Quest Diagnostics Incorporated (DGX) Earnings Call Transcript & Summary

Ladies and gentlemen, please welcome, Vice President, Investor Relations, Shawn Bevec.

Good morning, everyone, and welcome to Quest Diagnostics' 2023 Investor Day. Before we get into the agenda, I just want to run through the safe harbor. I'm not going to read through it. You guys can let it wash over you. So just a brief bit about our agenda today. Our President and CEO, Jim Davis, is going to kick us off and talk about why Quest is going to drive sustainable growth in a post-pandemic world. Then Mark Gardner will come up next, and he's going to talk about the investments we're making and the things we're doing around molecular genomics and oncology. Then Cathy Doherty will join us. She's going to talk about our Invigorate initiatives and how we're going to continue to drive 3% savings productivity. And then finally, Sam Samad, our CFO, is going to step on stage and deliver the financial outlook and the long-term outlook. And then we'll have plenty of time at the end of the session for Q&A. Now I'm sure most of you saw the press release this morning. We did update our corporate purpose: working together to create a healthier world, one life at a time. So before I invite Jim up on stage, we want to show you a brief video. [Presentation]

All right. Good morning, everyone. So we mentioned those 50,000 employees, and I know I sound like a broken record, but 40,000 of those employees never worked from home for the last 3 years. These are people working 7 days a week. Now I'd like to thank the other 10,000 people, and I'm one of those who worked pretty damn hard as well during the last 3 years. But I think it's a real tribute to what this team has done and what they're going to continue to do. So thanks for joining us. By the way, if you hear some bag pipers, there's a group of bag pipers here that will be doing the opening bell. We tried to get them to come up here afterwards, but I guess they had some other things to do. So here's what you're going to hear today. Number one, we're poised to grow based on our exceptional capabilities and relationships. We're going to talk about our relationships with payers. We've got 90% access. It's never been stronger. And now it's up to us to capitalize on that access and turn more of it into share for Quest Diagnostics. We've got the right strategy to accelerate growth. This company has gone from no growth to low single-digit growth to mid-single-digit growth. And we're committed to maintaining that single-digit growth, that mid-single-digit growth for the next 3 to 5 years, at least. Investments in advanced diagnostics, you're going to hear from Mark Gardner in CIT. That is going to help propel that growth. And Invigorate, we'll continue to drive operational productivity. We've set a 3% annual productivity target. We're going to continue to hit and achieve that target, while also improving our customer experience. So we do both. It's not just taking cost out of the business and becoming more efficient. It's also about improving the customer experience, broadly the customer experience day in and day out. Sam is going to take us through the long-term outlook, 2023 to 2026. But as we reaffirm this morning, mid-single-digit revenue growth and high single-digit adjusted EPS growth. So I think as you heard up there, it is a slightly new version of a purpose. We had a goal before called trying to create a healthier world or promote a healthier world. And what you heard here this morning, working together, right? Everything we do is collaborating with other people. Every time we run a test, we give that test to at least 3 people, a patient, a physician, a payer. Sometimes those results go to the CDC. Sometimes they go to state health agencies. So it's all about working together to try to create that healthier world, one life at a time. And we take that one life at a time very seriously, right? Every vial of blood, every tube, every container of urine, every single tissue that comes into this business represents a human life, and somebody is looking for some type of answer in that vial, and that's what we do. Our strategy, we help people make the best decisions. Who are these people? If you look down at the bottom of the page, who do we serve? We serve patients. Patients, we serve consumers. Consumer is a little bit different from patients, right? Patients come to us with a doctor's order. A consumer can come to us directly. And it's an important segment in health care that we're going to continue to serve. We serve physicians, hospitals, life sciences companies. We still do a lot of work with pharma, CRO and IVD companies. Employers are a big customer of Quest Diagnostics. We do drug testing for employers. We run wellness events for employers. Insurers, risk assessments for large insurance, life insurance companies like Northwestern Mutual. Retailers, right? You've all heard what retailers are doing in the marketplace. We're going to be there with retailers as they continue to grow. They're big national organizations, they want big national labs to work with them. Public health agencies and communities. Those are the people that make the best decisions to improve health by providing high-quality and affordable diagnostic testing insights. I'd also use the word transparent pricing to our customers. If you come to Quest Diagnostics, we're going to tell you what those lab costs are going to -- what it's going to cost you out of pocket. And I'm not sure many other laboratories can do that today, but we're going to pre-adjudicate that claim and tell you what you're going to pay out of pocket so that you know, and there's no surprises coming your way. High-quality, affordable diagnostic testing insights and services using our scale and extensive reach. Collaborating with payers, providers, partners to leverage our broad access. I mentioned the 90% access. We're going to talk about that later. Again, we're going to turn that access into more share for Quest Diagnostics. We offer the most extensive tests' menu in services. We have over 5,700 tests that we offer to clinicians. The menu is going to continue to expand. We brought Mark Gardner in to help us in the area of molecular genomics and oncology. And we leverage our data assets and services to improve population health. That's why we send our data, we provide our data to pharmaceutical companies, to the CDC and other state health agencies, is to help them see what is going on with broad populations of people. And we continuously improve our quality and efficiency. We have a motto at Quest. We're going to be better today than we were yesterday, and we're going to be better tomorrow than we were today. That's what we do every day. We pick up pennies and nickels along the way and turn those into real dollars that we use to reinvest in the business. But we do it by embracing artificial intelligence, automation and other innovative technologies. We are using lots of artificial intelligence today. Cathy is going to talk about it. It's pervasive across microbiology, urinalysis, hematology and many other parts of Quest Diagnostics. I've mentioned who we serve. Our culture is built on customer first. I know that sounds like a slang term, but we take that very seriously. When a patient appears to us in a Quest patient service center or at a physician office, they are first and foremost. We treat them with respect. We treat them with care. And we collaborate with physicians, payers and all the organizations that I talked about. Again, it's a culture of continuous improvement and also curiosity, right? We are always looking for innovative solutions and new technologies to bring to bear in our business every day. So a little bit about our team. I think it's the best-looking team in the industry, but I also think it's the most capable team in this industry. It's a mix of some new people plus some established people that have been in Quest Diagnostics. I'll point out 4: Dermot who leads our strategy group; Mike Prevoznik, who's been our Chief Counsel and Chief Legal Counsel; Gary Samuels; and Cathy Doherty. Collectively, they have over 100 years of experience in Quest Diagnostics. I don't mean to age them, but they've been here for many, many years and bring a lot of experience and wisdom. Sam, as you know, joined us from Illumina, extensive health care experience between Cardinal, Eli Lilly. Cathy, as I mentioned, largely replaced me running the regions and the operations of the company. Mark Delaney has been with us for over a year, seasoned sales executive. I knew him at GE Healthcare, but he had broader experiences after that. Patrick and Karthik ran 2 regions for us. Patrick now running our Services business; Karthik, a PhD, running our Clinical Solutions business. Mark Gardner, the newest member of our team grew up in the life sciences industry with Life Technologies, Invitrogen originally. Applied biosciences, Life, Thermo and ran a little company called OmniSeq, which was a spinout of Roswell Park, a really nice little cancer laboratory. Richard Adams is now running our Consumer-Initiated Testing business. Richard joined us from outside, no -- not a ton of health care experience but has a lot of consumer experience. He ran the Pandora, Pandora, the jewelry company, really transitioned that company prior to the pandemic from a complete physical presence to now what is really a 50-50 physical plus online presence. Dermot and Gabrielle. Gabrielle runs our IT organization, Cecilia leading our HR. And Mike, Gary and Kristin, I've mentioned, and Kristin is our Compliance Officer. So for those of you that may not be all that familiar with Quest Diagnostics, we serve over 50% of the U.S. hospitals and physicians. We serve about 1/3 of the U.S. adult population annually, about 50% within 3 years. I know the film just said something about 175 million acquisitions. When you add in the work that we do for employers, that would take that up to about 208 million requisitions a year, on average, 3 to 4 tests per requisition. You can do that math, and you can quickly see, over a 10-year period, we've accumulated over 60 billion patient data points. All of that powered by 13,600 phlebotomists across 7,300 access points. These are patient service centers, IOPs and physician offices. And of course, our presence in some of the retailers like Walmart, like Albertsons, like Safeway, and we think that will continue to grow. We've got over 4,000 couriers that go out every day, pick up specimens. We move them around our network with 20 turboprop airplanes; 26 regional and esoteric labs; and about 5,000 med techs, PhDs, MDs that do the pathology work in our business. So here's a look at our revenue, $8.4 billion, without COVID; $1.5 billion, with COVID, so $9.9 billion last year. About 70% of that comes from physicians' offices; about 19% comes from health systems, with $1 billion being reference and about $600 million being professional lab services. There's another 10% that comes from the following there, with the biggest chunk, about $600 million, coming from employer solutions, right, serving large employers, and our population health doing wellness events and our life insurance business. So those 3 combined are about $600 million of that $900 million. The other $300 million is spread amongst our consumer direct business: pharma services, where we still do work; companion diagnostics, providing information for clinical trials. It's our international business, and we serve ancestry.com doing much of the genotyping work that goes into the test that they provide to consumers. So let me come back to physicians. Again, about 70% of our business. About 50% of all our work comes from general practitioners, internists, family practitioners and OB/GYNs, but we serve every other type of ologists that exists in health care, from rheumatologists to cardiologist to neurologists. You name it, we serve all of these types of physicians. Most of this work, as you know, is paid for by commercial payers, Medicare and Medicaid. The health systems business is a very different business, a very different market. That $1.6 billion, again, about $1 billion comes from reference work. This is work that hospitals choose not to do because it's either capital intensive. It requires some type of expertise or they simply don't have the know-how to do it. And so that work comes to independent labs like Quest Diagnostics. And then again, professional lab services, about $600 million. This is Quest resources running hospital labs inside the 4 walls of that hospital. It is a growth business that continues to grow and propel our growth in the future. So let me talk a little bit about the health care market that we play in today. It's about an $85 billion market in total. This leaves out the consumer market, by the way, which I'll touch on later. About 64% or $55 billion of that $85 billion comes out of physician offices, the kinds of physician offices that I just talked about. The other $30 billion is really the cost of running inpatient laboratories. It's the supplies, the labor, the depreciation, the equipment and all the things that go into powering a lab within a hospital. So let me focus first on the left-hand side, the physician lab services. We said it's $55 billion, 11% of that $55 billion, I just showed you, we, in '22, generated about $5.9 billion of that. Other independent labs are about 43%. And hospitals, those inpatient labs, still pull a lot of outpatient work into those labs, namely from physicians that they own in the outreach market. We think that business is growing at about 2% to 4% per year. I think at our last update in '21, we said something on the order of 1% to 3%. Couple of things are powering it. One is in more and more molecular genomics, advanced oncology testing. And I think pricing, which had been a negative on this side, is now neutral to slightly positive. On the right-hand side, the hospital lab services business, again, $30 billion between our reference book of business and the $600 million of PLS, we've got about 5% of that $30 billion. There's other independent labs that get other reference work and also run labs within the hospitals. But as you can see, there's a huge opportunity for us to keep serving the needs of these hospital labs, whether it's more and more reference work, whether it's discrete outsourcing opportunities like pathology or microbiology. But in total, we really think this market is only growing 0% to 2%. Why is that? Because I think, as you all know, fewer and fewer patients are going into the 4 walls of hospitals. More of that care is moving outside of the hospitals into lower-cost environments that serve employers, serve insurers and serve many of us in this room very well. So before I go a little deeper on each of those markets, I want to just talk about 4 trends that are affecting and shaping this industry today. Mark is going to talk about advances in genomic and oncology testing, but the storyline with genomic testing is it's moved from single-gene to multi-gene panel to whole exome to transcriptome. And I think you're going to see in a couple of years that this whole market is going to shift to whole-genome sequencing as the cost point or price point of these tests really get down to somewhere between $100 and $200. We're going to project that whole-genome sequencing is actually going to be at a lower cost very soon than whole-exome sequencing. So why would you just not move to the whole genome? On the oncology world, we have $1 billion business in cancer in Quest Diagnostics today. We tend to play in the slower growth, common screening types of tests in pathology world. And Mark is going to talk about how we're going to position this company into the faster-growing therapy selection, therapy monitoring reoccurrence management world, which is where the growth in oncology is today. In the middle here, we've talked about the greater adoption of artificial intelligence. You see a beautiful digital picture of a pathology slide here. Mark will also talk about that. We are moving into digital pathology at a rapid pace. It's good for 2 reasons. Number one, you can move a digital slide anywhere in the world. If we have a brain expert or a glioblastoma expert that sits in San Francisco, but the slide is in New York, you can move that slide out to San Francisco in seconds. That has been pervasive in the radiology world for 20 years now, and we're quickly catching up to that. But the other wonderful thing you can do, once you digitize that slide, is you can start to apply artificial intelligence, right? And we all know what artificial intelligence and some of those tools have done in radiology and pathology is quickly catching up to where radiology is today. The third big trend here is these point-of-care devices. You've all heard of the companies, Binks, Visby, Detect. And we think that represents an opportunity for Quest Diagnostics. We're very close to piloting some of these devices in our patient service centers. And while the test that you can do on this particular device can all be done overnight in one of our laboratories. There are patients, namely consumers, that actually want to know the answer within an hour. They want to make an appointment at Quest, come in, get the test and get the answer. And so we think people will pay a premium for that, name -- the consumers, again, that will come in, make these appointments, wait around for the hour, get the test result and they're on their way. These new point-of-care devices, you're looking at one from a company called Tasso. Collections in Quest Diagnostics cost $1 billion a year. These are the cost of phlebotomy, all the supplies, and we are constantly looking for lower cost ways of getting specimens out of the human body. Tasso represents one such device that we've been experimenting with, piloting. It's not quite yet at the cost of one of our draws, but it will get there at some point. And these also obviously offer a more convenient way. Now you can't do every -- you can't do all 5,700 tests on our menu with that device today. But I can tell you, there's a lot of innovation going on in this industry that could help us reduce that $1 billion of costs. I think the last trend you're all aware of, consumers more engaged with their health care. We're monitoring everything. I'm monitoring myself here this morning as I speak. But consumers want data to fit into their ecosystem. And while we have 32 million users on our MyQuest, there's a lot of users that want our data imported into their Apple-centric data collection or Google so that they can marry up their exercise, their diet, their stress and see how that impacts their overall health, their lab results. So we will be part of those larger digital ecosystems as we continue to evolve the business. Okay. So let's go back to the strategy. What is it that we're doing in each of these core markets? On the physician lab services side, where I told you it's growing at 2% to 3%, we're committed to 4% to 5% growth on that $55 billion market. How are we going to do it? We're going to continue to partner with health plans. Again, our access is great, and now it's about partnerships to actually move more share. We're going to talk about value-based care, right? We all know that Medicare, Medicare Advantage are delegating lives into these organizations. It's a fixed price that they delegate the lives into that plays very well to the strengths of the Quest Diagnostics, and I'll tell you how that's going to propel our growth. And then I mentioned before, the retailers have all been very clear about what they're doing, Walmart, Walgreens, CVS, Rite Aid. And we're going to play with these retailers as they continue to expand their national footprint. On the hospital side, we continue to expand our reference capabilities, expand our test menu. Mark is going to talk about that. We're calling the PLS 2.0, how do we evolve our professional lab services business? The value proposition, when we got it started, was really about cost savings. But others can provide about the same cost savings that we can. And so now it's really about evolving and we'll show you how we fit into the broader hospital ecosystem, and we're working on metrics that are important to them. As you know, outreach acquisitions are an important part of this business. We acquired the outreach from health systems, but it's what propels the growth on the physician office side, right? We're acquiring their physician office book of business. That work going into a hospital lab. We acquired that book of business, it's simply redirected into Quest Diagnostics. On the consumer health side, we've stated a goal of $250 million, and we're going to tell you the 3 or 4 ways in which we -- and how we're going to get there. Advanced diagnostics is the way we grow all of these segments. When we talk about molecular genomics, when we talk about cancer, it really cuts across physicians, cuts across health systems. And a consumer genetics offering that we're going to launch here in April will cut across our consumer business as well. So let's talk about health plans. A key to growing our physician office business, obviously, is to have access to the patients that use the physicians. We've got 90% access today. There's a few states out there. There's 3 or 4 states where our access is limited. We continue to work with the plans where we have limited access in those states. And our hope is, obviously, to get that as close to 100% as we possibly can. The goal now, though, is we look at where we have a high access and where our capture tends to be low. And where most of that is, quite honestly, is in the middle section of the country. It's states like Minnesota, Wisconsin, Ohio and Indiana. And the common thread that cuts across all those states is very large health systems that own most of the physicians in those marketplaces. And so it is difficult to go into those marketplaces and get access even to the physicians. So we partner with the health plans, and we work on things like leakage programs, redirection programs. And where possible, we make outreach acquisitions in those marketplaces because that's one quick way for us to get quick access. The other thing we do in partnership with these health plans is it's really about getting into the minds of the patients and letting these patients know that when you come to Quest Diagnostics, it's going to cost you less money. But it's not just going to cost you less money, it's going to cost all of your employers less money. There's no secrets. We know health system pricing is 2 to 3x the independent labs. We know that employers are still paying for 80% of health care in this country. And so we actually go work directly with employers. And we try to convince large employers to convince their employees that if they use Quest Diagnostics, it can save large employers with 50,000 employees, it can save them $3 million to $4 million a year, which is meaningful, especially in today's higher inflation environment. And so we have revenue targets that we've set for the team that's going to propel this physician office growth. We think with that 90% access, there's another $600 million worth of growth that we can get out of that access. Again, we're going to work with the payers. We're going to make outreach acquisitions, but we think this is really achievable over the 2023 to 2026 period. We've also talked on calls about value-based contracts. And a value-based contract is simply nothing more than there's incentives in these contracts with payers that, when we move that share from high-priced health system labs to our labs, it saves them money, obviously, and it saves -- and obviously, it saves employers' money. And when we achieve these incentives, there's extra bonus payments for Quest Diagnostics. And so our goal is to get that up from 40% today to about 50% of our contracts having incentives that allow us to earn extra profits when we move that work. All right. I now want to talk about Medicare and how this is going to help our physician lab business. And we love the trend that's occurring in the marketplace. I think with Medicare patients, Medicare patients have 2 choices, right? They can stick with traditional Medicare or they can opt for a Medicare Advantage Plan. And today, it's about 50-50. And regardless of the trend, it's still going to be beneficial to Quest. So we all know what Medicare is doing. Medicare delegates lives to things called ACO REACHs. They are really large physician groups or organizations. And when Medicare delegates that life, they delegate grandma into those plans, they pay those organizations a fixed fee, right? And let's call it, $10,000 a year, but it's fixed. And they're now responsible for providing care. And if they could do it for less than $10,000, they obviously make a profit. Now generally, Medicare patients and Medicare Advantage patients, they stick with these plans for long periods of time, which is why these organizations are willing to take the risk. Medicare Advantage is doing the same thing, by the way. They delegate lives at a fixed price into these large physician groups. And why does this play well for Quest Diagnostics? Because once you delegate these lives at a fixed price, labs become much more important and much more strategic. Because at that point, it's all about prevention, it's all about wellness, and it's all about making sure that grandma does not get any sicker. Because if grandma gets sicker, it's going to cost them a lot more money. And so labs are really, really strategic. Now the other thing we noticed is remember on the previous page, I showed you that physician offices still are in the lab business, right? We call them POLs, physician office labs. They do about 11% of the work today. And what I can tell you is that when they start taking risk on these lives at a fixed price, that work quickly moves to us. Why is that? Because our prices are going to be lower than their costs, okay? Remember, these POLs were set up so that they can build third-party payers just like we do. They were generally getting higher rates. But when they start taking risk, when they get a fixed revenue line, costs become even more important, cost and quality become important. And so this represents a big opportunity for us. Last year alone, we did 30 deals with these ACO REACH programs. They're not capitated arrangement, they're client bill arrangements. And often, they're filled with other incentives that allow us to gain, again, additional sums of money when we help these organizations meet their quality and metrics goals. So what else can we do for these organizations? It's not just about our test menu. Our test menu is terrific. They love the test menu, but it's about all these other things, these other capabilities that we've accumulated within Quest Diagnostics over the years. It's things like providing data analytics and member insights to these organizations. We may know more about grandma than that organization does when they get grandma into their network. Why? Because we may have 10 years of lab data, okay? And we can provide that data, sell that data. Mobile phlebotomy services, Medicare patients, many times, they can't get to the doctor. We can go to the home and do the draws at the home. Health coaching and medication adherence. We bought a business called Pack Health. That's what Pack Health does. It provides coaching services to Medicare members to people -- we also serve the pharmaceutical industry. Convenient locations and testings. We can do things like prescription test. When that person shows up in our patient service center, these large organizations send us a signal and tell us, there's a gap in care. That patient hasn't gotten their A1C test. Please make sure that, that person gets their A1C test. So these are all the other value-enhancing things that we can do for these large ACOs or large physician groups that will ultimately help them achieve their quality metrics, which actually helps them get paid more for taking care of grandma. Okay. The last thing on our physician lab business. Again, no secrets on what these retailers on the bottom of the page are doing. Amazon as well. We didn't put that one on the page. Obviously, they completed their acquisition of One Medical. They've all stated goals. Some are doing it through acquisition. Walmart, as you probably know, doing it through pure organic growth. They already have 48 of these health hubs set up in about 3 states down South, we serve all 48 of those health hubs today. They've talked about expanding another 24 sites as they move up into the middle parts of America, and they're dead serious about playing in this space. So as these national retailers continue to grow, we're going to kind of grow with them. And our initial relationships with them were really about, let's just have a physical presence inside their stores. We had patient service centers in close to 90 Walmart stores. We have patient service centers in Safeway and Albertsons. But really, those relationships were strengthened during the pandemic. We still collect COVID specimens at over 21 CVS stores, over 1,000 Rite Aid stores, and we're going to leverage those relationships that we've built. So as they continue on their journey into primary care, there's lots of future opportunities for us to work with them. This could be putting kits on their shelves. So that as consumers come in, get the kit, do the test, send that test off to Quest Diagnostics. So we like this trend. We think it favors big national labs like Quest diagnostics. Okay. Let me turn now to the hospital lab services. It's a $30 billion market that I spoke to earlier. The first part of our business, we call it our reference business. It's going to these health systems. They all need to have laboratories. Small community hospitals don't have extensive test menus, but even the largest academic centers also have to refer test out from time to time. How do we win there? It's all about improved system health flow. When we go into these large institutions, we discover, they're probably using 30 or 40 different vendors. We try to help them consolidate it down to fewer. Very difficult for a lab manager at a hospital to start tracking specimens at 30 to 40 different laboratories that they may be sending tests out to. We're building all sorts of tools so they can track their specimens, they can look for the results. Where is the specimen inside our laboratory? If it's a microbiology specimen, we can take pictures of that digital plate and send off pictures back to the lab, so the referring physician can see it. Utilization management systems, right? We can track what physicians are ordering on what patients. We can look for that variability and help them as they try to drive standardized care across their system. Menu expansion into oncology and genetics in order to serve these health systems, especially the academic ones. We have to have a broader test menu, which Mark is going to talk about. And then I mentioned discrete outsourcing opportunities. So they may not want to turn over the whole lab to Quest. We may be getting bits and pieces across a broad range of testing, but there's a shortage today in the marketplace of microbiologists; cytologists, those that do the pap smear work; and pathologists. And so what we're doing with some of these health systems is we just take down the entire microbiology lab. We take down the entire cytology lab and move all of that work into Quest Diagnostics. PLS 2.0. I mentioned the initial value proposition of our PLS business was really around cost savings, and it was bringing our supply chain contracts. It was taking their test menu and slimming it down and moving some of those tests that were not really required to serve inpatients, moving them to our laboratories at a much lower cost structure. That business has grown nicely from about $280 million to $590 million in 2022. You can see along the bottom, Hackensack Meridian Health is a big flagship customer right here in Northern New Jersey. But over the last 1.5 years, we've added Lee Health in Florida, Northern Light Health up in Maine, Tower Health in Pennsylvania, and that will continue to propel growth. There's a large funnel of opportunities here. I think it's gaining momentum in the marketplace, the outsourcing of the inpatient lab. So what are we doing to expand? And I mentioned, it really is about helping health systems now achieve some of their operational metrics. Lab is important in the 4 walls of the hospital, right? You never ever want to delay a discharge in a hospital because they're waiting for a lab result. Even 2 hours, 4 hours, 8 hours extra bed time is really costly to a hospital. The other key metric that we help them with is patients that are coming through the ED. The walkout rate of patients coming into the ED is actually quite high. It can be 20% to 30%. So these are patients that come in, they get observed. Someone's running lab tests on them, but they get bored. They don't want to sit around for 2 to 3 hours. So really, getting those lab tests done very quickly and getting them into the physician's hands, one, you want to make sure that the patient is getting the treatment they need, but you never want to have a walkout because that's a lost revenue opportunity for the health system. We provide solutions to alleviate workflow challenges. I mentioned microbiology, cytology. These are whole departments within a laboratory that starts to shift over to Quest Diagnostics. And then really similar to our physician book of business, it's really about enhancing the population health, looking for ordering trends, looking for disease trends across the health system. Also on hospital lab services, we've talked about the acquisition of those outreach books of business. Now obviously, it's on the right-hand side, it's about -- there's always the important element of you're freeing up capital. You're putting cash into their hands that they can deploy in other probably higher-margin parts of their business, be it neurology, cardiology or whatever it is, they deem important. But it's more than just providing capital to hospitals, right? When they -- when we acquire an outreach book of business, first of all, they rarely have all of the physicians using the hospital lab. But when they center it down to 1 large company like Quest Diagnostics, we now have a much better handle on the entire population of patients that are using their physician network. And we can provide much greater insights into what's going on from a disease standpoint, and they were able to garner themselves. What we've noticed too is, in fact, physician satisfaction actually goes up. Remember, if you're a physician and you're sending your work into a hospital lab, chances are, there's a lot of work that's flowing out of that hospital lab to another lab, right? That's called the reference business. When we get that work, the turnaround times actually go up for these physicians, right? Because the work isn't flowing to multiple labs that the health system use. So physician satisfaction is up. More importantly, patient satisfaction is also up. Why? Because the out-of-pocket expenses are going to be lower when that work goes to Quest Diagnostics versus it staying inside a hospital lab. And again, it's that broad test menu that allows them to take advantage of the improved turnaround time. Here are some of the deals we've done in the last couple of years. Memorial Hermann got going right around right after the pandemic. Mercy, a large health system in the Midwest. Summa Health around -- located in Akron, close to the Akron, Ohio area. Northern Light, I mentioned up in Maine, we're also running their laboratories. And most recently, NewYork-Presbyterian right here in this city has decided to, again, outsource or we bought their physician book of business. This is a high-end academic medical center. And I can tell you, it wasn't just about the cash, okay? It was about all of these other things that were really important to the NewYork-Presbyterian system. Okay. I'm going to turn to consumer health. If you haven't been to questhealth.com, please go to questhealth.com. Try us. We think you'll like it. We would give you a coupon code to go there. So we launched the platform in the latter part of last year, October -- September, October time frame. Recall, we had a site that was up and running. It was [indiscernible]. It took 14 steps to actually get an order placed with Quest Diagnostics and get an appointment scheduled. We now have that down to really 5 simple steps. You can see it down below. We simplified the test menu. We have a more logical grouping of tests that are based on really the market research we did that said what do consumers really want. And I'll talk about that in a moment. Since that time, we've nearly doubled the conversion rate. And what is the conversion rate? If we attract 100 eyeballs to the site and looked at how many we converted with the old system versus how many we're converting with the new system, we've doubled that conversion rate. Our order volume is up, our fulfillment rates are up. Just because they order it and make an appointment to come to Quest Diagnostics doesn't always mean they're going to show up. But the fulfillment rate is actually up with the launch of the new site. And what we see is our acquisition cost is coming down, and our return on ad spend is going up. Now why is this such an important piece of our business and why is it such an important need in the marketplace? I'm just going to highlight 3 of the types of customers that come to us today. The first one we call watchful warriors. And these are people with chronic conditions. It could be diabetes. It could be HIV. It could be hepatitis. And these are people that want to know what's going on with their disease more frequently than their payer is willing to pay for. So let's take diabetes. Most payers will pay for -- a diabetic will pay for 1 A1C test a year. And so what these patients quickly discover is that why go to a doctor and spend $150 just to get a lab order that's only going to get denied. So you're down $150, and you're going to have to pay for the lab work out of your pocket anyways. So why not just come to Quest Diagnostics? You know what test you want. Order the test, come to our patient service center, and we'll get you the results the next day. That's actually a pretty big segment of our consumers today. The next one is actually the biggest segment, and we call them privacy seekers. And largely, the tests are STDs. And these are people that could be young adults. They could be -- it doesn't matter what their age is, but they don't want anyone to know what they're getting tested for. They want privacy. They don't want their doctor to know. They don't want their payer to know. They don't want their family to know, whether it's mother, father or spouse. And it is a big segment. And I can tell you, because we see the data, we give the data to the CDC. Gonorrhea and syphilis are growing leaps and bounds across this country. They're at pandemic levels. And so it's a very important group of patients and consumers, and we believe there's a real health need, and we're satisfying that need. The last group, we call them health care avoiders. And there was an article in the New York Times last week that highlighted that 55% of the men in the U.S. do not get an annual physical and know nothing about what's going on in their body. They avoid doctors. They have a fear of going to doctors. And by the way, for people of color, that number is even higher, 62% of men that are people of color do not get annual checkups. And so we're going to find ways to reach these people. They may not want to go to the doctor, but you know a venipuncture isn't that painful. And there's a lot of insight we can provide with a comprehensive health panel. So you may not want to go to the doctor, but we can at least provide you with the information on what's going on in your body. Now as we think about growing this business to $250 million, obviously, what we do first is our direct sales, our questhealth.com, we continue to expand the product portfolio and to test that we think they need. We're coming up on allergy season, and we're already seeing an uptick in allergies and people coming to us in purchasing those tests. We want to open up our distribution channels. We're willing to let other people sell these tests, other retailers for an example. And we're willing to unlock insurance revenue. And we did this during COVID, right? The payers allowed us to take in COVID orders directly from consumers and bill the payers. And why do the payers like this? Because it saves them money, right? There was no reason for a patient to go into an urgent care center, $100, $150, to get a COVID test, another $100. And what was the urgent care center doing? They were just putting the patient back into the room, handing you a swab, expecting you to swab yourself. And so now the payer is down $250 to get $100 COVID test. And so if that's true for COVID test, it's probably true for lots of other tests, where you really don't need to see the doctor to get the test that you want. So we're discussing this with our largest payers, and we think there'll be an opportunity there. And then finally, what we're doing to create stickiness with our patients, it's not just about providing the patient with the test result, it's about helping that patient with the next step in their journey. So we have relationships with lots of telehealth companies that, if you get a positive result or a result that causes you concern, we're going to hook you up with a telehealth provider so that you can take that next step in your health journey. And that, we think, will help build loyalty with the patients that are coming to us today. Now again, Mark is going to talk later this morning about advanced diagnostics. He's going to specifically focus on molecular genomics and cancer. But look, there's advanced diagnostics that cuts across all clinical disease states. We launched a blood-based Alzheimer's test last year that avoids a very painful cerebrospinal fluid test. We have lots of advanced markers in the cardiovascular space. Reproductive health is still an emerging area, especially around getting pregnant and managing your reproductive cycles, infectious diseases, lots of different advanced diagnostics. I mean think about it, diagnostics do not answer every single question in health care today. There's still a lot of things that clinicians have to turn to imaging for, because there is no good diagnostic for that test. And we look at all these areas across the human body, and we're willing to invest in anything that can provide clinicians with a faster, simpler, easier, more economical answer. On the topic of consumer genetics, Mark will go a little deeper. Again, we see a big growing market here. It's going to double from 2022 to 2030. I talked about why it's going to double. You can see the biggest growth coming on germline testing. Again, as the cost of sequencing comes down, and it moves from single to multi-gene to exome, transcriptome, it's going to quickly move to whole genome testing, and it will become pervasive across all elements of clinical care. Somatic testing is big today, but again, those same trends are going to occur in somatic testing. And we honestly think that genomic testing will be prevalent for all types of cancers at the earliest stages to rule out or rule in especially any type of hereditary genetics that may be at play. Cathy, later this morning, is going to talk about our Invigorate program. We've had great success with this over the last 10 years with all the pricing pressure that we had, we were able to expand our margins. That pricing pressure is alleviated. We talked in the last quarter about, it's only 50 basis points of headwind for us. But there's other headwinds that have come at us, right? We all know wage inflation, supplies inflation. And certainly, a 1-point increase in wages is not as tough of a hit as a 1-point reduction in price. But remember, 50% of our cost structure is wages. And a 2% increase in our wage rate is about equal to 1% increase in price. And that's the kind of inflation that we've seen. From 2013 to 2019, we had a 2% wage kind of inflation in this business. But over the last few years, it's tended to be 3% to 4%. So the headwind is still there and the productivity plans that we have in place are going to offset that. She's going to talk about leveraging our automation and AI capabilities. Reducing denials is a never-ending story within health care today. Every payer has different policies, and we have to continue to be mindful of those policies, fight back where we can and adjust where we need to. Selecting and retaining our talent. There's no secret in health care that attrition rates have gone up over the last 3 years. We've seen them come down. Cathy is going to show a chart on that. But really, the key to getting productivity in this business is keeping the staff that you have. When we bring in a new phlebotomists and expect that phlebotomist to get to an experienced phlebotomist level of about 25 draws per day, you don't just get there overnight. It takes 6 months to a year to get up to that productivity level. And then we'll talk about enhancing the digital experience, good for the patient and also good for us as it alleviates some of the back-office jobs that traditionally provided phone calls and phone support. So what I want to leave you with is the following. Number one, we're poised to grow based on our exceptional capabilities and relationships with payers, providers and health systems. We will continue to accelerate growth in this company. We'll keep it at the mid-single-digit level. The investments we're making in diagnostics and Consumer-Initiated Testing are starting to pay off. Invigorate, which Cathy will talk about, will continue to drive the operational productivity, productivity, slightly different headwinds, less price, more from wage inflation, supplies. And again, we're committed to this long-term outlook of mid-single-digit revenue growth and high single-digit adjusted EPS growth in the future. So thanks for spending 45 minutes with me, and I'm now going to turn it over to Mark Gardner.

Well, good morning. My name is Mark Gardner, as Jim said. It's a real honor for me to be here. I'm honored to be here largely because I represent 2,000 employees who are dedicated to providing the latest and best molecular genomics and oncology solutions to our patients. And I get the honor to represent those folks. And I hope I will do them justice today. Jim mentioned a phrase that we think of every sample or every specimen, every result as a patient. And I want you to come away from my particular talk, understanding that based on both economics and a variety of other things, that the value of that sample is only going to grow. As technology is advancing, what we can extract from each and every sample becomes more and more valuable, creating a virtuous cycle from that. And it is our obligation to honor those samples with as much as we can possibly do. So we take that very, very seriously. And I hope to convince you that I believe that Quest is actually uniquely positioned to do so. So we're going to talk about 4 basic things today. One is we're going to talk about how advances in Next-Generation Sequencing are changing the genomics market, favoring those with scale. I would postulate that the era of genomics could be broken into 3 eras or the time span of genomics can be broken in 3 eras. The first era was the era of single-gene testing, hypothesis-based testing. It was mostly done with Sanger sequencing, PCR. That era gave way into the second area, which is the era of Next-Generation Sequencing. Put this into context, the cost of sequencing molecule of DNA has come down by 8 orders of magnitude since 2006 when the first next-gen sequencers were put into the market. And 8 orders of magnitude sounds like a lot. We're about to experience the ninth order of magnitude. And you may say, well, what's the big deal about that? Well, I hope to demonstrate to you why that ninth order of magnitude actually makes all the difference in the world. That the first era was about discovery. The second era was basically about innovation. And the third era is all about scale, and that's where we win. Now we don't just bring scale. We also bring clinical expertise. We know what we're talking about. We have people that are positioned to be able to make value from this. I'm going to dive a little bit deeper into oncology. Obviously, oncology is the largest current segment in this space. It represents about $1 billion of business for us. Most of our business is in pathology, which has not benefited that much from the advances of Next-Generation Sequencing traditionally. But I would argue that there's a lot of reasons why it should and that we intend to take advantage of that position. And so I believe that we can actually grow faster than the market, even though this is a very rapidly growing market, given our scale and our clinical expertise, and our particular position in oncology in the space of pathology, which I will describe. So Jim talked about this slide. You noticed that a germline is actually growing faster than somatic. That's not really been the case for the last several years. Much of what has driven the somatic change over the last few years is that there's been huge synergy between precision medicine and testing. And that synergy continues to be the case. It's one of the key drivers of our industry. Sometimes, I say that pharma is the dog and we are the tail. We sort of go where the dog is going. Because at the end of the day, in addition to knowing what's wrong with you, people want to actually have a drug to do something about it. And if you can read the genome, you can certainly write the genome now. And so you're seeing more and more synergy in that space. But I would argue that a lot of the growth is mostly going to come in germline largely because of the nature of where we are reaching from an inflection point. And in order to do that, I think it's important to understand the context of genetics themselves. So I won't read every word on this slide, but traditionally speaking, most of the genetic era occurred in this far left column, which is that you either inherited from your parents a genetic disorder, or a BRCA, which we figured out early on was basically a predisposition risk for getting breast cancer for women. Or there will be alterations in your DNA in your body, a mutation, and that would lead sometimes to cancer. And we could test each of these things with sort of the traditional methods of our industry. Every gene in your body encodes for a protein. The average gene is about 10,000 to 15,000 base-pair long. And you can test for very specific points within each of those genes. But in order to do that, you have to have a very strong hypothesis as to what it is that you were looking for. Now the unknown little secret in this industry is that about 98% of most of these single gene tests actually report out normal. We're actually -- assume it's not very good at guessing what's actually wrong with the patient. And there's a lot of things that are wrong with the patient that are germline based or genetic-based, and we still don't actually understand the cause-and-effect relationship. 40% Of all disease is caused by genetic-inherited factors. In colorectal cancer, we know from looking at twin studies that about 30% of all colorectal cancer is actually inherited, yet there's only 2 markers that we really test for today, Lynch and EPC. That amounts to about 8% of colorectal cancer. So there's still a lot of discovery to be done. The second era really occurred with the advent of next-gen sequencing, where people could say, okay, well, I'd like to do a lot of testing at once. And I might aggregate those into need bundles, let's say, a child is deaf, and I want to understand what's causing this deafness. Well, there would be a set of genes that would be related to that. And there are economics that would justify doing a panel, and I'll show you what is it that was the dominant way to do things. And if you really didn't find anything through those panels, you might progress to whole exome, where all the major candidates for what would express to a protein would be found. Only in the super rarest cases would we go to whole genome sequencing, largely because it was very expensive. So as of even last year, if you looked at the difference between the various markets, and again, this is not meant to be totally precise in terms of our exact cost position or others, but you'd have to require a sample that requires placing an order, getting the sample, shipping it, accessioning it. In the case of sequencing, you'd have to do some form of sample prep, which in the case of panels, would primarily involve pulling down just the regions of the genome that you're interested in. Even the exome is only 1% of the genome, folks. So if you wanted to sequence the whole genome, there was a lot more sequencing costs. And you could see that essentially, there was a reason why payers were very reluctant to cover whole genome sequencing. It seemed like a lot of expense for not a lot of clinical utility. But in the last year, I would argue that this has changed a lot, okay? And what's happened is in addition to Illumina, announcing that they have the NovaSeq X, which provides a $200 genome, they actually have a lot of competition right now. There's 2 other companies that have announced a $100 genome. And I would posit that the competition level is only getting more intense. And if you look at where we are today or where we will be next year, you can see, look, we could be super nitpicky about exactly what these things are. But in general, there's really not a lot of difference between the cost of a panel, an exome and a genome. Now there's a word in there that I want you to pay attention to. It's called whole genome. And think about inherited disease or inherited risk is, is the same genome, your whole life long from loom to doom. And when you think about it, now looking at our whole genome over here, if I'm spending just as much money to acquire the sample, a typical laboratory takes about $100. A niche laboratory typically, it costs them about $100 to actually acquire a blood-based sample. If the cost of the whole genome is $100 to sequence, and the genome doesn't change, why would you continue to spend $100 just on acquiring the sample over and over again? You wouldn't. So what are we doing about this? Well, one of the main things we're doing about this is we're going to convert all of our panels over to whole genome. Now that doesn't mean that the payers are necessarily going to come along with us right now because they don't really understand that. That's okay. We'll all learn together because fundamentally, I can still bill for a regular panel. And at these levels of prices for the genome, I could still make the same amount of money. But that data will be there. And that data is not really going to change for the lifetime of that patient. And people say, well, it doesn't have a limit to the size of the market. Well, I don't know, there's 7 billion of us on the planet. I think that's a lot of whole genomes to be done. So we believe that going forward, that this is actually going to change everything, particularly in germline. But now there's a catch. there's a little bit of a catch. If you buy yourself a NovaSeq X, which costs $1 million, by the way, and you want to keep that machine running because you want to replace panels, too. To fill a single flow cell, basically to fill up the machine so that you're maximizing the value of that run, you need 128 genomes to get that price point. The average hospital lab does not run 128 samples a day. There are very few labs that run that kind of volume of genomics a day. We're amongst them. We have a unique privilege in that regard, in that we don't need a very long turnaround time to pull enough samples to take advantage of this. First was discovery, then it was innovation, now it's going to be about scale. There's one other thing that you'll notice here, which is if you look at the cost of analyzing this thing, that dark green actually represents just about as much as the light green. We like green, by the way, not just because it's St. Patrick's Day, other reasons. That's a joke, by the way. Look, if I were to do a whole GM sequence on each person in this room, each of you would have about 4 million variations from the reference genome. Well, which of those isn't that's causing something? Well, you have to sift through that. And in order to sift through those 4 million data points in an efficient manner, you need AI, you need software. We have been investing $20-plus million a year for several years now in the IT systems needed to essentially be able to process this data. And I would posit that we -- between our world-class team and our software systems, now the capability of processing a genome at a more efficient level than just about anyone else in this industry. And there's a big difference between doing that for a study where you're trying to discover the nature of relationships and for clinical practice. We do more clinical practice genomic sequencing than just about anyone in this industry. A lot of that's done through Blueprint over in Finland, but we are significant players in this industry. And we're able to do so efficiently. So you have this era, and I would argue, it's all about scale. Well, everybody else has kind of noticed that, too. Most of our smaller competitors in this industry are unprofitable. They're unprofitable, largely because they have had to take a single test or a set of tests and they had to do everything themselves from sample collection to running the samples, to getting the IT. We intend to open up infrastructure-as-a-service, which we call genomic sequencing services to others. There's no reason why everyone should be running around trying to replicate this on the road. We think that we can participate in this market through our own testing, whether it be for our own testing or the testing for others. And we intend to do so while also combining that with the fact that we -- as Jim Davis referred to, we actually have expertise in every one of these major fields of study because interpretation of the genome requires context. Context is the most important way to filter across those 4 million variants. So we're opening this up to the rest of the market, where others can have a modular or end-to-end genomic sequencing service to enable them to participate in this third era of genomic medicine, the era of scale, okay? And we put behind that a team that I think is world-class. We have folks from Illumina, from the Broad, from Thermo Fisher, from Invitae. This -- I've had a lot of teams in my life. I'm older than the average bear. And this is the best scientific team I've ever led, ever. And all of these people chose to come here to Quest, that most people do not associate with the cutting edge of genomics because they've been in this industry. And they, like me, inherently understand that if you want to bring genomics to everyone, not just to the people at the academic medical center, but to everyone, you have to do it through a company like Quest. You have to do it with scale. And that's what we're dedicated to. It's what I'm dedicated to. That's why I came here. I'm going to pivot to oncology now. Obviously, that's the largest segment in the space, as Jim alluded to. We do about $1 billion. Most of what we do today is in either traditional screening, which is things like running a PSA test or doing a pap smear. Or it's in the form of pathology services. We do about $500 million a year of pathology services of essentially saying this patient have cancer or not have cancer. CPT code 88305, if you're wondering. So we do a lot of that. And I think a lot of people say, okay, well, that's not really a great industry. It's only growing 1% to 2%, a lot of price pressure. Why are you so proud of this? Because the fact that I think most people don't understand, who have not worked in oncology, which is that you only have cancer when the pathologist says so. That's it. You can light up like a Christmas tree. But until a pathologist looks at a slide and declares you definitively do have cancer, you do not technically have cancer. They won't do surgery on you. They won't give you a drug. You do not have cancer. That moment that matters, that initial diagnosis is what sets apart the whole rest of the journey. And we are doing that day in and day out for thousands of people. And we think that, to that point around every specimen is really special, that every specimen represents a person. The specimens, in this case, tend to be FFPE blocks from tissue biopsies. We intend to leverage as much value from that FFPE block as possible because the patients deserve it, right? So genetic risk, we're going to -- we participate a little bit in that today. I would argue that much of that will be transformed by the whole genome sequencing world that we talked about. We're not really participating a lot in the CRC, MGD screening space today. We do have a variety of people that are interested in using our blood collection network, largely because we do it very efficiently, much more efficiently than they can do on their own. So it enables us to participate in that space. We're involved in traditional screening, which I would argue, there's a lot of informational value in that, which we have yet to figure out how to partner with others, but we're open to because there's incredible value in some of these traditional markers for area under the curve in prediction of where you are with cancer. Pathology, which is the core of our revenue and therefore, requires strengthening. And then the things post-diagnosis where we own the block. But in order for us to maximize the value post the block, we have to maximize the value of what we do in pathology itself. As Jim alluded to, the biggest change in pathology today is the conversion from traditional methods to digital methods. And the conversion from traditional to digital, first, a lot of the workflow looks exactly the same. You still have to do the biopsy. You still got to go get the thing. You still got to embed it into a wax block. They still got to do 5-micron slices. They still got to put it in a water bath that will fix it through a glass slide. So a lot of the labor that we associate with pathology, we still do, you still do. But once you digitize that slide, as Jim said, it can be sent anywhere. So that can be used to dramatically improve the quality with which we do diagnosis. And we can also do so by a combination of the pathologist and AI. And as Jim had said, and I completely agree with this, we're just getting started with how AI is going to transform pathology. So once we have that tissue block and once we have digitized the slide, there are many things that we could do to profit in terms of actually being able to deploy AI and make better calls. I would argue that this is also a means for us to vertically integrate into things such as, from these H&E slides, there's a lot of data. We forged a partnership with Paige AI. We believe that, that will yield a lot of insight on how do we better diagnose solid tumor cancers, prostate in particular. We think that there's evidence that you can replace PD-L1 testing with this. There's evidence that you could replace a lot of the Oncotype scoring with this. Because the patients are waiting, you already have the tissue and you can apply the AI right then and there. Now I want to take you through a study. This study was done by our friends over at Thermo Fisher. It was presented at ASCO last year. And it highlights the importance of turnaround time in our industry. Now I'm going to walk you through this slide. If you look at the folks at the very top, they're in the blue, what they essentially said is, if you harbored an actionable mutation that lend itself to a targeted kinase inhibitor, tyrosine kinase inhibitor, or TKI, Tarceva, for example, is an example of that. If you waited on getting tested and then the person actually had that mutation, and you gave them the appropriate drug on the basis of that, how do they do? And that's the blue. Look, I'm used to looking at curves a lot worse than this, folks. I've been in oncology for a long time, okay? Now the people in the yellow, they are the ones where they went in, they waited too long. The person is scheduled to come back and the doctor sits back with it. I'm just going to put him on chemo and then leave him on chemo. So these are people that, post hoc, we know had an actual mutation, but they were never sequenced and they just went on chemo. There's a huge difference, obviously. So getting your sequence done post diagnosis does matter, okay? But I want to highlight the people on the red, because they're the ones that actually make me the most upset for the patients. These are people that had an actual mutation, didn't know about it, went on chemo. Then realized, oh, you have an EGFR mutation or some other. Then they put them on the TKI. But by then, because of the power of evolutionary biology in tumor cells, it really didn't matter, right? The red looks a lot closer to the yellow than it does to blue, doesn't it? Patients are waiting, folks. Like every time 1 block comes in, we know that, right? Last year at ASCO, we went -- we published a study that demonstrated that using Quest Precision pathways, we could take a health system from a 35-day turnaround time on average from diagnosis to resulting one of these things, down to 16 days. With every ounce of my strength in my body, I'm trying to get our organization down to 7 to 10 days. There's no reason why it can't be in 7 days. Because if you wait for 3, 4 weeks, that patient is probably going to go on chemo. And if there was a better drug for them, it's probably not going to matter. You have to sequence every patient. We control a huge percentage of the tissue in this industry. We're making the point of diagnosis. So you don't think of us in the same breath than some of the market leaders in this space. I would argue that turnaround time is increasingly going to be the thing that people care about the most. We run the TSO 500, it's equivalent in performance. I would argue, it's better in performance than the market leader in the space. But that's not the most important thing. The most important thing is that patients are waiting, and we can do something about it, okay? So as we talked about, we have a lot of ways to enter into these post-diagnosis categories. One example is we deployed TSO 500 last year. We're going to be scaling that up in Lewisville, Texas this year. And we think that, that's probably the way that we should be participating in a lot of this market. We're not in the kit business. So we buy kits from others. If we can stay at the cutting edge of the science on the basis of what Roche or Luminor, Thermo or others provide us, that is always our preferred path, right, is to just buy the kit. But look, if that doesn't work, we can license it. We can develop it organically. We've done a number of those things. Our LeukoVantage panel is an example of a panel that we developed all on our own. We can send it out. We announced earlier this year that we have a partnership with Agilent through the resolution lab, largely because they have a single-site PMA for a KRAS 12C mutation liquid biopsy indication. And they met that PMA threshold. Obviously, we'd love to work with those guys on bringing that in-house for ourselves. And then lastly, we can acquire something because we can do that, too. That's what we do with Med Fusion and that's really how we serve the Texas oncology community. But if you look at kind of the overall market in oncology, I think that there's actually a lot more interest in MRD these days than there is in therapy selection. And I would argue, over time, it's going to be a much larger market than therapy selection. Therapy selection is dedicated just to people with advanced stage cancer. It's a Stage 4 cancer disease, which out of the 1.7 million Americans that get diagnosed a year, about 600,000 of them will have Stage 4 cancer. 1.1 million of them typically will have some form of surgery with the intent to cure. And if you've ever known anyone who's had surgery with the intent to cure, and you asks the surgeon, "Did you get it all?" The answer always comes back, "All that I could see," right? Which unfortunately, given the limits of imaging, meant in a lot of cases, that people are going to recur. And MRD is transforming this market. 25% of all oncologists last year ordered some form of MRD testing. Now if you're an MRD provider and you look at Quest and you say, "Well, do I want to build this whole thing on my own? Or do I want to partner with a Quest?" There's a lot of reasons for them to want to come partner with us. We have a huge sales force. We can take orders directly into our EMR. We have lots of infrastructure to both to do the tissue processing, which most of the MRD is probably going to be, it's called tumor informed. That means you start by taking the tissue itself, learning either through an exome or a genome, what are the mutations to track that are specific for that tumor. And then serially doing blood draws after that, which, again, if it costs you $100 to draw that blood versus what it costs me to do it, which is a fraction of that, that's a lot of money out of your pocket. So we get calls all the time from people that want to do MRD with us because we can do the tissue sampling. We can draw the blood. If they want to take it to the FDA, we've done a lot of that. We report the thing directly in the EMR. As somebody has served the oncology community for a long time, I got to tell you they hate PDFs. Oncologist hate PDFs. They want to see the thing in EMR. And perhaps most importantly, we have relationships with payers to get this thing paid. MRD today is mostly a CMS reimbursed market. You've heard some announcements recently about the Blues. I would argue that over time, it's going to improve quite dramatically. But that's something that we actually can help quite a lot with. So I think MRD is a great case study of this new era and why a company with scale is actually really well positioned. So I'll just leave you with, we think the era of the $100 genome is ushering in the third era of genomic medicine, the era of scale. We think combining that scale with our expertise, from both our own testing and for the testing of others, is a great way for us to deliver shareholder value. Again, the more medical value we deliver, the more shareholder value we deliver. We think in oncology, which is a huge and growing market, that we have a unique position given our strength in pathology, that we do about $1 billion in this industry already; that we're poised to both strengthen the core of that, which is pathology, given the advances in AI and digitization; and that we are poised to profit from once we have that tissue, that incredibly prescious tissue, that we can give answers to these patients. Anyhow. With that, I'll hand it over to Cathy, and she can take you through what we're doing to improve the productivity of the company, so.

So good morning, everyone. It's great to be here face-to-face. And why that's important is because if we weren't face-to-face, you wouldn't have felt the passion from Mark Gardner about what it is he's doing for us to help patients. So thank you, Mark. So I'm here this morning to talk to you about optimizing operations to drive growth. And what you're going to hear from me is that we've had a strong track record of delivering Invigorate savings while, at the same time, improving the customer experience. And what I can tell you is that there continues to be a whole lot of opportunity across our complex value chain to continue to do that. And our path to doing that includes driving productivity improvements through automation and AI. It's about getting paid for the work that we do. It's about enhancing our patient and provider digital experience. And as Jim mentioned before, making sure that we attract, retain and develop our frontline talent, who are critical to our operations. At Quest, as you've heard before, we're committed to delivering on that promise of delivering a superior customer experience at a lower cost. This isn't an either/or imperative. And what I can tell you is that we're delivering on both of those things. Our Invigorate program has consistently delivered value for the past decade. More recently, the savings have been realized through the deployment of a new urine analysis platform, the expanded rollout of our schedule at check-in at our PSCs, the continued optimization of our PSC network, the continued optimization of our logistic routes and the reduction of third-party logistics spend and the additional testing consolidation on our [ Intellica ] platform. Tremendous opportunity remains, and we're organized to deliver 3% of annual productivity savings every year, in -- year in and year out. So I mentioned we're lowering costs. We're improving productivity. And we've made measured improvement in certain productivity levers. We've increased the number of patients that we can serve for FTE by 16% in our patient service centers. We reduced the number of nonproductive stops by greater than 30%. In lab operations, we've improved productivity by 16%. And total contacts, that include phone, chat and e-mail, have decreased by 40% per 100 requisitions. And we've done this all while experiencing higher frontline turnover than pre-pandemic levels. As we improve productivity, we also are delivering an excellent patient experience with a patient NPS score of 73. And by the way, this compares to the health care industry average of 58 and a 91% customer satisfaction score, and this represents the sum of the top 2 boxes, extremely satisfied or very satisfied. Now Invigorate is going to continue to deliver operational efficiency, and we'll continue to improve the customer experience. And we'll do this by leveraging automation and AI by reducing denials and write-offs; by enhancing the digital experience; and again, by selecting and retaining our frontline talent. So let's start with leveraging automation and AI. Automation and AI is going to help us improve productivity, but it's also going to help us improve quality. This is critical given our reliance on manual labor in many areas. We're looking at automating and leveraging AI across the entire value chain. This is not just limited to the laboratory. And I can tell you that we're making progress along our automation journey, and it has allowed us to improve productivity by 15%. This includes end-to-end automation of the clinical or microbiology labs. And what this means is it's from sample receipt to reporting. And some of you may have had the benefit of going on a tour at our Clifton or Marlboro laboratory, and that's what it is I'm talking about. We're working on implementing this in Lenexa, Kansas, which is in the middle of the country. And in West Hills, California and Lewisville, Texas, we're implementing microbiology automation. Now what I would tell you is that not every 1 of our labs, Jim mentioned that we had 26 regional and esoteric labs, not every lab has the size or the physical layout to accommodate end-to-end automation. And that's why modular automation is so important. And this is about automating a process within a lab department. Recent modular automation includes noninvasive prenatal testing screening, where automation created an integrated sell of instruments from different suppliers to eliminate the manual transfer of plates. Now again, that might seem small, but doing that across our network in lots of different places can create a lot of value. Again, automation has allowed us to improve productivity by 15%. And I can tell you that there are lots of opportunities to automate across our whole supply chain. Now automating urine aliquotting is going to be a focus for us in 2023. We're working with suppliers to develop and implement a custom solution for Quest. Today, we currently have about 80 FTEs that are manually processing urine specimens. And essentially, what they're doing is they're pouring out of the urine cup into a tube to get that specimen ready for the platform it's going to be tested on. And what I can tell you is that there's not a lot of folks that actually want to do that job, right? The process is further complicated by the fact that urine cups in our industry are not standard. And so it really does make automation challenging. We plan to pilot a solution in one of our main labs in 2023, and we expect productivity improvement of at least 30%. So to automate our digital processes, we're looking at AI solutions, again, across the entire value chain from order to cash. And in the lab, AI solutions can support image and graph interpretations. And what this does is it improves productivity, but it also improves quality. Data extraction in our patient service centers as well as our labs is another process where AI can convert paper recs into our lab system. Different AI solutions are being assessed to enable us to better manage our processes and flows, such as optimizing logistic routes dynamically. And in our customer care centers, we're looking to provide answers faster. And so we're using AI across all of these areas. Now AI is currently helping us to automate manual processes with mass spec interpretation. And this is improving productivity by 50% and again, improving the quality of the results. To put this in perspective, we have about 3 -- a little less than 300 mass spec units across the enterprise. And we do prescription drug monitoring on this platform. We do steroid and hormone testing. We do clinical tox testing, nutritional testing as an example. And prior to AI, a tech would have had to manually set up a calibration curve and quantitation software. They'd have to manually import QC and patient data, and then they'd have to manually review each QC and patient sample and then make a judgment call on what the results should be. With AI, software does it all. It automatically identifies, classifies and calculates the results and requires only a few seconds of the technician time before we release that result. Only a small subset of samples require significant technician time. And what this has done is it's led to a greater-than-95% improvement in technician time review, which is good for employee engagement, and it's improved productivity by 50%. And again, it's improving the quality of the result. I mentioned microbiology earlier. Jim talked a little bit about microbiology automation. We have a solution that's reducing our FTEs by 40%. And in this case, prior to automation, microbiologists would have to perform 8 manual steps from sorting to streaking, to loading and unloading samples and incubators, to then reading the plate and counting the cultures to identify the positives. The automation solution takes that 8 manual step process down to 2 steps. And AI identifies and classifies 100% of the cultures, which was previously performed by the microbiologists. The other thing that I would say is that these digital plates are also automatically scanned and stored. And why is this important? We can take that digital plate and provide it to the referring physician. Oftentimes, that referring physician wants to actually see the culture growing. And so we think this is a differentiator for us. Again, the solution reduces FTEs by 40%. It also improves turnaround time by 40%. So that's good for our customers, and it's good for patient care. And as Jim talked about, our health system strategy, outsourcing microbiology, this is a solution that really differentiates us in the marketplace. So let's move on to reducing denials and write-offs. There's a significant opportunity, and I think everyone knows, to reduce miles and write-offs or patient concessions and it represents a greater than $500 million opportunity. But as Jim said earlier, our work in this area of reducing denials and improving our collections from patients is really never ending. As you can see, the bulk of denials are driven by test coverage and benefits. And so here, we have to collaborate with the health plans to educate them on the benefits of certain tests to provide -- that provide insight to patient care. Now collecting the patient responsibility portion from patients is also challenging, especially when almost 50% of our patients don't actually -- their specimen doesn't get drawn within our PSC or IOP network. So we don't have that face-to-face connection. So here, we're continually working to make the patient bill faster, more accurate and transparent to our patients. Now by improving billing accuracy, we can reduce denials and increase cash. Traditionally, the process for billing was the doctor placed the order. We would attempt to collect the information that was necessary to bill the insurer. We'd go ahead and bill the payer, and they'd either pay the claim or they deny the claim. And in that particular case, Quest was taking on all the risk associated with getting paid for the work that we do. We've been hard at work to change that traditional approach and reduce our risk. We have been driving more electronic orders. We're working on increasing real time adjudication, as Jim said. And this is helping us create pricing transparency around the patient responsibility. These actions are mitigating the patient risk for the testing that we do. This continues to be a big opportunity, and we have a goal of reducing denials and patient concessions by somewhere between $100 million and $150 million over the next several years. And here's a snapshot of the progress that we're making. Our electronic orders have gone from 72 to 82. -- collection of patient open invoices at our PSCs have gone from 50% to 57% and collecting payment information from the patient has gone from 42% to 46%. These are all elements that are going to help us reduce denial and improve collection from patients. Now I also talked about denials, right? So we have to partner, and we're continuing to partner with health plans to reduce denials because the majority of the denials that we experience are associated with their coverage policies. So how do we collaborate with them? Well, we do this by medical to medical education. We do it through trade-led education, and we do it around efforts to ensure accurate coding, accurate coding meaning payable diagnosis codes. This is something that takes time. It's not something that happens overnight. And these are some of the examples of recent successes. So now let's talk about enhancing the digital experience. We spend an awful lot of time trying to understand our customer journeys to identify their pain points, the critical touch points and their customer service needs. This represents a high-level depiction of customer journeys for patients and health care providers. And what this does is it really helps us guide our investments and delivering against that superior customer experience goal. So over the past several years, we've invested an awful lot in our customers' digital journey. Since 2020, we've seen steady adoption of digital tools, which delivers a win-win, right? It delivers an improved customer experience and it delivers productivity improvement for us. By way of example, on the patient side, patients have increased appointments scheduled by 80%, and we're driving greater preregistration information collection prior to visits. And what this does is it eases the burden on the phlebotomist, right? Because if that information isn't collected prior to the visit, the phlebotomist has to go ahead and make that happen. On the health care provider side, we've seen strong adoption of our self-serve specimen pickup and online ordering tools that are similar to an Uber digital experience. Again, this creates a better customer experience, and it improves productivity for Quest Diagnostics. And as we think about 2023 and beyond, we're going to continue to enhance the customers' digital experience because it's good for both of us. On the patient side, we're using SMS texts and e-mails. And we're doing that right now to drive increased appointment compliance, right? When somebody makes an appointment, we want to make sure that, that customer/patient comes and sees us and the likelihood of paying bills. So that's how we're using -- enhancing the digital tool. Proactive communication touch points include letting the patient know when their doctor has placed an order with us, providing the patient with the status of their order, updating the patient on the availability of results and their billing responsibility. On the health care provider side, we're providing enhanced self-guided tools at critical stages, including a streamlined and semi-audit -- semi-automated onboarding process for new accounts. And finally, within our customer service contact centers, where we handle greater than 8 million calls a year with about 600 FTEs, we're deploying technology to provide more contact channels for customer interaction from chatbots to live agent chat to texts and e-mails. We've seen rapid adoption of these new contact channels, and that's reducing our number of calls. You'll notice that our total number of calls are down 21%. Again, these investments are improving productivity, and they're also delivering against an increased customer expectation because this is how the rest of their life functions. Now let's move on to selecting and retaining talent. As Jim mentioned earlier, and I think I may have mentioned it earlier, our frontline is critically important to the operations of our business, right? We couldn't operate if we didn't have those folks. And therefore, selecting and retaining that talent is absolutely key. From a market perspective, there's a medical technologists shortage, and wage inflation has gone up. While 5.1% is the average, as Jim mentioned earlier, we've experienced wage inflation of 4%. And more importantly, that's double what it was versus pre-pandemic levels. And because of this labor market, we're also experiencing higher frontline turnover. Pre-pandemic, we were just north of 14%. We peaked at 28% in 2021, and we've since come down to 23%. This is absolutely impacting our productivity and increasing cost. Jim used phlebotomists as an example. I can tell you, even when it comes to specimen management and getting those specimens ready to get tested, it takes a while for our employees to ramp up to experience level productivities. We're focused on efforts to attract, retain and develop our frontline talent. And here are some of the ways that we're doing it. We're expanding the phlebotomy school certification program. We're partnering with universities to build a medical technologist pipeline and we're improving scheduling functionality to offer employee flexibility, which we think is important in this day and age. In summary, what I want you to take away is that we have a strong track record for reducing costs. At the same time, we're improving customer experience. There is a significant amount of opportunity to continue to do just that. And we think we can do that by leveraging automation and AI; by reducing denials and write-offs, which we said was greater than a $500 million opportunity; enhancing that digital experience, which, again, is going to improve productivity for Quest, while helping -- while enhancing that customer experience; and again, making sure that we retain and develop and attract frontline talent. This is our path forward to continue to deliver 3% in annual productivity savings. Thank you very much. And I'm going to hand it over to Sam to take us through the financial outlook.

Good morning, everybody. So my pleasure to be here to provide the last section, which is an update on the long-term outlook for Quest. And the key things that I want to cover today, so first of all, look retrospectively around our execution through this pandemic over the last 3 years. I want to talk about operating margin expansion, obviously, something on all our investors' minds, and I think it's important for us to talk about what our expectations are for the next 3 years in terms of operating margin; talk about our balanced capital deployment philosophy, and I'll focus a bit on that; and then finally, and obviously, last but not least, is our projections around revenue and EPS with the expectation of mid-single digits growth in revenue and high single digits in EPS. Looking retrospectively, I think more important than the actual financial results is the execution that Quest has had through the last 3 years. I think we've provided an incredible service, but not just to this country, but to the world overall in terms of the testing infrastructure that we've set up through this health emergency, how we've mobilized as a company to serve patients, to serve the country again with testing needs. I think we've been a leader in this capacity, and we're very proud about that at Quest. But also, we're proud about the financial performance that we've had. As you can see here, 9% compounded annual growth rate on the revenue line over the last 3 years, 15% in terms of adjusted EPS growth over the same period. In terms of base revenue growth last year, we closed out the year with approximately a 5% base revenue growth as well. So as we start to see the core business and the base business, rebounding post-pandemic as well and utilization rates going up. So proud of the performance, I think we've executed very, very well through very tough circumstances, but more importantly, with the service that we provided, again, through our testing infrastructure that we've set up. I'm here to reiterate 2023 guidance that we shared on our Q4 earnings call back in early February. So it's unchanged. We are guiding 2023 revenues, base revenues at $8.65 billion to $8.75 billion, which translates to a growth of 2.6% to 3.8% or 3.2% at the midpoint. For COVID revenues, again, we guided to $175 million to $275 million on the Q4 call, so a midpoint of $225 million. For adjusted EPS, we guided $8.40 to $9 or $8.70 at the midpoint. And underpinning these guidance numbers are a few key assumptions. One is that we will grow base business margins. So we are going to see expansion year-over-year this year. As you've heard us talk about throughout 2022, and on the call in February, we are seeing a more favorable pricing environment and more favorable price outlook. We're seeing price improvement, our work with the payers. I think Jim shared some of that with regards to value-based contracting is definitely yielding positive benefits around price. The growth investments that we've been referring to, again, through our communications and through our discussions with you all, which we sized at about $150 million last year. We're going to continue to make these growth investments behind advanced diagnostics, behind consumer-initiated testing, but they will be less dilutive prospectively as we look forward, starting with this year, driven by the fact that we're going to start to see some returns from these investments. So even though we're going to continue the investments, we're going to start to see a payback. Again, on the Q4 call, we talked about $100 million reduction in SG&A that we basically executed and identified towards the end of 2022, will start to take effect this year. It basically translates to about a 1.5% reduction in workforce. A lot of it is through our, what we call enabling functions, support functions, cost reductions that we've made to respond to, obviously, the environment that we're in, which is inflationary and the recessionary environment that we're in. And those reductions, those $100 million reductions in SG&A expenses will start to take effect starting in Q2. Those are beyond the 3% productivity improvements that we've referred to around Invigorate. Finally, around COVID, expectations this year are for 5,000 to 10,000 tests a day. So coming down precipitously from 2022. And beyond mid-May, when the PHE -- when our expectation for the PHE is to end, we expect to see the reimbursed price being below $51 from where it is today, which is close to $90. So with regards to COVID, I referred to this just now, when I talked about the precipitous drop, we expect to see COVID revenues this year at a midpoint of $225 million. That's what's basically embedded in our guidance. More importantly, I think COVID, as of 2023, really -- or beyond 2023 becomes part of our base business. As we look towards 2024, the expectation is we're not reporting COVID separately from the base. It's really 1 number. We look at revenues. This is now one of our tests, one of our many tests, an important test, but it's no longer -- it doesn't have the same significance that it had back in 2022 and before that. So I think we're getting into the endemic part of this health emergency that we're in or health crisis that we're in. And as of the second half of 2023, really, we expect testing volumes to come down significantly, but that's factored into the 5,000 to 10,000 test per day that we've talked about. Let's talk about operating margin, and this is more of a retrospective look again, but focusing on 2023. Our expectation for this year is that we're approximately in the 17% operating margin rate. So we're close to where we were pre-pandemic. As you can see there, 17%. The reason we're close, not quite there is because the 17% has COVID revenues in it. Reason we're not back fully to pre-pandemic rates is, I would say, 3 things. One is we still -- as I talked about, we have $150 million of growth investments that the pandemic afforded us the ability and the capacity to do and we started doing, but that's reflected in this operating margin rate. And before the pandemic, we didn't have those growth investments, as I mentioned. So that translates to about a 1.5% impact on the rate. The other one, which is a big one, is inflation. Obviously, we're in an inflationary environment and still weathering that inflationary storm, so to speak. And so that has an impact on OM rates this year. And then finally, the PLS business, which has grown significantly, as you saw in Jim's section, grown over $300 million over the last 3 years, very profitable business, very high return on invested capital, but it has a lower margin rate than the rest of our business. So that has also a slightly dilutive impact on operating margins. But as I said, a very, very attractive return on invested capital. So let's talk about PAMA a bit and the pricing environment, before I shift over to operating margins prospectively and also long-term guidance. We are right now still under the law that says PAMA cuts good return, right? They've been delayed 3 times now. They were supposed to happen in 2023. They got delayed into 2024, but current law is still basically PAMA. So if PAMA cuts were to return in 2024, we would expect to see a 15% rate cut cap for the next 3 years and no rate cut cap beyond that. What that means from a financial standpoint or a pricing impact on our business in '24, which was largely expected -- that same number, which was largely expected in '23, is roughly an $85 million impact on pricing. So that's one scenario that we have, is that PAMA cuts happen in 2024. Now the other scenario and one that Quest ACLA are fighting for and lobbying is really the passing of SALSA. SALSA, which is Saving Access to Labs, Services Act, really is a permanent fix for PAMA. So if enacted would be a permanent fix for PAMA, would be a much better outcome for the industry and for Quest. Now if SALSA were to be passed, then basically what you would see -- and this is assuming that it's passed in 2023. So really a 1-year delay from when SALSA was first proposed back in 2022. But if it were to pass, it would be a 2.5% rate cut cap in 2025, no cuts in 2024, a 5% cut in '26 and beyond. So basically, you would see no cuts in 2024. That would be a really, really important outcome. Now if SALSA doesn't happen, I think our fallback will be to continue to push for delay of PAMA again. It's been delayed, as I said, 3 times so far, and we will push again to have it delayed in 2024. But what our financial projections do assume is the high end of the range that says effectively SALSA is passed, and the low end of the range that says PAMA will come back under current law or will happen in 2024 under current law. So transitioning to operating margin expectations for 2026, which is basically over the outlook period, our operating margin guidance calls for a 75 basis point expansion on the low end to 150 basis point expansion on the high end. As I said, the high end would assume that SALSA is passed in 2023. The low end would assume that PAMA cuts return in 2024 to the effect of close to $85 million. Now other drivers for operating margin expansion, I think, first and foremost, volume growth and revenue growth that we expect to see in the business. To the extent that we can grow volumes, and we will, you will see that drop to the bottom line and definitely translate to leverage as we cover more fixed costs. As I said before, a more favorable pricing environment that we're witnessing and that we're really affecting through our collaborations with health plans on value-based contracts, that is driving also operating margin favorability, as well as, last but not least, Invigorate; and the 3% productivity that will help offset some of those inflationary pressures and other input costs that we're facing. Let's shift to capital deployment. So our capital deployment philosophy is intact. Our focus and our commitment is to return the majority of our free cash back to shareholders. But here's what we're going to do in terms of priorities. We're going to reinvest in the business as we have been doing over the last few years. The growth investments that we've talked about are a great example of that. We're going to continue to execute on our M&A strategy with a goal of delivering 1% to 2% in revenue growth from these M&A investments. To the extent that we don't find the suitable strategically complementary and accretive M&A investments, then we're going to return that cash back to shareholders in the form of more share repurchases. And we have done that through our history in the last 3 years with the cash that we generated from COVID. And also, we remain committed to raising our dividend over time. So we have a solid commitment to our dividend. Again, all anchored on our philosophy of returning the majority of our free cash flow back to shareholders. So we're not going to sit on cash on the balance sheet. A great example is what we've done over the last 10 years. If you look at the last 10 years, our operating cash flow and the cash that we've generated is approximately $16.4 billion. That's been generated while funding some important growth investments. Now at the same time, we have invested roughly $6.6 billion through CapEx, so capital expenses, and through M&A that we've done. And we have returned to shareholders roughly $9.9 billion through share repurchases, and elevated through the last 3 years with the cash generated as a result of COVID revenues and also dividends within that of $2.6 billion. So that line at the bottom is about $16.5 billion of either investments or cash returned to shareholders that we've done over the last 10 years, which is almost exactly the same as the cash that we've generated from operations. In terms of acquisitions, what's our focus area -- and we've, I think, talked about these before, we remain committed to 3 key areas in terms of M&A focus: hospital outreach acquisitions, regional labs as well as capability-building assets. Hospital outreach labs is definitely a key one for us. It's acquisitions. I think Jim talked about this in his opening section, acquisitions where we can basically work with health systems. They need some of that capital. They are feeling the pressures just like a lot of companies, and a lot of other institutions are feeling those pressures. And it affords us a way to really help them monetize some of these books of business, have an injection of capital and really provides Quest with the opportunity to acquire that book of business and provide a really important service to patient, which is lower cost. Some examples on hospital outreach lab acquisitions that we've done, NewYork-Presbyterian. I think Jim mentioned that. Northern Light, which is up in Maine; as well as Mercy, which is a large health system in the Midwest. We have, I would say, a very attractive and pretty thriving funnel of acquisitions in that space that we're going to be focused on, that's going to drive a portion of that 1% to 2% growth from M&A that we talked about. Regional labs. I think those are really important in the sense that, again, we can consolidate and provide -- they're immediately accretive. Labtech is one in South Carolina that we acquired back in 2021. We see less and less of the opportunities in that space. I think there's been consolidation here. And so the opportunities are not, I would say, as numerous as they were maybe a while -- a few years ago, but still definitely some opportunities to consolidate. And then last but not least, capability-building assets, where we have potentially gaps in our test menu opportunities to acquire different assets that help us fill those gaps. Some examples that we captured here, Pack Health, which is really a health outcomes company and health coaching company that helps patients manage their comorbidities and other health issues is one that we acquired. Blueprint Genetics, which I think Mark referred to, which is a really leading specialty genomics company that deals with bioinformatics. We think it's leading in the space. And so those are some of the acquisitions that we've made on that part. But I think we have really important opportunities, particularly on the hospital outreach to drive value. So putting all this together in terms of our long-term outlook. In terms of revenues, we believe over the next 3 years, we will grow organic revenues by approximately 3%. We'll drive additional growth acquisitions of 1% to 2% for a combined revenue growth in the mid-single digits as a compound annual growth rate. We believe that on the adjusted EPS front, we can grow adjusted EPS by high single digits from a CAGR standpoint. And then in terms of return to shareholders, both through adjusted EPS in the high single digits and through our dividend yield, we think we can drive a high single-digit to low double-digit return back to shareholders through those 2 combined. And free cash flows will grow commensurate with earnings growth as well. So again, proud of the execution over the last 3 years, focused on operating margin expansion over the next 3, remain committed to our balanced capital deployment philosophy. And our long-term outlook, we believe we can drive mid-single-digit growth in terms of revenues, high single-digit growth in terms of EPS. So thank you, everybody. I'm going to call back to the stage here, Jim, to close this out.

All right. Thank you, and we really appreciate you spending the last 2 hours with us. I just want to sum a few things up before we bring the rest of the team up for some Q&A. So hopefully, you've seen the relationships we've established in this industry with payers, providers and health systems and more importantly, now with retailers. And as retailers continue to expand their national footprint from a provider standpoint, we're poised to grow with them. Second is I do believe we have the right strategy to continue to accelerate growth in this country. I think there's a lot of trends that still favor independent labs like Quest Diagnostics. Employers are getting more and more tired of the escalating health care costs, and we offer employers an opportunity to reduce that spend. Providers are increasingly looking to us to do more than just provide diagnostic testing services, and we have a nice complement of complementary services that can help their practices. We'll continue to make the investments to lead in advanced diagnostics. I think you have felt Mark's passion and energy around that. It starts with the patient. We're here to help providers and patients lead healthier lives. I hope I've convinced you that the consumer-initiated testing business, it's real. There's real segments of consumers out there that want to come. We want to democratize lab testing. We should give them access to it. Not everybody wants to go to a doctor to be able to get a lab test, and we're committed to helping those individuals. Our Invigorate program has delivered a lot of savings in the company to offset what was initially priced -- a lot of pricing pressure back from 2013 to 2019. That pricing pressure has gotten a lot easier, a lot softer. But we're now facing some inflationary headwinds, and we're convinced with the opportunities that we have in front of us that we can continue to offset most of those pressures. Again, our long-term outlook that Sam reaffirmed here this morning, mid-single-digit revenue growth. We think we'll be able to continue that into the near future, and high single digit and with our dividend, low double-digit EPS growth going forward. So with that, I'm going to invite the team up. And Sean is going to moderate some Q&A here, and we'd love to hear your questions.

First with A.J. upfront here. No, Helen will -- they're coming with a mic.

It's A.J. Rice from Credit Suisse. Just maybe expanding a little bit more on comment Jim made about seeing insurers be a little more willing on the consumer direct to cover some of that. Can you tell us where you're at and where are you seeing interest as a particular test and so forth? And then maybe expanding the question to broader value-based arrangements. Are you seeing any changes in terms or the types of things that payers are interested in contracting around?

Yes. So early-stage discussions with lots of the payers. And we had the discussions, obviously, during COVID. I think COVID is a great use point of why allowing consumers to use their insurance without going to the doctor can actually save the health system money. Look, there's a whole segment of patients out there today, young consumers, 18 to 30 years old, that actually may not need a physical exam every single year, right? The AMA has been studying this for years. But a wellness panel once a year to make sure that, in fact, what's going on inside your human body. So actually, things like that can actually save the payers' money, and they're looking at that. Obviously, that has to be coordinated with the various medical societies and things like that. So I don't think there's any one particular test, A.J. But look, STDs are one where I think the payers understand that early diagnosis leads to lower cost of treatment. And if people were afraid to go to the doctor and they want that privacy, that could be one test category that could open up to us.

Kevin?

There's a little bit of change [indiscernible] a little bit of nuance in some of the things in the past. Your past guidance, I believe, organic growth was 2% to 3%. Now it's 3%. M&A used to be 2% plus, now it's 1% to 2%. Is that a message to us? Are you taking share? Is that reflective of pricing being better on the organic side? And the fact that M&A is a little bit less than it was before, are you telling us maybe less M&A than in the past?

Let me start out, and then I'll ask Sam to add in. So the higher organic growth rate, I think, is driven by 2 things. Number one, we're going to continue to expand our own test menu. Mark talked about the advent of molecular genomics and the cost price point coming down significantly will open up more testing and within the oncology space as well. On the M&A front, look, our balance sheet is very healthy, as you know. We're committed to doing as much as we possibly can. Why the 1% to 2%? Look, as you know, these things are lumpy, right? And there could be a year where we do 1, there could be a year where we do 3. I don't want to just peg it every single year at 2%. As attractive as these hospital outreach deals are and as full as the funnel is, it just takes time to get these things done. They're emotional types of deals, right? All the hospitals are happy to consider this. But then they say, "Well, but we don't want to let any employees go." Well, you can't do a hospital outreach deal and really not release any employees because you had all these people in the lab doing the work. So it just takes time to get these things over the goal line. And I think that's -- so there's no lack of motivation. There's no lack of urgency. It's just the chunkiness of it is why we said 1% to 2%. Sam, any...

Yes. I think you covered most of it, Jim. I mean substantially, Kevin, there is really no change -- material change from what we've said before. I think we're still committed to the mid-single digits in revenue and high single digits in EPS, which is largely consistent with what we've said before. We wanted to be a bit more specific around M&A for the exact reasons that Jim mentioned without going into them. But again, as I said, also on the regional lab space, for instance, we do have some less opportunities there. There's been a lot of consolidation. On the capability building assets, I think we're going to be selective. We need to be really selective and discerning around what's strategically very complementary, drive synergies and drive accretion as well. So we're not just going to do anything that can be perceived as just really not responsible for our shareholders.

Over to Jack.

So for Jim or for Sam. So I think the economy in recession are top of mind for a lot of investors right now. Can you talk about the sensitivity or the variability in the targets that you've laid out through 2026, where Quest could have some exposure to a slowdown? And then do you think it's possible this could drive more opportunities for you guys around consolidation?

Yes. So let me just tell you, right now, I don't think we're seeing any recessionary impact in the business. Now maybe there's more to come, hard to predict. We came out of last year, we told you the base business in 2022, ex-COVID, grew 5%. The guidance we've given still predicts a robustness. Now look, we've gone back and looked at the impact of a recession back from the '07, '08, '09. Ironically, when unemployment spiked, there was initially a surge. While people were in COVID, they used up their benefits, then we did see a little bit of an impact. But Sam, thoughts on that?

Yes. I mean, I think to your question, Jack, more specifically on the financial side in terms of the projections, we have modeled some sensitivity around what happens, mainly on a couple of fronts. One is with regards to price, and I talked about price, it's not as much related to the recession or the environment we're in, but it could be related to PAMA or SALSA. And I talked about that in the presentation. We did model, though, on the inflationary side, higher inflation that could drive maybe more towards the bottom end of the range, lower inflation or current inflation, that could actually drive the middle to the high end of the range. So we did model those just to see what the sensitivities would look like with a different cost environment.

Derik?

Derik De Bruin from Bank of America. Two related questions. I mean, how quickly do you think the whole genome sequencing ramp will occur? And is there any incremental payer coding changes need to happen first to get this really going?

Mark?

Yes. I think initially, that, that will be mostly kind of in the background because right now, there really isn't a lot of reimbursement for it. But I think everyone else is doing the same math we're doing and saying, why spend $150 to create a library if the sequence itself is $200. So we're obviously working with our payers on other novel ways, given the permanence of the germline genetics, that we should be thinking about this problem in terms of long-term storage, personal privacy, sample once, interpret many times. So there are a number of things that I believe will roll through in the next several years. Our commitment is to be technically ready for that.

So that's a great follow-up. It's like when you talk about doing deals for capacity building assets, I mean, would you consider doing a dilutive genomics deal, technology deal given some of the valuations? Some of these companies have dropped significantly. Do you need to do your own MRD assay and work with that? Or are you comfortable partnering with other companies?

Yes. So as we said, the strategy is the following: Number one, like all testing in Quest Diagnostics, we turn to our industry suppliers that have a lot of expertise in this, the IBD companies. In the cancer space, I think that there's 3 primary companies: Illumina, Roche and Thermo Fisher. We know in detail what their pipelines are. We have discussions with all those companies every 6 months. So we know where they're at. Now if we don't think that gets us there in the time frame that we want to get there, there are at least a dozen small MRD companies out there. We talk to them all. We watch them all. Similar to how we got into the NIPT space, we didn't invent that. We licensed that technology. So we're open to licensing that technology. And as Mark said, many of these companies aren't going to -- they're spending enough money on the test development itself. Now you got to think about to really monetize that, you need 1,000 salespeople. You need people to collect blood. You need logistics. You need a company to actually scale the test to get into the cost point that the payers are willing to pay for. So those are all the things that we can bring. If that doesn't satisfy us, would we be open to an acquisition? Sure we would. But we work it in that order.

Dave?

Dave MacDonald, Truist. A couple of payer questions. You guys have talked about the 90% access for a while. Can you talk a little bit about what you've seen in terms of market share underneath that 90%? Where it was pre-COVID? Where you are now? Where you hope it to be in '26? And then secondly, on value-based care, you put the slide up about the 40 moving to 50 over time. Is there an opportunity to also look at more metrics and potentially drive bigger bonus payments within those in addition to kind of growing the pie?

Yes. So on the chart, recall we got access into UnitedHealthcare Horizon in certain states with Anthem, Elements into 2018, early 2019. And so we made a lot of progress from that, right? There was over $600 million of growth right from there, $400 million, $500 million. Now -- and look, we did that during the pandemic time frame. And I can tell you switching lab providers during COVID just wasn't on the minds of any physicians, okay? But we still didn't grow growth. But there's still lots of growth there to get us to the market share that we enjoy with the Cigna, Humana's, Aetnas of the world. So there's still growth potential there. The other side of that page, what we showed is the percentage of contracts that have some type of value-based incentive, meaning if we can move work from out-of-network labs from high-priced health system labs into Quest Diagnostics, there's incentives built in. But we're also working towards incentives around patient satisfaction, physician satisfaction, turnaround time. And all of those things obviously really matter to the health plan that is trying to maintain loyalty with the physician base and the patient base.

And then just one last one, if I may, on labor. You put up the turnover slide. Can you guys give us some sense of what you've seen in terms of year 1 employee turnover? Has that kind of moved similar to the overall number?

I would say the trend is similar. Obviously, if that's average turnover for all employees, you would imagine first year is going to be above that curve.

Patrick?

Patrick Donnelly from Citi. Sam, maybe one for you. You kind of picked through the revenue swap from last guide to this. So maybe just on the earnings side. I think the prior guide was 7% to 9%. I think that included PAMA the whole time. Now it's high single. If PAMA goes away with SALSA, maybe it's the high end; PAMA, maybe it's the lower end. I guess, first, is that the right way to think about it? And then secondarily, maybe just on the price/labor inflation inputs, and it might be one for Jim. How do you think about that piece? I know you talked about the inflation side. It used to be 2%. Now it's a little more 3% to 4%. What are you anticipating going forward on kind of that price inflation swap as well?

Yes. So maybe I'll take the earnings one. And Cathy can take the other one.

Yes.

I think the short answer is yes. You're looking at it the right way, Patrick. It's -- we've modeled EPS growth to basically reflect either PAMA or SALSA, with that being the opposite ends of the range. So if PAMA does happen and cuts come back in 2024, there's obviously cuts in 2024. There could be cuts in '25, still need to determine that. We're not sure there could be cuts in '25. So -- but we have modeled some element of that. And that would be the low end of the range. If SALSA were to be passed, then I think you would be looking more at the high end of the range. So I think you're looking at it the right way is the short answer.

So in terms of labor cost inflation, things like that, obviously, you can calculate the cost structure of the company, revenue minus income. We've told you before that about 50% of our cost structure is labor. That quickly gets you to something just under $4 billion, all-ins, labor benefits. We've said it had been inflating 2% a year from kind of 2012 to 2019. Most it's just, it's been in the 3% to 4% range. So obviously, that incremental 1% to 2% on $4 billion. It could be 80 on the high side and 40-ish on the low side. Will it stay at those levels? Look, the report out this week. We think in February, they saw a little less inflation. So we're hopeful.

Rachel?

Rachel Vatnsdal Olson from JPMorgan. So just a follow-up to Derik's question earlier. Within oncology, you talked about MRD being that meaningful growth opportunity. But obviously, some of that is driven by reimbursement. How are you thinking about the timing for reimbursement from some of these large commercial payers? And then how meaningful do you think that MRD can be a part of these 2026 targets?

Well, if you compare the rate of reimbursement in this space versus, let's say, therapy selection, it's clearly been a much more favorable environment, both from a CMS perspective and also a commercial payer perspective.

All good?

Go ahead.

Yes. The other thing I'd add, Medicare is covering it, right, for therapy selection for sure and for limited therapy monitoring test today. That means Medicare Advantage is covered, right? That means commercial plans that have Medicare Advantage plans are covering it. Kind of hard pressed sometimes to say we're only going to offer it on Medicare Advantage and not on the commercial side. Now it takes time, it takes medical evidence. But the fact is, we believe these things can save money for the health system, for the health ecosystem, right? These MRD tests applied right after surgery, what it's going to do is it's going to say some patients actually don't need adjuvant therapy. And so it's going to save everybody money, and it's good for the patient. But it will also say some patients need targeted therapies. And as Mark showed, there are some patients today that get traditional chemotherapy. They find out it isn't working. They go do some genetic sequencing. And then they put them on some higher-end targeted therapy, precision therapy, which may be too late. And so you really added expense, and you really haven't helped the patient. So I think there's really a good health care economic story around these tests. The other thing I'm going to tell you is it may -- it probably will save a PET CT and a whole body MRI exam, right? If you think about cancer care today, you have surgery, you go on adjuvant therapy. And what do you do after adjuvant therapy? They put you in a PET CT, $1,000 to $1,200. And quite frankly, if it shows up in a PET CT, I'm not going to say it's too late, game over, but it means it's metastasized. And the whole hope of these tests is to get it before it's metastasized in a meaningful way. So we don't see it in your liver, brain or bones.

Brian?

Brian Tanquilut, Jefferies. Sam, just to follow up to your answer to the question about the guidance range. Maybe just thinking about how effectively the high end kind of ticked down because now, if PAMA was there, we won't hit the high of the guidance range. So just wondering what are the factors that drove that change? I mean, is it just inflation coming in higher -- or the inflation expectations are higher going forward? Or are there other factors that we should be thinking about?

There isn't anything that's really significant, Brian. I mean it's -- again, it's a range. So there's definitely a range of outcomes. I think our low end of the range assumes that PAMA is back. As I said, the cuts resume in 2024, and the high end assumes that SALSA passes in, I mean it's a certain degree of range of outcomes that's embedded in the guidance. So I wouldn't say there's anything that's really that markedly different. And the guidance range as well, just to give you some context, we are assuming that we have 225 million of COVID in 2023, and that is significantly less by 2026 as well. So keep that in mind as well as you think about the long-term guidance. We're going from -- even though we're considering it part of our base business in 2024, that 225 million that's part of the base becomes something that's much, much smaller in 2026 because it's just another test.

So let me say something optimistic about PAMA, though. The reason PAMA has been deferred 3 times is because the CBO office, in the last 2 times, have actually scored it by deferring PAMA another year, it will save the government money. And why did they come to that conclusion? Because there's going to be a new data collection process. The new data collection process, we think, will be a fair process. Meaning they're going to sample health system labs and what they're getting paid for outreach work and they're going to sample independent labs, and they're going to put the data sets together. That didn't occur the last time. And so -- plus you have inflation and they're committed to paying inflationary -- to pay for inflationary impacts. That's why we got a draw fee increase from CMS this year. So the reason PAMA got deferred twice now is because the CBO office scored it as a money-saving opportunity for the government. So we're optimistic that we're going to push for SALSA to get a permanent fix. But if not, we're going to continue to push for a deferment.

Erin?

I'm sitting in the back here. Erin Wright, Morgan Stanley. So can you speak to what's embedded in your long-term guidance in terms of just core underlying volume growth? And has anything structurally changed that you're discovering here in a post kind of COVID world? And where are we now in terms of getting back to pre-COVID testing levels or baseline levels? And then my second question is just again on the regulatory front, a little bit on SALSA. So does the high end of the guidance assumes that the SALSA benefit just drops through to the bottom line? Or is there an assumption that you do reinvest some of those savings that would be incremental relative to PAMA?

Sure. On the second part of the question, the SALSA benefit drops through. We're not assuming necessarily an investment -- an additional investment, right? So within a certain degree of -- again, of variability within the range that we have, there's noise in there, but there's no significant investments that we're going to make if the SALSA benefit drops through. We still are committed to those investments that we have in the base that I've talked about, which were $150 million in 2022. With regards to your other question, Erin, we're not providing any volume outlook for the next 3 years, but I'd say qualitatively speaking to it, we've had a benefit in 2022 in terms of rev rec. And some of the things that are above the volume are providing benefit to revenue above the volume growth. So things like patient concession improvement, payer and test mix. And notably, the flu volumes that we've seen on the flu and COVID test panels, the flu volumes show up in our base business, that's been a benefit in terms of revenue -- in terms of our revenue per requisition as well. So that will probably moderate to some extent as COVID volumes fall because we've been seeing a benefit on the rev rec from that. But otherwise, there's nothing really substantial that we would expect to see as a change in the trends that we had in 2022.

More question in the back there?

Vijar from Golden door. Can you guys highlight some things about technology investments? Three years ago, you guys probably had to make a big shift during COVID, saying, "I'm underinvested here or I'm over invested there." Can you talk about the changes that you made in the last 3 years? And what you might be that are underinvested in today or is overutilized like going into the future, hardware and software.

So I'll touch on some of the hardware. Cathy, Mark, you can fill in, Mark, on the software side. So look, our investments over the last 3 years have been broad-based across the ecosystem from order to cash. So if you haven't been to any of our patient service centers recently, they're all upgraded. We've modernized all of the e-check-in features multiple times. Our logistics team, Cathy talked about how clinicians now can just literally get online, push a button and order a pickup. These are for offices that don't have specimens every day. And it's very valuable so that we don't go to an office where there's no specimen that exists. So all that IT infrastructure was put in place. In the laboratory, if you haven't visited our Clifton lab, it was a substantial investment that we kicked off pre-COVID, finished during the COVID time period. Cathy showed a map, we're committed to upgrading several of our labs across the network. So that's what's all in the capital expenditures that Sam has shown, and we'll continue in that $350 million to $400 million reinvestment. Cathy, anything else on the infrastructure side?

Yes. No. I mean the only thing I would say is, look, on the customer experience side, we're going to continue to invest in 2023 and beyond to, again, improve that customer experience while we're getting the benefit of productivity improvement, is how I would describe it in terms of adding to what you said, Jim.

Mark, why don't you describe on the bioinformatics side, the software side? Some of the investments we're making, especially as we move to whole genome sequencing?

Yes, there's really 3 things I'd highlight. One is that in order to be able to report out from a full next-gen sequencing machine, one of the key attributes that we've been working on and now have is the ability to mix and match across multiple workflows and sample types. So that most of the industry kind of built itself up on, you would have 1 sample type, 1 machine, 1 limbs, 1 LAS. And if things didn't fit within that, then they had to go to a separate machine. Well, in this world of competing on scale and scope, you have to have the flexibility to actually operate across multiple different library types. And so we've actually built that, deployed that. And it makes a huge productivity difference in terms of filling the machine and maximizing the leverage from that. The second thing I highlighted briefly was that we've been investing very heavily in interpretation software because, again, you started from this massive number of candidate genes and you have to really pair that down to what's really driving pathology. And I think that we would say that we have amongst the world's best software in that regard. We're obviously willing to continue to iterate with other people on that and so forth. But it makes a huge productivity difference, whereas historically, it might have taken, let's say, an entire day to interpret 1 exome based on not really understand what's wrong with the child. Now some of our geneticists are able to do in the 10s per day of those interpretations. So from a productivity standpoint, that really matters. And then the third thing, and it kind of touches on this whole genome, is that we've been moving towards a universal product code, which is, I guess, internal speak for, if you're going to run one backbone but have many different products from it, you have to have the ability to launch new products very quickly. And so by having a universe of product code that enables us to -- with a single workflow, be able to have a dedicated, tailored workflows, depending on the clinical need and the context and so forth. So we think that will enable us to continue to be at the very cutting edge of every single application with a single backbone. So all of those kind of lend themselves to centrally an economy of scale.

Andrew?

Andrew Brackmann, William Blair. Jim, you mentioned piloting some new systems and service centers. Can you maybe just sort of talk about some key considerations that you're looking at before sort of formally bringing those in? And then I guess just bigger picture, can you talk about how utilizing some of those might sort of help enable some more of that consumer-driven testing?

Yes. And so as I mentioned, there's a range of companies out there, you probably all know them all, Detect, Visby, Binks, others. Visby, as you know, has taken it through an FDA process. We work closely with them. We're close to piloting some of their devices in our patient service center. We think the consumer archetype, if you will, is right now, it's approved for 3 different STDs, as somebody who wants to know the answer right away within an hour. And we're going to pilot them. We're going to put it on our consumer menu. Those same tests that you can do in an hour can be done overnight. But again, there's a market -- a consumer segment out there that wants to know more quickly. These devices, and there's a range of where they are from a development standpoint. There's a range of technologies. Some are really full legitimate PCR technology. Other is something they call lamp-based, pretty good technology. But the target is they're molecular devices, right? So any molecular. It could be hepatitis. It could be HIV. It could be STDs, but they're molecular tests. We have 20 -- roughly 2,200 patient service centers, and we believe it could be a value-added service.

So the health plan ramp, the $600 million in health plan ramp that you described before, is it the same mix of payers that you've talked about in the past? And can you give us a renewal status update on maybe one of the marquee payer contracts you have?

Sure. There's a few important renewals coming up this year. Within the fiscal year, it is Aetna and Evolent, Anthem. And then at the back end of this year going into 2024, UHC is up for renewal. So discussions are underway with all. And we fully expect to remain in network with all 3 and, hopefully with 1 of them, actually expand our market access. So we'd like to drive the 90% higher. Again, I mentioned 3 states that we continue to work on, where our access is a bit limited. And so it's growth through the ones that we got into in 2019, continued growth there as well as growth coming from new access that we expect again.

One more from Brian.

Jim, just a follow-up to a question regarding the value-based comments made earlier. So as these value-based primary care groups get bigger and more prevalent around the country, does that open an opportunity for accelerating share gains because presumably, it's easier to gain contracts and scale? And then would PMPM contracting or other economic models make sense to potentially drive margins as you gain penetration in value-based here?

So we absolutely believe it's a mechanism to grow our physician office book of business for a couple of reasons. Many of the ACOs want to consolidate down to one laboratory, and it's important, right, to be able to offer population health-type services for prevention and wellness. We have not entered into any capitated per member per life or per member per month arrangements with these, okay? And as I mentioned, now primarily, this is in the Medicare space right now. Why Medicare? Because again, patients tend to stay with either Medicare or Medicare Advantage. And therefore, provider groups are actually willing to invest for the long term, if you will, right, and do the things that should be done upfront to ensure wellness. So -- but it's important. It's not just about the -- so again, it represents a growth opportunity, share gain, right, for 2 reasons, right, a lot of these large provider groups have POLs. In the minute they fix the revenue line, then it all becomes, well, what is the cost of care and the quality of care. Our prices are going to be less than their cost. And so we find these same provider groups where they take risk on patients, we get the work. Where they're still doing traditional fee-for-service, that work can be run through their own POL. So Medicare is committed to delegating 100% of the lives. I put a date up on the chart, and Medicare Advantage, I really think, is going to do the same thing. So a big growth opportunity.

I guess that's it for questions. Jim, do you have any last words?

Yes. Again, thank you for spending the morning with us. We hope you appreciate the story, the outlook, what we're doing from a purpose strategy and culture standpoint. Happy St. Patrick's Day to you. I would say Shawn did this all in green for Quest, but maybe there was a bit of St. Patrick's Day on his mind as well. So thanks -- thank you all for coming out.