SOPHiA GENETICS SA (SOPH) Earnings Call Transcript & Summary

Hi. My name is Casey Woodring from the Life Science Tools equity research team here at JPM. Welcome to our Annual Healthcare Conference. I'm pleased to introduce our next company, SOPHiA Genetics. Just a quick reminder before I hand it off to the management team, if you would like to ask a question during the Q&A portion of the presentation, there's an option to do so on the conference website. And with that, I'll turn it over to Jurgi. Thanks.

Thank you so much, Casey. I'm excited to be here today. Welcome to everyone, and thank you for attending our presentation. It's the first time that SOPHiA GENETICS is presenting at the JPMorgan Healthcare Conference as a public company. And I may say that I'm very eager to share our story with all of you. Before I start the presentation, I want to remind everyone that I will be making some forward-looking statements for which actual results may differ materially from those indicated as a result of various important factors highlighted in the cautionary notices, slide and in our public finance. As you may know, Sophia is a Greek word and it stands for wisdom. And at SOPHiA GENETICS, we believe that there is an unprecedented opportunity to create a wider and more sustainable health care system through the practice of what we call data-driven medicine. Founded in 2011, SOPHiA GENETICS has a headquarters in Boston and in Geneva, where today, over 500 employees, out of which 30% hold a PhD in data science or in computer sciences. And since we launched our technology to the market in 2015, we've seen great adoption with today over 790 customers, which are primarily university hospitals, comprehensive cancer centers, private labs as well as biotech and biopharma companies across over 70 countries around the world. To build upon such a mission, I'm very proud to say that we've been, over the years, able to built a very strong executive team with skills that complement very well to each other. And yesterday in one of our press releases, we were announcing the arrival of 2 new members that we believe are going to help us accelerate our penetration into both the clinical and the biopharma market, but in particular, in the biopharma market. Those individuals being Abhi Verma who joined us as Chief Technology Officer from Novartis. Abhi has been for many years managing the real-world evidence data strategy at Novartis; and Peter Casasanto, who is joining us from CellCarta and before that has been at Tempus and NeoGenomics, selling for many years technologies and data capabilities to the biopharma industry. Over the last 10 years, I think we've all observed that there have been a number of technologies such as genomics, digital pathology, proteomics, radiomics that raised and enable us to make amazing discoveries in science and biology. And beyond that, I think we can all recognize that those technologies and the companies that are leveraging on those technologies are being as well -- able as well to make big difference in our understanding of diseases and in particular, I would say, in cancer, which we much better understand now in terms of diagnosis and treatment decision. While this has been great, I think that the data that are being produced are still undervalued because they are disconnected to each other. And we believe that SOPHiA GENETICS that the world of tomorrow will be a decentralized work where there will be a tech platform that is going to gather all these data, breaking data silos across the modalities, genomics, proteomics, radiomics and others but as well across the institutions producing this data to create at the heart of the platform type of collective intelligence and continuously better deliver the clinical and the biopharma world in order to help them serve patients. With this mission in mind, SOPHiA GENETICS commercialized a cloud-based platform back 2015 into the market called SOPHiA DDM and the platform got fantastic adoption since inception. The basics, I would say, foundations of the platform really resides on the security of the data we compute, but as well on the artificial intelligence base algorithm that we've developed ourselves and enable us to better serve our clients as we compute their data after they have been producing the data, load the data into our cloud-based platform. The more data we compute, the more our artificial intelligence becomes smart. And so the more the network size gets bigger, the more as well benefits we can bring to all the users of our platform. The first 2 years, so after launch the platform in 2015 to 2016, we've been able to already cover the genomics profiling, computing of the genomics profile of over 78,000 profiles. And since then, I would say the adoption has been amazing. And by end of 2021, we're already at 920,000 genomics profiles computed in the platform, and we're going to break the barrier of 1 million genomics profile before this summer. So while we started our journey breaking data silos in genomic through institutions around the world, the platform has been designed since day 1 to be able to break data silos as well across modalities. And today, beyond genomics, we as well combine the diverse data sets, including radiomics data, so where we compute an extract signal actually from CT scan, MRI and PET scan data, in particular, in the world of cancer. And then by combining this data with genomics, clinical data as well as biological data, deliver multi-mix insights to our customers. Our platform is always agnostic. That's I think something very important to recognize. We can compute data that are being produced by any type of sequencer or by any type of imaging device, and we continuously leverage on our artificial intelligence through machine learning, pattern recognition and deep learning algorithms to deliver predictive models and serve other clinical and biopharma market. Now I think it's important for you to know that we consider there will be other data modalities that are going to as well move from license research to the diagnostic world, in particular proteomics digital pathology, special genomics, transcriptomics and metabolomics might be technologies that are going to enable everyone make a bigger difference in the field of data-driven medicine. And we think -- well, it's all we think we have actually organized the platform so that these data modalities can be as well onboarded into our platform. And by combining them with the existing data modalities we already covered, deliver even further insightful outcomes to our customers. So today, our market is primarily oncology. We actually do 80% of our business in oncology. And in oncology, our customers can work with us to follow patients all along the patient care continuum, either through our genomics or radiomics capabilities from cancer screening to early detection to question diagnosis, therapy selection, disease monitoring. And if the patients are failing into the therapy that they are being given as well in accelerating the onboarding of those patients into clinical trials. Our position is pretty unique because we can deploy these technologies not only for any type of tissue in genomics. So for example, tissue biopsy or liquid tumors. But as well beyond that, our technological capabilities can serve hospitals and biopharma for any type of cancer, lung cancer, colon, breast and beyond. While oncology has been important in our journey since 2011. We are already active in other disease areas such as rare diseases, cardiology, neurology and metabolic disorders, which we believe are still at the beginning of this journey in data-driven medicine and should as well contribute into our growth and our impact on patients as they are being popularized into the market. Now something very important to recognize is that our platform is not only universal and compute any data produced by any device. But on top of that, it's a collaborative platform, right? The intent being to create this collective intelligence at the heart through data pooling and knowledge sharing to better serve any of our customers. So in the clinical market, we've demonstrated this to be extremely powerful and now we have created network effects that continuously enable us to deliver better and better actionable insights to fight cancer and inherited disorders. And on the basis of the collaborations and technology we built into the clinical market, we started more recently as well to serve the biopharma industry by leveraging on our technology, on our network or on the data we capture into the clinical market to serve the biopharma market all along their drug development cycle by enabling them to deliver more quickly, more targeted drugs into the market. Beyond our impact in the clinical market in the biopharma market as a former scientist, I'm very proud to say that as well over the years, we've contributed on making new discoveries, supporting a number of academic centers in high-impact peer-reviewed publications. And all in all, this has been 300 high-impact publications that has been made feasible, thanks to our technological capabilities in genomics, in radiomics or by combining those data sources through multimodal approach. And 2021 has been a record year for us with 127 high-impact publications that were made possible, thanks to the use of our publications. I'm very proud about it. Speaking about multimodality, some of you may have heard that at RSNA, we had announced we were as well launching in our platform, an observational clinical study regarding patient suffering for non-small cell lung cancer stage IV, this study being called DEEP-Lung-IV. And today, we announced another press release, and I'm very proud about that to say that we've already in 6 weeks time, been able to onboard 12 centers that are going to contribute to this study, including the Carbone Cancer Center of University of Wisconsin and the hospitals of Paris. And the intent of this study being to follow 4,000 patients, we have already secured to follow about 3,000 patients with the 12 centers that we have onboarded. This will enable us to probably validate a multimodal biomarker that has a predictive value in who responds for as the patients who are being treated first-line immunotherapy for patients that suffer from non small cell lung cancer stage IV. And we believe that the materialization of this study really could be transformational for SOPHiA in our multimodal journey and tells a lot about the value of a tech player that is capable of capturing real-time real board data to serve the clinical work, but as well leverage on this data afterwards to serve the biopharma industry. We will obviously inform you upon progress during the year. But the first data point we got in terms of accuracy are very promising and we're very much looking forward to see how our algorithms are going to evolve as we are adding more data into the platform. This study is being managed in our platform through a module that is going to become increasingly more important, called the CarePath that intends to use our full multimodal capabilities to serve beyond the radiologists and the pathologists, oncologists and DEEP-Lung will be probably a first in kind that will leverage basically in our multimodal capabilities in the platform through the CarePath. And we will be very much looking for us to update you as well on the progress we're making on the CarePath as we move with our successes in 2022. We don't tend to work ourselves at SOPHiA. We like to enable others or partner with others. And along the line of what I shared with you for the CarePath as well as for the DEEP-Lung study, I would like to remind you that we have a global partnership with GE Healthcare. And in this partnership, we are basically combining our cloud platform capabilities of SOPHiA DDM together with the Edison platform from GE, which is an on-prem platform that computes and collect EMR and imaging data into the hospitals to accelerate basically this movement of breaking data silos across modalities and across sites and continuously deliver better insights. And I'm pretty proud to say that so far the partnership has been pretty amazing. And we're working already in a number of leads in the commercial -- in the clinical commercial angle so that we could jointly accelerate this movement of data-driven medicine as soon as 2022. At SOPHiA, we believe that in the space of data-driven medicine, like in the space of the tech world with Google and Amazon, there will be a dominant factor that will be at the heart of this data movement, leveraging on the network that the platform has been able to create and the data that the platform is digesting continuously. And a bit like a snowball effect will get better and better as more data are being computed, as more institutions are joining the platform, as more modalities are being computed as well. And we're pretty confident to say that SOPHiA has taken a lead with such a position. And we believe that we are in a unique position to end up being this platform that will deliver the most insightful outcomes as we progress in the next years into both the clinical and the biopharma market. Our TAM is estimated today to about $35 billion, out of which $21 billion are for the clinical market. and $14 billion for the biopharma market. And beyond, I would say, this is rational TAM I'm pretty proud to say that over the years, SOPHiA has been excelling in operationally delivering under its promise. And here, what I'm highlighting is basically the number of genomic profiles that we've been competing each quarter since 2016. So for the one that don't know SOPHiA so much we're being paid on consumption on news. And so for us, following the number of patient data we compute on a quarterly base in the platform is a very important metrics to follow our success and the adoption of our technology. But of course, as well to show the economical value that we are creating. And I'm really proud to say that Q4 has been extremely strong for SOPHiA with another record quarter where we've been computing all in all 66,000 genomic profile in the platform, and we hope or we expect rather these trend to continue as of Q1 and Q2 and further impact to be able, as I said, to cumulatively impact on over 1 million patients computing their genomics profile before summertime in our platform. Our strategy commercially is pretty simple and pretty typical from a tech player. It's really a so-called land and expand strategy. So the land intends to penetrate into the accounts, and this tends to be hard because of the nature of data we compute but as well because of the trust that the hospital, the lab, the biopharma need to gain on our technology and our capabilities, I would say, as well to secure their data. We land either selling directly ourselves or through distributors or through partners like GE. And once we have landed, and you will see that from our net dollar retention, we expand very nicely into our customers by the fact that their volume update are going up, and so they are loading more data into our platform due to the fact that we enable them as well with new applications. And so this ultimately makes up volumes as well are now growing for a new type of diseases, but as well historically with the fact that the mix price has continuously improved for us just as an anecdote, in 2015, our ASP was $50 per patient. And today, we are at an ASP of $140. And I think this really highlights not only the value that SOPHiA delivers to the customers, but as well the fact that the more technologies are delivering digital data, the more data-driven medicine becomes important, the more I would say data analytics is being valued by customers, and we expect these trends to continue as new data modalities such as proteomics and digital pathology are moving from licensed research into the diagnostic market and are being computed within our platform. In our long-term plan, we have 6 pillars on which we're working. And actually, all the 500 colleagues working at SOPHiA are incentivized along those objectives. So the first objective really intends to continuously increase the size of our network into the clinical market. The second objective intends to increase the usage of our platform in the network. The third intends to expand the menu of offering to continuously serve our clients with new technologies or supporting new data modalities. The fourth intends not to do that by ourselves, but leverage on partners to accelerate this movement. The fifth intends to leverage on our technology and the data we compute in the clinical market to serve the biopharma market. And last but not least, I think that remains still extremely important as we grow, we as well try to improve our operational capabilities being very focused, obviously, on the gross margin. But beyond that as well, creating a path to profitability, with the intent to obviously be a self-sustainable company in the midterm. 2021 has been a momentous year for SOPHiA GENETICS. We made our IPO in the NASDAQ and raised $263 million, which we are now using to accelerate our business. We have been serving existing customers, I would say, pretty exceptionally and this is being highlighted by 2 numbers. Our net dollar retention has been 140%. So which means that we've been growing our business 40% just on the basis of the existing customers we've already signed in 2020. And this 140% basically compares if we look at cloud companies, which are publicly listed and look at the top 50 of those companies, so an average of 118%. So I would like the one hearing us today to realize that as a tech player, we have really exceptional numbers in the delivery of our business. Not only that net dollar retention has been amazing, but as well the customer churn has been extremely low despite the special situation with COVID, and we lost below 1% of our customers. So not only we've been very good at serving existing customers, but on top of that, we've been good at launching new capabilities into the market and signing new partnerships that are going to pay off from next year on and it should enable us to increase our revenue. We launched 30 new products, including an application to support fully the TSO500 assay from Illumina in which we really count. And beyond that, for the 1 who have been following us during the earning calls, we launched as well a unique deep learning technology for HRD. You may know that the HRD biomarker is extremely important for PARP inhibitors and PARP inhibitors are extremely promising drugs that may serve multiple cancers and saw this might be as well a big catalyzer for us starting from next year. Speaking about partnership, we've worked hard and well on our partnership with GE and are already sharing leads in the clinical markets together before moving to the biopharma segment together. But I would like to highlight that beyond the GE, we've been signing as well other partnerships like the one with Agilent in genomics or IBEX in digital pathology. So end this the 2021 year very strong with a record number of analysis in our platform, 660 -- excuse me, 66 genomic profiles computed in the platform. All in all, 240 for the full year. And as well, we've been able in Q4 to secure 60 new customers, customers which have not yet been onboarded into the platform in routine. And so have not yet produced to -- not contributed to our revenue neither to the number of analysis we compute in the platform. With our business, we have a good visibility on our forward-looking performance. And today, I'm happy to share with you our guidance for our '22 revenue, where we expect to land between $51.5 million and $54 million revenue. Last, I would like to highlight that at SOPHiA, we are now in a unique position to better serve the clinical and the biopharma world in helping patients because our technology has not been as strong as it is today ever because operationally over the last 2 years, we've been building unique capabilities. And last, because with the IPO, we've been able to raise a substantial amount of capital that is now going to be used both to serve new customers, extending our network with the existing products, but on the same time as well, investing continuously in R&D to deliver new products to the market. With that, I would like to thank you, and Casey, I would like to welcome now our CFO, Ross Muken, so that we can take your questions or any question we would have from the audience.

Great. Thank you. That was a great overview. Had a few questions come on via e-mail here. So starting with data. So data is only as good as the technical ability of those who can put it, right? So the challenge of different languages and handwritten notes. Is it enough for you to work only with tech savvy doctors and hospitals?

So it's a very good question. And I think the question highlights the fact that data tend not to be very standardized, right? And indeed, the nature of the technologies that are producing the data and genomics or in radiomics and especially in the decentralized world make that the data you get to compute can be quite diverse in terms of quality, one from the other. And this is where basically SOPHiA has been uniquely positioning into the market. So our unique has been on building algorithms that can standardize data, almost irrespectively of how they are being produced, right? And this is what has been driving, I would say, our adoption since 2015, and we launched the platform. Our algorithms really are able to distinguish signal to noise, so that kind of irrespectively of how they are being produced the outcome will be equivalent.

Got you. That's helpful. And then one on sort of clients and relationships. So Kathy Hibbs is on your Board. I was wondering if you have any formal relationship with 23andMe. And then as a follow-up, do you have any insurance companies as clients?

So we don't have any relationship with Kathy. But Kathy is known to be, I would say, one of the most experienced person in the world of regulatory in the U.S. at least when it comes to health care and digital data. And in the journey of SOPHiA, we take regulatory and data privacy extremely seriously, and that's why we wanted to have a Kathy part of our Board. As you will read about us as we are progressing, we have high plans well to move into IVDD, IVDR and FDA-approved solutions. And we believe that the experience of Kathy will be pretty unique in helping us as well into this trajectory. When it comes to insurers, today, we don't have any payers neither insurers who are part of our clients. But definitively, I would say, as the principles of the value-based medicine are being proven and eventually, drug dealers or drug companies are being reimbursed according to the outcome, right? So the success of patients to benefit from the drugs, SOPHiA will be in a unique position as well to be a partner there, given the nature and the type of data we capture into the platform.

You can think about the CarePath product we spoke about today as being an obvious solution, not just for our clinical customers in the hospital and lab market. But ultimately, I would say, a great interest to the payers relative to the data that we can provide and the predictive models when you think about the outcome of DEEP-Lung, and it would be great to understand response, right, for the patient on day 1 as they're going through a prior authorization for that therapy typically given its cost. I think there's a huge amount of merit there and something we'll explore over the upcoming 12, 24 months.

Got you. Just had another one come on via e-mail, you guys are popular this morning. What percent of your business is in North America? And how do you address any regulatory requirements for using your products for clinical diagnostics?

I will start with the first second, and then I will leave Ross to answer the first. So today, our clients are primarily academic centers and private labs, right, in the U.S. And so when it comes to genomics, which still is our main activity, they develop their own LDT solutions, right? And so we compute the data as our own on the base of the LDT solutions that they have developed themselves. When it comes to the percentage of our business in the U.S., do you want to share some figures?

Sure. So obviously, you can look at our latest filings with the exact number. I would say, ultimately, the U.S. or North America is now north of 10% of analysis and revenue in terms of the mix. And we noted in the most recent quarter, North America was up triple digits, right? And I would say going forward, and what's imputed in our '22 guidance is continued, very strong momentum in the North American market, both from a clinical standpoint as well as from a biopharma standpoint.

And quickly, maybe as a reminder, we started our commercial journey in Europe and from 2015 to '18 exclusively sold in Europe and started selling outside Europe in 2019. And today, we have over 100 customers in the U.S., which are underpenetrated with our technology. And so we really expect the Northern American market to continue being the market that grows the fastest for us but as well the markets that will end up being the biggest for us.

I would say the most recent development the last, call it, 3, 4 months that's greatest interest to us is the activity level we're having with centralized and specialty laboratories in the U.S., right? Obviously, the U.S. market is a bit of a different dynamic than Europe and other parts of the world. And what's interesting, if you look at our pipeline, and understand where the conversations are, I think our position as a technology enabler in the U.S. market is enhanced. And I think there's a lot of interest from a wide spectrum of large and somewhat focused specialty labs, particularly in the oncology space to utilize our technology. Many of them already do in some form or fashion, but I think a much broader strategic sense, that will be a development to look for in 2022 that we're quite excited about.

That's helpful. Going back to one of your earlier comments. So the central lab dynamic seems to be where the bulk of your business will be in the U.S. Over what time frame do you think decentralization will play out?

So first, I would say that a lot of precision medicine initiatives started in centralized lab, right? Because at the time, it would take courage to start them. And that's why I would say this started often in the U.S. within central labs, and this was the case with hereditary cancer then solid tumor cancer and then liquid tumor cancer, right? Or liquid biopsy. Now what we see is already a big wave into decentralization even in the U.S. That doesn't mean that the number of samples and the volumes of the specialty labs and the centralized labs will decrease, right? I think it just shows that things are getting democratized, and that the understanding on how to leverage on this data makes it so that now many more centers are as well buying sequencers. Yesterday, I think we heard from the leading company in the sequencing market that they expect this market to boom as well in the next year. So I don't think this is by chance. I just think that with players like SOPHiA, data analytics has been demystified. So it's basically much easier and now buying a sequencer using our platform, make the adoption so much quicker, right? So what you should expect in the next quarters and years for SOPHiA is to expand our penetration into the academic centers in the U.S., but in the meantime as well, build strategic relationship with centralized that may not necessarily have the capabilities we have today to enter into new -- these areas or enter into new markets.

I think there's a healthy ebb and flow, right, in the market and you look at it in terms of historical technologies, right? PCR would be a great example where, obviously, newer technology, higher risk reimbursement, that tends to stay within the centralized laboratory and as it becomes more mainstream, it begins to decentralized. But then at that point, a new technology emerges and sort of grows again, right? And so I think if you think of it from that context, we're in the very early stages, right, of NGS in a clinical setting being adopted broadly. And so we're starting to see some of the early areas, whether it's hereditary cancer, BRCA, et cetera, start to enter a phase where decentralization is more broad-based. But ultimately, if you think about liquid biopsies, some of the other areas that are newer or even early detection, or whole transcriptome, these are places that are growing up in the central lab, but ultimately also will move to sort of decentralized and then there will be maybe a whole genome, right? And so there's a constant refreshing, right, of sort of technology and evolution. And it's a world where we can help empower our customers, but also frankly, enable many of these centralized players also to evolve and launch new products and move into new areas quickly.

That's helpful. I had another one come in via e-mail. Using Pfizer's relationship with Israel as a case study for a population, have you formed any relationships with governments to that end?

Which relation?

So in terms of governments, working with government agencies...

So far, we have not worked on that angle. I would say, being very pragmatic and been working bottom-up convincing practitioners. And I think in health care, changing the way we practice medicine is very challenging. And the best way is to work bottom-up, supporting practitioners to adopt new technologies.

Got it. You're launching HRD capabilities this year. How significant is this product? What level of interest have you seen from biopharma and clinical users? And how should we think about the revenue ramp in 2022?

So I don't think we will share our forward-looking revenue, right? But the product is extremely good and the interest is very high.

Got you. Maybe I'll go at that a different way. Given the accretive pricing of the newer products, how do you expect ASPs to trend in 2022 and beyond maybe...

Yes. I think this will be an interesting dynamic, right? So rather, this year, a lot of our net dollar retention or underlying same-store growth was driven by volume, right? I think you will see next year be both a mix of volume as well as ASP. As you think about HRD, obviously, I would say, being a nice driver for the business next year, clinical exome is as well, I would say, an area of interest and that carries an ASP that is higher than our average. And so this sort of overall push to richer and richer analytics per patient, all of this will benefit us. And again, as you think back to the land and expand slide that Jurgi shared, the wonderful thing about the SOPHiA business is it's not just one metric, right, that ultimately drives the revenue, it's really this sort of balanced algorithm in any given period, different parts may influence that growth rate more so. And so I think, again, as you think about '22, I would not expect the drivers to look the same as '21 did. And I do think while we'll have continued strength, frankly, in all aspects of the business heading into next year, I do think ASP has the opportunity to maybe contribute a bit more next year than it did in '21.

Got you. Quickly on the biopharma business, you've been signing 3 customers a year since launch back in 2019. What can you do to accelerate this pace? And then what's your thinking around the pharma monetization and pricing model there?

Yes. First, I would start telling that it takes sometime to find the product market sheet, right? So if one looks at our historical performance where we had -- we were more, I would say, testing the weather, and we didn't have any dedicated team to the biopharma segment, it will not give a good perspective of where we stand today. So today, we stand in a very good position better than ever and as well the recruitment of Peter Casasanto as Chief Biopharma Officer; as well as Abhi Verma as Chief Technology Officer. And our offering is pretty clear. We are leveraging on our technology, including HRD, and we've been talking about that in the context of a deal we signed with AZ . But beyond that as well, you can expect that we will leverage on our technologies to better support or further support the biopharma industry on the base of their own data. And beyond that, I would say that with our decentralized [indiscernible] now being perceived by biopharma players, including clinical research organizations as being a unique source to access to the data, right, either pre-approval or post approval of a drug to accelerate the recruitment of patients or as well identify centers into which eventually there needs to be reps going to do some advocacy as these are centers that are identifying patients that may benefit from some sophisticated treatments.

That's helpful. Maybe touching on competition quickly. How frequently do you run into competitors like Foundation and Flatiron on the clinical side and Tempus on the biopharma side. What's uniquely advantageous about SOPHiA's business model?

So obviously, we hear about those names and others. But I think fundamentally, the difference between the names you shared and SOPHiA's is that we support a decentralized work, right, like in the tech world, while those actors, which are being pretty successful are doing that through their lab capabilities. And while I think Foundation as you have seen as well as being planning to decentralize their capabilities, I should say that today, we don't see them in a decentralized world. When it comes to the biopharma discussions, indeed, the type of actors we talk to are using Tempus and others and us. And I think they understand that one shouldn't go only for one unique source of information, right? Because you want to make sure that you get the maximum number of information before you take decisions, especially considering how expensive can be the development of a drug.

Got you. Maybe last one here before we have to wrap up. Something that's been a key investor question that we get a lot on you guys is the potential for customer churn, which you guys have seemed to reduce here to less than 1%. So can you maybe elaborate on that?

Yes. So I think historically, maybe there's a little bit of confusion with some of the disclosures. So when we talked about our customer churn in the S-1, it was over a 5-year basis, right? So 15%, that was around 3% a year, right? And I think if you put that in the context, again, of our net dollar retention, which is normally how it's looked at, we are best-in-class, right? If you looked at other companies similar to us in the software space, these are some of the premier names, right, whether it's Twilio or Snowflake, right? So I would say our retention and same-store growth metrics are unmatched. To have sub 1% this year is, frankly, sustainable, right? That's not something I would expect to repeat. Normally, there is a healthy amount of churn that happens over the course of relationships. So I think it speaks to how the health care space, though, is sort of unique, right, in that once you adopt the technology and we start expanding with an organization, the switching costs are quite high. And frankly, we've also delighted our customers, right? So I think the mix of high friction to leave and how well we've executed speaks to that very sticky base. But frankly, I think the best metric that you should grade us on is that net dollar retention. And again, I would argue if you look at the spectrum of, frankly, all software companies and put us on it and looked at where we fit on that continuum and then looked at how others are valued in the software space, I think you would find a pretty big disconnect in sort of the understanding there of where we slot in and how impressive those statistics actually are.

Got it. Thank you. It looks like we're out of time. So I guess we'll leave it at that. I want to thank the team here. And yes, enjoy the rest of the conference. Take care.

Thank you so much, Casey.

Thank you so much.

Bye-bye.