Medtronic plc (MDT) Earnings Call Transcript & Summary

Good morning. I'm Travis Steed, the Bank of America U.S. medical device analyst and we're happy to have Geoff Martha, CEO of Medtronic here this afternoon. So thanks for joining us.

Yes. Thank you, Travis.

Good. And I'll turn it over and maybe open with a couple of opening remarks and then ask some questions. If there are any questions in the audience, feel free to raise your hand and we'll get a mic to you.

Sure. Well, first, thanks for having us and thanks for the engagement today with Medtronic. We're really -- I'm really excited to be here for -- and talking about the company because given where we are, where the industry is but also where Medtronic is right now, with -- the last couple of years have been, I'd say, challenging between COVID and then supply chain and just the state where our product pipeline was. It's coming, it's coming. But as we sit here today, a lot of that innovation is in the market. And while these supply chain issues are behind us and you're starting to see our growth accelerate and really excited to talk about the -- some of the different areas of innovation and kind of how we're seeing and just the state of the market, too.

Okay. Great. FY '24 kind of a new start. You put out guidance that kind of set the company up for success, the last 3 or 4 quarters of kind of accelerating growth in every single quarter. I think the question I get the most is why is now the time that you have the confidence that you can kind of continue to sustainable kind of mid-single-digit revenue growth going forward?

I'd say there's -- I'd say, 3 things. In the -- 1 is there's been a couple of tough years for medtech with COVID and supply chain and even China VBP. I think those are, particularly COVID and supply chain are largely behind us. And even VBP is almost -- I think we've got our arms around it. So the markets are much better. So they're back to pre-COVID, levels are better. That's one of the market specifically for Medtronic, I believe our underlying fundamentals are better in terms of our supply chain, in particular, global operations and supply chain. The resiliency, we've been working on this for a couple of years now and brought in a lot of new people, made investments in new technology and automation. And I believe our global operations and supply chain under Greg Smith is in a very good spot from a resiliency perspective and actually a cost perspective and that's more, I think, durable and stable. And then finally, the innovation I talked about. Like, while we've been talking about some big pipeline projects for years, like this, our Hugo soft tissue robot, our diabetes business, TAVR. And we've got [indiscernible], diabetes business turnaround, the Hugo's robots in the market. We're now becoming a bigger player in atrial fibrillation. This is a big market. So the -- there's various innovation that, in some cases, you're seeing the impact on Medtronic right now, like TAVR, accelerated TAVR market share gains and diabetes turnaround and others that are over the next couple of years, you're going to have a multiyear acceleration from Hugo soft tissue robot and our Cardiac Ablation Solutions business is where AFib and PFA. These are the 3 reasons.

Okay. Makes sense. And when we think about pricing, pricing historically has been negative, couple of hundred basis points for you guys and more recently, it's been flattish. What do you think the potential is for that to stabilize going forward kind of post an inflationary environment because that's an automatic tailwind on your growth as well?

Right. I do think the pricing increases go beyond an inflationary bump. Because if you think about it, we've been holding, as you pointed out, flat pricing now for 2 years. Beyond inflation, we've also had to offset VBP within there. So China VBP has been much bigger impact than even inflation from a pricing perspective. As well as like this year, the other countries like Japan having [ ozone ] cuts and these are things we're offsetting. Normally, in years where we had like a China VBP or [ ozone ], that 200-basis point price decline in total, that was more. And so we're more than -- so it just shows like the pricing muscle that we've built. I think there's -- it will be durable and I'm not committing to this yet but I'd like to see even some upside there. So I do think it's going to extend beyond inflation.

Great. And then when you think about the supply chain, you touched on this a little bit. You've got 2 things, the things that you've kind of fixed already, some of the things that needed to be turned around to get back to the level playing field. And then you've got the opportunity going forward. So maybe to start with and talk about bringing in Greg Smith and some of the opportunity, the things that he had done over the last year to really give you confidence that supply chain is kind of fixed at this point.

Yes. It's been since April of 2021. So it's been over 2 years since he came in. He spent -- he's out -- from outside the industry, so he spent a couple of months learning the company and the industry and the dynamics. He visited a lot of customers. And then he spent some time building a new team. I mean, we brought in, probably 90% of the people below him are from outside the industry, let alone outside the company from various different industries known for supply chain and operations excellence. And we've invested in new tools, software tools, supply planning, demand planning, automation in our factories. These are a number of things he's done and then started to consolidate our supply base. We've had way too many suppliers. So first, it's putting a strategy in place. Two, getting the new team. And then three, starting to implement the strategies underneath this new team. Supplier consolidation is probably the biggest one that's helping us with resiliency and cost. We had too many suppliers. Even though Medtronic is a big company, we're small when you spread it out over -- or small to these suppliers when you spread it out. So like take -- I used this example in a couple of meetings here is, think metals. We were buying metals, various types of metals from 150 companies. And now we're going through a process of bringing that down to 10 or 12 companies. And moving that down into those 10 or 12, we can get contracts with prioritization for us. We get better pricing. We've got significant savings coming out of that exercise. And that's just 1 anecdote. We're taking that across all areas of spend. So that's helping us with both resiliency and price. So these are some of the things that we're doing under the supply chain.

How much opportunity is there in the gross margin line, gross margins kind of like more mid-60s. I think you're hoping to get back to upper 60s. When you think about the metal as an example, is that going to be how you get to kind of the higher gross margin levels?

I think it's going to be a combination of things. One is maintaining that mid-single-digit revenue growth because having a certain amount of revenue growth helps with the margin. But the bigger piece is the pricing, which we talked about, the cost of goods sold and that is our $10 billion line item on our P&L. And we're now just getting -- we haven't quantified it exactly but I'll give you directionally, is 2x to 3x the cost of goods sold productivity each year, every year than we used to get prior to kind of during, even during COVID and prior to COVID. In the short term, some of that is being masked by the inflation sitting on our balance sheet, right? We make the products at a higher wage -- higher wages, higher cost of materials still because inflation is still sticky. As that comes off our balance sheet when we sell those products and inflation continues to kind of moderate, I don't know if it's going to come all the way back down for a while but it's moderating. As that happens, you'll start to see these cost programs show up in the gross margin line. We've got to stabilize the gross margin first by getting all this inflation off our books in FX and these cost programs will start to show in our -- so that's a big piece. And then the other piece, pricing, COGS and other piece would be G&A. We had a fairly significant reduction in G&A last year. And as we move forward, we're going to be growing that G&A significantly lower than revenue. So all those things together are giving us the gross margin.

There's a couple of things you can do and let that pass through the earnings growth and margin expansion, you're going to reinvest and probably able to do some of both. When you think about reinvestment though, getting your investments more focused and thinking about how you're prioritizing some of the investments to drive the top line growth.

Yes. So what we've done -- it's a good point. Over the last 3 years, we've been moving our R&D as a percentage of sales, up from in that 6% range up to 8%-ish and I think we need to be in that 8% to 9%, somewhere in that percentage range. So getting them out of R&D [indiscernible]. And then to your point, we are focusing it much more. The capital allocation is done by a subset of the leadership team. We meet a couple of times a month on this. As we are digging, so the team, it's myself, it's our CFO, Karen, it's our Head of Strategy, your former colleague, Bob and it's the people that run our different businesses. And those are the biggest group there. And we are all allocating at the Medtronic level versus if you're just in the neuroscience, you're only talking about neuroscience, you have a vote on the whole thing. And we're focusing on the highest growth, what we call secular growth markets that we have confidence in not only the growth but the size of the market, AFib, diabetes, surgical robotics, structural heart, areas like this and it's how we're doing it. And you're starting to see the output of that. Take diabetes and we've increased our level of R&D in there like double. And we've also worked with Blackstone. We got some third-party money and now we're doing acquisitions. In the old world, it would have been, hey, wait, that's enough for diabetes. What about me over here in this other business? Now, we're focusing on same thing with AFib. We did multiple acquisitions over the past couple of years plus a healthy organic investment in R&D. In the past, it's like , "Hey, you did that 1 acquisition, now it's somebody else's turn." There's no turns. It's where the growth is. And that's how we're doing and where we feel we're well positioned, where we have a right to win here, not a right to win but the capabilities to win, positioning to win. So those are the -- that's how we're doing it. And those are the big areas. The one I didn't talk about was neurovascular, the structural heart, neurovascular, soft tissue robotics, AFib and diabetes.

And what about for M&A, like, how are you thinking about the M&A environment overall, your appetite for M&A and the size of M&A that you're willing to do at this point?

The environment, I don't see it being particularly worse or better than historic. I mean, it might -- we might be entering a phase here where with the interest rates being high, that some of these pure-play companies that we focus on, smaller might be more affordable. But where we're focused is on tuck-ins. So we're focused on tuck-ins, which we define from a dollar size, mid-single-digit billions and below. If you look at the last 3 meaningful deals we've done over the last 2 years, they've all been, whether it be diabetes, patch maker, we just announced, the Affera PFA deal we closed and the Intersect ENT deal, all were about $1 billion each. So somewhere in that $1 billion, $2 billion. Those are the -- could go slightly higher, those are the -- that's the type of size. We're focused on businesses that -- areas that we're in, either dead center like ENT, where it goes right into our bag, or like a near adjacency. At least you might have to build up some incremental salespeople, the less the better. It'd be better if it fits in our bag and we're looking for time to revenue to be short. Either there is already revenue or the, like Affera, we closed and like within 6 months, we started getting regulatory approvals when we launched. So that's how -- those are the priorities for M&A.

No, that's helpful. I thought we had to talk about China at this point, pretty topical. A lot of things going on between economy and anticorruption and geopolitical. So maybe just kind of overview, kind of the puts and takes on China. It sounds like China is still growing for you guys despite some of the anticorruption stuff going on, so.

Yes. Last quarter, we grew 4%. I mean that's down quite a bit from pre-COVID where it was growing like 12%, 15% [indiscernible]. We used to call it an independent growth vector for the company. It was highly profitable, like one of the top. I want to just talk about where it was, where it is now and where we think it's going. Where it was, it's a good memory. It was the highest -- it was like one of the highest profit regions in the world for us and it was growing strong double digits consistently, independent growth vectors, 8% of our revenue, growing really strong. Then you had COVID, you had VBP. And that -- those 2 things, I'll get to the other point you brought up, those 2 things -- COVID is behind us now, procedures are back but pricing is -- our business has been repriced by the -- it's been our fiscal '21 -- sorry, '22, '23 and into what we're now our fiscal '24. Those, call it 2.5, 3 years of our fiscal years. Over that 3 years, about 80-some percent -- 80% of our portfolio has been repriced through VBP. By the end of this year, we think the balance of that 80% will be done and this will be behind us. And now we have a smaller business and it will start -- it will get better, the procedures are still strong. And it will get back to that high single digit, double-digit growth, we believe. And we're starting to see, it was minus 6% for us last year, minus 6%. This last quarter, it was 4%. And we believe as the VBP anniversaries and the procedures continue to be strong, it will get back. The one thing to that high single or low double digit, somewhere in that area of growth. The one thing that's come up that I get questions on, okay, what about in the short term, what about this anticorruption and in the long term, what about geopolitics. In the short term, the anticorruption, we have not seen an impact. Like I said, we -- as we said on our Q2 call, procedures have been strong. The growth is picking up. We have 3 hypotheses why the anticorruption has not impacted us. One is that it seems to be more tied to capital equipment. Two was VBP. I mean, VBP, the volume-based pricing has made the pricing fixed, contracted and very transparent. So I think that has a impact. And the third that I've heard is, so far, a lot of the corruption is, the officials that have gotten impacted by corruption has been in smaller hospitals. The question we have is -- so that -- we haven't seen anything as we're sitting here. We haven't seen the impact. Are we insulated from this on a perpetual basis or is this something that will affect us down the road, we'll see. But right now, procedures are strong. And on the ultimate geopolitics, look, clearly, the U.S. government and the U.S.-China relations are -- I don't know that they're at a low point but they're lower than the past. I think we've, I'd like to think we're passing a low point but I don't know. And clearly, there's certain technologies where there's going to be a kind of derisking, like high-end, latest technology semiconductors and the equipment that makes those semiconductors. But they're also looking for, both governments have told me directly at the various highest levels that they're looking for places to cooperate. And health care is one of those places. I don't think the U.S. government is too worried about our technology. We may be but the U.S. government is open to letting us cooperate with China. And China is very active in trying to draw on foreign direct investment and match it with their own investment. So I'm optimistic that health care will be a place that we can -- the 2 countries can collaborate on, work together on, at least not separate on. So we'll see but that's what I'm being told and that's how we're thinking about it.

Okay. That's a great overview of China. Let's skip to the AFib market. You've got Affera. So maybe talk about how Affera in Europe is launching -- to get launched over the summer. And then in the U.S. as the pulse field ablation market gets those approvals, how you think about cryo as a risk factor and also PFA, your 2 devices in the U.S. as an opportunity?

So we think -- look, we look at AFib as one of the secular growth markets where, as the population ages, AFib going to become more and more of a health need, public health need. And we believe the medical device solution for that ablation is becoming better and better and better, especially with PFA. And it is going to become more of a first-line therapy over the current standard of care, which is medical management. So that's the macro. What we like about PFA is, not only is it safe and it's effective but it's easier. It's faster for physicians. And so that seems to be a good trifecta. And it's safe and it's effective for patients and for physicians, it's something that isn't too complicated and doesn't take too much of their time. So that's why we think this pulse field ablation is going to be, there's going to be a transition from other ablation technologies to pulse field over time. And we're very well positioned and we can get into that, the 2 products in a second. But we get questions on cryoablation because that's one area that RF and cryo this will be a headwind for that. We're the leader in cryo. What we're -- we don't -- this will be a headwind for cryo growth but we don't see cryo going away. Matter of fact, in the new -- the Boston data that just came out, what's that called?

Advent.

Advent data. I don't want to memorize too much about that. But that, the data that came out, the cryo showed really well. The efficacy was very good and the safety was very good, better than the other arm of that study. And I think we're going to continue to make cryo available for these physicians. And they're -- the physicians that are using it, we believe and they're telling us they're going to continue to use it. So we don't see it going away. And any headwind will be more than offset by our growth in PFA. There's 2 segments in PFA, the smaller segment but faster growing in anatomical. And then there's the bigger segment, not growing quite as fast but still growing quite a bit in the point-to-point. And we have PFA catheters across both the -- our organic program is -- which we believe will be either first to market or tied for first in the U.S. Our PulseSelect product, which is organic, is in that fast-growing anatomical segment. And then Affera, which we purchased and just launched in Europe, where in a limited market release gets to the other point to point. And that also comes with a very updated, an updated and easy-to-use mapping and navigation system, which we think this will give us the ammunition to take share from Biosense Webster, J&J's franchise, which has been a very strong franchise. We think between the mapping and the PFA, this is going to give us the opportunity to take some share and grow the market. So we're really excited and you asked about Europe and how is the Affera launch going. It's a limited market release and it's -- the demand is super high. I get -- I've asked my team to just forward me the e-mails and texts from physicians and every day, I get a couple. And they're all very effusive in their praise about the ease and the effectiveness. This is a company we bought from an Israeli startup. And so Israeli startups have great innovation but we've got to tune this for scaled manufacturing. And that's what we're doing right now. And -- but the demand is off the charts. And we feel over the next couple of years, this is going to be such a big growth driver, you'll feel at the Medtronic level.

No, that's a great overview. And skipping to diabetes. It's kind of been the tale of 2 coins, where you've got the OUS international business growing double digits, where you've had the products in the market. U.S., different competitive environment but due to -- you had the warning letter that -- which has now been lifted. So the U.S. business has been declining. When should we expect the U.S. business to really start turning to positive growth and kind of the sustainability of the pipeline and diabetes and keeping this business kind of accretive to Medtronic corporate average?

Yes. So first of all, when I stepped into my prior job of running the neuroscience business, I had a real focus on turning our spine business around and we've done that. And when I stepped in the CEO of Medtronic, 1 thing that I really was focused on is diabetes, among other things. But getting this diabetes business back to being competitive and driving innovation like we've done was a big one and we had fallen behind. But I feel like now with the -- in the automated insulin delivery segment and the smart dosing segment, so you got patches, pumps paired with sensors and algorithms and they get pen paired with the sensor and algorithm. This is our strength. And this is what's driving the tail to -- coins here, as you said, 2 sides of the coin. This is, this 780G system with our latest algorithm, it's available and our new sensor is available outside of the U.S and it's driving a ton of growth and share gains. I think we've been growing in the high teens. And we're seeing a much higher -- significantly higher attachment rate of our sensor. So the way the revenue model works, is we sell the pump. But we -- the real revenue impact for the company comes in with the consumables, the sensors, the infusion sets. And that's why you see our OUS business growing so well because we've had time to get the base of pumps in there. And now that's throwing off all this revenue. In the U.S., now that we've got the warning letter lifted and we're launching this technology in the U.S., you've seen -- I think we, in our last call, we talked about a 30% growth in pumps overall. And you're seeing -- but still the U.S. is shrinking from a revenue perspective. That's because -- that will turn around, that's because we're now seeding the market with these systems, the razors. And now we'll be -- once we are able to start selling razor blades, the infusion sets and the sensors, you'll see the revenue grow. So in the next couple of quarters, you'll see the U.S. start to flip to growth. And we expect -- our diabetes business went from shrinking to flat to growing 3% for a couple of quarters. Now last quarter, 6%. And all of this is based on the OUS business with nothing in the U.S. to grow. And now we have something in the U.S. to grow. So we think this will get back over the next couple of quarters to a double-digit growth. And you asked about the sustainability. Our algorithm, we keep improving. We're giving 90% time and range for patients out there. And we're -- because we're checking on insulin levels every 5 minutes and adjusting and micro dosing, this algorithm will continue to get better. And then we've got our pipeline of sensors and new form factors, new pump, patch, both inorganic that we announced and organic coming. So we feel it's very sustainable. This double-digit growth market of type 1s. Unfortunately, these GLP-1s, they may help in the type 2. But look, every market check we've done with all of endocrinologists, unfortunately, for patients, type 1 is continuing to grow. And AID, automated insulin delivery is still very underpenetrated for insulin intensive type 2s and type 1s and still only 1 in 5 patients have this. And with the improvement in the technology that's driving this 90% time and range, you're going to see that penetration go up and it's certainly one of the different -- I hope it's not too much but -- talking about this topic.

No, no, that's helpful. Yes. No, exactly. And the 30% pump growth that you had in the last quarter, you actually -- you have 2 buckets. You've got new patients coming in, maybe former Medtronic customers and you've got upgrades from your existing customers. Is there -- are you seeing signs of new patients coming back either due to Medtronic or old Medtronic patients coming in and [indiscernible] 780G? I think that's the proof point that this is sustainable.

Yes, we're seeing a lot of patients upgrade that are in our existing base, okay? So that would be, I guess, to be unbiased, that's the lower-hanging fruit. But we are seeing patients that are new to -- are going from MDI to pumps, coming to us versus competition. And we are seeing patients switch from the competition, for sure.

And on the CGM side, I think that's the next product approval in Europe for Simplera. When should we expect that?

Any day, especially the stand-alone. And then to get that on the system, we have to do some clinical work in Europe, I believe that, clinical, if it's completed. And then in the U.S., we are done with the adult portion of that clinical work and we started enrollment for the peds, the children and then we'll submit that to the FDA. So that, that, we believe that sensor is very competitive.

Okay. And then Hugo, you've got progress in international markets. Maybe talk about where you're placing this in the international and then kind of the pathway? And I know you can't give really timing for U.S. but maybe some of the back and forth and how the trial is designed and where you're at there.

So Hugo, we got -- or we started in non-CE marked countries that are pretty small but then we got CE marked and that's when things started really becoming real for us. And we've gotten great feedback on the function of the robot. We're seeing the robot to start out with urology and gynecology, now has gone to more complicated general surgery. And now it's tackling 85% plus of the type of procedures that are currently done robotically. So they're showing that it's got the capabilities and we're getting great feedback from surgeons that it's very competitive with the competition. And now our inflection points are 2, that really see this growth, be felt at the Medtronic level. And those 2 inflection points are, #1, getting our market-leading instruments transition from just exclusively laparoscopic uses today to laparoscopic and robotics. So think of our stapling and energy where we lead, getting those on the robot. And the second inflection point and these aren't in any order, is the U.S. approval. And because today, robotic surgery is globally 4% of all procedures. But in the U.S., it's closer to 20%. So the U.S. is leading in terms of robotic procedures. So getting on the market in the U.S. is where you'll see the -- that and then having these -- more instruments. In the U.S. trial, it's interesting, the FDA raised the bar on robotic approvals. They're using this, I don't know if that it's new but it's seldom used. So it's kind of new for us, de novo 510(k) approval process. And they're having us do -- they put a cap on the number of patients we need to do. I think it's 100 -- what is that, Ryan, 120 or something like that, 112. So it's -- that's the cap. But they ask us to do a certain amount of procedures -- certain type of procedures, a certain mix, a certain number and then show the clinical results. So we get that, we paused. We've shown the results. And then it's kind of dynamic. Do you go forward? And if you go forward, how, what mix and number? And so, so far, it's been going well. But because of that dynamic where it's not completely like, we don't have the exact timing but things are going well. And I think the FDA would like to see another technology on the market here. And obviously, there's a huge pull for it from customers. You asked also where we're selling these today in Europe. And this is a little different. I think a lot of investors are asking me the question. It's a leading question they ask, "Are you going where the competition is not?" Are you going where Intuitive is not, like countries where they don't have a big footprint. And where we're getting the biggest pool is from the large robotic centers today in Europe and they already have 1 da vinci or 2 or 3 or whatever but they want our platform as well. That's where the biggest pool is coming in. That's where we want to be because that's where a lot of the cases are and the more experienced robotic surgeons today. And so we're getting feedback from the highest bar, if you will.

And it's probably indicative of the U.S. rollout that you think -- like I don't know if you've had conversations with customers in the U.S but kind of the confidence that you can compete with Intuitive in the U.S., it's kind of a different market.

Yes. No, we -- it's a very similar confidence level. I know these surgeons have seen it at these different society meetings, right? So we demo, we're allowed to demo the system at different society meetings. And I think there they're surprised -- they're pleasantly surprised in a positive way, just for the avoidance of doubt. I think people had seen so many robotic companies try and fail in the past to get to a certain level where they -- where surgeons are looking for an alternative today but they're not going to dip and take a step back in functionality and capabilities. And I think our system is competitive and that's the feedback we're getting. And look, Intuitive, they got a great product. They've done a great job building out this market. But there is, I think, not just room but a real demand for an alternative. And we -- our robot has very unique features. It's different. It's got the open console, which has a lot of benefits in terms of training and in terms of physician engagement with the OR and ergonomics. It's got the modularity where you can wheel in all 4 arms, 1 arm, 2 arms, 3 arms. It's compatible. It's going to be over time backwards compatible. It's compatible with our current generator, so that generator can be used in laparoscopic surgery and then using robotic surgery. So there's efficiencies for the health system. So there's a lot of unique benefits to it even though we are going up against a really well-established and respected competitor.

That's great. I was -- I guess we can move to ask about GLP-1s. I wasn't going to ask but you brought it up earlier. So...

Yes. Absolutely. Yes. Look, first of all, it's an exciting class of drugs for patients that have real benefits. And I think a lot of those benefits are just being -- starting to be understood beyond weight loss. So the questions we get around diabetes and bariatric surgery in particular. And on diabetes, what we keep hearing from endocrinologists and others that are familiar with this space and understand GLP-1s is that this will not impact our business. We're mainly type 1s. And unfortunately, these drugs won't -- aren't a cure for type 1 and type 1 is still growing. These autoimmune causes of type 1 are unfortunately growing and this will not affect our business. And I know there was an England Journal article that came out a couple of days ago that caused me to circle back with my team and a number of endocrinologists, they held firm. They had a number of, I think, context around that article that I think wasn't clear. And I've been here at your conference pretty focused on investor conversations. But I understand there was a call yesterday where he actually said, the author of the study said that he doesn't think this will be, you probably know better than me, it's not going to impact pump sales that would...

Yes. Basically. It's like, yes, 1 small impact for consoles, if any at all.

Yes. So we don't expect it. And that's not based on my optimism, that's based on conversations with physicians.

Yes. I think you said about 1% at most or something like that.

Yes. [indiscernible] There won't be.

Right. And then I guess, a lot of interest in AI. And you guys -- initially, if you kind of think about AI it's not going to matter to health care. But I think the way you put it makes a lot of sense, it's like, AI is not going to replace doctors. The doctors who use AI will replace doctors who don't. And so I think it's another area that you've invested in and putting money behind. So maybe just tell everybody what you're doing in AI and kind of some of the early evidence that you're seeing of how this can help your business and health care?

So a couple of years ago, I think, 3 years ago, even right before I became CEO, I was in the President role, I was given control of the budgeting process for the company. And we held back some R&D just for AI. And then we have like a Shark Tank kind of competition around a couple of businesses. And we funded some AI projects and these are now FDA-approved products, in spine, in several -- couple of our cardiac businesses, in our Endoscopy business, our GI business, for colonoscopies. And we've learned a lot and we're seeing a tremendous impact. I think this -- the intersection of AI with biomedical engineering is pretty powerful. So for example, take the GI one is easy, the coloscopy one is easy to understand and it's easy to explain where we've -- basically, what we learned is physicians and the analysis we've done of after a full day of doing colonoscopy is, they start to miss polyps. And our AI is basically, just imagine like a green box on the screen, surrounding everything that's a potential polyp. We're finding that the AI is picking up 50% more polyps than physicians, they're missing a lot. And we have clinical data to back this up. And the polyps, as you know, are very correlated to cancer. And once you're in there doing the colonoscopy, it's easy to pull them out. And so this is a win-win for everybody. Health care systems actually make more money pulling out more polyps. And clearly, it's good for patients. And we're able to sell that as a service on top of the equipment and we're getting annual fees, a subscription model and it's better for -- so this is the kind of power. Now it takes -- you have to have the data, you have to label that data and that takes a lot of work and investment to take all the video from these colonoscopies and manually hire folks that -- our own people or other docs to go in there and identify the polyps and build the algorithm. Once you get the algorithm built, it builds on itself. But then the FDA asked us to -- we have to walk through all this logic with the FDA, then you have to train it, you have to compare it to real-world data. So there's a lot of work and expertise in this. So it's not like a tech company can just fly in and do this. We're building the data science capabilities. We will be partnering with -- we are partnering with some tech companies like NVIDIA. We've announced that partnership to accelerate this. But that's kind of what's happening and it's good for patients and it's definitely good, it's good for the health care system and we're getting a premium for this. I can go into the other examples like spines. As you know, the spine market is shifting from kind of implants and [ rep ] relationships to a technology business, so robotics, interoperative imaging, navigation. But on top of all the powered tools and it's all being integrated. But on top of all this, we built a surgical planning software that's AI-driven, that factors in, it personalizes the spine surgical plan for patient based on gender, height, weight, bone density, all the clinical literature that goes into this particular , whether it be a complex case for scoliosis or a 2-level fusion. What's the literature say you should do given this diagnosis and it builds that plan. And then it helps basically, gives a driver-assist technology to the surgeon during the procedure. And so you're going to take spine, which I think is more of an art form historically to a science, backed by data. So it's super exciting, what's happening. And so now we're looking -- we hired a Chief Technology Officer and one of the big assignments and the reason for doing that is to drive an AI platform across the company for us. I do think this is a technology that scales across virtually everything we do.

And a pretty good protective moat around your AI capabilities because of the data that you've got to build yourself.

Yes. I would say the data is the cap on innovation today. I mean the more data you have, the more innovative you can be, data is the currency of innovation, if you ask me, going forward.

Okay. And then Ardian, there's not been a lot of expectations, post the data, the panel. But just kind of curious like what do you -- how are you thinking about the panel and kind of the opportunity if the FDA approves that or not?

Well, obviously, disappointed a bit in the panel. We definitely expected because we had the 1 trial, the -- not our pivotal trial, pivotal trial passed the OFF MED trial, the ON MED trial was a supplementary trial the FDA asked us to do and it was a sham-controlled trial. It's very hard to do in hypertension world. And unfortunately, 80% of the enrollment took place during COVID. It wasn't designed for that dynamic where people aren't leaving their home. And that, in our opinion, all right, that contributed to that not hitting the endpoint. However, when you pierce through the data, it's very compelling that Ardian is obviously safe, which the panel unanimously said but also effective and effective compared to the standard of care. When you pierce through the data, there's a 10x medical burden difference between the patients in our ON MED study that had Ardian and patients that didn't. And that 10x burden, I don't know is fully understood. And I think the FDA is -- despite the panel, the panel even though, some of the ones that, the vote was tied on the risk benefit, we won 13 to 0 on the safety. We had a majority on the efficacy. And then the risk efficacy versus risk benefit vote was where it was split even and then the Chairman split the tie negative. So it was very close. But even on the ones that said no, they said no, but or no, yes, if. No, but yes, if. And so I think the FDA has latitude to prove it if they want. I do think, I really do -- I've been working closely with the FDA since becoming CEO. I've got a view and I really do believe they want to do what's right for patients but they're not going to -- they want innovation in the market but they're not going to sacrifice safety or efficacy but they do want to see innovation in the market. This is a breakthrough device. They have a lot of data. They're investing the time to really look at it. I think they're going to make an informed decision. We are, we believe that this should be approved and -- but I don't want to get ahead of the FDA and handicap that. But I do think they're going to make an informed decision and look at this in a very deep way, maybe deeper than the panel even had a chance to do.

Great. No, I think we're out of time but helpful conversation. Thanks, Geoff.

Yes. Thank you, Travis.