Amazing. Thank you, everyone. You've got Patrick on the U.S. MedTech team, and obviously, delighted today, to have Joe Almeida, the CEO of Baxter, and Clare Trachtman, who runs the IR function, to join us for what should be a fun chat. Before I get started, we've got the delightful disclosures, morganstanley.com/researchdisclosures. And then also you can reach out to your sales rep, if any of you feel, the unending need to do so. Thank you so much for joining us, both.
Thank you.
You know, Joe, maybe if we could start with sort of a bigger picture question for Baxter. You know, innovation and driving growth up to our mid-single digit range is kind of a key focus.
Mm-hmm.
How do you feel the pipeline of innovation is looking, and what are you most excited by?
I think we look at the growth story for Baxter as three different vectors. The first vector is acceleration of commercial execution, so going to areas of healthcare that today we cover, but we are not focused on. ASCs is one of them. We're very much a complete company when it comes to ASC, plus the ability to partner with great companies that can come in and do business with us. We're accelerating that as we never focus, so that is a market growing 7%+ a year, and the growth has been incredible in terms of the multiplication of sites and the transition from acute care into the ASCs is starting, and you're gonna see probably five years more sick patients in acute care care settings, and much faster turnaround in procedures that can be done in ASC.
So we have everything that you need to cover the ASC, and with the partnership with a couple different companies in the orthopedic space is one example that can get us there. The second vector is acceleration of innovation. As you said, we're launching 20+ products this year. We are planning to accelerate that. We have a large exercise that we're doing right now, where we do it every year for the LRP, is what is the unfunded activities that we need? So we see that accelerating, expanding in R&D by not a great deal, but few dozens of basis points will get us there.
The third is connected care, so not only making our products ready to connect, which they are, from our current pump to a new pump is connected to the EMR, also our beds, our monitors, and several of our devices, which are connected, and the ability to now get insights. So acceleration of that. So there's the three vectors of growth that will put us on a mid-single-digit trajectory.
You mentioned obviously connected care there, and Hillrom was a big part of accelerating-
Mm-hmm
... That strategy. What do you think within the healthcare system overall is the roadblock today to stopping faster adoption of real data analytics and connected care?
It's actually, one of the interesting things is who owns the data? So give an example. If you have a data lake that has significant volume infusion data and safety data, so you can actually mine that and learn with learning algorithms, artificial intelligence, latest generation, safer thresholds for delivery of a drug. The question is, depends upon the country you are, that data may not be yours. Where's the data residence? It's in your machine, it's in the cloud. Who owns the cloud? So every different hospital is a different agreement that you've got to have or different IDNs, different agreements. So I think the ability to understand who owns the data, it makes a clear path, but also how do you monetize? The second thing is the monetization of those insights.
In the past, those insights are more of a adjunct to get more sales of your basic products, so they're more giveaways. So we're trying to change that. Baxter has over $250 million in sales of connected care devices. We need to accelerate and get multiple times that, and we have the formula to do it. But you've got to get it right, because for hospitals to pay subscription fees on data insights, it has to be well-proven, and the ownership has to be there. So I think in the past was more nebulous. How do you follow the money? Who pays for second? Who owns the data?
Then, you know, obviously, supply chains and cost inflation have been extremely volatile over the last 18 months or so. How are things looking today, and how do you feel about the next sort of 12 months?
As all of you know, the inflationary pressures last year were really, really difficult on the company. We see a much different scenario now. Now, these inflationary pressures that came in, such as labor costs, material costs, inflation ex resins. Resins are oil-based, but the stuff that was components going into our boards, going into our devices, some of this cost persists. And we are on a $300 million a year journey and taking it away, and also with price action in different parts of the world, continue to work to offset eventually that. But how it is today is a much better situation. We have rolling orders that are 48, 24 months in most of our componentry, electronic components, semiconductors. That has made a huge difference for us.
We are in much better position today. We're still resolving several issues of dependency on single supplier. We're diversifying our base wherever we can, and we have a transfer office, well-staffed inside the company that is transferring products from supplier to supplier, getting not only best deals, but also back up. So tremendous amount of learnings for Baxter, and actually for our industry in terms of our dependencies. But the situation of supply continuity, availability of components has been all but mitigated at this moment, and we can see that our backlogs, for instance, starting to come down to healthy levels. We need to have backlogs, but last year, the backlogs were unhealthy, to a point that I was concerned about people canceling orders.
So this year is a much different situation for frontline care, for our patient support systems, our beds, and for our pumps as well.
Joe, maybe flipping onto the injectables business. You know, Baxter took a strategic redirection to refine the portfolio a little bit fairly recently. Recent growth has definitely been quite a bit, quite a bit more than I thought it would be. Maybe some comments on that market, you know, pricing, volumes, that sort of thing would be very helpful.
So, that market is all about timing and choice of portfolio. The timing is when you see more entrants in a specialty space, you've got to have more specialty drugs that go from a vial into a bag. So if you know Baxter, a portion of our portfolio is premixes, and the premixes are stable APIs in solution, either sodium chloride or dextrose, and they are either room temperature, refrigerated or frozen. But those are ready to use in hospitals, so there's no need for compounding at a hospital that does compounding for almost every drug that they have to administer, either via a pump or via a drip. So we made a portfolio choice. We eliminate from our portfolio some of our very low end, very low sales and tail. We also accelerate the innovation to be able to offset.
There is price erosion, but we're offsetting that with new products, such as norepinephrine in solution, such as bendamustine, and a couple others also, that has made a difference and will continue to make a difference. So you could see robust results for the last two quarters, how we came out versus the past. So we have a new head for that business, new segment president called Luc Soun, and Luc has a very simple execution philosophy. It's 10 products filed, 10 products approved, 10 products launched a year, and he has done a great job of shaping that group, and what you have today is more of a pipeline.
That business always welcomes some tuck-in acquisitions of molecules ready for launch into a different form, and they will continue to look past 2024 to continue that tuck-in. But until then, this business, you know, continues to do organically extremely well.
I mean, a few of your competitors filed Chapter 11, and it seems like the drug shortage list has gone up a little bit. You know, and then at the same time, you know, trying to accelerate ANDAs. How, you know, how much of that growth do you think is a function of sort of the market environment versus the sort of expansion for you into different form factors?
Yeah. So let me address one of the questions we get all the time, which is, which was the Rocky Mountain Pfizer plant that had an unfortunate tornado hit the distribution center of the plant. Our ability to supply those products, we said, this year is $10 million-$15 million. So if you look at the size of the business, it is very small. So while our focus was more into transforming your current vial or ampoule, injectable into a specialty generic, which is the mix that we do with our proprietary Galaxy product in the United States. So all our drugs are done stateside, by the way, they're in Northern Illinois. And those are, for the most part, very, very well-designed processes.
So the ability to get those ANDAs on the current drugs reformulated and stable for for direct use in hospitals is what made a difference for us. So it was Zosyn that made a difference. We formulated that many years ago. Our two or three drug launches this year, we have more next year, that allowed us to do this. Was not on the back of drug shortage, but was on the back of innovation to get this done. We also have a compound business outside U.S., it does pretty well. We are a very reliable source with tremendous quality. We don't have that business in the U.S., but we have a very successful business in Canada, U.K., Ireland, Australia, and New Zealand.
Then maybe flipping to PSS. You know, you mentioned last quarter the order book was improving and growing i.e. sequentially. How's been the market uptake of Progressa? How are things looking in that market overall?
It's doing well. It's doing well. The uptake in orders have been well within our estimates, and it's a little bit above that. The backlog of quotations and conversion from quotations to orders has been extremely well positioned, and that product's doing well. That product has been converting competitive accounts. We just had conversions in Canada and U.S. of competitive accounts. We like that. Also, don't want to diminish the fact that we launched a new feature of our Centrella, you know, the best-selling bed in the United States with continuous lateral rotation that is doing well as well. So that business, one of the things that tell me, Reaz Rasul , the president of that segment, is the rate of innovation needs to be a little faster.
So when I say accelerate innovations, as our second factor in growth, is to be able to get the cycles a little faster, because they tend to be long. They tend to be eight to 10 years, and I think we need to be a little shorter. We did a little bit with Centrella now, with the lateral rotation, continuous lateral rotation. It was a good way of getting that cycle revamped. So we've got to do a little faster, either with the smarter surfaces. One of the things we're seeing, we are seeing how smart surfaces are picking up momentum. So versus just a regular surface on the bed, this is a surface with sensors.
We look like that business is picking up good momentum now, and the situation in capital is alleviating, as we can see in the third and fourth quarter this year. Like we'd said before, it's picking up, you know, turning itself around versus what we had last year.
To see, I mean, you mentioned earlier before, obviously, the shift towards ASCs, in some cases becoming day cases. Does that change the type of bed? Because presumably the residual patients are sicker, if you know what I mean, that are doing the inpatient-
Mm-hmm.
Does that change the product offering over time?
We have the configuration of the bed will change. But if you think about the ASC, that is important, the ability to have the pumps and the medicines and the anesthetics and the sets and the tables in the OR, the video systems in the OR, and the software to manage that. So that is something that we bring to the table. But the beds are differently configured. They need to be confident to be utilitarian, and there's a configuration of a possible Centrella to a different level, for the ASC.
On the mention of pumps, any update on Novum?
Yeah. There's no better interest to get the Novum approved than ours, more than yours. So what we see with the pump today is we are still working with the FDA. We have one hardware issue to address. We're working through that. While this is progressing, I don't want to take the spotlight from our Sigma Spectrum. We see volume on unit basis between 2023 and 2024, growth of 20%. So we still have a demand, a strong demand for our current Sigma Spectrum, which is, by the way, fully connected to the EMR, two-way communication, and does scribes on the EMR and vice versa.
Great drug library, but we want to have our Novum, because Novum opens more volume for us and a better platform in terms of integration with the rest of Baxter products. That pump will automatically integrate through Connex to our Baxter gateway, and that connects with our beds, our monitors, and everything else that Baxter has. So we will do that for our current pump, backward integrate. That will take 12-18 months. We're more focused in getting the issues resolved that we need to get resolved, and have an approvable pump with the FDA.
I mean, the pump install base, because the pump markets just had recalls from peers and all sorts of issues, presumably the install base, particularly in the U.S., is a little old. How much is... and you might have had some customers waiting, still waiting for Novum.
Mm-hmm.
Is there a catch-up effect that could happen next year?
Possibly, if, you know, once the approval happens, possibly. The replacement rate for pumps is about 10%. If you think they last eight to 10 years, depends upon the institution, how they're used, can be a little faster, maybe 12%, 13%, 14%, depends upon the year. So but there is a bonus, and there's significant amount of work that needs to be done by competitors in updating their latest configurations. A lot of pumps to upgrade. So there is, believe me, all hands on deck. A lot of efforts put in to get this through.
And then, maybe shifting to China, I guess there's two topics. There's VBP, and then there's the anti-graft corruption kind of things.
Mm-hmm.
I don't know. You know the questions on both, so whichever-
No, I haven't received those questions in the last three weeks that I've been with most of you. The corruption is, you know, it is what it is. They will do what they need to do. We, as a company, are seeing that we shift from in-person to virtual very quickly. We sell a therapy. We don't sell a product, a technology, but a therapy. And a therapy is a little bit more than a product. It's also how you get the patient to be followed up at home. So all those phases are being done virtually. We also have technical service and clinical service going to hospitals. That has not stopped. One has changed.
If you're launching a new product, you see that the ability to interact with physicians take a toll in the speed of launch, you know? So we don't have many of those at all. We have one drug that we had, you know, very low sales expectations for this year. We saw a little impact, but that is the minimum, not even worth talking about, but we saw that. So if the business has a lot of launches, a lot of interactions with physicians, you can see a reduction on that. They're very cautious and concerned. The other thing, the VBP that you have asked, we, you know, so if you know, VBP was provincial last year, the year before, and now went to the national level. We did not get caught on the national level.
We were excluded from the national level. We have some data that indicates that at the provincial level, competitor products are creating more cases of peritonitis than ours do. And as I said, we don't sell a product, we sell a therapy system. So we hope that that becomes more clear in the next months, and we can have a constructive discussion about this. But we're happy that for this cycle, we were excluded. For the national VBP, not the provincial. The provincial, we were part of it.
peritonitis, thinking of PD and then renal, you obviously reached the strategic decision that spinning-
Mm-hmm
Renal was the best thing for both the Renal business-
Mm-hmm
- And for the parent.
Mm-hmm.
Maybe you know, because PD is a good business, but maybe you could give some color to the audience about why you felt that was better as a standalone entity for Baxter?
So when you make a decision like that strategically, and then you have to look at, who benefits from that, and what is the, the amount of work that needs to go through to get it done. So we did a more extensive amount of work. We are now confirming that the work we've done in terms of cost of separation, agreements between the companies will be done how we planned. But if you go back to the strategic reason, is they are two very different businesses. Their go-to-market is completely different. The cost of serving is completely different. And how the reimbursement works, for the most part, is a capitated market. Even in the U.S. with private insurance, eventually, that gets blended into, into this, into, Medicare, and the blended cost is capitated.
So it's a business that there's no DRG, there's no innovation gets paid more. Innovation doesn't get paid more in renal. What innovation does is has to reduce cost of care. So when we are designing this new cycler, the first objective is deliver equal or better treatment of PD, which we do extremely well. However, the cost per treatment has to be lower. Why? Because unless there's significant changes in terms of reimbursement, we've got to do that. So the whole process of innovation, of serving your customers and your customer base is very different. Baxter's an acute care company, ex renal. We are a hospital company, we're a doctor's office company, and we're now moving more specifically to ASCs with the purpose of being ASC company. We are not a therapy company, the rest of Baxter.
So the strategic decision is, these are companies with very different ROICs, very different operating income as a percentage of sales. And because of that, when you try to optimize, it costs more money. Now, we need to make sure that as we're going through this and putting together the actual case, that we verify that all the separation costs and other things together make sense for the company. So we're marching down that path, but we want to make sure, as always, that there is an advantage for the shareholder, not only strategically for the company, but we can see at the other end, the shareholder can benefit.
I knew Chris from his time at Varian and then SHL. Great guy. What was it that, that out of the candidates, made you feel like he was the right guy for the job?
Chris worked his whole career with a product that had to obtain reimbursement per treatment. So it's a very specific, it's a therapy, it's radiotherapy. Varian did a phenomenal job, Dow and the folks there, now that, that bought the business and his predecessor. So they create a business that's similar to what we do today. That's 100% capital. It's different than their business. The margins are very different, but Chris understands how to stay with the cost envelope and how to create the next chapter for that business. So he'll be talking to you about telecare, it's expansion of our Share source. It's the creation of water system for the home that is, that is feasible. Also, they'll create the ability to deliver technology to enhance...
And also trim portfolio to exit markets and business like we just did for you know shutting down our facility in the U.S. for when the product is not feasibly profitable. So he brought all those components. Chris is a phenomenal leader. As an individual, has impressed me quite a bit. And now he brings that—it's not about charisma, it's about the assertiveness and followership. So he got followership quite quickly within Baxter, and he brought some people who worked with him in the past, so he's building a great team.
I guess on the topic of management, other than being good with numbers, for yourself and the board, what are some of the key criteria for, you know, the ideal CFO candidate?
CFOs, if it's just about closing the books and doing the work, we have phenomenal people in the company, strong people in FP&A, accounting. We have strong in every part of the financial organization, very strong people. Look at my left here, Clare, you know, has been doing this business for a while and knows the business, is passionate about our company. So what we need more than that is an operational CFO, who is my right-hand person, who understands the strategy, but also understands the environment. We operate in a different margin level than most med tech companies. They operate different than we are. We are a mix of pharmaceutical injectables, medical devices, with some disposable and equipment. So we're a different company.
I've got to get somebody who has the ability to quickly learn, understand how to always keep the strategy being fueled by lower cost base, and also be a partner to our segment presidents in bringing them into a growth on the top line, but responsible growth, where you also don't spend every dime you have for five years to fund an initiative. So I think we're almost there.
I've got my resume here. Obviously, it's kind of one of those unanswerable questions for both Clare and for you, Joe. You know, your guide implies a slowdown in the back half of the year after, I think, a faster growth than most of us were expecting in the first half.
Mm-hmm.
It's the inevitable, "Is this conservatism?" question that you can't answer, because if you did, then it would be invalidating the question, but, that question.
Well, I'm just going to start, and I want Clare really to elaborate on this. It's not conservatism. It's how you see it at the moment you're doing. So it's not a chalk line. I said, this is how we see it today. I'll tell you that the markets are healthy. The capital market is recovering. Utilization is good. So when people call conservatism, I call you're prudent at the moment and very truthful to the moment you're doing it. So when things change intraquarter, we don't communicate, but we want to make sure that we have the ability to foresee things that maybe you don't see, because every business is very specific.
Yeah, no. So one, I think top line, you are right, it does decelerate a little bit. The primary driver of that is our renal care business, and it's the factors that we've talked about. We're facing some difficult comps from the prior year. We had about $40 million in one-time payments. We also have some impacts from China, from both VBP and also just excess mortality, the impact from that. In addition, the pharma business, there's a little bit of an impact there in our hospital pharmacy compounding business, so we've reflected that-
Outside the U.S.
It's that business is all outside the U.S. So the injectables piece will continue to kind of on that same trajectory, but those are the factors that really drive that. And again, I'd say the largest of it really does come from renal. The rest of the businesses, I would say, are steady on that trajectory going forward, with improvements, notably within our HST business, which is the former Hillrom business. We're going to see a marked improvement in the second half for that business. Now, on the flip side, I will tell you, while we do see that on the top line, some deceleration, the margin expansion, we're expecting, you know, about 300 basis points of improvement from the first half to the second half. So we are seeing some nice progression across the rest of the P&L there.
I think probably people who haven't worked in industry may not realize how astoundingly time-consuming a spin and things like that can end up being. How's it going? How are you managing juggling that and the base job, and do we have any updated vision of when we might get to a more final place around that?
Well, we will-- We're still on time for July 2024. It is significantly time-consuming. We have at Baxter a phenomenal group of very talented people and has been, and we have no shortage of talent coming to the company. We attract-- We have a good brand, and we attract good people. It's been tough, of course. People working a lot. I am, Clare is, everybody is, but we're working with an objective in mind. We've got to make sure that we got this all these costs in place, we understand what they are, and then we progress on to a potential Form 10, and then this being, again, the July 2024.
And then, you know, it doesn't affect your business tremendously, but it's the hot button topic, so I have to ask. GLP-1's view of the world?
This reminds me of statins back 25 years ago. We—I think, you know, there will be an impact in medical devices. They are dependent upon either surgery or other things. For Baxter, the long-term impact, the issues that cause acute kidney diseases and chronic kidney disease are somehow related to diabetes, but not necessarily 100% related to diabetes. There are other factors that cause dialysis, you know, patients to go into dialysis, which is a chronic disease that doesn't reverse. So I don't think that impact in that business in the short and near term or mid-term will be there. Need to see the effects of the drugs in the patient population with large volumes, large cohorts over time. But, you know, we can see the peritoneal dialysis.
If you think about peritoneal dialysis is about, it's always been, and will continue to be a fast grower within the dialysis patients, because the modality is more convenient for the patient. And we are seeing that our technology is better than what is in the market today. We have indications on that, on competitors in the U.S. who are not doing well in PD, and we are. So I want to make sure that we do not lose perspective, that that technology and that space is a, you know, X, the mortality of, of, of COVID, is a business that grows 5%+ a year.
Okay. Clare, have a timing. Thank you for joining us today.
Thank you.
Thank you.