Good morning, everyone. So good to see so many happy, smiling friends and faces here this morning. I'm Fredrik Ruben, I'm the CEO of Tobii Dynavox, and I will lead today's discussion. This session is being recorded, hence there is this usual disclaimer about the content that we are presenting. I'm not expecting you to read it right now because you are here in the room. Together with me, Fredrik Ruben, I am the CEO. I'm a 46-year-old father of three. I'm an avid Scout leader, that's what I like to do in my spare time, but I've also been the CEO for Tobii Dynavox for the past 10 years. That means I've been through the acquisition of Dynavox back in 2014, the IPO of Tobii in 2015, the listing of Tobii Dynavox as its own separately listed company on Nasdaq Stockholm in 2021.
Before I joined Tobii Dynavox, I was predominantly in the software space as CEO and leadership positions. I'm an engineer by education. And with me on stage you will also hear Linda. Hello, Linda.
Hello. I'm Linda Tybring, CFO of Tobii Dynavox. I've been working here since 2018. I probably have the best job in the world. I've also been the interim CFO for Tobii back in the days and also led the listing process internally. I have a background with software and fashion industry, etc. I'm not that old, but I have two kids. I have two kids spending way too much time at the soccer field at the moment, trying to dream about spending more time at the golf course.
Great. And then we have Tara Rudnicki. Hey, Tara.
Hey, good morning, everybody. I'm Tara Rudnicki, and I am President of Tobii Dynavox North America. I am also President of ATIA, which is the Assistive Technology Industry Association, and have been part of that organization for the past 18 years. I am 21 years young in my mind. I have two older children who are both in the medical field who actually prescribe and work with our devices so they see firsthand what we do, which is pretty fantastic. So I think I have the best job, however. I've been in this industry since 2001, and you will understand why that's such an important part, is when funding first started in the United States for assistive technology. So I have quite the journey we're going to talk a little bit about later.
I think I have a better job. I have a better job.
Last but not least, Nils.
So the absolute best job I have, of course, and I will not disclose my age, sorry for that. So I've been with Tobii Dynavox for 6 years soon, and before that I've been with a number of different companies, from the smallest startups that I founded myself to the biggest company in the world, with Apple, with Microsoft, and Nokia, for example. I'm very happy to be here today to talk about my markets, which is sloppily referred to sometimes as the rest of the world.
Great. Okey-dokey, thank you so much. So we had a Capital Markets Day in the end of 2021, actually in this very same venue. This was in conjunction with the separation from Tobii and the listing. A lot of things have happened, obviously, since then, and this is what we will partly take you through, but then also we will look a little bit into the future. So if I just look at the agenda for today, click. We will talk a little bit about the company, some market fundamentals, and then we will take a snap, from my perspective, on our solutions and our products. Then we'll take a break of 30 minutes, and I highly suggest that you then go out in the foyer and meet with my colleagues out there, but more importantly for yourselves, try out our products and get a better understanding.
Then we'll be back here, and then we will hear more about our strategy going forward, about the profitable growth journey that we have embarked on. And we will, of course, then hear more from the likes of Tara, Nils, and Linda. And then we will have some concluding remarks, and then hopefully there's going to be a lot of juicy questions for us to answer from your perspective. How about that? So we talk a lot about our tagline, which we call "Power to Be You," which again is the fundamental part about enabling a person who's been for some reason hindered to express themselves or communicate with the world to actually do that.
We also sometimes talk about "Power to Invest for Good." We see that as, from an internal perspective, that's the investments that we do in our staff, in our products, and our systems, but obviously towards you as the investor community, because being part of the Tobii Dynavox journey is not just about investing in a solid business, it's also about making a real impact. We have a strategy which we won't change. It actually summarizes in Dig where we stand, because we have found a super important piece of the market, we've figured out how to service that market and how to go about, so Dig where we stand, but better, faster, stronger, and everything like that.
Our biggest challenge, why this is not a bigger industry and we are not a bigger company today, is the lack of awareness, and hopefully this will be crystal clear once we have gone through today's session. This morning, an hour ago and nine minutes, we issued a press release where we updated our external financial targets. This is also something we will dig a little bit deeper into today. They replaced the ones that we issued in 2021, then just before the listing, and obviously a consequence of the fact that we have since then seen a strong development both in terms of revenue and also profitability, hence our financial position is much, much more solid today, and we want to be more explicit on how we plan to share our profits together with stakeholders such as you, the owners.
If I be a little bit more precise about what we talked about this morning: we express these targets on a 3 to 4-year horizon, and if we start with growth, we say that we want to grow, on average, our revenue by 20% per year. We calculate this in local currencies, meaning that we omit fluctuations in foreign exchange, but we do include if and when we make profitable acquisitions. We focus on selling communication aids, we have a market with super low penetration, we believe that we can continue on this journey for many, many years to come. We do sprinkle it with occasional acquisitions, however the main model for us is organic growth. And like I said, we do adjust for FX because we can't take credit and probably blame for whenever the krona is fluctuating with other currencies.
There might be some fluctuations over time, we will have stronger quarters and better quarters, but 20% on average per year is the target we have set. If I then move to profitability, where the aim is to deliver an EBIT margin of 15% or more, this is a consequence of a business with a very high gross margin. We sell 90% of our sales are as prescribed products, meaning that it's paid for by private and public insurance systems. We have a cost base that, to some degree, is fixed, R&D for example, where of course it grows with inflation, but a large part of our cost base is rather fixed.
We continue to invest in educating the market. That's definitely something we want to spend our money on. We want to invest in internal capabilities that we build a really solid company. And then, of course, once we see that our prescribers are getting better, they need less service, less hands-on work from us, and also that we see replacement sales, someone who's been successful with the communication aid starting to replace, we see good opportunity to further leverage our profits. Hence, that's why we have the bar of 15% or more. Last but not least, we are also more explicit when we talk about our dividends policy. Then, if you look at Tobii Dynavox, it's a fairly asset-light type of business. We have upfront payments from solid payers.
We have a capital structure, we need to maintain a capital structure that enables some M&A, that's definitely part of our model, and we want to continue, obviously, to invest in creating this market and in our internal capabilities. But still, when we look at this model, it is a business that does generate significant excess cash. Hence we are explicitly saying that we want to have a dividends policy to distribute at least 40% of available net profits to shareholders in the form of dividends, share repurchases, or comparable measures. Obviously for this year, we already in the Q4 report said that there's going to be no dividends, so this is again a target that should be seen in the coming 3-4-year period. All right.
Not only will you meet the likes of myself and my colleagues today, you will also get to know two very, very important typical people in our ecosystem. The first person you will get to know is Brock, on the picture to the left, he's a 6-year-old that loves to jump. But Brock also has autism, which is a non-speaking version of autism. Here you see Emily. Emily is a speech-language pathologist and the prescriber of the types of products that we work with. She works in an autism center, and one of her patients in her caseload is Brock. So we'll get to know them a little bit more, and we'll try to frame this Capital Markets Day to some degree around those two. So with that said, how about we get to know Brock a little bit more?
Dad, pick me up.
Brock is such a sweet, silly kid with so much energy.
Jump high.
He will jump and jump for hours if you let him.
Stingray.
We knew he had lots to say, but he had trouble getting his words out.
Yellow fish.
This was our first clue that he might be on the autism spectrum. When Brock started working with a speech therapist...
Spin me.
...they recommended a communication device. The day he got his TD I-110, he was hooked. He takes it absolutely everywhere. Now, Brock shares exactly how he feels...
I am thirsty.
...and tells us exactly what he wants. His vocabulary has grown tremendously, and we love seeing our little man finally being able to speak his mind.
So that's a typical user, and it's also important that you heard the voice of Brock's mom, Brianna, and to hear her say his vocabulary has grown tremendously, and Brock is six years old, and we love seeing our little man finally being able to speak his mind. That's a pretty big thing for those of you who have children of your own or realize the fact that you are able to speak your mind is something very, very fundamental. If you look at the ability to be able to communicate, we could also talk to some of our other types of users, and this is a quote from a gentleman I know really well, his name is Scott, he lives in the U.S. as well, and Scott has ALS. And for Scott, he says, "For me the ability to communicate is primary.
I can't imagine not having the Tobii, it's my lifeline, I really don't know how I survive without it." These are quite strong words. Again, we have said so many times, if you have the hypothetical question to ask Scott in this case, "Hey, you need to surrender either your wheelchair or your communication aid," it's an easy task to say, "You can take my wheelchair away." Mobility is of course nice, but if you take my voice away, that's a whole different story. So take us a little bit back into the story of Tobii Dynavox and where we're at for those of you who might be somewhat new. First of all, if you look at the timeline, in 2000 or so, a company, a U.S.
Company called Dynavox, among others, worked to lobby to make sure that there is public funding for the communication aids that we provide. Typically referred to as AAC, Augmentative and Alternative Communication. Almost at the same time, a group of gentlemen, one of them actually being in the room, was inventing the technology around eye tracking and applying that to how you can control a computer using your eye gaze. That was Tobii. And then in 2014, we actually made the move to acquire Dynavox, and what we brought together then was of course highly technical expertise and coupled with a company with more clinical expertise and U.S. presence. Quite pivotal.
If I fast-forward a little bit more to 2019, that's actually when we formally incorporated Tobii Dynavox as a company within, as a business unit within the Tobii Group, and then a couple of years later, a little pandemic, I should probably say, in 2021 in December, we then rang the bell and we split out the two companies. The shares of Tobii Dynavox distributed to the shareholders of Tobii. So that's the journey that we are on. Being a part of this company is probably not, I'm highly biased obviously, but it's probably not like any company. We are a highly mission and vision-driven company.
We of course would like to see a world where everyone can communicate, and we focus on a specific market, meaning people with disabilities, and hence we have an outspoken mission statement that reads, "We empower people with disabilities to do what they once did or never thought possible." And for the colleagues in the room, they're tired of us saying this because this is a mantra we repeat over and over again. But this tagline also includes two quite distinct user journeys. The "do what you once did," that's Scott. Someone who was able to communicate and live and work throughout his life until a diagnosis such as ALS or Parkinson or MS, which rendered that person unable to communicate, and we are now enabling hundreds of thousands of users again to do exactly that.
The other story is the "never thought possible." That's the millions of children who are being diagnosed, and the circle of adults around them basically points a finger and says, "She will never be able to." And trust me, we have so many examples of children who are both still children and they are growing up and they are able. Wow, they are able. And I guess Brock on the picture here that you already met is one example of that. But this is also important for not just for my colleagues and us in the 700-some people in the team, also our partners and ecosystems of people around us, but obviously hopefully also to the investor community.
We talk about this market that is hugely underserved, and this is a metric that we need to also remind ourselves, both in good days and bad days, about the fact that there are 50 million people out there who have a condition so severe that they're unable to communicate unless they have a communication aid like ours. 50 million. About 2 million of those are being diagnosed every year, but we estimate that only 2% of those are actually being helped by us and our industry peers. This means that saying that this is an under-penetrated market is an understatement in itself. This is a non-penetrated market, it's very, very nascent. The main reason why this is a fact is that there's a lack of awareness.
You are one of the lucky few in this room and on this webcast eventually who understands that this exists, but the vast majority of the population in the world are completely unaware of the sheer existence, and if you work in this space, you're probably maybe aware, but you don't feel at ease with working with this. That's the real challenge we have. So when we talk about customer, it's important to say that the customer can look in different ways. We have decided to define our customer base as three main groups. The first group down to the left are the users. That's the Brock, but it's also the parent or the caregiver or the spouse or someone in the close circle around that user. The second customer group, and actually a slightly bigger ring, are the prescribers. They are both the gatekeepers and the enablers.
They are the ones who help, not just getting a device in the hands, but also more importantly, once the patient has, once the user has gotten a device, to start communicating. Then there's a third group, that's the funders. Those are in the typical cases the ones that actually pay for our products, and they are again public or private institutions, but of course we need to make sure that we fulfill the requirements for all these stakeholders. We need to have products that are reliable, regardless of which aspect you're looking at it from. They need to be simple to use and prescribe and work with. We need to have a comprehensive offering. We can't just have the little thing. We need to take care of everything before and during a prescription and assessment and then after.
We need to take care of the bureaucracy and the complications about how to acquire a device, and hence we must have all the pieces of that, and hopefully you will have a clearer picture about that after today. So what does that look like? If I just briefly talk about what we sell: comprehensive communication solutions. That in practice means that if you start on the left, we have the language systems. We have the communication symbols. We own and develop and maintain the world's largest communication symbol library called PCS. We own the synthetic voices that speak appropriately for your language, your dialect, your age, and so forth. Then of course we package that into a language system that obviously is quite specific depending on the type of user. If we then go up, we package this into a software.
That software has to be run on some sort of technical platform, and as you can imagine, the software for a six-year-old with autism or a 55-year-old with ALS, they're very, very different. One of them being literate, for example. Then we package this into a piece of hardware, and that hardware has certain requirements and technical capabilities. It's typically super rugged. It has a long battery lifetime, it needs to live with our users day and night, and it also needs to fulfill a lot of formal criteria such as medical regulations. Then, and this is maybe a little bit more odd, we also take care and help and lead through the funding system. Because again, the bureaucracy is not just a hurdle for the user, it's also typically a hurdle for the prescriber.
Hence we have a big team and a lot of capabilities to navigate through the local funding system depending on the user and the location. Then last but not least, we have a big team on a global level, who speak so many languages in so many time zones, to make sure that also when you have a product and if you need help or assistance to continue to be successful, that's where we're at. All these pieces are fundamental, and frankly, if you take even one of them away, maybe our offering will be rendered useless. If you look at Tobii Dynavox from a world map perspective, three-quarters of our business stems out of the U.S., and again you will hear more from Tara, and that's because the U.S. is not only an important market, it also was in the forefront of having funding available.
We operate, however, and sell our products in some 65 other markets, so 64 of them Nils will talk about a little bit later, but we sell in two different models. We sell either directly, that's what we do in the U.S., U.K., Ireland, Denmark, Norway, and Sweden, and in some 60 other markets we sell through a network of some 100+ reseller partners. From a staff perspective, we are, like I said, a little bit over 700 people in the team, some 70% of them are in the U.S. So even though we are here in Stockholm, it's a Sweden headquartered company, we have really been successful in the U.S. Maybe the future will make sure that we are equally successful globally. So if you put that into numbers, not only are we some 700+ employees, they're reasonably happy, at least when we ask them.
They give us an employee satisfaction score of 78, which is pretty high. But not only are they also serving, you know, hundreds of thousands of users and prescribers, and they seem to be reasonably happy, so we constantly measure Net Promoter Score for customers, which is around 50. We had SEK 1.6 billion of revenue last year, continuing to grow from a profitability, so just under 10% EBIT margin or SEK 155 million. Last year we gave the world 25,000 more voices than we did in the prior year. That's a pretty strong thing. That's something we definitely celebrate and feel quite proud about. And like I said, we service that on a fairly global level. Not only do we have the products, we have the contracts with all these payers.
The top right circle on the customer screen: over 500 pre-made contracts so that we don't need to go through a lot of hassle. And so that means that the vast majority, 90% of our products, are sold to either a public or a private funding system. I'm not here alone, and not only the beautiful crew that you saw here on stage. We have a management team where a lot of them are here today. A lot of them have been with us for quite some time, so we have a lot of expertise. Markus and Michael down at the bottom joined us in conjunction or just after the split, but otherwise that's the team that I, together with me, that runs the company.
Then of course we have a fantastic board of directors where, again, similarly here, a lot of them have been with us either prior or in conjunction with the split. We had Martin that joined us roughly a year ago. This is all chaired by Åsa Hedin. Åsa is here in the room. Åsa has also announced that she's not up for re-election at our annual general shareholders' meeting coming up in May. But I can already say, now is not the time for thank yous, but Åsa has also of course been instrumental in taking us to the journey here. So, positioned for sustainable growth is what we try to summarize on how we see the future of this company. So our solutions are not just another toothpaste. Our product really improves people's lives and they really work. So we have an offering that really, really hits it.
We're also the absolute global leader in this space, but in a market which is so nascent that we can't pride ourselves about being big because it's still a fairly small pond, but we have a fantastic position and there's significant growth potential for us to do this. We own pretty much the entire ecosystem of the offering, so we don't rely too much on, you know, outside expertise or components. We have everything that is needed in order to fill the needs of our users, not just product-wise but also services-wise. Then we have been able to show consistent, profitable growth. So there's nothing magic that needs to happen. I think we have the recipe. If I then go up in the helicopter a little bit and look on the market that we serve, so first of all, assistive technology is nothing new as such.
Frankly, if you look at other types of assistive technologies, we have mobility aids, some $9 billion estimated annual revenue, obviously a market that's been around since humanity to some degree, even though they are of course much more sophisticated these days. Almost as big of a market, $8 billion in annual revenue, you have the hearing aids market, actually quite shares a lot of similarities with what we do. Slightly smaller, we have memory aids and cognition aids, typically dealing with people who have some sort of cognitive impairment, a big market, and pretty much the same side, you have the low vision blind aids. Then we have the new guy in the room. That's us.
If you look at the addressable markets, the numbers of users, and the systems that provide for this, there are a lot of fundamental similarities between these markets. We are just in the beginning of our journey. It's time for us to make another acquaintance, and this time it's with Emily. As mentioned, Emily is a speech-language pathologist. She lives in Louisiana in the U.S. She worked then, in this case, at an autism center, and one of her patients on her caseload was Brock. This is a very interesting perspective into the life of being a speech-language pathologist, I think.
We're dealing with insurance, we're dealing with paperwork, we're dealing with fighting for kids to have services.
I maintain about 20 hours of direct treatment per week, which is about 40 sessions, write daily notes for every one of those sessions every single day, making the schedules for all of our speech-language pathologists, parent conferences, authorization paperwork for insurance, peer reviews with insurance, ordering food for feeding therapy, ordering toys, feeding evaluations, and AAC evaluations. My name is Emily Kramer Leonard. I have been a speech-language pathologist for almost 5 years now, working primarily in the autism center. We have 30+ kids in here at one time. There's lots of banging on the walls. It's loud, it's chaotic, but it's a good chaos that keeps you going. What we want to see is the child interacting with the device and taking ownership of the device. We do have a good number of parents that are skeptical when we bring u
p wanting to do an AAC evaluation.
The biggest fear for parents is that if we give a child a device, they'll use it too well and they'll stop talking or it will prohibit them from talking. We'll videotape their child using these high-tech devices, and I send it to the parents, they're very quick to say, "Okay, we want one of these." We're working with kids who don't have the coping skills to kind of say, "Okay, well, it's broken right now, so I'll just wait for it to get fixed." It kind of ends up being like the end of the world, and it's a serious situation. You see how much people appreciate you, and you see everything that you're able to do for these kids, and you see them grow up, and you see them go to school, and they're successful because they have a device. Communication is an essential human need.
What we strive for and what we want to do is let people know there are things out there technologically that no matter what, we are going to help you continue to be you.
We will help you to continue to be you. I like that. But it's also a very realistic picture of the world that we're dealing with. This is not just a tech spiel. So again, if we look at the customer landscape and we're up in the helicopter, right, there are large variances, obviously, among user groups, countries, reimbursement systems, but the underlying principles, they remain the same regardless where you're at. It's just that some places are slightly more ahead in terms of development. There are a large number of users in need. This is absolutely a niche market, but it's a niche market where we have a lot of things to do.
Most people are unaware of the sheer existence of this. That's quite a fundamental principle to deal with. The system is also very, very complex, and it requires collaboration. It's the collaboration with the parents, the user, the caregivers, assistants, or whatnot. It's obviously the therapist, etc., that needs to be highly engaged, and then you have the entire ecosystem of supporting functions typically from society one way or the other. It needs to work. There are some quantitative measures, just to put this into perspective. So if I start by looking at the users, I already mentioned those metrics: 50 million people out there is the estimate, 2 million being diagnosed with conditions that cannot basically cope without the communication aids like ours, and we estimate that 40,000-50,000 are actually being served every year. That's a 2% penetration.
So a very, very limited number of users served, even in the best markets and countries in the world. If you look at the prescribers, the Emilys of the world, and now we are honing in to the U.S. because that's a country where we have the best data. So there are some 200,000 registered speech-language pathologists in the U.S., and this is a master's degree education. It's a licensed job title. We believe that some 5%-10% of those, and Tara will talk more about this after the break, that has ever had any contact with communication aids. The rest of them work with other types of speech-language pathology. But if we even go further down, we estimate that only 5% of those, so now we're talking about, you know, 1,000 or so, do prescribe any meaningful quantities, and we have set the bar at prescribing four devices per year.
So meaning having a skill and doing it at least once quarterly, that's where we set the bar. It's a fairly low bar. So that means that out of the 200,000, a very, very small subset in the U.S. can be seen as proficient in what they do. So a limited number are educated, and they've never really been properly educated in this space. Last but not least, and we're staying in the U.S., there are some 1,500 insurance providers or funders in the U.S. We have contracts with more than 500 of those, and having a contract means that we have a much smoother process, that we can we can make sure that you get funding for this. That's, of course, a very, very important asset to have, but there's limited consistency.
All of these 500+ contracts are different, they have their own rules and processes, and they need different types of paperwork. Out of the 400 faxes we receive every day, for example, in the U.S., there's a lot of inconsistency. So why don't we just serve more people? Well, we have decided that we want to do that. That's the first case. But it's not just about flipping out a device and having the likes of Brock communicate. It's, of course, a complex journey. But we have identified three main areas, or three growth levers, that we're focusing on when we want to go about and do this. And this spells as follows. The first one is about education. Again, raising the awareness, specifically among the prescribers and professionals in this space, about how to work with communication aids. What is the process?
It's the technical aspects, it's the clinical aspects, and it's, of course, the developmental aspect. The second growth lever that we're going to dig deeper on today is funding. To make sure not only that there is funding in a specific market, but also how we operate that system. Because here we're talking about a lot of operational excellence, and really making sure that the funding process is super, super smooth. The third one is about partnerships, and specifically having our own people on the ground. Are we having sound problems? No? That we have our own people on the ground, or someone that speaks the language. Because if we're too far away from the prescribers and the users, then probably we won't be that successful. So these are the three areas of focus that we will walk in today.
Talking about the products and the users, a little bit coming back to wAat we're offering, and hopefully we'll give you a better picture when you try out our products for yourselves in the break. If we make a super simplistic classification of our types of users, we have some sort of line here where we, on the left side from your view, we have the people with intellectual disabilities. Basically, having an issue to form and create language, but not necessarily, or not at all, a physical disability. Again, you saw Brock jumping around. He has no problem with that type of motor skills. And then, on the other end of this line, you have people who only have a physical disability, meaning they're unable to use their limbs, probably unable to speak and form language. And we service every customer group along this line.
So that means that diagnoses that we often hear about are ALS, Autism, cerebral palsy, Down syndrome, Huntington's, muscular dystrophy, MS, Parkinson's, Rett syndrome, spinal muscular dystrophy, spinal cord injuries. But I think it's safe to say that we have a lot of our users who don't necessarily have a specific diagnosis. They have an impairment or disability, but we need to be able to cater for all these. And this, of course, shows in the products. So when we look at these types of products, first of all, it takes a village. It takes a high degree of interaction of not just the speech-language pathologist and the user. You need everyone in this room to embark on this journey, and of course it looks very different depending on the user. You need a quite high level of motivation, and specifically if you're on the prescriber side, confidence.
That not only do I believe in this model, I believe in the product, and that has to do with quality and glitches and support and those kinds of things. So confidence is, of course, super, super important. Emily has quite a hectic day, as you could notice. Let's look at some use cases of how our products are being used. Brock will come, but there will be additional people as well.
Brock is one of millions of people across the world who are unable to speak because of a disability. He uses one of our devices to connect with the people around him. Ensuring Brock is able to express himself isn't just about the tools he needs to communicate. It's about the network that supports him in integrating them into his life. Ready, set, go. People who struggle with communication will often see a speech-language pathologist.
To support these professionals, we provide assessments that help them determine the right solution for each client. Because Brock can use his hands, a touch device works best for him. Spin me. Spin. Communicators who cannot use their hands might prefer one of our devices that can be operated through eye tracking. Checkmate. People who can read often choose a text-based language system, but Brock, who is still learning, relies on our library of colorful symbols that represent everyday vocabulary. These symbols appear in the software that Brock uses with his device. Paying for a solution like Brock's means having to navigate insurance. We help families manage this complex process until the device arrives on their doorstep. As they explore their device and software, Dad, pick me up. We support them through their journey.
It takes a complete communication solution that combines technology and guidance to help our customers achieve greater independence and self-expression.
So this is what it looks like in at least two realities. And if we just look specifically at Brock, what does he have? So first of all, Brock has a language system. He uses the PCS communication symbols. He also uses a voice that he has picked himself. And you notice, Brock actually uses an adult voice. He picked that voice. And that's through our subsidiary Acapela. He uses a software called TD Snap, which is a communication aid. Sorry, these are the symbols. He uses a software called Snap. It looks like this on his device. And this is a symbol communication software that basically, of course, has symbols, but it helps you through the journey of hopefully becoming literate one day. He has a piece of hardware.
It's the TD I-110 that he talked about. You will also find it here in the foyer in the break. It's a super rugged, medical-certified communication aid with large speakers. It also is, you know, it will last through the day. And it's controlled using his fingers because he doesn't have necessarily a motor impairment. Scott and his family and Emily, the prescriber, were helped by our team of funding specialists and funding consultants to navigate through which type of funding is available for Scott. And that doesn't necessarily have to be just one insurance provider. That could definitely be multiple. So it's a quite complex journey to navigate. And then, obviously, at the end of the day, once you get the checkmark on that, we send an invoice, but more importantly, we pack the box and we send out the device to this user.
Last but not least, we're there to support. Support could be, you know, a phone call about how to do things, but of course it could be something where you have a malfunctioning device or we need to do to fix something. This is, of course, important. You saw in the video from Emily; if a device breaks down, your coping skills are complicated. You can't just wait for a week until it's repaired. We need to be quick here. When we talk about that, this is a comprehensive solution. It's quite complex, and I think it's also important for us to understand that it's not that easily replaced unless you have the full spiel.
I will take a break here, and you will be able to get some refreshments, some coffee, etc., and most importantly, perhaps meet with some of our colleagues and ask questions. So, welcome back. Hope you had a restorative coffee and product break. So, the second half of today's session, we have labeled "Strategy for Profitable Growth." And if I look at our growth journey the past couple of years, we can see that we used to think that there was some sort of inherent speed of a 10% annual growth in this industry. And if we adjust for foreign exchange, we grew by almost 30% last year. And for the past seven quarters, we have been on that trajectory. At the same time, we have improved our profitability. We closed the year at 10% EBIT margin in 2023.
But we, of course, believe that we will continue in this trajectory, but not just by magic, by actually having concrete actions. And this is hopefully where we will give a little bit more clarity to you guys in this session. So, our ability to improve, I mentioned briefly before the break, we try to summarize that around these three growth levers. We call the first one education, the second one funding, and the third one partnerships. And if you look on the first one, which is about education, here it's actually about getting more people on the ground. Getting more Tobii Dynavox colleagues or representatives to continue to educate the local prescriber community. This is something that has to be done locally, in your local language, in your local time zone, in your local city.
Hence, a way to do that is not just by hiring a lot of people and just throwing out on the ground. We have a strategy, and the strategy that Tara soon will talk about is what we call "splitting territories." The second growth lever is around funding. Here again, the context of funding is very complex and very local. It depends on which type of patient you are, which country you're in, which state you're in, what kind of insurance providers that are associated with you. It's really about figuring out what is the right or maybe only solution for this specific user and help them navigate through that complexity. Like I said before, in certain cases, a device that is provided is not necessarily just paid by one funding source. It could be multiple. But this is, of course, something we can do smarter.
The third one is about partnerships. When we talk about partnerships, we do believe that having your own feet on the ground will enable us to be much better, smarter, service the market better, have happier customers and prescribers. We could do that, obviously, by growing organically, but we have also embarked on a road where we do that through acquisitions. Nils will give more flavor on what we have done and what we're thinking going forward there. We believe that having market expertise, which is kind of a summary of all these three growth levers, is the foundation. We need to understand, and we need to be the go-to company. In the U.S., as you will learn, it's a lot about operational excellence. Taking a concept that really works today, but make it bigger, smarter, better, faster.
In Europe and the rest of the world, well, A, we can, of course, mimic a lot of the successful recipe that we have in the U.S. and do more of a business development, and then, of course, evolve the market, both through our own efforts and indirectly. So with that said, I'm going to have Tara Rudnicki come up on stage. So again, Tara is the head of this little market that represents three quarters of our entire business, meaning North America and specifically the U.S. So over to you, Tara, and I'm going to trade places with you, and I'm going to be your clicker.
Great. Good morning again, everybody. Did we all have a nice break? Yeah. All right. I didn't get a cinnamon roll yet, so somebody please make sure to save me one.
As Fredrik said, I am Tara Rudnicki, and I am currently running the North America team of experts, and we're going to talk a little bit about that. We say the U.S. is the largest market that funds assistive communication, and you would think with that comment that we are probably the most mature. We may be mature in that aspect, but we are so underserviced and underpenetrated within the market. We are just barely scratching the surface. I was fortunate, as I said earlier, I started with the lobbying efforts. Okay. With the lobbying efforts, assistive technology devices were unobtainable prior to funding, to be honest. In 2001, when funding actually got into place, was when I got to start my journey with this.
So it is a long and winding road, and one that has been so, so personally rewarding for both myself and all the individuals within this company. So I'm going to tell you a little bit about why it has taken us a little bit and why we think we're a little bit immature. We have, over, as Fredrik has said, over 200,000 prescribers of communication, assistive communication. Really important to understand, in the past several years, master's degrees as well as doctorate degrees have now been required for them to be licensed professionals. What does that mean, and why am I telling you that? They get one communication class in that advanced education on how to do communication for people with disabilities. With that, if you start really narrowing down, we know that 10% of the overall SLPs Fredrik talked about does and specializes in assistive communication.
That's about 12,500. If you start to break that down, how many of them work with AAC every day? And it's less than 10% of that staff. So you see these numbers just keep going down and down. Why is that important? Because each and every device that they recommend almost becomes like a new one, a new beginning, a new start. Because if you're only doing it several times a year or only several times within a given time period, it's learning because things are constantly learning. So the education becomes more and more important. The other big thing of that is the education of the services and support and devices, but also understanding the funding, like Fredrik said, the complex funding. And if you look at that, 55% of all devices in the United States require more than one insurance company to support the acquisition of that.
So those are some pretty big numbers, right, Fredrik? All right. So let's talk about the 500 contracts that Tobii Dynavox has to help with that. We have over 200 trained professionals throughout the organization, especially in the United States, that meet with our customers. Important to understand, when people talk about the United States, everybody says, "Oh, the United States, they're all one big thing." We are not. There are some national coverages called Medicare, but then there are individual jurisdictions. So look at it this way: each state and each province in Canada are like each country. Each one of them has their own set of rules. Everything can be, and requirements can be very different. So it's really navigating through all of that. What that means is our territories become very unique.
It becomes unique for both the demographics, the geographics, as well as the conditions within a given area. We'd be remiss without talking about the beautiful, wonderful pandemic. It's like life before the pandemic, life after. Well, it became very challenging for us, as you guys can imagine, for us to meet with our customers, our face-to-face meetings. I will tell you, we did everything in this industry to make sure that we continue to service our customers. And we could tell you stories and show you pictures, but we did it. What we also did as a company, we really took this opportunity to realize, "What do we need to do to get where we want to be?" We really doubled down our efforts on education and operational excellence. We put together lots of great programs that we're starting to see some of those rewards.
For example, the first reward that I would say is our annual revenue. Our FX-adjusted revenue grew 22% in the year 2022 and 24% in 2023. Fredrik talked about awareness and education. It is truly, truly the heart of what we do. It's our heart of our growth, and it's the heart of the company. There's no more individuals or these experts wanting to go out and talk about what we do. The field reps, we know our field reps. You might hear me refer to them or Fredrik referring to it, solution consultants. We really believe that they go out and they offer solutions to the prescribers. They are more feet on the street, but they're not just out there. They are experts now, with all the education internally, and then they help the externals of the SLPs, speech-language pathologists, do the jobs that they need to do.
We then take, and as I said, we really evaluate territories. We look at population, we look at mix, we look at conditions, we look at age brackets. There's so much that goes into that because we want to make sure we put the right people, the right amount of people in that supporting that territory. 2019, I keep talking about that pivotal year for me because it was really, truly apparent that we needed to scale to meet our growing need. There's just such a growing opportunity, as we say, with diagnoses continuing to grow. So we sat down. What are our keys to success? Trained professionals.
We keep going back to that. If you have professionals who have to recommend our devices, if they don't know how to, they're not aware of it, they don't know how to do it. We are here to teach them and support them.
So what's also important? Part of their role was that the field reps would go out and they would have to teach an SLP, speech-language pathologist, from actually evaluating the end user. Then it was this whole funding process because we talked about how difficult and complex that is, and we'll get into more details, but then to delivery. There were several steps along the way. So then, an inability in 2020 to really go out and really help the way we wanted to. We weren't able to really reap our rewards of getting all those people on the street, getting that education out there until 2021. And as you can see here, the growth of our territories from 2021 to 2023, 77-83 territories. We experimented and we tested a lot.
We learned a lot of lessons along the way, and I really do believe we came up with the recipe for success. And as Fredrik said, split territories or territories, how to really evaluate them. So for years, we've been looking at different ones, and if I can bring this up to show you at the top, we have a territory as an example, Ohio. What type of adjustment was it? It was a geographical one. We went from 1 field rep to 3, and if you look at this over the years, the growth, the revenue growth, went up approximately 260%. And then our revenue increased per FTE 20%. If you look at Southern Florida, again, that was a demographic change. We went from one f ield employee to two. We went from revenue growth up to 125% and a revenue increase per FTE of 10%.
And then if you go to Los Angeles, California, and again, you look at a geographical one, we went from 2 of our field staff to 3. Our revenue growth, 120% and upward, and 45% revenue increase per FTE. Our model is scaling. This is a more recent, just to give you a little more of our recent territory splits in 2022, the percentage of increase is 40% total. 70% of that was our pre-split, again, aligning with our model. Why do I show you past and then this more recent, and why is it a little bit lower? I bet you're asking. Because our first year, and these two were first years, our first year made a major investment in internal and external training. So we really have those professionals out there feeling comfortable, competent to go out there and train and get others to do the same.
So first year is our big investment, and then as you heard, you saw some of those other numbers after the first year, initial year. So just as important, this is kind of weird, just as important of awareness and education is navigating the complex funding system of the U.S. It is our biggest second, what we call our second growth lever. Funding is truly, you heard my numbers before, funding is truly essential for our users to acquire a device, and we want to make sure that happens. So if you take a look, we did some surveys, we did some real research, and we realized that 30%-40% of our field reps' time was supporting funding. And they had to do that because that was necessary to get that SLP, the end user, all the way to the finish line of getting that device in their hands.
So while that was super important, we needed to understand how do we help build the focus of our reps for awareness and education. Then we decided that the SCs, field reps, were really starting to do is looking for their experts within the company. So they were the middleman. So we said to ourselves, "Okay, let's start growing these two great teams. We have the teams externally working with the SLPs and what they know best, and let's start developing this operational excellence of this incredible team inside who know funding best." So they really got to learn and become the experts of navigating funding. So right now, to talk about the team a little bit, our team right now is 80 funding experts.
We are educating the prescribers on the process from the beginning, from the very beginning of an evaluation, what's necessary to the end, making sure that they receive everything that they need to do, paperwork support, and making sure that they're in the best position to receive funding. So we have this team. What do they do? They also navigate and negotiate reimbursement with these companies, insurance companies, the many, many that we spoke about. We have over 500 unique contracts within the United States. 500 plus, excuse me. So you're probably all sitting here saying, "Hey, these are great numbers, math. Why not just go out and get more?" I wish it was that easy. Unfortunately, we are not a typical DME, durable medical equipment provider. It's not as straightforward. It can be very complex, actually getting the contract.
Complex, lengthy, multifaceted, and in a lot of the cases, does not result in a contract. So why is a contract—why am I driving this home as one of our important levers? There's three top reasons. If you have a contract in-network, a lot of you might know, we have claims processing. It's 20% faster, so more efficient to get through the process. If we have a fee schedule, which increases our payment structure by 35% faster. So that means from the invoicing date to the money in the door, 35% faster with a contract than without. And lastly, and most importantly, it lowers our end user. It lowers the user's out-of-pocket expense because there is still a component that our customers do have to provide.
It is truly a win-win having a contract for all of us: for the prescribers, for the company, for our end users, and for the industry because it helps us continue to get that need filled. Keep in mind, if you don't have a lot of experience with insurers, especially from the United States, the first word, and I think only word that they're taught in training, is no. You say no. No, no, no, no. And people don't understand. There's a difference between somebody getting a wheelchair and somebody actually deserving to have a voice. And sometimes it's a choice. And the funders will first always say no to coverage. Without a contract, they can deny the funding. And then that whole process starts of how do we help and assist to have that overturned.
When we have a contract, I want everybody to understand, it doesn't mean we get it check every single time. We don't. We actually do get quite a bit of denials with contracts in place. But what's the difference with a contract? Again, it's because we're able to appeal that decision in a much better way. We leverage the internal experts that to get the contractual status and overturn the denial. Appeals of denials result in overturned decisions. What does that mean? It means devices in people's hands. And for us, what does that mean? It can mean millions dollars, as you can see here. And most importantly, very many happy customers and very appreciative customers of us taking them through that entire complicated process.
So in summary, now that I've probably confused everybody, what am I trying to say or what I want to make sure that everybody walks away from? The United States is the biggest market today, but I promise you, it is most underserved and continues to be as diagnoses increase. The biggest challenge is truly our lack of awareness. We need more educated reps in the field to support our professionals. The way to grow our market penetration is via territory splits and growing our field reps to focus on educating prescribers. We need to have a strong infrastructure of operational excellence to be able to support those in the field. And we create a better outcome for everyone through the systems and tools of support that we have built and continue to build. So with that being said, are you ready? Of course I am.
So you got to hear—no, not yet. No, I am. There you go. You got to hear a little bit about my world in the United States, and now you get to see talk about the big, big world. Over to my colleague, Nils.
Thank you, Tara. So I am running this rest of the world, and there's only some 7.8 billion people in that world. And we're active in maybe 60-65 markets out there. So historically, we have complemented our organic growth with acquisitions. And Fredrik usually refers to this as the sprinkle on the cake. And we've been doing two types of acquisitions. It's either product acquisitions or acquiring local presence. The target has been to complement our product portfolio. The target for product acquisitions had been to complement our product portfolio with new innovations and new products.
In the summer of 2023, we acquired Rehadapt, the leading medical-certified mounting solution for communication aids. Rehadapt adds a great product portfolio, a fantastic team with a culture fit to our company, and profitable growth. Rehadapt also adds one component that is really important for me, and that is presence in the German market with some 50 colleagues in this market that is the second largest AAC market compared to the U.S. In 2022, we acquired Acapela. Acapela is the world leader in synthetic voice in our space. And Acapela also added a fantastic product portfolio, a great team, again, with a culture fit to our company, and profitable growth. They also added presence in Belgium, in France, and in Germany. We currently do not see a lot of product acquisition possibilities. There are some, but it's not our major focus right now.
We see much more opportunity in acquiring local presence. This brings us to our third growth lever: partnerships. We believe that having local presence is fundamental for our understanding of our markets and how we can serve them. We do this by either having our own experts on the ground while fulfilling the needs through partners or resellers, or by going direct, meaning that the market is served by Tobii Dynavox without a middleman. We operate in the direct model in the U.S., of course, but also in the U.K., Ireland, Sweden, Norway, and Denmark. In 2022, we added Denmark and Ireland as direct markets through acquisition of our resellers there. The reasoning behind these acquisitions was, number 1, we got quick access to the market, to the funding systems, and to the professionals in the market.
Number 2, we could increase the top-line revenue by saving the 30% we pay in partner discounts. But number 3, the most important one, we could clearly see that we could grow this market organically with limited investments in people, marketing, and a very small but important detail: loan and trial pools for prescribers to use to test our solutions with their users. Now, both of these reseller partners were, as most of our partners, small and consisted of a handful of people serving their respective markets. Our first acquisition was Safe Care in Ireland. It's a great partner that we've been working with since 2015. While they made great progress, they have reached this maturity or this level of how they could penetrate the market because of sheer size and muscles. So we decided to join Safe Care's local expertise with our operational excellence and our financial muscles.
After our first year, as you can see on this slide, we grow revenues profitably by 143% with very small investments. We had a similar arrangement when we acquired our Danish partner, ASK, in the summer of 2022. Again, the first year, we achieved over 100% profitable revenue growth with very, very limited investments. In both these cases, we are just scratching the surface. We see continued strong growth, and I would like to point out it's organic. It's organic growth in these markets. So to conclude, we strongly believe in investing in the local markets to better understand and to better serve those markets. We will continue to invest in partner markets, including adding more staff on the ground. When there is opportunity, we are open to go direct through merchant acquisition.
We are typically looking for markets with an existing assistive communication infrastructure, well-functioning finance systems, and a good product fit to our offerings. I believe the list of possible targets will grow tremendously as the industry matures. Finally, the potential for growth in the rest of the world is massive. Of the 50 million people that Fredrik talked about, 48 million are located in the rest of the world. Those people really, really need us to succeed. With that, I'd like to hand over to our CFO, Linda.
Thank you, Nils. So now when you all and we have a better understanding of our growth strategy, I, of course, want to talk about the numbers and our new financial target. So to make a little bit of an introduction, Tobii Dynavox, as we already mentioned, became a standalone company in 2021. We have proven since then to grow profitable.
We've, over the past 7 quarters, actually stable growth, and we have gradually improved our profitability. Tobii Dynavox, as we have said a couple of times, we are the global leader of assistive communication. We own all the components in our solution, so we are a one-stop shop in one way. It's also important to understand, and Tara talked about that a little bit, that during the pandemic, that was a really hard time for us. We couldn't meet the users. FaceTime calls are possible for some, but having a kid with autism taking a FaceTime call, that's pretty challenging. We managed to keep our revenue flat during this period, and I think that's a strong belief. At the same time, during this period, we actually took the opportunity to invest in the awareness of this type of products.
We also invested a lot in our local presence, doing two things at a time. So let's talk about the top-line performance. I think the first two things you need to understand, since we have the big country of the U.S., we actually have a lot of our revenue in U.S. dollars, which means that our revenue can, from time to time, fluctuate depending on the currency exchange rate. But the positive thing is also that we have around 70% of our costs in U.S. dollars. So the impact on EBIT is actually that not big. Another important thing for you to understand is that the seasonality that we have in our business, and that is usually Q1, is actually very slow, Q2 slightly better, Q3 slightly better than that, and then Q4 is very strong.
And that is mainly driven by the calendar in the U.S., as an example, where the funding system works from a financial year. For the past two years, we have seen growth in all geographies, all products, or user growth. If something, we have seen slightly stronger growth in the user segment autism. During this period, we have had a CAGR of about 22%, ended up at SEK 1.6 billion at the end of 2023. As already Nils talked about, I think going direct has been a good success for us. We go direct in the U.S., Sweden, U.K., Ireland, Norway, and Denmark. You probably heard about them a couple of times now, but this really gives us a better understanding of the market, the funding system, and we can also build the right product.
We can sometimes think it's not that hard, but the language is really something that is localized, even the pictures that we talked about earlier today. During 2023, we also had a positive impact on our sales price. Medicare, that is the public funding sources in the U.S., communicated at the end of 2022 that we were allowed to increase prices with about 9%. What happened then is that that starts to implement it directly. But all the other 500-some contracts, we actually need to negotiate or change out the appendix when it comes to our sales price. So over the period, it actually takes some 12 months to implement such a sales price improvement. But that also improves our gross margin, of course. But of course, we have continued to invest in sales expansion and training, and that's something we need to continue to do.
We also, as Nils talked about, we acquired 4 companies, 2 within products and 2 going direct. So talking about our gross margin, historically, our gross margin has been around 66% or 67%. COVID was the perfect storm again. We had a hard time actually sometimes finding products, and sometimes we actually found the components that we needed, but we really got charged a very high price. At the same time, the freight cost was super high. So in 2022, our gross margin was actually very low. Getting into 2023, the component prices normalized, and we had built up inventory levels that made us actually start to ship things by boat instead. That, of course, improved both the margin but also helped the environment, which we think is important.
Of course, what I already mentioned about the sales price, that gets a significant improvement on the gross margin as well. Talking about our OpEx or our cost, a majority of our cost is actually staff. We have added some 230 people since we actually became a standalone company, and that, of course, includes our acquisitions that we've done. That's significant investments that we have done. If we look up here, the selling expenses that Tara and Nils are talking about, it has been kind of stable the last 3 years of around 36%-37% of our revenue. That has been because we need to continue to invest in local partnerships to really get the economy of scale, having the prescribers being successful. That will help us lower the sale costs in the future.
If they are successful and prescribe more and more products, we don't need to spend as much time. Of course, another thing that is important is what we call repeat sale or replacement sale. That is if we do this successfully and our user continues to be successful, we actually, a person that is a user of ours, will live as long as anyone, which means you need a new device every 3 or 5 years. These devices live kind of a tough life, I would say. Over time, we will see an increase of a replacement sale, and that will also help our scalability in the future. Up here, let's talk about R&D. We have actually had challenges during 2022 and the beginning of 2023 to actually fulfill some of the recruitments that we have had in the R&D organization, specifically in the U.S.
Now we have been able to get people on board again, but that means 2022 was kind of low compared to now when we are more on a stable level and recruited what's needed. The majority of our R&D costs are also salaries, but we also have external costs, and those can, from a quarter to quarter, actually fluctuate. That can depend on where we are in the process of development, for example, hardware or delivering hardware, a new hardware product. Over time, we have a product portfolio. We have it all there. Of course, we need to continue to innovate and make our products even more successful for our prescribers and our users. That means we need to continue to invest, of course. In relation to revenue, this will slightly go down. Of course, in SEK million, we will continue to invest.
About 50%-60% of our R&D costs we capitalize, and we amortize that over a 2-4-year period. Then the administration cost that has over the period actually increased. And there are a couple of things related to that. First of all, when we became a standalone company, I needed to build a new finance organization, HR and IT. We had part of that organization, but we needed to become on our own and needed to add some resources. So that's why some of the costs increased. The other part is acquisitions, and there are maybe three points with acquisitions. First of all, it's the transaction cost during the acquisitions. Secondly, the acquired company also has an administration cost, and then we have a pocket of amortization on the assets that we have bought. Summary: As revenue grows, profitability will grow faster.
We have proven an incremental improvement of profitability over this period, ended up in 2023 at SEK 155 million EBIT or 10%. This one I know you like. So Tobii Dynavox has a very attractive cash flow model, and I will explain why. 90% of the device that we ship, we take revenue upfront or when the user has received the product, but 10% we keep on the balance sheet and depreciate over a period of time between 3-5 years. And that relates to that. We have future commitments. So it's an IFRS rule. So we need to continue to support. We need to help them if it breaks down, etc. At the same time, we get paid 100% when we ship the device. Another important thing is that all these private funding bodies, they're reliable payers, which also helps the improvement of getting paid.
We, of course, have during this period, since becoming a standalone company, continued to build our balance sheet and also improve what we say, the net debt. It has gone from 2.6 to 1.9 times net debt EBITDA. To repeat what Fredrik said earlier today, we today announced the revised financial targets. Those should be seen at the 3-4 year horizon. The revenue part spells, on average, grow revenue by 20% per year, adjusted for currency effects, including contributions from acquisitions. So we have proven for the past 7 quarters that we have a growth above that. We have proven that we are on a revenue momentum. We are in a market with low penetration. We have talked today about the growth levers, local presence, operational excellence, and M&A. This will help us scale in the future as well.
EBIT delivers an EBIT margin that reaches and exceeds 15%. We have proven to build the growth with incremental improvement of profit. We need to continue to invest in the future with improvement of scale. We need to continue to educate the prescribers that they become more self-sufficient and they both get successful, but also the user to get more of the replacement sale. As a consequence of this, we think there's a good opportunity for further leverage. How revenue growth translates into reaching and exceeding the 15% margin. We have also updated the dividend policy. Tobii Dynavox has already talked about it, has an attractive cash flow.
Given the growth opportunities that we have, we, of course, want to maintain the capital structure that enables the strategy flexibility to pursue potential new investments like acquisitions, but still expected to have access to cash and our policies, therefore, to distribute at least 40% of available net profits to shareholders on dividends, share purchase, repurchase, or similar programs. Fredrik, I think it's time for the conclusion.
Great. Time flies when you're having fun. Thank you, Linda. Thank you, Tara. Thank you, Nils. I must say that I was personally super energized 2+ years ago when we stood here on stage preparing for the spinoff. We talked a lot about the empowered company, the fact that we only have one focus, not multiple focuses, the fact that we, you know, there are some soft elements of being able to control our own destiny, so to speak.
Obviously, a lot of the things we stood on this very stage and said have actually turned out to be true. It's also important to me to say that our message and our focus hasn't changed materially because we believe we have ample opportunity in the dig where we stand strategy. I am personally, and maybe it shines through, quite excited about the journey that we have going forward. I think we're building this on a very solid foundation. As everybody knows, there will be good days and bad days. We're expressing these targets on a 3-4 year horizon. I think we have a very strong fundamental to believe in why we should be able to reach these targets. With that said, I would actually like to invite again my dear colleagues on stage.
Then I know I have other colleagues who have microphones because now the stage is yours, because we would like to hear your comments or questions or thoughts, and we will try our absolute best to answer them. Do we have an y questions or is this crystal clear? Crystal clear. There are no questions. The lights here make it difficult to see if there are any hands in the air. Let's go ahead. Over there. Yeah. Okay. Not yet. Have you put it on? No, sorry, sorry. Borrow my mic. Can you hear me now?
Okay, perfect. Thank you for the presentation. In the first part, you introduced us to Brooke, and he's part of a user group that is growing faster compared to other user groups at the moment.
So I was wondering if this trend continues, given that I assume your earnings margins for your touch solutions are lower compared to your eye tracking solutions, that they will hold back your earnings margin expansion.
Do you want the long answer or the short answer?
Long, please.
Okay. The short answer is no. And Linda will explain why.
I mean, of course, the average selling price is lower on that type of device, but it's actually a lower selling cost. So for us, from a profitability perspective, it's not big of a difference.
Thank you. I have a second question, if I may, please. Of the total number of individuals who get into the clinical assessment process, how many individuals fail to get the product in their hand due to funding issues? Do you account for the appeal decisions?
Yeah, I think the short answer is we don't know, but we probably have one of the top experts to say what's your gut feeling, Tara, on that?
That's a tough one because it's all different diagnoses. Honestly, ALS is probably the least that they get at the fastest because there's so many things that are regulated in the states to get that pushed through better and faster. Unfortunately, I think it takes us longer with autism or cerebral palsy as examples. If they don't have traditional funding, then we look for alternative funding sources. There's a lot of foundations within the industry. The Gleason Foundation is one. Other ones that try to help support that. So we don't really have a great number. But I will tell you that every single person in this industry tries to do whatever they can to get that funded.
But so metimes they give up, and that's the hardest part. That's where that awareness comes in. If it's so frustrating for these families, they give up, not understanding what the impact of the positivity is if they keep driving through in the appeals process. So I don't have a great number, but I hope it explains a little bit more.
Okay, thank you. I mean, if you pool together all the user groups, can you give us a rough estimate?
It's tough because I would say probably if it gets to an assessment process and it gets into an individual company, I'd probably say it's probably around, again, this is a total guess, between 10%-15%, perhaps. But remember, they're very far into that process. That's not even at the beginning. Some give up before they even get assessed. And I think that's important.
That's both the awareness and actually getting to the assessment. That's probably where it's most challenging.
Thank you.
I can actually add to that that sometimes one thing we haven't talked about today is the competition. Yes, there are other companies that do similar things to us. There are only very, very few, and it's more of a co-opetition because we collaborate a lot. Of course, if we have a specific rep in Tara's team, for example, they visit an autism center, they go in and the user, together with the SLP trials, our device, and then they try another device. The following day we get a call and we say, "No, we picked another solution." That's, of course, perceived as competition for us.
But in fact, the fact that that assessment even happened is the unique thing because the vast majority of cases out there, they never even come to that assessment. Daniel here. Daniel here. Okay. Yes.
Thank you. All right. So surprisingly, I have a few questions on the targets. So first, just the EBIT margin target. I don't know if I missed sort of the timeline on that, but 3-4 years, is it that in 3-4 years or do you think that you can reach a target like sort of during the coming 3-4 years?
We will reach and exceed a 15% EBIT margin during the time period. That's how precise we are.
All right. So exactly. So I mean, is it sort of no change from the previous communication in that sense?
It's pretty much the same verbiage.
Perfect. The next one, just on the raised targets that you have on sales. So just you're talking a little bit about your increased effort during the pandemic while sales growth were a bit slow due to the pandemic. But so just how can you be assured that the current run rate of the 22% organic growth is just not a pent-up demand? And I think you've talked previously about the market growth being approximately like 10%. So yeah, just a few words on that, please.
Yeah, I can start, but then I think Nils and Tara should fill in. Our assessment is that we've actually raised the water level because there is more awareness. There's slightly more pull than push, meaning that we don't have to do so much hand-holding to make every transaction happen because the prescriber community is simply better educated. But Tara and Nils, do you want to chime in?
I can comment. In my market, it's clear that funding is evolving. So we see some clear signs of improved funding, and then it automatically gives us opportunity.
In the United States, I could tell you from the fe e dback when we talk. We see all these SLPs. We look at their caseloads. We can tell you what comes into the funding pipeline. None of this is pent-up. This is all new devices, all new opportunities. As you guys said, it is everything that the awareness continues to grow, which is what we want.
Perfect. Just another one, just on the replacement sales. So if you could just talk a little bit about the dynamic. So in terms of timing, I think you mentioned before you launched TD Snap, was it 2017 something? That should be more than five years now. I think that most of your contracts are, I don't know, three, four, five years as you allude to. Why do you think that the replacement sales hasn't really kicked off yet? Or do you think that now is sort of the inflection point where you can see that increase?
First of all, the funding rules, they differ quite a lot depending on the funder and the country, etc. But if you take Medicare, which is a big funder in the U.S., that's the national funding, they stipulate that you're eligible for a replacement device every five years.
So technically, if we have played our cards right, if we keep our NPS scores high, if we make sure that we don't mess up somewhere together with the prescribers, it's highly likely that the stickiness of this type of product, provided that the patient is still around, is a replacement sale. But it's also a very slow market. And we definitely have tons of users out there who still have 10 year-old devices, etc., because maybe they're unaware of the fact that they're eligible for a new device or maybe their prescriber isn't super, super tech-savvy. So technically, we would start to see a good chunk of replacement sales now. But I think part of the growth that we're seeing is when this is starting to catch up. Technically, replacement sales should overtake new sales if you look at the installed base.
But then you need to add to the fact that we have a 2% penetration. So there are so many unserved, there are so many first-time users out there still, so that opportunity is still quite much higher in the shorter term. But if you take some examples from your markets and then Tara on replacement sales.
Y eah, I could add that even though Snap, for instance, was launched in 2017, it takes time for us to localize to different markets. We're in different phases in different markets. We can't localize, we haven't localized the software immediately. It's been released in U.S. English first, and then we get to the other markets. So there's a little bit of delay in this one. And it's, again, sorry, connected to the previous answer as well. It's connected to how well funding is evolving.
When funding evolves, getting better systems, then we get into these recurring sales.
I would say a little bit of my market, 20% of my market is unfortunately, for example, ALS, and they usually don't make that 5-year mark. So right there, that brings my demographic way down. However, it's a combination of a lot of things. We are seeing more repeat sales because people are becoming more with the education that we're doing. These SLPs are understanding there's more options out there, which is the part of what we want to do. And unfortunately, there are quite a bit of our customers who, if they have something that works for a child and it continues to work 6, 7, 8 years, they don't want to change that. It's when something breaks down. And the good news is we have great hardware.
So until something breaks down is when they will seek out that alternative or the new device.
Personally, when I open up my computer every morning, I have yesterday's sales in the dashboard, and I have the most updated Net Promoter Score dashboard because that, at the end of the day, is what really matters for repeat sales and long-term sales. Are the various stakeholders, prescribers, parents, users, funders, etc., happy with the type of products and services we provide? Then we will be there in the long run. But it doesn't happen overnight.
Excellent. Thank you. A short final one, if that's okay. Just on the financial targets and on the revenue target, that includes M&A. I think you don't have a gearing target anymore. So just on the financing part and sort of just also, is it just s prinkle-on-the-cake acquisitions that you sort of think into that? Linda.
Yeah. I mean, what Nils was talking about, the vertical M&A, I mean, those are small targets. So it's going to be sprinkle-on-the-cake like it has been historically.
So a vast majority organic growth.
Absolutely. That's our main focus.
Thank you.
Yes. Thank you. And for a great day and good demonstrations also in the breakout. A question actually that we haven't touched upon so much today, and it would be on the separate product Boardmaker, if it's still representing like 10% of sales. And how do you see that market developing in, for example, EU? So perhaps a question to Nils and.
Yeah, I can frame it though. So Boardmaker is the solution, how we introduce symbol communication in the classroom.
So this is actually the tool that the teacher uses to translate what could be normal curriculum into a symbol-based curriculum, which is obviously then typically what the students in that classroom are responding back with. So again, you see the symbols, the PCS symbols. This is about how to implement that communication model into the classroom. It does represent less than 10% of our annual revenue, but it's a super important tool in order to enable the symbol communications, the Brocks of the world. If you recall in the video, Brock was pointing at a poster on the wall with the same symbols that he has on his device. That was made in Boardmaker. So Boardmaker is still communication, but it's kind of how you implement this alternative way of communication also in the classroom. Boardmaker has actually been around for decades.
The PCS symbols and the Boardmaker model is probably used by millions of teachers around the world, not just in the US. So it is definitely omnipresent. But we still see that as it's highly connected to our communication aids. I don't know, Nils and Tara, if you want to add to that.
I'd just like to add the PCS symbols are critical, not only for Boardmaker and our software. It's also used for people developing other products like books and signs for playgrounds, etc. And that's super, super important for us to encourage that because that gets our symbol system into the world. So that's what we're working quite actively with as well.
And it's not just that. It's Google's, Microsoft's that are currently using it within their products as well.
P erfect. Thank you. And Nils, you mentioned that you saw some improvement in some of the perhaps European markets on the funding side. Can you comment a little bit more on.
Yes, there are some interesting pockets. I could just take you back. When I started at this company in Italy, if you were born with a disability, you had no right to have it funded, chuck it up, more or less. That has changed completely. Italy is now funding aids for people that are born with disabilities, these communication disabilities. We see some interesting movements in Eastern Europe. It's quite interesting that Slovenia is one of our best markets per capita. Quite interesting. Then we see new pockets entering or money, or should I say financing? We see some new pockets in the UK and some new pockets in France as well. So it's a continuous development.
What we would like to see is kind of a European Union thing happening around assistive communication because it's very, very scattered right now, the systems in each country. But there are things happening, absolutely.
I think we can go up in the helicopter even further and talk about accessibility and inclusion in society. This is obviously something that is still immature, but it's actually something which is on the agenda for a lot of companies and countries, for that matter. It's also a part of the S in ESG, which we're often reminded about. So we do have a good, positive kind of political momentum that inclusion for people with disability is something that is key for society. And then slowly, slowly, we see improvement. We see improvements in the best of markets, and we see improvements in nascent markets.
For those of you who are Swedish here in the room, I can say there is a Börje Salming, the famous Swedish hockey legend that unfortunately passed away in ALS, in every country. ALS has actually carried a lot of awareness for us, starting with the Ice Bucket Challenge. When was this? 2014, 2015? 2014, 2015. Yeah. Started by two of Tara's users in Boston, where you live, in fact, users of Tobii Dynavox. And that was actually to improve funding for ALS patients in the U.S. It spread around the world. ALS is definitely something that is helping us with awareness. And now it's, of course, spreading. B ut it's rarely so that a market gets going from no funding to perfect funding. It's incremental improvements for diagnoses and groups, etc.
And across the world, in any market, ALS is the number one that gets these aids. It's clear. It's very clear. There is a big momentum behind ALS as a condition.
If I could j ust add one more thing with the Ice Bucket Challenge, what's been really successful is the FDA now has come up with several drugs that are now increasing the age or the length of ALS, which then gives us bigger opportunity, one, to get our devices there, but more for the families to have the opportunity to speak. So it's a win-win from something very small to where it is now.
Perfect. Thank you for a super answer. The final question for me, a bit shorter perhaps, to Linda, on the replacement revenues that we might see. Is it possible to give a ballpark of the 20%, how much is replacement, a couple of percent or 1%?
It's very small at the moment. The majority is new sale still.
T hanks.
Hello.
Thank you very much. Very interesting. I have a few questions. One is on the costs. I got that R&D is going to leverage a bit, grow the sales. On the part of salespeople, I would like to ask you, in the states, Tara, as you were saying, that each state is kind of a different country, the states in bureaucracy and all that. So if you have covered all the states, all the regions that you want, or should we see more growt h in those, let's say, selling costs?
You want to answer? Well, I will say. I'll tell you, from my perspective, no, we have a huge growth opportunity for us, getting more people on the street to do what we do and do it better. As you can see, the numbers are proving that out. But I will let the CFO talk more.
She always wants to spend money, but she actually brings in the money as well. No, I think it's important to understand that we need to continue to invest in our sales and marketing expenses. That's because, as Tara already told about, we have not scratched the surface. Even in the U.S., we need to continue to split the territory. A rep is actually traveling a lot. If we can lower that time and they can focus on an area, we will have the scale effect also in the future. Also adding the operational excellence, like the funding consultant, if they are to a lower cost than maybe a sales rep, that means also we have a scale effect over time. But we need to continue. We need to balance this, of course, to grow, but not grow our selling expenses in the same pace.
And I think I would like to add, it's not just about spending the money. We need to make sure that we find fantastic people. We need to find the right recruitments. The Emily that you met is probably a pretty good picture of what our own sales reps look like. We need to properly onboard them. We need to have a good background strategy. We need to have the right management, etc., so that they become successful in their job. Just putting an infinite amount of people on the ground too fast could also break us. So it's a fine balance. But we are happy to invest when the metrics look like Tara's story splits. It f eels like as long as those trajectories remain the same, that's an investment that we happily make.
And for Nils, I guess it's the same thing. As soon as you get a new country where funding systems start to work, you need more sales costs there as well.
Yes, to some extent. But there is also another important thing, is that we are trying to empower these people that you saw, the Emilys of the world, to do the work for us. We are providing tools to them to scale our business so we can spend less time in the needs of the users by supporting the prescribers.
So I guess the existing 15% EBIT margin that you're not going to talk more about, it's a margin where we are still seeing not all the costs fully leveraged.
Correct.
Okay. And on acquisitions, even though they're going to be bolt-on, maybe small, what kind of multiples will we see?
A very generic answer, if I look on past M&A we have done, and then I specifically look at the vertical M&A when we go in the market, is that these companies are typically profitable, typically profitability in the same range as ourselves. And so far, we've paid pretty much 1x annual sales for that kind of company.
Okay. And last question from my side. Taking account the debt that you have, a few bolt-on acquisitions, you're going to generate more cash, and you will start paying a 40% payout. What level of leverage do you want to have going forward?
Of course, we need to make sure that we have a capital structure and have the flexibility of doing this type of acquisitions investment, but also in the sales market.
So we are actually taking that out because we feel that we have strengthened our balance sheet so much now.
But I mean, the debt leverage is very much in our control, as you could see by how we evolve. And then from time to time, the board of directors will decide. And there are external and internal factors that say what is the right debt leverage. Obviously, we need to be smart about how we allocate capital. And being a debt-free company is quite pointless. So we should definitely share the excess profitability and the excess funds we have with our shareholders.
Thank you very much.
Mr. Laséen.
Yes. Hi. Thanks. I have a few questions on the selling efficiency, primarily in the U.S., to understand the scalability there and how it works.
First question is, what are the factors that have triggered an SLP in the U.S. to prescribe more than four devices per year? Could it be the special focus maybe that that person has or the patient group that they are targeting, external factors, or if there are any internal factors, success factors within your company that have resulted in that efficiency?
It's really everything you just mentioned, honestly. It's first getting out. You got to remember why I brought up about the one class. A lot of these SLPs come out of school, and they don't know how to do this. So we partner with them. We invest in the time of showing them, giving them the tools and opportunity to become competent. Once they become competent and they have success, as you said, with clients, it continues.
If they continue to do it on a daily basis, then it becomes very much easier for them. If it's somebody who does it once a month, once a quarter, once a year, it becomes very difficult for them to multiply because they have to relearn a lot of things. So it's a lot of different factors. One is definitely the education that we provide. We give them the competencies that they're missing, or we support them with that, as Nils said, for the prescribers. The second is the support side, this funding. If we could take that off the SLP because they are, just like the reps, we're a major component of that from each step of that. If that then gets put over to our internal operational competence of funding, then that's one less thing an SLP has to do.
Then they can go back and doing and seeing more patients to do more multiplying. What company are you going to do that with, somebody that you can partner with, that you feel is teaching you and making sure you and not necessarily just everything about us, but the industry, to make sure that they're having and Fredrik said, "We're competitors, but we're all in this for the same reason. We want to increase this market share. This is how we do it." So we are being. I really, truly believe the more time that we put in our competence, the two levers of putting people that are knowledgeable experts on the street and that's increased. We have over 75% of my sales team that are speech-language pathologists right now.
And then we have our inside operational excellence that we're taking the lion's share of supporting that is making that SLP a success.
And I can probably add, over the past 10 years that I have followed this, the U.S. market has been definitely evolving from something where we have trialed, fixed, altered the route, etc. Now I feel that we have a fairly good recipe for the market. Now it's all about operational excellence. And hence, I would think that from your perspective, it's been much more of a numbers game where we exactly look at efficiency factors, where can we put another rep, what's the density of population diagnosis centers, how much revenue per FTE are we measuring.
It's become much more of an operational excellence game, maybe as opposed to you, Nils, who has still a little bit more of business development to be done, but 7.8 billion people.
O kay. Do you have examples of regions in the U.S. where you don't have to put in that many resources that sort of takes care of itself?
That's really easy. No. Each one and why each state is very different and the requirements are very different. I could tell you maybe if you wanted to look at a funder, which is the least, is probably Medicare, which that is a large population of ALS. That is usually fast-tracked with a lot of legislation. I would say that's probably, if I understand your question correctly, is that the least that we have to put in during the process.
But we still have to make people aware of what is out there to support an ALS patient.
Yeah. I was thinking about how much resources you have to or how much time you have to spend on an SLP that is up and running on 10 per year as opposed to, I mean, one per year or maybe two.
Oh, I misunderstood. Yes, absolutely. And that is one of my team's goals, is to get those multipliers for that very reason because we bring them in. The investment of time is at the beginning, making sure they see success through the funding, through the process, through the product. Then we are there to support them internally and externally, internally with the operational excellence. We have a learning hub that there's all different things that we can refer them to to constantly keep them up to date.
So after four devices, you're right, it becomes much, much easier. They feel confident, and they are ready to do this pretty much on their own. They're carrying our water out there for us.
We steer and incentivize, to be honest, our staff quite a lot on raising those prescribers that prescribe four or more devices per year because it's a win-win situation. They are more successful. Their patients will be more successful. And frankly, we will be more successful with those two.
Okay. I have a few more on this topic. It's quite critical, I think. So how many field reps do you plan to add in the U.S. in 2024-2025 to supp ort 20% sales growth?
We don't say exactly how many reps. How many reps do you have today, Tara? 96. 96.
Our feeling is that we will continue to, at the right pace, fill up the market until we see that those KPIs are starting to go down. We don't know where the ceiling is at, but we can't do it by hiring 200 people tomorrow because then it will be low quality and onboarding. So there is some sort of pacing. But even kind of off the record, I wouldn't be able to tell what the maximum capacity is for the U.S. market. And that is the best market still. So high is the vague response.
Okay. Yeah. And just another one. I'm curious about the reimbursement side, how scalable that is. You have 80 employees in that side. Is that enough, or do you need to increase it, I mean, 20% or 10% more? Or how much can they handle?
Again, we're learning that, right?
We're doing a lot of testing, and things are very different in different states. So it's really a game of learning it. Do I need more? As Linda said, I always want more. But I am trying to scale and scale the operational excellence. That's really important, inside systems, making it and expediting as quickly, as efficiently as we can. So is it enough? It may not be enough. We may be looking more at contracts, right, or denials that we need more appeals people. But as our business grows and scales, some of those numbers will as well.
We have a model where we actually want to offload the field sales reps with as much administrative work, to do as little administrative work as possible, meaning funding. And right now, as you can tell, we have almost like a ratio 1:1.
I think that's probably not a bad thing because the in-house sales and support people, including funding, they are slightly easier to find. It's a job which has a lower cost profile overall, not just salary, but also the total cost of employment. Right now, we feel that an investment we say investment in sales and marketing. We mean both the sales reps and the inside sales people. Think about the ratio currently being pretty much 1:1.
I have two questions. First, I would like to hear a bit about your user base. I think you mentioned 20% is ALS in the U.S. But sort of what are the other groups? And is there any particular group that is growing more?
I can start by adding. I interviewed a colleague of mine, a Swedish person.
She was traveling with one of our reps in Boston last week. She met with three patients in a day. All of them had undefined diagnoses. So the whole kind of diagnosis focus is very hard to tell because you have an intellectual disability or you have brain damage and stuff like that. But with that said, I believe, Tara, correct me if I'm wrong, that if we still look at diagnoses, the three most common diagnoses, and they're about the same in terms of size, is ALS, it's cerebral palsy, and it's autism. Did I miss something?
Got it.
And anything that is growing faster, or?
Autism is growing fast er in terms of number of users, I should say.
Great. And my second question is regarding the price increases or the quite large price increase you saw in 2023.
So just the background on that, if it was driven by sort of you pushing for that or more driven by sort of the healthcare system putting more value to these kind of services. And then going forward, what sort of price increases do you see more over time?
So first of all, in the contract, it doesn't stipulate exactly which KPI is the steering KPI to decide the annual price increases. Medicare, in this case, which is they are the ones that communicate the new price, and then the rest of the providers basically follow suit. If we can just look at the historic numbers, it's been somewhat related to inflation. I think that is our best guess going forward. Tara, we don't do any specific lobbying, etc., to push for a certain price increase every year, right?
It's s omething that comes at us. We're at the receiving end of that.
Absolutely.
Absolutely. Thanks.
Any more questions? Something tricky to put us on the spot? You have us here live and direct. Okey-dokey. Then that concludes the session today. I am super happy to see so many people in the room. I love the types of conversation we have in the break and the question that you get now. We try and pride ourselves with being transparent, accessible, and open about this. So don't ever h esitate to reach out also between Capital Markets Day or earnings calls, etc. Until next time, thank you so much.
Thank you.
Thank you.
Thank you.