on the utilization question. And I note that you've not mentioned in terms of establishing utilization the actual nurse to patient relationship contract because I would believe that this is a fairly critical decision point whether the nurse makes a decision as to whether to actually test or not. I'd further comment that if these -- if the people at that [indiscernible] position are not absolutely committed and passionate about SOZO and that they see it can give the people I care about a wonderful post-surgery life, they're likely to perhaps negatively impact on expansion of use within a facility. And I would expect that these people are part of a community that come from like facilities around the area and perhaps even nationally. And as a consequence, if they are not very positively engaged, will not be proactive in helping the success of SOZO broadly. I'd like to just get your sense on that. I also like to make a comment on your statement opportunities, your broadened product offering through provision of composition started as a broader care and customer relationship. I'd suggest that those capabilities would give those nurses at the point of patient contact a lot more confidence and a lot more ability to give a much broader care provision to those patients. And that that's an extremely valuable part of the offering in terms of getting these people on board.

Absolutely. And you're 100% right. And then a lot of the people I met when I visited the customers are doctors, but the nurse practitioners, lymphedema therapists, the administrators that were doing the management. So you're 100% correct. They are absolutely critical on both implementing SOZO once the sale has been made but also on managing and driving utilization. So we have a CPS team that worked very closely there with that group of health care providers, just to help drive utilization and we kick low utilization sites on a weekly basis just to make sure what uptake looks like, and we are extending patients that would succession from large account to across the border group, which is just [indiscernible] groups who are virtual webinar opportunities where they can dial-in and then talk about the data that they're seeing and help manage their care. So you're absolutely right. Utilization is absolutely key because we've got to create a positive experience for them to pick up the additional sites. And I kind of referenced earlier, we've got around 21% of sites. We've got 3 devices or more, which means there's a large number of sites in one device, it could actually go up. And so that's the low-hanging fruit for us as a business. And we've got to make sure they get the best possible experience. So that's by driving utilization in [indiscernible], but you're right, and that's why the body count data is really important because that's a lot more holistically patient's care and have a broader conversation.

Yes. That's fantastic. I'm really happy to hear that. I have 2 more quick questions. One is, can you tell me how many of the sales through regional are associated with the [indiscernible] Foundation?

No, I don't actually know that, but I'm meeting regional this afternoon. So I can find that out, I talked to the leads today, but I'm going to go do it in person.

Okay. That's great. My follow-on question to that, how can that be leveraged?

I'll ask them that, 2 questions.

Okay. I'd also like to ask about -- I think you've recently lost 2 salespeople. Can you talk me through the lead time in getting a rip-up to being 100% effective and productive?

Yes. So what we -- it's going to take time. So it's probably a good 3-month process. So what we've done is we were losing team, we're actually bringing the opportunity to bring the CPS across. So we've actually got the existing staff that can rapidly get us to speed. And then as we realign our territories, focusing on [indiscernible] got experience to it really managing those parties and opportunities. But you're right, we've got to keep up the [report], it's top focus and really support them to help them execute on the sale.

[Operator Instructions] And our next question is coming from Grant Percy from [indiscernible] Equities.

Thank you for the excellent presentation. Would you be able to just talk us through macros or the involved organized [indiscernible] going forward? I understand that I suppose we're paying them quite a bit in consulting fees to help us with the pre-NCCN Guidelines. But now we've got post, will they still be involved with IPD going forward?

Sorry, Grant. I just -- I missed the start of that question. Who are you referencing?

Macro. So that would be Chelsea's team that helps with all the...

The reimbursement team?

Yes, correct.

No, no, reimbursement remains critical, so we only got 15 states. We've got to get all our major providers across the board and across the line. So that remains critical. What we will do is look at shifting out Case Assistance Program support, where we don't need that anymore from a local reimbursement support to having that reimbursement team work on the critical accounts at the account level. So we've got some states where even 85%, you still need a reimbursement support still and that we can't leave and lock at this very specific payer mix and help them understand their return on investment for the device as they've put this into place. So we're going to refocus the way that, that team looks in the next couple of months as we get our reimbursement up.

Okay. Great. And I suppose following on with Peter's question. Is there anyone actually writing up testing programs for, I suppose, each patient? Or is it really that random? And are any, I suppose, existing user bases running either the IPD plan? Or are they running their own plans?

So there was a number of protocols and guidelines that are out there for clinicians to use. So we have the PREVENT Trial, which has the recommendation of a given test to be done over 3 years, and there are [indiscernible] of breast cancer surgeons has a guideline which actually has 13 tests to be done and then the L-Dex Clinical Practice Guidelines, which are written by Shah has got 17 tests over 5 years. So they really vary by the account, but we give them the guidelines around the L-Dex Clinical Practice Guidelines. So there are very guidelines that we have to support the teams to go out and the permission to go out and implement. And that is provided as part of the implementation program.

Okay. So are there actually running 2 programs at the moment?

Yes, there's a number of systems they've been on for over a year now with a very, very successful lymphedema programs. And we're really looking to emphasize those as we bring new payers on. Because [indiscernible] implementation of LPP. There's also a very -- implementation of a new service line for these providers in the U.S., which also generates revenue. So absolutely.

And we now have a question from Ian Hyde, who is a private investor.

Just quickly, SOZO Pro, update on that, please?

SOZO Pro is still in the process of development. So we are just working on the development and launch plan from that one. Right now, it's important to come out. But right now, the focus is just rolling out the current SOZO within the U.S. opportunity.

Okay. So more news later this year?

Yes.

Yes. It's a little, I guess, to buy it out in world, with the MASCC Guidelines that came out, can you provide some clarity around what impact that will have in what areas for the company?

Absolutely. So the MASCC guidelines are interesting because it's in a world-leading journal which -- it's probably a little bit more ex-U.S. with BMJ probably being key 1, but it still is one of the world's latest journal, essentially because it specifically reflected and specifically references out in its guidelines. I know these dialogues and it is fit for an international audience with less access to [indiscernible] in the U.S. So the kind of minimum testing is a lot less 5 to 7 versus what we are recommending and what the American breast cancer surgeons recommend in the U.S., which is 13 tests. It's something that is useful for us as we try to expand on this international market and see what the opportunities are. But it is the paperwork that we are leveraging in the U.S. just for the strength [indiscernible].

Sure. If I remember, part of the MASCC Guidelines stating that what they said was then subject to further investigations. So the guidelines could be updated potentially at any time or after further studies or something?

Yes, yes. Yes, and I don't think there's a time line on that guidance. But I think all guidelines continue to develop and evolve the go forward. But we haven't heard of a time line or an update on that.

Okay. NCCN, we've got 22 of 33 bodies using it. Have you been able to identify what the holding point for the other remaining hospitals?

We are working through those in the bodies of the NCCN, the large IBAs and the cost of accounts and just line by line. And that's where medical affairs team has been important just to reach out and start, and make sure we've got those relationships with the centers that are using it to really try to find out what the barriers are and how we convince them to come on board. So absolutely focusing on really building the relationships into those centers and understanding what -- how to bringing it on. And may be reimbursement -- I mean, reimbursement has this go -- have this narrative or decide the main key. But not on the net count [indiscernible] count basis, yes.

That's more to watch in this space. Okay. So have you been able to identify as yet with the 6-month time line to get the contract over the finish line, standard issues which could help to reduce that at all? Or it's really a case-by-case situation?

No, it's standard ones. One is which is why we're having a look at the pricing model, right now going through an OpEx and a CapEx approval process, divide sales plus monthly fee takes you through 2 different budgeting approval process. The part of the new pricing work is we're partnering not just a volume-based kind of pricing model also on a monthly basis, but just try to standardize the offering that was just gone for rolling the -- trying to streamline the [indiscernible] OpEx approval. IT assessment take us a while. And so what we've just done is put a single point of contact within ImpediMed that really is kind of owning and managing across the whole IT privacy security screening process. So those are probably the 2 figures bottlenecks that we're seeing at the moment across this just to try to accelerate these approvals.

So is there, I guess, from a layman's point of view, common sense with some of these issues? Have you found that there's any difference between the size of the hospital or clinic as in a smaller hospital or clinic potentially could be nimble around some of these areas? Or that's -- you haven't seen that at all?

Yes. They both take -- they both probably take -- they both need the budgeting in the IT privacy and the contracting. Maybe in some cases, the low-hanging fruits is probably the small effect where we can. The opportunity is given the time and investment needed is to try to get the existing sites to go up. Of course, everybody got the IT assessments done and they've already got a standard contracts. So there's the kind of low-hanging fruit that we really need to see if we can drive utilization or more devices around. And then for the new sites, definitely trying to go after a bit of scale, larger sites just because the time and the work needed is very similar across sites.

Sure. And with the LPP, with everything that you've been finding out, have they been tweaked around your structural or what's provided is that at all to users and/or new customers?

There is not pronounced structured, but just more content. So a lot more is important. In fact, this morning on the sales call with teams created a better clear implementation deck that sales team will use at the outset. Just really just want to tweak the sales process and the understanding of the customer and what they need to have in place as they rolled this out? But we are getting a number of sites. When you look at the installed base in the U.S., there are a number of sites now putting either LPP programs in place or even treatment program. So hopefully, that critical mass will grow, the [indiscernible] will grow.

Sure. Okay. I had a question, and I'll just go into a [indiscernible]. I can't think -- so just back to lymphedema. Is there some sort of a time line around when that may have some progress and you can actually start executing on that?

Well, we're trying to accelerate it. Right now, we're just looking -- trying to build on the users that we've got. So we've got an existing base that's using it. What we're just doing is just developing and tightening up the clinical plan, just understanding to fit in additional data or what [indiscernible] needed to do that. So we'll come back to you on the time line because that hasn't been a focus for the business. So it's something that -- as well as something new that we have now put into place in the last 6 weeks to really drive forward.

Okay. So putting -- thinking about all the things that you put in the process with all these new processes, procedures, customer contract generation, et cetera, et cetera., this has all been done without any new staff. It's just been refocusing and redeploying the existing personnel, i.e., no more costs?

Yes. No, absolutely. So a lot of it was done, like there were things that were already underway, and the team is already there. They are working very, very hard. We're just trying to refocus a little bit. So that's the existing basis, yes.

Okay. And lastly, with -- I know it's not a focus right now, but we already have [indiscernible] through the half. The inference is you're looking at doing some free get-it-off-the-ground studies, what I am understanding, is that correct?

Yes. Understanding really at the start, right? What is the good data that's needed because the company has developed and now [indiscernible] just one thing cut off. What we've got to do is just understand from doctors what -- the base of the data that's there and then what else is needed and what is the best way of addressing that. So we really need a top business plan, [indiscernible] on that. But there's it would appear -- given as reinvestment and then algorithm, there's an opportunity that we really do need to understand better fast.

There are no further questions at this time. I'll now hand back to Ms. Bains for closing remarks.

Absolutely. I just want to thank the investors for your ongoing support and just a reassurance that we're absolutely driving towards where the new [indiscernible] of costs and really trying to ensure that patients that need access to this clinical technology have access to it. And so looking forward to connecting on the roadshow, I think McGregor and I will be on the road for the next couple of weeks, and please reach out anytime for questions. Take care.

Thank you.

And this concludes the conference today. Thank you for participating. You may now disconnect. Have a good day.