All right. Hi, everyone. My name is Ana Renzi. I'm one of the associates on the med tech team here at Piper. Today we're pleased to have Mike Dale from Axogen, the CEO, give us a little presentation on the business. With that, I'll turn it over to you.
Thank you very much. Thanks to all of you for joining us today. Looking forward to sharing a little bit about our story. My name is Mike Dale. As she's mentioned, I've been with Axogen for almost a year and a half now. I consider it one of the most interesting and exciting new market development opportunities in health care. Without further ado, I'll kind of walk you through that. One of the most important things I like to share with people is what's the purpose of any business? For us, like a lot of health care companies, we want to restore health. We want to improve quality of life. The way we want to do that, the whole purpose why we exist, is to establish an expectation to restore peripheral nerve function as a standard of care.
It's important to understand that today that is not the case in almost any expression of the manifestation of this type of problem. In this little animation, you see a mother and you see a child. It really embodies the whole expression of peripheral nerve care. The motor control, the woman pushing behind, her ability to touch and sense that bicycle, the child, the pedaling, all that's dependent upon sensory and motor control function. It's something you take for granted in everything you do. Some of you are touching your face right now. Some of you are writing. Some of you are eating. Your eyesight, all that is peripheral nerve function dependent. Up until recent years, when you lost that function, whatever it might be, what you would receive in response to that is a little lament and some solace and some condolences.
It was just one of those unfortunate elements that happens in life secondary to trauma or an iatrogenic injury. Axogen, just to put a capstone on it, is all about leading the way to establish the restoration of peripheral nerve function as an expectation, as a standard of care. That's the opportunity. As I've just discussed, there's no part of your life that is not affected by this function. It's just something you don't think about until it's not there. We're going to talk a little bit about the various expressions of that and the priorities that we've established in terms of turning this into a business based upon fulfilling this mission and also making it a great vehicle for all stakeholders involved in the business. The opportunities that we're talking about are huge.
That's why I said in the beginning of my comments that I consider it one of the largest untapped new medical development opportunities in health care. We have established with our business over the next three to five years these as our priorities. There are many others. It is really about where we can provide value in the most efficient and effective way. Extremities is the largest opportunity, very underpenetrated in each case across these opportunities: breast, OMF, head and neck, and then prostate. Nerve injuries today, as I have mentioned, are significantly undertreated, primarily driven by awareness, lack of clinical care guidelines, and the supporting tools and training in order to do the procedures. Therein lies the opportunity that we are building upon, that we have the ability to build upon.
The last thing I would say is that the business that we have today, while very handsome, profitable, fast growing, is strictly a domestic business. This is a global health condition. Therefore, the opportunities outside the United States are just as significant as they are here. We intend to exploit those in the coming years. Now, what causes nerve injuries and how do they express themselves? The majority of it is through some form of accident. There is classic trauma. You are literally in a car accident or some sort of accident that involves the breaking of limbs or cuts that lacerate your nerves. Therefore, these nerves need to be reanastomosed and reconnected in some fashion so that they can regenerate and heal. The other element in terms of the common manifestation is iatrogenic injury.
You're there for some other procedure, very commonly cancer, whether it be breast, whether it be prostate, whether it be something head and neck, mandibular. When you're doing these procedures to deal with one problem, you're creating another problem by virtue of the dissection of those individual nerves. There's also chronic disease in terms of the expression. Whether it's a cut laceration, whether it's compression, whether you've stretched and pulled the nerves apart to some fashion, or in the cases of amputation secondary to some of these situations, if you don't properly deal with the nerve at the conclusion of that procedure, you can lead to neuroma causing pain. There are many different manifestations. These are very simplistic renderings of those.
What we have developed at Axogen are the tools and an algorithm that allows you to successfully address these at effectively no risk, but with the potential of benefit. Very unusual in health care to have a situation where your benefit-risk proposition is essentially one that has the opportunity to provide you benefit. You can't guarantee exactly what that would be. You're essentially introducing no risk to the patient because the risk is the index procedure that leads them to be there for treatment in the first place. The algorithm is comprised of connection, protection, and termination products. Connection is literally, as the name implies, you're putting those nerves together. You need devices to facilitate that.
In the case where the native nerve cannot be reconnected directly, the opportunity is with Avance in terms of an allograft, human allograft, bioactive that gives a chance to bridge that nerve discontinuity and allow that nerve to regenerate. That is the exclusive foundation that the Axogen house is essentially built upon, is that unique product. Unique in the world and one that has really allowed for us to make the progress that we have today. The other collateral products, protection, are designed to ensure that you give the best opportunity for that procedure to succeed. What we are really talking about is nerve regeneration, the healing process that needs to take place. You are oftentimes dealing with very inflamed beds. Those inflammatory responses can create scarring and tissue adhesions. You want to avoid that. The products we make in terms of protection are products that facilitate that outcome.
Finally, in the situations where the nerve cannot be reestablished in terms of function, you want to cap that nerve so that the nerve does not keep trying to grow back to something that it has no ability to grow to and creates what is called a neuroma. Those neuromas are sites that create terrible pain for an individual patient. The proper termination of that nerve is critical for good nerve repair. This is what we do as a company. This is what we lead in. We are completely unique in terms of the work that we do and therefore why we are considered the leaders in developing nerve repair. As I mentioned, this is a situation where we believe that we are positioned to lead.
We are pursuing these efforts in terms of classic market development and all the things that need to be done based upon what we're building upon, which is the trust that we have with the physician community that write the guidelines and do the work in these particular spaces. We have now a history behind this that we can look to and point relative to benefit-risk and in the literature that supports the claims associated with benefit-risk. Finally, the access that we've established to bring forward new products and greater nerve care applications in the various hospitals that provide these services. The priorities that we've established for ourselves are these four. They're really based upon where we think we can bring to bear the greatest advantage. We have a history in extremities, i.e., the expression of trauma. We continue to build upon that.
These are primarily emergent procedures. In other words, they're not planned. The other three areas represent elective procedures where there's high potential benefit versus risk. Breast cancer, you have a primary index procedure designed to mitigate the danger to life associated with that cancer presentation. As part of the journey in breast cancer, we now provide the ability to restore aesthetically the basic characteristics of that woman's breast. As a natural progression, we now have the ability to restore sensation along with that procedure so that this area is not numb and so that you also resolve and eliminate pain, which accompanies most of these procedures. OMF head and neck, the whole upper body is very nerve dense, as you might imagine, for very basic functional reasons. When you have procedures in these areas, the nerves are affected.
It's an area which is very nerve-centric in terms of nerve care. Allograft and some of the other care techniques are new. That's what we're doing in terms of making awareness and building upon that. These are also elective procedures. Logistically, much easier to plan for and to work. Finally, prostate. Prostate, not indifferent from that of breast insofar as you have a unique situation where it's recognized that the dysfunction results from these procedures that we mitigate the cancer. We hold the opportunity to further reduce those side effects associated with those particular procedures. Much like these other procedures, breast and prostate alike are characteristic and unique insofar as the patient can also advocate for their own treatment once awareness is made. Extremities, as I mentioned, is where the company originally grew up in terms of establishing and building its presence.
This is the most numerous area in terms of presentation of defect associated with injuries. It's the most diverse in terms of the care providers. There's a lack of consensus and guidelines. This is starting to change. We've had good progress in terms of establishing care guidelines this year. The bottom line is we provide a portfolio and the ability to train to actually provide good solutions to these types of problems and raising awareness. It's a high double-digit growing area for our business. We expect it to continue to be so. Oral maxillofacial head and neck. Likewise, as I've mentioned, this is an area of work that is elective in terms of the procedures, highly complex, and with the opportunity from a benefit-risk standpoint to provide great benefit to these patients undergoing these types of procedures at essentially no risk.
The procedure today is one where you probably had the people who are most skilled and knowledgeable in terms of nerve. What we're providing to them are the products that allow them to do the work that they do today, but to do it more efficiently and effectively. Breast, as we discussed, secondary to these procedures, when the breast is removed, you're removing the nerves as well. Even with aesthetic reconstruction, this particular part of the woman's body is completely numb. Also, depending upon how the nerves are removed, you have neuromas that can form that lead to pain. The vast majority of women have some issues associated with the pain as well as the numbness that's associated with these procedures. We have the opportunity to ameliorate that and provide the opportunity for restoration of sensation.
Our primary work that we engage in today is, one, making awareness that this is now an option for treatment. Two, developing the training and the techniques within the individual institutions to actually do these types of procedures. Finally, prostate is the newest area that we're developing for the same reasons that I've just discussed with regards to the dysfunction that transpires associated with the prostatectomy. We have the opportunity to provide a potential very important improvement in restoration of function without introducing any risk. The key things that we're working on with regards to this particular area of development is ensuring that we can teach this procedure. It is a complex procedure. The cavernous nerve is different from other types of nerves. Those were the elements we're proving out. We expect that we'll be able to succeed in that regard.
From an addressability standpoint, it's probably one of the most addressable markets given the number of service providers that actually do prostatectomy and the near unanimity that this problem exists and that they believe that this is an opportunity to further add value with this type of health care intervention. Almost one year ago, we established for prospective shareholders and stakeholders exactly what we would do in order to honor our mission purpose. We established a strategic plan. We put this out. I encourage anyone who has an interest in the company and following up to go look at the full detail of that deck. It was a full day. We went in great detail. You get to see the entire management team in terms of what we're trying to do.
To use the baseball analogy, it's like Babe Ruth saying, "I'm going to hit the ball that way." How are we going to do what we're going to do? Why are we going to do it? This represents the various elements of that. It's pretty straightforward stuff. From a public company standpoint, what kind of growth do we believe you can generate and you can count upon? We've established that as a basic metric. Which markets we would attend to, why we would attend to these, why these would be the most efficient, effective areas for us to spend our time. Which new markets we would develop based upon our value proposition, i.e., the ability to ameliorate nerve discontinuity. Ensuring that we ultimately establish standard of care, which is more than a word.
It's an actual formal process where you socialize with individual societies that deal with these types of problems and their membership based upon evidence, which is also necessary ultimately to establish coverage and payment and achieving those outcomes. Commercial excellence, basically developing the various business models necessary for customer creation because each one's a little bit different. What's required to develop and retain customers in breast is different from that in trauma and so on. These all had to be developed. Completing the final regulatory elements relative to the movement from a device-regulated product to a biological licensed product, which we will complete hopefully this week. Finally, continuing to develop evidence in the future to further burnish the value propositions that we have. With regards to coverage and payment, strategically, we continue to make progress here.
While there's more work to do, we currently enjoy on the commercial life side, which is really the most important for a shareholder if you were to look at us today, is where do we stand? Because that's where the majority, based upon age, are the patients that we serve or will be paid for is through the commercial insurance line. We enjoy about 64%. We've added the millions of patients this year. We expect through the strategic planning period, we will close that gap to effectively full coverage based upon current progress and work underway. Just last week, CMS has introduced new changes in payment, another expression of the recognition of nerve repair and what's required to appropriately cover cost. This is a major barrier reduction in terms of the improvements in reimbursement.
We'll allow the expression and application of care more broadly outside of the hospital itself. It's also key for commercial payers because commercial payers basically pay a multiple off of whatever CMS pays. Again, another expression of confidence in nerve repair and the opportunity for better adoption going forward. We also have explained to our stakeholders early on that we will invest in the future. There are basically three basic areas all necessary to good nerve care that we're investing in. I hope in the new year, I'll be able to speak more specifically to several of our projects in these areas. First and foremost is protection. As we said, when you do a procedure, you need to protect that environment so that the nerve has a chance to heal as well as possibly can transpire.
Finally, easy coaptation, basically the ability to connect two nerves together. Sounds very simple. These are very small structures. It's not easy to do. It's highly skilled. There are techniques and technologies that are available that we're developing that we believe can make these procedures much easier without sacrificing effectiveness. Finally, the next generation of Avance. The form factors necessary to promote regeneration of nerves is obviously a near and dear to the future. We're heavily invested in that. I said in the new year, we expect to be able to speak more openly as to exactly what those projects are and how we're working on that. Finally, with regards to evidence, we have a great deal of evidence. I think it's notable for people to realize that 70% of all nerve repair literature was published within the last five years.
That will give you some idea as to how the momentum is building here and recognition of nerve care as something that should be more top of mind in terms of all expression of its deficiencies. We now have more than 300 publications peer-reviewed in the literature crossing nerve care associated with Axogen products. We plan for the future, higher levels of evidence. Why do we need to do this? Because it's appropriate to do so when you have a value proposition like this that you're trying to establish a standard of care. For our customers, for others, we're investing into the future, investing into this work so that everyone can have confidence that this is work that's appropriate to do and necessary to do.
With regards to the expectations that we've established for people, we, as part of our strategic plan, set as a goal for ourselves that we would be able to generate over the planning period 15%-20% growth year on- year. That we'll be able to do this with continuous improvements in gross margin, relative profitability of business. Very importantly, we'd be able to do this by fund these operations through our organic cash flow and ultimately build cash. This is the expectation that we've made very public. We still expect to be able to execute against. With regards to the forecast, when you look at it in the future, what are we doing here? It's with the things I've already talked about. It's basically four basic things. Number one, pursuing the market development elements that are necessary to achieve standard of care status.
These are concrete specific actions that you need to take for any new novel therapy. We are doing that. Finally, expanding the commercial team that's necessary to executing and fulfilling these ambitions. This is a team that we will expect to grow each year on an incremental basis across each individual workstream. Finally, new product and new application development. These are the elements based upon the under treatment that exists, which is why we believe that this kind of growth rate over that time period is sustainable. Importantly, at least in the near term, we can point to the fact that we have met and/or exceeded our guidance for this year through third quarter, both in terms of overall revenue growth, gross margin, and cash flow. We fully expect to meet our guidance through the end of the year.
Thank you very much for your time and listening to the Axogen story. If there's any questions, I'm more than happy to take those.