Todd Fruchterman
Analyst · Cowen. My apologies. Matt Taylor from UBS, your line is open
Thank you, Agnes, and good morning, everyone. We appreciate you taking the time to join us and learn of our progress this quarter. There is much for our team to be proud of as we build our foundational strength and make advancements towards realizing our vision of democratizing medical imaging and transforming care by enabling more informed clinical decision-making. And while we are improving every day, based upon our most recent experiences and the current healthcare environment, we must reset expectations for revenue for the balance of the year. While our revenues for Q3 grew 44% year-over-year, we are falling short of what's necessary to achieve the annual guidance provided by prior management one year ago and reaffirmed by me in May of this year with the information I had, having just joined the Company. For 2021, we now expect full-year revenue growth in the range of 30% to 34%. This represents good progress in our current commercial activities in mounting user enthusiasm about Butterfly, but is offset by healthcare logistical challenges, and doctor, nurse, and medical technician fatigue concurrent with COVID conditions and it's broad consequences. To understand our user base, it is important to recognize that there are multiple layers of Butterfly users. Many individual practitioners, and early technology adopters are excited about our portability, affordability, and breadth of utility. We appreciate their early adoption, advocacy, and feedback. Many of them have been engaged in life-saving, practice altering work, and hold a deep understanding of how Butterfly can improve decision-making to both accelerate and enhance care delivery. A second group of users across multiple specialties is increasingly adopting Butterfly, as we properly segment, educate, and integrate the power of Butterfly into their respective areas of practice. Here we are focusing on specific capabilities of this system and helping users to rapidly incorporate it into their practices and workflows. Over the coming quarters, we will continue to roll out programs targeted at specific specialties and procedural use cases, and are aligning commercial energies around doing so. Finally, because of the unique aspects of Butterfly, we are well-positioned to increasingly engage a third group of users, large integrated health systems. Our value proposition reaches wide for the enterprise user across many divisions, departments, and sites of care. As we alone, can integrate new clinical data and insights conveniently, cost-effectively and at enterprise scale. We expect our journey with hospitals and health systems to be collaborative as we work together to practically unlock valuable clinical information that will fundamentally change the course of diagnosis and treatment of patients in a variety of care settings. Such enterprise engagements require close integration to optimize enterprise workflows and systems, and ensure proper compliance, security, building integrity, and continuity. Introducing Butterfly to the enterprise is less about sale cycles and more about partnerships, and we are pleased with our current momentum among this important user audience. Across all three layers of customers, in all geographies, we need to recognize that we are early in our journey and that commercialization, development, and clinical advancement will be iterative. One clear thread that permeates all of our customer lanes is our commitment to consistently and persistently drive ease of use and simplicity. Delivering ease of use and simplicity in all we do is a north star for our journey we'll be a clear value differentiator in the market and there's a personal commitment from our team and from me as we support doctors, nurses, and technicians to help them more effectively transform the way they practice medicine. It's important to note that there has been a significant management evolution since projections were first made that included an aggressive back half, 2021 ramp. While we have rapidly reoriented strategy team, and the Company overall to adjust to the need to shift from a direct to user led market approach to a more integrated commercial approach to health systems and specialties. Our near-term performance has been negatively influenced by confluence of factors. We believe that many of these factors are transitory and that our commitment to evolve and expand our commercialization approach, while constructively supporting behavior change in clinical practice, will be a long-term competitive advantage and one that Butterfly, with its innovative solution, is well-positioned to do. On a macro level, it is well understood that the healthcare community is suffering from exhaustion and severe human resource constraints resulting from the most recent COVID, Delta wave, as well as overall labor shortages. Butterfly was specifically developed to support these very medical professionals in their ability to diagnose and treat more effectively more rapidly, and more affordably. Amid these unprecedented times, however, we have seen prospects and customers alike have to shift their attention to the pressing issues of the times rather than focusing on deploying new technology or adopting large-scale behavior change. We expect that these conditions will pass, but we do not expect them to disappear during Q4. To further respond to the needs and opportunities of the market, we have strengthened our talent in areas to enhance enterprise customer and prospect engagement and augment solution ease-of-use. These changes have resulted in high-value work streams that are currently active, and we believe will significantly accelerate growth in 2022 and beyond. The leading indicators of this progress are the quality of the leadership team we are building, improving customer satisfaction, which is evident in our Q3 sequential uptick in net promoter scores, and our in-process discussions with large institutions to kick-start enterprise level implementations, all of which give me great optimism about future business acceleration. We believe Q3 and Q4 revenues are a lagging indicator that reflect the transitory challenges I just described. Butterfly is digital health and practice. Our disruptive system is uniquely positioned to deliver the value of better clinical information at the time it is needed. And our evolution to emphasize enterprise level commercial strategies, carries with it, our commitment to listen, learn, create, collaborate, and rapidly develop solutions that maximize not only the amazing utility of Butterfly, but enhance its ease of integration for those who will implement Butterfly at scale. Our goal is not simply to replace larger, more expensive technology with one that is more affordable. That alone is allottable and an obtainable goal, but if falls short of our societal and commercial aspiration. The differentiated power of Butterfly is that it guidance better clinical decision-making and subsequent care planning in a practical, cost-effective way. Butterfly has the technology and capability to fundamentally change the way medical information is gathered, decisions are made, and care is delivered. With Butterfly, clinicians can dramatically improve diagnosis accuracy and speed, inform the course of treatment, and provide an unmatched patient experience and better outcomes regardless of care setting. An important component of bringing Butterfly public and obtaining more than $500 million of funding was the understanding that maximum impact would be created through connectivity and collaboration with frontline healthcare professionals and industry thought leaders. You see our commitment to that in the leadership team, we have assembled and the board members who have joined us. In the coming quarters, you will see that confirmed by larger collaborations with institutions of scale who share our vision to dramatically improve the standard of care by deploying Butterfly as an advanced assessment tool throughout our institutions and systems. To further support our go-to-market approach, in only a matter of months, we have reoriented our technology group under the leadership of CFO Andre Andrei Stoica, to include industry-leading best practices for enterprise and workflow software development to bring agility and speed to our enablement of larger scale enterprise collaborations. This is not only reflective of the iterative journey of co-development we are undertaking, but it is demonstrative of our perpetual commitment to emphasize ease-of-use and take more of the user burden onto the device and system, whether it be at the platform level, the solution level, or with our investment in AI. Furthermore, we understand that a component of enabling ease of use requires removing implementation barriers to facilitate behavior and practice change. And at the beginning of the journey, enhancing education is critical. This is why we continue to build and optimize our team around these critical priorities. We have augmented our clinical leadership under the direction of Dr. John Martin to better participate in and drive expansive clinical conversations with prospective partners as a means to advance the evolution and incorporation of ultrasound information into clinical workflows. We have also revamped our sales organization under our Chief Commercial Officer, Stacey Pugh, to give us the human capital necessary to more deeply engage with our clients. We have complemented our internal investment in AI with an exclusive agreement with caption health, which I will discuss in more detail later in the call. I recognize that it is frustrating to the investment community and to our management team that you cannot see the full evidence of our progress in the revenue stream in the back half of 2021. But we believe we are making significant progress and are better positioned to capture the full potential of Butterfly moving forward. Despite our revenue shortfall, our adjusted gross margin, and adjusted EBITDA are projected to exceed the original plan and we continue to invest aggressively in products, people, and commercial expansion. Our underlying momentum is building and we expect to see accelerating revenue growth in 2022. We will communicate our complete 2022 forecast to the investment community concurrent with our Q4 earnings released and investor call. However, I will share with you today that we are confident that our rate of revenue growth for 2022 will exceed our projected full year 2021 growth rate. We have made significant and measurable headway in 2021 and our team is sprinting forward. As a true growth Company, I want to reiterate my personal passion and conviction that we are here to invest higher, build, partner, collaborate, and co-create across all aspects of Butterfly. We will enable superior image and data capture everywhere and anywhere, from assessment in traditional healthcare channels, alternative sites of care, the home, across specialties who have never had access to timely imaging information before. And within geographies that have never had high-quality medical imaging. We know that every version of success for Butterfly starts with building a highly talented, capable team to support our vision and growth. I'd like to share a few leadership updates from this quarter. To support oversight on our growth and innovation strategy, we expanded our board with the appointment of Dr. Erica Schwartz. Dr. Schwartz brings a breadth of healthcare management and public health experience to the Board of Directors. Most recently, serving as Deputy Surgeon General for the U.S. Department of Health and Human Services. Where she led the country's public health deployment and response to the COVID-19 pandemic. She also spent 24 years in the uniform service with the U.S. Coast Guard, serving as Chief Medical Officer, and then other leadership roles. Dr. Schwartz will serve on our newly formed technology committee with Dr. Rothberg and Dr. Edelman, providing oversight of the role of technology in executing our strategy and supporting our business and operating requirements. As we continue to scale and expand the business, we have been adding executive leadership in areas that would support our strategy and initiatives to accomplish this. In the third quarter, we added Troy Quander as our Senior Vice President, Regulatory and Quality to lead this critical capability. He brings over 25 years of FDA and industry experience with a focus on regulatory affairs, compliance, quality, and post-market surveillance teams. Troy previously held roles at Olympus, Roche, Becton Dickinson, OraSure Technologies, Johnson and Johnson, and bioMerieux. With the addition of Troy to our existing regulatory and quality team, Butterfly further strengthened our ability to bring additional innovative solutions to market in a compliant and timely fashion. I'm very happy with the rapid evolution of the leadership team and with the addition of Troy, we have become even stronger to take us through the next part of our journey. We also find confidence and are encouraged by the growing evidence in scientific publications that demonstrate Butterfly use across different settings and phases of Capex. Recently, the New England Journal of Medicine published an article that talked about the growing use of POCUS and factors that have led to broader adoption being driven by the advent of smaller, more affordable ultrasound machines combined with evidence that physicians without a radiology background can be confident and use them effectively in practice. Beyond publications, there are more and more stories spanning a variety of procedural areas being told by physicians who are using Butterfly in their practices in institutions. One that I would like to highlight was presented at Pacira Biosciences recent Investor Day. Pacira is a specialty pharmaceutical Company that creates therapeutics to manage pain. An anesthesiologist from a leading academic medical center walked investors through a timeline about the use of regional anesthesia during surgery. He then showed a picture of Butterfly as a disruptive technology that has enabled the broader adoption of regional anesthesia to improve patient care and post-operative recovery. Even with extensive training, it is challenging to administer regional anesthesia without complications. Butterfly changes that. With our solution and Needle Viz technology, the anesthesiologist can see the targeted area and safely and effectively administer the anesthetic. This is what Butterfly makes possible. There is more to come as we meet the needs of our customers and innovate so that Butterfly is not just accessible, but present in the pocket of all physicians and healthcare providers everywhere and anywhere. Another important enabler of behavior change ease of use. In August, we announced an exclusive partnership with Caption Health, the creator of Caption AI, the first and only FDA cleared AI guidance, ultrasound software. And the recent recipient, not only of a technology add-on payment or NTAP from CMS but also of Time Magazine's best invention of 2021 recognition. With an AI powered Butterfly and Caption Solution, we believe we can meaningfully enhance cardiac assessment. Specifically, our integrated solution will take on more of the burden of capturing and interpreting the ultrasound, while providing practitioners with quick and relevant information about a patient's cardiac state. Not only is there significant opportunity to better manage identified cardiac conditions, but there's also considerable undetected disease in an across our communities. As a recent study from circulation heart failure showed, 46% of heart failure patients diagnosed in the acute care settings has potential heart failure symptoms during primary care clinic visits in the previous 6 months. We believe that advanced diagnostic solutions, like the one we'll bring to market with Caption, may be able to help identify undiagnosed heart failure earlier and bring people to therapy sooner before they get sicker, resulting in fewer unnecessary acute care visits and decreased medical costs. Butterfly and Caption Health are expected to introduce the combined platform on Butterfly iQ + in the U.S. later this winter. Another way to expand access to information is through unlocking new markets. As we evolve as a Company, global expansion will become a greater focus as the demand for Butterfly growth everywhere. We are excited to share continued momentum in the growth of our distributor relationship, a key mechanism to expand our reach. You will recall that last quarter we shared our entry into the Hong Kong region with a partnership with Chindex Medical. True to our mission to democratize care around the world, I'm pleased that through partnerships we entered into this quarter, we will make Butterfly available in Chile, in Pakistan, and through a more recent strategic partnership with Abdul Latif Jameel Health, we will bring Butterfly to the Middle East, North Africa, Turkey, and India. With these activities, we are helping to address global health equity needs by introducing Butterfly to market that need better, more advanced technology and information to deliver a higher standard of clinical care. And this is not just about creating access. One focus area for Verizon, our partner in Pakistan will be on improving health outcomes for expectant mothers, leveraging the affordability, portability, and capabilities that are unique to the Butterfly solution, such as the new OB tools, including the gestational age calculator that we launched last quarter, they will be partnering with provincial governments to aid healthcare workers to take Butterfly devices into the homes of pregnant mothers and provide access to care that otherwise is just not available. Another important driver of our growth is organic innovation. This quarter, we released a new product for the veterinary market. We launched Butterfly iQ + Vet, our second-generation veterinary ultrasound device which is designed to bring more valuable information and capabilities to veterinarian in a variety of clinical settings. The iQ + Vet has many new features. Comes with color Doppler sensitivity, and Needle Viz tool. And notably was designed with a 15% smaller probe face and a 10% shorter probe for easier overall use and maneuvering. With the introduction of iQ + Vet, we have also expanded our market reach. The product is now available for purchase in 19 new international markets. And we continue to grow with large-scale partnerships and distributor relationships in the U.S. And now the UK. We are very excited to bring value to the veterinary market in parallel with our work in human healthcare. Additionally, we announced the large-scale partnership with Rarebreed to bring Butterfly to all of their veterinary hospitals. This adoption reflects an important change in the perception and deployment of Butterfly that is different from traditional ultrasound use in veterinary medicine. Rarebreed had several experiences with Butterfly that catalyzed their decision to adopt across their hospitals. There is one instance that I would like to share with you. A veterinarian at a Rarebreed hospital worked with a dog was reported [Indiscernible] lumps by the owner. The veterinarian performed a physical exam and used Butterfly to perform a quick ultrasound of both lesions where the vet noticed marked sonographic differences between them. This led the vet to perform a quick fine needle aspirate, which led to a diagnosis of a tumor. The vet then used Butterfly to ultrasound the liver and spleen to look for metastatic disease. All of this occurred during one appointment. Rather than waiting to obtain insight by referring out to a specialist, the veterinarian was able to acquire valuable information to guide an accurate diagnosis and provide information immediately to the pet owner, reducing the stress associated with waiting for diagnosis and allowing the owner to focus on the wellness of the past. I hope this story helps to illustrate yet another flavor of what Butterfly makes possible. Before I turn it over to Stephanie for a more detailed financial discussion, I want to reiterate a number of points that I think are crucial to understanding our direction. Butterfly's great potential is to re-imagine healthcare by enabling more informed care decisions. The differentiated power of Butterfly is that it unlocks ultrasound information in a practical, cost-effective way. Through the confluence of a transformational device that enables information acquisition and innovative software that makes the information usable, we are creating an entirely new clinical experience. We know changing behavior requires hard work and we are now well-positioned to drive this positive change. We will relentlessly pursue simplicity and ease of use to enable Butterfly to be used in the broadest number of locations by the broadest number of users across a broad range of clinically meaningful and impactful applications and settings. We don't just want to make clinicians better [Indiscernible], we want Butterfly to make practitioners better clinicians. We are already in the process of changing clinical behavior, and we are continuing to see proof points that acknowledge the use of ultrasound to establish a clinical diagnosis or to guide a procedure. Even with the challenges of the current environment, we continue to build momentum and are still seeing strong demand for Butterfly. And finally, in my 8 months at the Company, my commitment and excitement have only grown stronger. I will now turn the call over to Stephanie for a review of our financial results. Stephanie.