Kestra Medical Technologies, Ltd. (KMTS) Earnings Call Transcript & Summary

Good afternoon, and welcome to Kestra Medical Technologies Fourth Quarter Fiscal 2026 Earnings Conference Call. This conference call is being recorded for replay purposes. We will be facilitating a question-and-answer session following prepared remarks from management. [Operator Instructions] I would now like to turn the call over to Neil Bhalodkar, Vice President of Investor Relations, for introductory comments.

Thank you, Carmen. Good afternoon. Thank you for joining Kestra's Fourth Quarter Fiscal 2026 Earnings Call. With me today are Brian Webster, President and Chief Executive Officer; and Vaseem Mahboob, Chief Financial Officer. This call includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Statements are made on this call that do not relate to matters of historical fact should be considered forward-looking statements. These statements are based on Kestra's current expectations, forecasts and assumptions, which are subject to inherent uncertainties, risks and assumptions that are difficult to predict. Actual outcomes and results could differ materially from any results, performance or achievements expressed or implied by the forward-looking statements due to various factors. Please review Kestra's most recent filings with the SEC, particularly the risk factors described in our Form 10-K for additional information. Any forward-looking statements provided during this call, including projections of future performance, are based on management's expectations as of today. Kestra undertakes no obligation to update these statements, except as required by applicable law. During today's call, we will also discuss non-GAAP financial measures. These non-GAAP financial measures are in addition to and are not a substitute for or superior to measures of financial performance prepared in accordance with GAAP. Please refer to our earnings release for a reconciliation of these measures to their most directly comparable GAAP financial measures. With that, I will turn the call over to Brian.

Thanks, Neil. Good afternoon, and thank you for joining us on today's conference call. We are excited to discuss the details of our strong performance in the fourth quarter and the significant progress Kestra made in fiscal 2026. As always, I'd like to begin the call by focusing on what truly differentiates Kestra, that is the lives we protect each day and the patients, families and clinicians we serve. The reality of cardiac recovery is that risk doesn't always resolve when a patient leaves the hospital. For some patients, the journey to recovery is far more complex than anyone anticipates. Every patient is prescribed ASSURE with the hope that its protection will never be needed. Unfortunately, cardiac recovery doesn't always unfold that way. One patient recently reminded us of that in a very profound way. The patient was a 43-year-old woman recovering from a recent heart attack and living with advanced heart disease. Like many patients beginning recovery, she was prescribed ASSURE while her care team monitored her progress and evaluated long-term treatment options. 72 days after her initial prescription, the system detected a life-threatening arrhythmia and delivered life-saving therapy. For many patients, that would have marked the end of the event. For her, it was only the beginning. As she was rushed to the hospital, the arrhythmias didn't stop. Through ambulance transport, hospitalization and every subsequent cardiac episode, Assure remained with her, delivering therapy each time it was needed. By the time physicians could provide stabilizing treatment, the system had delivered 12 successful therapies, protecting her through a prolonged and unpredictable period of instability. Every patient's recovery is different and some emergencies are far more complex than anyone could predict. In this case, the patient required 12 separate interventions before she could be stabilized. That level of sustained protection isn't simply a feature. It reflects a deliberate design philosophy centered on supporting patients through even the most demanding clinical scenarios. This is just one patient story. In fiscal 2026, our cardiac recovery system was used to protect 18,000 patients at risk of sudden cardiac arrest. We remain thankful and humbled by this responsibility entrusted to us by prescribers, their patients and their families. Now turning to our financial performance. We concluded fiscal 2026 with another strong quarter. We continue to reach more patients at risk of cardiac arrest, accepting over 6,300 prescriptions written for the ASSURE system. Revenue was $28.6 million with growth of 66% compared to the prior year period. For the year, Kestra generated $95 million of revenue, resulting in growth of 59% compared to FY '25. Gross margin of 54.8% expanded by over 10 points year-over-year and 200 basis points sequentially, reflecting the attractive unit economics of our rental model. This was our 10th quarter in a row of sequential gross margin expansion. Our full year gross margin of 51.4% increased by approximately 11 points compared to FY '25. We remain confident that Kestra is on a path to 70 plus -- 70% plus gross margins over the next few years. Although FY '26 was a year of investment with the strong revenue growth that Kestra is generating, we continue to see improving operating leverage in our business. This growing leverage supports the investments we are making in the company's key growth drivers to take advantage of the large and attractive market opportunity we see. The investments that we believe will drive significant near- and long-term value for Kestra include expanding our commercial team, enhancing our revenue cycle management capabilities, growing our fleet of devices innovating to extend our product advantages and growing the body of clinical evidence supporting the ASSURE system. One such example was the investment we made at the start of FY '26 to meaningfully enhance our commercial training and onboarding capability. This has reduced how long it takes a new territory manager to reach a key sales ramp productivity milestone. This accelerated sales force productivity strengthens operating leverage and positions us to more effectively capture the significant growth opportunity in the WCD market. We continue to expand our sales organization with the goal of further penetrating existing accounts as well as calling on new potential ASSURE prescribers. As we have discussed previously, we are targeting geographies in which a high volume of WCD prescriptions are being written and where we also have strong in-network payer coverage. As planned, we ended fiscal '26 with approximately 130 active sales territories, up from about 80 at the end of fiscal '25. The impact of this is clear. Our commercial team is winning in the marketplace with the number of new prescribers for ASSURE growing by 55% in fiscal '26, while the number of ordering facilities grew by 65%. It's exciting to see that some of these new ASSURE customers are, in fact, new prescribers of WCDs as a category. Turning to the WCD market. We have previously noted that despite the overwhelming evidence that an external defibrillation shock is effective at terminating dangerous cardiac rhythms, WCD therapy remains underutilized with 6 out of 7 patients that are indicated for WCD not being protected by one. We believe the innovation and clinical evidence we have brought to the category started to change this in fiscal 2026. Based on our financials and that of the incumbent, we estimate the WCD market grew in the low to mid-teens. We are still in the early innings of market expansion, and we see this category growing into a multibillion-dollar market in the years ahead. I wanted to illustrate this last point with a few examples of strategies we are employing across various geographies. The first case study is a leading academic medical center in the Southwest that demonstrates how commercial -- our commercial model drives sustained account expansion. When Kestra entered the institution in March of 2025, it had never prescribed the ASSURE system. 15 months later, utilization has grown to more than 60 prescriptions with 40 unique prescribers activated across multiple specialties. That growth has been driven not only by commercial execution, but by repeated clinical validation in our service delivery model. A recent example of this institution highlights that dynamic. Patient experienced ventricular fibrillation while wearing ASSURE, a system delivered a life-saving therapy and our proprietary ASSURE Assist feature alerted emergency medical services even before the patient's spouse completed a 911 call. Within minutes, the treating physician had been notified, enabling rapid coordination of care as the patient was airlifted for advanced treatment. The event reinforced the value of the entire ASSURE platform, not just the therapy, but the speed of emergency response, clinical communication and continuity of care. That experience translated directly into broader physician adoption. Within one week, four additional ASSURE systems were ordered by physicians who had never previously prescribed our platform. Adoption in this system has since expanded beyond the initial heart failure service line with electrophysiologists beginning to prescribe ASSURE after observing its clinical performance, patient experience and integrated support. This account reflects a pattern we're seeing repeat across the country. While clinical outcomes accelerate adoption within an institution, physician education creates robust prescribing networks that continue to expand long after the initial engagement. The second case study is a territory in the Midwest that illustrates the long-term impact of that strategy. When the Kestra territory was established, the hospital had previously generated about 20 WCD prescriptions annually. Through focused engagement with the heart failure program, fellow education and ongoing clinical support, utilization more than doubled to 50 prescriptions during FY '26. Growth accelerated through a combination of physician champions and clinical education, expanding ASSURE adoption among both existing and new prescribers. A key driver was the team's investment in fellowship education. Six of the programs' eight fellows became active ASSURE prescribers during training. As those physicians entered independent practice, they carried that experience with them, prescribing ASSURE at other hospitals. Rather than expanding a single account, our team is building a growing network of experienced ASSURE prescribers that continue to drive adoption beyond the original institution. Our strategy also extends to enterprise health systems, where we're working to integrate ASSURE directly into standardized care pathways. The third case study is one of the nation's largest independent cardiovascular organizations in the Southeast that is working with our team to integrate ASSURE into standardized heart failure care pathways across its physician network. Working alongside physician leadership, advanced practice providers and clinical operations teams, we're embedding ASSURE into workflows that support patients from hospital discharge through outpatient recovery. This collaboration began shortly after presentation of the ASSURE post-approval study data at AHA last November. Since that time, prescribing within the organization has increased by approximately 40%, reflecting growing adoption supported by both clinical evidence and operational integration. Today, that organization includes approximately 120 cardiovascular providers, creating an opportunity to expand this care pathway model across multiple affiliated practices and regional markets. This represents another important driver of sustainable long-term growth as we partner to embed ASSURE into standardized clinical workflows. These examples demonstrate how clinical evidence, physician education and enterprise partnerships are working together to accelerate market adoption. Turning to clinical evidence. On prior earnings calls, we discussed the results of our ACE-PAS, the largest real-world prospective WCD study to date with over 21,000 patients enrolled and protected. The study's findings corroborated what patients experience every day with the ASSURE system, low false alarm rates, comfort that drives higher wear time compliance and 100% successful conversion of dangerous arrhythmias. I'm pleased to highlight a newly published paper focused on the future of sudden cardiac death prevention that cites the ACE-PAS study as contemporary evidence demonstrating persistent ventricular arrhythmia risk among patients with ischemic and non-ischemic cardiomyopathy. The paper was published in the journal of Heart Rhythm, which is a Heart Rhythm Society publication, specifically highlights observed ventricular arrhythmia event rates. The HRS recommendations state that clinicians should consider WCD use after myocardial infarction or a new heart failure diagnosis while guideline-directed medical therapy is being optimized and better risk stratification tools are being developed. The paper further identifies WCDs as potential strategy to reduce sudden cardiac death in patients not yet eligible for an ICD. From a strategic perspective, this is a meaningful endorsement. The paper was developed through an HRS-led think tank that included many of the field's leading experts. The inclusion of ACE-PAS demonstrates that our data is being incorporated into the broader scientific dialogue around risk stratification, sudden death prevention and the role of temporary protection for high-risk patients, areas that may ultimately influence guideline development. Regarding our clinical evidence strategy, we plan to publish multiple abstracts and manuscripts over the next 12 months, highlighting compelling data from ACE-PAS, our new enhanced algorithm and new innovation in our pipeline. We believe this growing body of evidence will support increased share capture and expanded WCD adoption. On the product development front, we continue to pursue innovation that benefits patients and clinicians. In mid-January, we announced a strategic collaboration with Biobeat Technologies to expand diagnostic insight for hypertensive patients prescribed the ASSURE WCD. That co-development project is progressing as planned. In April, we released an enhanced ASSURE detection algorithm, which we project will further reduce our already low false alarm rate. This new algorithm is now shipping to all patients. Our team has some other exciting projects in progress intended to further extend our clinical advantage with the performance of the ASSURE system and also bring new first-in-category capabilities to the market. Over time, we believe this will help us accelerate market growth and win additional market share by further differentiating our product from the incumbent. And more importantly, by providing additional clinical value and diagnostic insights to physicians, we believe it will result in them prescribing WCDs to more of their patients that heretofore had gone unprotected. In conclusion, the fundamentals of the Kestra story and business remains strong. The clinical evidence of the ASSURE system is compelling. We like our competitive product position in an expanding WCD market. Kestra is delivering premium revenue growth while significantly expanding gross margin, and we have fortified our balance sheet to facilitate investment in that growth. Our execution has been crisp across all elements of the business and the foundation we have built positions Kestra for strong and durable growth for years to come. I'd like to thank our incredible team in the field and also here at the home office in Kirkland for their passion and commitment to the Kestra mission. Now I'll turn it over to Vaseem, who will discuss fourth quarter financial results in more detail and provide our fiscal year 2027 revenue guidance. Vaseem?

Thank you, Brian, and good afternoon, everyone. We had a strong financial performance across the board in the fourth quarter. Total revenue was $28.6 million, an increase of 66% compared to the prior year period. Revenue growth was driven by a 63% year-over-year increase in prescriptions, reflecting market share gains with existing customers, activation of new accounts and expansion of our field team. We are also continuing to see improvements in all three key drivers of our revenue model, our prescription fill rate, our bill rate and our collections performance. As we continue to bring more payers in network and enhance our revenue cycle management capabilities, we expect to see benefits in revenue growth, gross margin and our profitability profile. We are investing in revenue cycle AI tools and other automation projects that will drive operating leverage as we scale the business. Turning to gross margin. Our margins increased to 54.8% in the fourth quarter versus 44.3% in the prior year period. As Brian mentioned, we have now expanded our gross margin sequentially 10 quarters in a row. This continued expansion in gross margin was driven by the attractive unit economics inherent in Kestra's business model, an increase in our revenue per fit from more in-network patients and a decline in our cost per fit driven by volume leverage and cost improvement projects. In the quarters ahead, you should expect to see steady and consistent increases in our gross margin as our rental model benefits from the volume leverage. We remain confident in our ability to achieve 70% plus gross margins in the next few years. GAAP operating expenses were $55 million in the fourth quarter compared to $55.8 million in the prior year period. Excluding nonrecurring costs and stock-based compensation, operating expenses were $44.7 million in the fourth quarter of fiscal year 2026 compared to $29.7 million in the prior year period. The increase was primarily attributable to investments in our commercial organization, including support resources and revenue cycle management capabilities to capitalize on the large and expanding WCD market opportunity. GAAP net loss was $38.8 million in the fourth quarter compared to a GAAP net loss of $51.1 million in the prior year period. Adjusted EBITDA loss was $26.7 million in the fourth quarter compared to an adjusted EBITDA loss of $20.3 million in the prior year period. Cash, cash equivalents and investments totaled $262 million as of April 30. It is important to highlight that our operating cash burn in the fourth quarter declined on a year-over-year basis. Specifically, net cash used in operating activities was $18.7 million, a reduction from $24.1 million in the prior year period. We expect this trend to continue each year going forward. This afternoon, we also issued a press release about our new $200 million term loan facility that we have entered into with Pharmakon. This nondilutive financing was a great outcome for Kestra. It fortifies our balance sheet, reduces our cost of capital and provides a significant financial flexibility to invest in our commercial strategies and expand our fleet to drive durable, best-in-class growth for years to come. Only $75 million of the facility has been funded at closing, a large portion of which was used to retire our existing term loan. Included unused unavailability under the new term loan agreement and excluding the uncommitted M&A tranche, Kestra has a total liquidity of approximately $357 million. In summary, 2026 was a foundational year for Kestra. We delivered top-tier revenue growth, significant expansion in our gross margin and fortified our balance sheet with a follow-on offering in December and today's nondilutive financing. Our investments in the field team and RCM capabilities position Kestra to drive durable revenue growth with meaningful operating leverage for years to come. I will now to our fiscal year 2027 guidance. We expect revenue of $137 million, an increase of 44% compared to fiscal year 2026. We expect prescription growth to be driven by deeper penetration within existing accounts and the activation of new accounts as we invest in the regional coverage. We expect higher revenue per fit to be driven by a higher mix of in-network patients and continued improvements in our revenue cycle management capabilities. We expect Kestra to generate significant operating leverage over the next several years even as we continue to invest in our business to capitalize on the large, growing and underpenetrated WCD market opportunity. With that, operator, we have concluded our prepared remarks and are ready to proceed to the Q&A portion of the call.

Thank you so much. [Operator Instructions] One moment for our first question please. It comes from Marie Thibault with BTIG.

Congrats on a really strong finish to the fiscal year. Apologies in advance if there's any background noise, I'm in an airport. But I wanted to start here by asking for a little more detail, Vaseem, on sort of what the assumptions are behind the fiscal '27 guidance. Certainly, your prescription growth has been tremendous. It sounds like you're seeing a lot of nice momentum following ACE-PAS. And of course, the conversion rate has continued to move higher with all the revenue cycle management improvements. So if there's any details you can give us on how you're thinking about that $137 million, the assumptions behind it, that would be very helpful.

Sure, Marie. Thank you for the question. Our revenue growth has historically been driven by prescription and volume growth, in-network mix, revenue cycle management improvements and quite frankly, the growth of our field team. These KPIs are all tracking in the right direction and give us confidence in guiding to 44% growth in fiscal year 2027. Higher prescriptions will be driven by winning new accounts, going deeper in existing accounts and quite frankly, as Brian mentioned, expanding the market. And we expect to continue the in-network mix to be in the low mid-80s as we continue to make progress on the payer side and also the significant improvements that we'll make and have made on the revenue cycle management process. So we are starting the fiscal year with 130 sales territories, which is up 80 from the start of fiscal year 2026. So we're really confident in the guide that we are putting out, and we'll continue to give you updates as we go through the year.

Okay. That's very helpful. And I guess as a follow-up question here. Certainly encouraging to see the Heart Rhythm publication, the recognition of ACE-PAS. What are your latest thoughts on guideline recommendations, stronger support from societies, is that something we could start to see more of this fiscal year?

Yes. Thanks, Marie. This is Brian. I think it's going to be a journey. The papers like this are the start of that journey. We'll be publishing our manuscript for ACE-PAS soon. That will be the next milestone, and then we'll continue to work with our clinical advisers to get on the docket for this conversation about guidelines. I do think that what's also meaningful about that recent paper is the insight they had into not just the typical WCD patient who's a post MI patient, but also the heart failure patient population. So really good news in that and really good news in that, that was a parallel activity that a body of really high-caliber physicians took on to step back away from the evidence and look and say, "Hey, what should we be doing to improve sudden cardiac death rates. And so I think that's really positive for us.

One moment for our next question. It comes from Travis Steed with Bank of America Securities.

Congrats on a good quarter. I guess maybe I'd ask a question about just kind of the share gains that you've been getting. I think you're taking about 4 points of share in the market over the last year. Is that kind of the steady state that we should think about going forward? Or is there ways you can accelerate the share gain capture in '27 as you expand territories and build up coverage?

Yes. Thanks for the question, Travis. I think that the share gain we saw in 2026, it doesn't fully get the benefit of a lot of the hiring we did in 2026. So I would expect that we'll see even more share gain, in particular, in those territories where we were not in before adding new reps. And so as those reps come up the curve, I think we'll see that share gain start to grow. Now of course, the other good news is it's not just about share capture. It's about market growth, and we're seeing pretty exciting market growth occurring, and we'll continue to push for that as we do our market development of the WCD category.

Okay. That's helpful. And then I did want to follow up on the financing. Why raise money needed the equity offering last year? Why more money now? And then why the structure of this deal a little unique with different tranches available. And one of the tranches mentioned availability for acquisitions? Is this a sign that potentially you're going to be a little more acquisitive going forward?

Yes. So let me start, Travis, and maybe Brian can also provide some color. So we -- when we started the refinancing conversation, it was purely to go out and seek lower cost of capital. If you remember that the term loan that we had with Perceptive was three years ago when we were a private company. And quite frankly, what we were able to achieve in our cost of capital was a 24% reduction from what we were paying Perceptive. So that was the impetus for going out and looking to enter the market. But as we kind of went through that conversation, we decided that we should have and retain the financial flexibility that continues to allow us to invest in our business and gives us the optionality to do different things. So I'd say we didn't need more cash. Like I said, we finished the quarter at $262 million of cash on the balance sheet. This was just purely being opportunistic working with a great partner now and having the flexibility to do Biobeat-type tuck-in deals to do more M&A. So that's really from a structure and a deal perspective. So, Brian, I don't know if you want to comment on that.

Yes. I would just add that the M&A tranche is a prospective one. It's -- there's not something right in front of us there, but we do continue to be very interested. We're building a first-class direct to cardiology sales force, and we want to take advantage of that channel. And if there's new technologies that we can bring to the table that can be additive for our clinical partners, and we're going to be very interested in that. I think the other thing it should demonstrate is we're pretty bullish on our story. We want to make sure we've got financial flexibility to be able to invest in the assets to continue to grow the market. And with the market growth showing the way it is, we're leaning into the Kestra story in the WCD category. And this just provides us a little bit more financial flexibility as we look forward.

Our next question is from Matthew O'Brien with Piper Sandler.

Maybe to follow up a little bit on Travis and Marie's question on guidance. When I do the math on the growth rate in the market that you guys are accelerating plus your share taking, which Travis is right, it's 400 basis points last year, but if it's up to 500 this year, whatever it may be, I'm getting script numbers that are at least 10% and more like 12% to 13% higher than kind of where you're guiding roughly. So what is it that we're missing, especially with all these new reps and all this momentum that you're seeing that would put the guide into the $137 million range versus something higher? Is there something competitively, something else just in terms of adding all these reps at once, something else like that, that we should really be considering? And then I do have a follow-up.

Well, I would say very clearly that there's not a competitive dynamic to that, that's driving that. I think it's us just being a rational management team. It's the start of the year. We want to make sure that as we get the year kicked off and we do absorb a lot of these new sales reps, that we set ourselves up for success. And so I think 44% growth as an initial guide is pretty darn fantastic, and we're excited about the year ahead.

Okay. Fair enough, Brian, 44% is great. Vaseem, on the profitability side, I know you said the operating cash burn came down by about $5.5 million year-over-year, but the revenue number was up about $11 million. So -- and when I look at the SG&A per new script, it's the lowest it's the lowest -- the highest amount of SG&A per script that we've seen in several quarters. So how do we think about the profitability on the EBITDA side trending or maybe even on the operating cash burn trending throughout fiscal '27? Because from a revenue perspective, it seems like you're about a year ahead. From a profitability perspective, you seem like you're kind of on track or maybe a little bit behind. Do you think this is a year where we see a bigger catch-up as far as profitability goes?

Yes. No, that's a great question, Matt. I think fiscal year 2026 was a foundational year as we have talked about from an investment perspective, right? We hired to the 130 TM goal. We got there sooner. We invested in regional leadership with commercial support resources like clinical specialists to really help form those accounts and see the prescription trend that you saw. Our prescriptions grew 17% in the fourth quarter, 1,000 higher than the previous quarter. And quite frankly, if you even beat our own internal expectation in the fourth quarter. And we have invested in our revenue cycle management capability. And this really positions us to drive durable growth in fiscal year 2027 and beyond. Now having said that, even this level of investment of our operating cash burn declined by $5 million. So you should look at that, right? So our operating burn was down $5 million. So we'll continue to invest in 2027, but maybe not at the same pace in 2026. But really, you should start to see some good operating leverage in 2027 and 2028 as we continue to drive the top line higher based on the investments that we made in 2026.

One moment for our next question. It is from Rick Wise with Stifel.

I'll add my congratulations on the excellent finish to the year, Brian. I thought maybe you could expand on your comments a little bit about your sales territory goals. I mean, obviously, 130 to finish the year up from 80. That's a big expansion. And you've always been very clear about the metrics that you want to see related to reimbursement, et cetera. How many more ideal or optimal opportunities are there? And do we see similar expansion in numbers for the year ahead? Is that the right way to think about it?