Good morning, everyone. Welcome to the Respiri Investor Update for the September quarter. With me on the line, I have Marjan Mikel, who's going to present to you today, and Chairman Nicholas Smedley. Down the bottom of your screen, you should have a Q&A button. If you could put any questions through there, Marjan will assist with answering those that we can get to today on the presentation and can assist with any further via email. I will now hand over to you, Marjan.
Thank you very much, Nyree, and good morning, ladies and gentlemen. Thank you very much for joining us today. You can probably tell I've got an upbeat tone in my voice because I'm looking forward to sharing the progress that we've made, the very strong progress we've made in financial year 2025. Hard to believe that it's almost the end of calendar year 2024, but much has happened over the last six, or sorry, four months of this calendar, of this financial year. And much of it you know of, and I just want to touch on it in a little more detail to provide a little more color on the pieces of the strategic and operational jigsaw puzzle that the team has been working on at Respiri for some time now, and they are beginning to come together very, very nicely indeed. Oops, excuse me.
Some of the highlights of what it is that we have in store moving forward. It's important to note that although our numbers have been doubling very, very quickly over the quarter, the opportunities that exist for the organization with regards to the current total addressable patient market that we have with our current clients at 50,000 patients. We've only scratched the surface of those moving forward, and I've discussed many times that we've got about 8,000 patients on identified patients at the moment that we are currently actively looking at onboarding onto our programs and doing so as quickly as we possibly can. At capacity with the new onboarding process, we are able to onboard or contact about 1,000 patients a month, and at capacity, a conversion rate of roughly 350 patients per week. Sorry, not a month, a week. So I do apologize for that.
The other very exciting thing is we have a very, very strong pipeline with advanced discussions with quite a number of clients where the patient pool for the real patient RPM pool is 250,000 patients. Now, these accounts are qualified, and we are in very, very advanced discussions with them. So the future looks very rosy for us moving forward. As you know, we have 29 contracted clients at the moment, and those numbers are expected to grow significantly over the next couple of months. It's also important to remember the value proposition that we provide touches on the large incentives that have been put in place for providers and payers to deliver healthcare services in a very different way to the way they were delivered in the past. We are aging. Chronic conditions are increasing.
The stresses on healthcare budgets continue to be a major issue, and changing the way that healthcare is delivered, not just in the United States, but globally, is a necessity for us to do more with the money that's available to treat the conditions and healthcare in the United States, so remote patient monitoring and connected care services that we have and can deliver on behalf of clients is a critical part of that narrative. Now, it's important to note that the regulatory environment, and we announced this a few days ago, or yesterday, I should say, the regulatory environment is extremely supportive of these connected services. You would have seen yesterday the AMA has endorsed, for want of better words, the continued requirements for RPM moving forward.
They have made changes to the RPM programs that make it easier for patients to qualify, easier for doctors to claim the reimbursement codes, hence broadening the number of patients that will be eligible and qualify for these services. Now, that's really important from our perspective because if you look at the current reimbursement rates, we anticipate from our forecasting that our per patient per month fees that are currently sketched for $70-$90 per patient per month could double under the new regulations that have been put, or the new recommendations that have been put forward by the AMA. Now, these still need to be ratified by CMS, Medicare, but they invariably in the past have followed the recommendations of AMA.
Now, that kicks off January 1st, 2026, which is exciting, but the much more important strategic issue is that remote patient monitoring is seen as a key part of the healthcare investment mix moving forward. It does not appear to be going anywhere. Very important to note, and that's a wonderful backdrop and strategic foundation for the business moving forward. As I've discussed, patient programs are growing at a great rate of knots. You would have seen we clocked over 2,400 patient programs in the September quarter, and this is growing at a great rate of knots at the moment as I speak. We'll have more to say about that when we release this current quarterly report in January. Important to note that we continue to actively assess potential acquisition targets. This is a key part of our strategy moving forward. We're not going to be buying anyone.
We're buying very specifically targeted organizations that supplement what it is we do and add to the organization that we would become should we decide to actually bring them on board. These organizations will be EPS accretive, or the, sorry, the transactions will be. That's our intention, and it's not just a case of how much we save through synergies with these organizations, which is quite significant, but also the cross-selling opportunities that we know we can deliver to organizations, and we have done with our, for instance, our Ceras partners in almost doubling the number of services that we provide to existing Ceras patients. Now, we know we can do that, and we know we can do it very quickly, and this is one of the key parameters for anything that we would consider bringing into the Respiri family.
Important to note, we recently announced that we can now put hand on heart and say that our services provide superior patient outcomes in reducing events, healthcare events that result from poorly controlled conditions, chronic conditions, reduced hospitalizations, reduced re-hospitalizations, reduced visits, and really importantly, improved compliance. Those four parameters are the key drivers of healthcare outcomes for patients and, needless to say, are a key contributor to the growing expense line that CMS and insurers are currently experiencing with an aging population. You reduce those, you reduce costs. You reduce costs. We're a very popular, popular partner for people. We've also announced that we're currently at roughly AUD 6 million on a recurring revenue basis and have already banked about $211,000 in September on a monthly basis. So we expect those numbers to continue to grow at current growth rates.
We double those in quarter three versus quarter two, and we expect very similar numbers moving forward. Why people look to Respiri as a partner is pretty straightforward, and I think I should touch on these. I mean, we have a patient onboarding and engagement program that is second to none. We have the ability to be able to get patients on program very quickly. Importantly, once they're on program, we keep them on program. We're twice as good as the average CMS performance in that regard. Our clients like that. We're also very happy to put our money where our mouths are. So we are in advanced discussions with ACOs, payers, and IPAs, ACOs being accountable care organizations, IPAs, independent physician associations, and are willing to enter risk-sharing contracts with them where we don't get paid per service, but we get paid per member that we are looking after.
The benefit of that is the day the contract starts, we start getting paid. So there is no lag time. And the other opportunity, depending on the contract, is we get to share in the spoils at the end of the 12-month period. The contract's usually three to five years, but after 12 months, there's an upside and a potential downside that we need to potentially participate in. Now, the downside is, as you'll see later, something that we mitigate heavily with our services, but also are in a very good position to calculate based on our analytical and AI capability. So we know pretty well where we're at when it comes to what the risk is to any one of these contracts. As I said, we are in very advanced discussions with a number of these clients.
In fact, I was on calls with some of them this morning, and they are moving ahead at a great rate of knots. Important to note that wheezo still remains a differentiator for us. If you want to do remote patient monitoring in anything to do with lungs, you can only do it with wheezo. Now, that is an important piece of our mix that we will not lose moving forward. We've got the ability, an analytical and AI ability to be able to identify high-risk patients, but not just high-risk patients of today, but high-risk patients or patients that are forecast to be high-risk in the period that we will be managing. That's really important because we need to, particularly for the risk-sharing contracts, be in a position to target those patients that are likely to cause most issue when it comes to complications and costs.
Typically, for a contract of a risk-share contract where we have, let's say, 5,000 patients, Respiri would need to target typically somewhere between 8% and 15% of those patients with a program to deliver the necessary savings that our clients would need to affect the savings that they require. That's roughly one in ten patients needs to be on a program. The typical numbers for per member per month, that is, of the 5,000, we get paid a fee for every one of those 5,000 is somewhere between $10 and $40. We only need to really engage with one in ten of those. The numbers are very, very attractive if we get things right.
Clinic in Cloud remains an important part of what it is we do because we use that as a way of completely mitigating the choke points that we've experienced with clients in the past in getting these programs up and running. We take on board all components of the remote patient and connected care programs that we have, allowing our clients to focus on doing what it is they do, and remote patient monitoring isn't something that they do. We have a policy of hiring locally because that makes a big difference when it comes to the patients that we're dealing with, particularly in places like Hawaii where we're getting a very good foothold in the business over there, and the way that we process the data required for billing and claims also makes us an attractive option for our clients.
I think all of this, and as I said, the things that we've done, the narrative that we have, the pieces of the puzzle that we've pulled together is being recognized with a reasonable share price response over the last couple of months. I wanted to take time to remind people that we haven't been in the United States for 10 years. We entered the U.S. market with a distributor model in January of 2022 and achieved quite a bit over that period of time through our partners. Let's just say, and you know this as a part of my narrative, I wasn't necessarily completely sold on the way that our partners were engaging with their clients. I just have a difference of opinion, as I often do. In August of last year, we bought one of them to be able to do two things.
One is take greater control over the operational issues relating to the business and do it our way, the Respiri way. And secondly, and more importantly, provide our clients with a total solution across all chronic diseases. It's important to note there are very few clients that want a solution for a particular chronic condition. They have high-risk patients, high-risk patients who have many comorbidities, and they rely on a partner like Respiri to identify those patients, identify the condition that we need to be targeting, and then monitor that patient's totality and also monitor the data around the condition that's causing most grief. So there's been a constant stream of achievements over the last 12 months. We're very pleased with everything that's going on. Where we are today is essentially 14 months on from the time that we bought Access Telehealth.
So that is not a lot of time in anyone's imagination, but launching in a new country to achieve what it is we've achieved, I'm very, very happy with. Now, it's important to note that the opportunity that exists for us is being driven by the expensive nature of healthcare provision in the United States. One in two Americans have chronic diseases. These chronic diseases contribute over $4 trillion in healthcare costs, not billion, trillion. It is a huge problem, and it is growing exponentially. I spoke to the fact that the traditional model is reactive, and it is failing patients with chronic diseases because today a patient leaves their doctor, leaves their clinic, no one's got any idea what's happening with them. And it's not in the clinic they have the issues. It's at home. We help bridge that gap.
Readmission rates are a major cause of cost explosions in the United States, and importantly, as I've said in the past, CMS actually fines hospitals if they breach readmission rates. So it's really important to note that the cost of this particular market that we are in is huge, the conditions driving these are the usual suspects. Cardiovascular, diabetes, and COPD are the three major areas of cost in healthcare, and it is important that any organization dealing in this space has solutions for these three areas. Respiri does, and I'd argue that in COPD, we are the only company that has something that is easy to use, reproducible, and acted upon. So that's a really important piece of the puzzle and the narrative that we give our clients. We address all of these.
When you look at the types of conditions that we're looking at, it's again your usual suspects. Hypertension, over 120 million people. Most of them not controlled well. Congestive heart failure, 7 million people, very expensive clients, over half not controlled. Diabetes, again, 28 million people, very expensive when they're not controlled, and 60% are not controlled. COPD is the third leading cause of mortality in the United States. 43 million people, 60% uncontrolled. Respiri and wheezo are really the only options available to be able to intervene with these patients in an ambulatory setting. So we've got all these covered, which makes us a very attractive option and partner for our clients. I thought I'd just go through what it looks like when we have a typical client journey. This is part of our competitive advantage.
We really do provide a service that very few of our competitors do, if any, in combination. I've spoken many times. We get typically three years of claims data, reimbursement claims data from our clients and their doctors. That allows us to analyze exactly what's going on with their spend, who their high-risk patients are, who we think they're going to be, what conditions are causing the most problems for those patients, and how best to intervene with those patients. Nobody else really does this as well as we do, in our opinion. That gives us the ability to assess the situation and work out the sorts of numbers that we are talking about when it comes to cost savings based on what it is we think we can do.
As I said, we project our risk scores for the patients and target those patients because they're the ones that we can really make a difference with. Each of the programs is personalized for a patient group depending on their conditions. The connected care programs are then designed to target the high-risk condition with that patient. Remembering that most of these patients have many comorbidities. There's a lot of conditions they've got. Not all the conditions are necessarily causing the grief when it comes to their events. It's laughable to think that we're going to give someone 20 devices and expect them to use them. We have to pick the eyes out of that and get it right. We're very good at doing that. Importantly, it doesn't end with just the analysis and the execution.
Part of our goal is to make sure that we implement and monitor and engage the client to make sure that they are aware of what it is we're doing, the benefits that we've delivered, and importantly, to troubleshoot any issues that we might be having with the programs moving forward. Now, it's important to note, right, that our providers aren't equipped, and our customers aren't equipped to do this. They don't have the time. They don't have the people. They don't have the experience. They don't have the capital. They don't have the cash. And they don't have the infrastructure in place. It is laughable to think that a doctor turns up to their practice on a Monday morning with 100 screaming patients that they need to address quickly and have them think, "I think I'm going to start a remote patient monitoring program." It just does not happen.
That's why we are a partner of choice because we allow them to focus on those 100 patients, screaming patients, or we allow them to focus on running their hospital or their ACO and let us be deputized to do these programs for them. We make sure that everything's done. We make sure patients qualify. We make sure that their insurance covers. We make sure that we are in a position to put the patient on program as quickly as possible. And it's important for us to be able to do all this so that our clients continue to focus on their core competency. And this has been very, very well received. And it's one of the reasons we are in advanced discussions with a number of ACOs, independent physician associations, IPAs, and insurers about making this a standard of care for them.
More to talk to about that as we move forward throughout the year and early next year. A patient - sorry, I'll go back to this. This process can take anywhere from one month to six months, depending on how complicated the client is. Needless to say, the larger the organization, the bigger the bureaucracy, the bigger the bureaucracy, the longer this thing takes. But our typical number is three months. Okay? Important to note that for a typical patient, it's not a complicated pathway that they take. The patient pathway, I like to call it sophisticated simplicity. It's not complicated. The sophistication, however, comes into how we actually engage with that client. As I said, we engage the client to see what their eligibility is, to make sure they actually qualify for the program. We get their consent. We provide the devices and train those patients.
We commence routine telehealth monitoring, which means we get data on an ongoing basis. Where appropriate, we recommend the relevant provider visits and, by exception, escalate issues that may be causing the patient's grief before it becomes a problem that will lead to an exacerbation of some sort. Okay? So it's not a complicated thing. What is complicated is making sure that we provide a person that can do that and make it easy for the patient, easy for our client, and importantly, builds a longitudinal relationship with the patient so that we can continue to grow the interventions that we need with that patient that will drive improved outcomes, but importantly, potentially more revenues per patient from our side. We don't have a call center per se. When a patient's assigned to a Respiri care coordinator, that's their care coordinator for life.
Revenue, just touching on the three areas of how we get paid. Now, I stress this is how we get paid, not what we do. Okay? That's an important piece of understanding. The traditional fee-for-service model is we do all the work. Somewhere between $70-$100 per month per patient is the revenue number that's generated for us. We provide the services. We provide the data that's given to the client, and then they submit the reimbursement claim. As I said previously, the AMA RPM proposed changes will potentially double our per patient per month revenue streams from January 2026. That is a huge revenue opportunity for us. That's doubling on existing clients. Now, I will state we don't know what the new reimbursement rates are, but at current rates, it's doubling our current monthly revenue stream from patients.
Fee-for-service with our Clinic in Cloud, that's where we take complete control of the process. We do the processing. We do the submissions. We do it all. Now, in that instance, we get a slightly better margin, well, a much better margin, and the numbers are there to be seen by all. Now, this is an area that a lot of our clients find very attractive, and this is an area that is growing for us as a component of our total business mix. Again, changes to the RPM rules by the AMA will add about $70-$90 to each patient per month. Again, very exciting. The final piece is the risk share. Now, again, the services we provide do not change. What we do with patients remains exactly the same. This is just a different way for us getting paid.
Now, in this instance, we get somewhere between $10 and $40 per member per month. That's per group of patients or insured members that have been given to us to look after. Understanding that we don't provide services to every single member, it works out to be roughly one in 10. One in 10 clients. The range there of $10-$40 is purely predicated on how large the size of the prize is at the end of the 12-month capitated period. How big is the upside and how much of that we're going to share and how big the downside is and how much of that we're going to share. Okay? So that is important to note that the service we provide does not change. Our people do exactly the same job. What does change is how we get paid.
Now, the risk share component is a very, very attractive revenue option for us. The margins are very, very attractive. You can imagine one in 10 patients, 5,000 patients at $40. That's a lot of money per patient on program. The issue is we need to deliver. Otherwise, we'll be handing some of that cash back, and we're very comfortable with our outcomes data and our analytical capabilities to deliver on exactly what needs to be done, and important to note, the ACOs, IPAs, and insurers love the fact that we will put our money where our mouths are. I mentioned previously our services deliver results. This is really important to note and is one of the very attractive pieces of our narrative to our clients moving forward. These numbers mean a lot more to them than they probably mean to you at the moment.
We can attach a number to each one of these, and the numbers add up very, very quickly. And having the ability to put hand on heart and say, "These are the expected reductions in these very costly healthcare events that you can expect when you work with Respiri," is extremely well received by clients. And again, very much providing us with tailwinds with some of the contractual negotiations that we have at the moment. I'm not going to go through everything that we've announced over the last 12 months, but it just suffices to say that a lot's been happening and a lot more will continue to happen as we move forward, as we continue to make great progress in the United States. And as I said, bring together the strategic and operational pieces of the U.S. healthcare business puzzle that we've been working on now for some time.
So please look forward to hearing more from us as we move forward. Our clients like what it is that we do. They endorse what it is we do. And we've only scratched the total of the 50,000 potential patients that we should be having on program with existing clients. Now, a satisfied client isn't a destination. It's a journey. And we need to make sure we continue with that. But suffice to say that the leaders here, for instance, as examples, are very pleased with what it is we've done, very pleased in what it is we're doing, and extremely pleased in where it is we're taking their patients and their businesses moving forward. So we're really pleased with the way that our customer engagement, key account management processes are working because, as I said, the job really starts when we kick the programs off.
We need to make sure that our clients understand the value that we're generating for them. Our people in our customer success group are expert at doing that. We've got a team that's experienced in doing all this, and me, of course. I'm very comfortable with the direction we're taking. We continue to grow our U.S. presence. Matt Roby has extensive experience in the payor, insurer, and risk share space. He's leading up our commercial operations in the United States at the moment and building a team now that's sort of approaching 30-odd people in the United States. Much more to be said here as we move forward. We really are building a team in the U.S. because let's face it, that's where we're domiciled. Current priorities, nothing new here. Our priority is to show monthly profitability in the coming months' quarters.
We need to get the 7,500 patients to do that. We've currently got 8,000 that are identified that we need to enroll into programs. We've got a pipeline of roughly 15 clients that are in advanced discussions. That includes four ACOs, IPAs, and insurers for capitated models. That really is a huge opportunity for us because these are more than qualified. These are in advanced discussions. That's a 50% uptick in the number of clients that we've currently got. We continue to pursue operational efficiencies right across the business in onboarding, in clinical services delivery, and in client engagement. All those things are items that we have been targeting over the last 12 months since we bought Access Telehealth. They take time.
Now, we've made significant progress, as you would have seen from our patient numbers growth over the last few quarters, in getting these things right. We continue to focus on potential partners/acquisitions with regards to going through due diligence processes, and I'll have more to talk to you about this, but potentially in the next quarter or so. Recent trip. As I said, we've made significant progress in my last trip with three of the ACOs and payer contracts. Now, it's important to note this covers over a million lives. Our opportunity from the fee-for-service opportunity is 250,000 lives. This is a million lives outside of that. We've signed a completely new set of patients, as we announced a few months ago, with regards to the skilled nursing facilities.
They're the interim mid-tier facility that patients go to when they're discharged from hospital but are not well enough to go home. They have a motivation to get their patients to the home as well. And we have started in Hawaii with two of those. And there are over 40 skilled nursing facilities in the Hawaiian Islands. And they're all basically run by the one group. So we're in active discussions with a lot of those guys in the context of moving forward with these transition care programs and at-home monitoring programs so that they can get patients home and comfortable as quickly as they possibly can. We've spoken about the Covenant HealthCare System contract that we've done with our partners at Ceras, and that continues to move ahead nicely. I've spoken about the acquisitions.
We continue to look at ways of expanding and rationalizing legacy clients that we've inherited from Access and also others that we are talking with our partners at Ceras. Some of those will stay. Some of those will leave, depending on how we move forward and if we can make the necessary adjustments to get our clients to more align around the way that we want to work moving forward. Now, that's one of the cool things about the position we find ourselves in at the moment.
We can actually say today to clients, "Unless you do things the way we think they need to be, we're not particularly interested in working with you because we know it's not going to work." Now, that is a necessity to be able to say no to the wrong business because it dries up resource, and we don't want resources being directed to those clients where we know we've got limited chance of opportunity and success. So we're looking at that all the time moving forward. Really cool to note that in Wisconsin, our wearable clinical study has kicked off. We've already got our first cohort of 15 patients commenced on program. Our target is 30, maybe 40, depending on how we're going, and data is currently actively being collected, and we're looking at it every day.
And the preliminary data that we're collecting with the wearable is very, very, very positive. So it's a great way for us to be testing the algorithms around the sort of physiological parameters that we hope to be measuring with this. Remembering, of course, that the wearable is not a replacement for wheezo. It is an addition to our portfolio, another differentiator in the respiratory space, and a device particularly designed for transition of care of patients with COPD from hospital to home. Nothing like that exists at the moment. And we're excited, as are the investigators in the study, about moving all this forward. Now, Chief Investigator there is a guy called Dr. Scott Parrish. He loves what it is we're trying to do and can see great utility in the wearable device.
These are the things that we've made some significant progress on in the last month or so. There's a lot more happening, as you can imagine. In closing, I know I'm biased, but here are some investment highlights that are probably reasons why we are driving what the share price is responding at the moment. Our pipeline looks very, very, very attractive. Our onboarding of patient programs is very, very promising, but still only scratching the surface of the 50,000 that we believe we have as a total addressable market with clientele. We are on the cusp of something that will continue to grow throughout financial year 2025. We've achieved a lot in the last four to five months of this particular financial year and really don't see things slowing down at all.
From a patient acquisition perspective, new clients, capitated risk share models will be things that we will continue to pursue and close over the coming months. And we are looking and actively looking at potential partners/acquisition targets that can add value to what it is we do as an organization and also at scale. So with that, I want to thank you again for giving me your time today. And I'm open for questions. Thank you, Marjan. We have no questions that have come through the QA yet. I will just give it another moment for anyone typing their questions.
Okay. Must be the high quality of my presentation over, I think.
That's it, Marjan. And it looks like you have covered everything thoroughly. No questions have come through. Oh, no. Sorry. Sorry. I spoke too soon. Here they come.
Okay.
Someone has asked how the new regulations in the U.S. can double fee-for-service rates.
Okay. Okay. That one's a pretty easy one to answer. But one of the changes in the regular or the recommended changes in regulation are to drop the number of data points required to be captured by a patient on a device every month from 16 days to 2. Our current conversion rates for that particular CPT code now, the number is 99454. Now, that might not mean anything, but that's the data code that we claim against to earn about $30-$35, that is. We know that with the reduction to 2 days, our conversion rates go from about 50%-70% to 90% overnight. That'll deliver an additional $109,000 for every 1,000 patients we have on program. Right? So that's a really important piece.
Now, given our forecasts, internal forecasts, we're talking millions of dollars in additional revenues, which is all margin. Right? We're already dealing with these patients. It all falls to the bottom line. The second are the changes that have been made recommended for patient engagement by our clinical staff. At the moment, for us to qualify for the number is actually, don't quote me on this, but I think it's 99457 and 99458. Those codes are predicated on 20 minutes being spent with patients by one of our clinical people. The recommendation is to reduce that to 10 and that 10 become the new standard and that for every 10 after that, you get an additional payment. Now, based on current reimbursement rates, it'll be two 10-minute hits at a reimbursement rate versus one 20-minute hit.
So if things do not change with reimbursement rates, the current work that we are doing doubles the revenue opportunity for the same amount of time that we spend with patients. So we still need to wait on final recommendations on reimbursement rates. But even if reimbursement rates fell by 50%, it's still a 50% upkick in our revenue numbers without doing anything more. And importantly, strategically, it is a validation by the AMA that remote patient monitoring is a critical part of the healthcare investment mix with patients moving forward. It ain't going anywhere. Now, that is so important to us as an organization because a great proportion of our revenues come from reimbursement claims. I hope that answers the question.
Thanks, Mario.
Thanks, Marjan. We have a further question asking what % of patients are expected to be brought in through the Clinic in Cloud?
Clinic in Cloud, we are forecasting that about 20% of our fee-for-service business will be Clinic in Cloud by the end of this financial year.
Read it yes and no.
Thank you. And the final question we have online is seeking an—sorry. No, sorry. I think that we have already addressed that one.
Okay.
There's no further questions received.
Wonderful. Ladies and gentlemen, thank you once again for your time. I know time's precious, and I hope that I've been able to give you a little bit more color around what it is we're doing, what it is we plan to do, the achievements we've made, and where we hope to be in the next six months. It's a very exciting time for us, a lot happening, a lot more to announce over the coming weeks and months. And I look forward to keeping all of you well informed of our progress. And if there are any questions, you have my contact details. Please do not hesitate to reach out to me to have a discussion. Thank you so very much.