All right, good morning, everyone. I'm Richard Close with Canaccord Genuity covering digital and tech-enabled health for Canaccord. I'm glad to have Butterfly Network here today. Very exciting device story with handheld ultrasound devices, but also an interesting and innovative hardware-software technology story developing for the company. So from management of Butterfly, we have Joseph DeVivo here, Chairman and CEO, to tell the story, and we'll open it up to questions after Joe presents.
So Richard, thank you so much for having Butterfly here. I've known Richard for a long time, a lot of respect, and very, very honored and appreciative to be speaking at the conference. So I'm going to give some updates on Butterfly. Some parts of the presentation, I'm going to be talking as if you've never heard of Butterfly before, but then near the end, for those who do, I will give some updates.
We are a public company, and there will be some forward-looking statements. First of all, that picture on the right, yay for anyone who's ever heard of the Galien Award. It is the most prestigious award in medicine. It was founded in 1970 for basically rewarding Nobel laureates for their innovations in science and in bio.
There are about four or five pharma awards, but only one medical technology award in the world, and we won it for the best product in 2024. It was a great honor, and if you learn about this award, it's amazing because it's something that all the employees of Butterfly own. As you understand the story, you'll understand why our company earned this award.
We deserve this award because we're changing the world in a very, very positive way. Let's go operational. We did report our Q3 at the end of September. We did $20 million and grew 33%. I had told investors that 2024 was going to be the year that Butterfly gets its mojo back. We grew 14% in the Q1 , 16% in the second, 33% in the third. I think our momentum is going to continue.
We have a great product, a great market, and a great company to execute on that opportunity. So a lot of exciting things and our new product, iQ3, which won this award, is now launching in markets all throughout the world and will be bringing a lot of benefits to investors and to patients in the future. For those of you who don't know Butterfly, the semiconductors or the supercomputers, they used to be huge, right?
Now everyone in this room has one in their pocket. Well, imaging devices are huge and in the future, every doctor and every nurse will have one in their pocket to help diagnose and manage all different types of ailments. We know that whenever we learn something early, we can deal with it better. It's a basic principle in life.
The awareness of something and the awareness of it sooner allows you to intervene and deal with it before it becomes a bigger problem. And Butterfly brings that concept of medical imaging to not only all of the mature imaging markets in the world, but two-thirds of the world don't have access to medical imaging. And Butterfly now, at one-tenth the cost of a standard ultrasound cart, democratizes imaging around the world.
To know Butterfly is to understand our semiconductor and our ultrasound-on-chip technology. We are not a typical ultrasound company. Ultrasound uses a very analog method of using crystals, crystals like lenses on a camera, where you need multiple lenses to see different distances. There's no autofocus with piezo crystals in ultrasound. But because we have a semiconductor, we can produce any frequency that any other individual handheld ultrasound can produce. And we can do so at increasing powers.
One device can do what many low-end carts can do today. That sits now in the pocket of a physician. That power is what we continue to leverage. Because we are a semiconductor-based business, we have an exponential development evolution curve. With Moore's Law, every 18 months, processing power doubles. Analog, they'll tweak and modify, and we will be able to revolutionize.
What it does is it transforms patient care. Because when a doctor or a nurse has a device on them, they can immediately see, oh, I have abdominal pain. Well, what is it? Is it an obstructed bowel? Is it an early onset of a triple A? Is it an appendicitis? So is it a pelvic issue, a hernia? There's all these different things now. With ultrasound, you don't have to diagnose and then send for radiology.
You can just do a quick scan and get reimbursed. And this is changing medical care. And not only is it changing medical care, it is now maturing. A study just came out about two months ago from the University of Rochester Medical Center who made a decision. They made a decision that they're going to give one probe to every doctor in the hospital.
So they purchased 900 probes over a year and a half period, and they gave them to each one of the doctors. And they started to see a lot of early diagnoses, a lot of things caught early. But also, by putting an enterprise software program in place by Butterfly, they were able to capture reimbursement that they never got before because a lot of the ultrasounds were just too difficult to file for reimbursement.
But because everything is integrated with Butterfly, we have our semiconductor, we have our cloud, we have a middleware that integrates into Epic and into reimbursement. And because it's simple and easy, their reimbursement hospital-wide in imaging went up 116% in a year and 38% in the mature departments where they already had ultrasound, like the emergency room. And so this is starting to inform hospitals that every doctor having their own probe is actually possible.
Because doctors today have been buying it themselves. Probably 10%-15% of all doctors around the United States have probes now. And hospitals now need to build this into their workflow. What's an amazing analog is digital photography. Now, some of you here are old enough, you'll remember this, but I see some of you who might not remember because you look younger.
In 1995, Kodak, who had 80% market share in film, launched the first digital camera. They were going to disrupt themselves. Brilliant. Everyone was so excited, and they were like, are you kidding me? I don't have to develop film. I can store. I don't have to develop pictures I don't want. This is insane. Two years later, they famously shut the program down.
Every business school in America has this case study of giving up too soon, trying to disrupt yourself. Who didn't give up was Fuji, Toshiba, Canon, Panasonic. They realized that it was about semiconductor evolution because the image quality of Kodak's was a one-megapixel. It was very grainy. No one would replace that grainy picture with film.
But then in the late '90s, we got three-megapixel images, five-megapixel images, seven-megapixel images because they stayed on the semiconductor development pathway to where in 2003, more digital cameras were sold than film, and it never looked back. So that digital evolution took over analog. Well, Butterfly is doing the same thing.
This year, that award-winning product had double the processing power of its second-generation counterpart and is now as good or better than any other handheld in the marketplace because of the evolution of our semiconductor. And that's not stopping. And now we have 21 different presets on our probe. When you plug it into your phone, you select the preset. You say, I want to do a cardiac scan, a pulmonary scan. I want to do a, I want to look at the spine.
And then the moment you select that setting, it changes the array, it changes the frequency dynamically, and then you go. So I mean, we have over 1,000 of these in Ukraine right now. Every medic in Ukraine theoretically has, or every, not every medic, but 1,000 medics in Ukraine have a Butterfly. Why? Because one device can see the entire body. They don't have to figure out which device to have with them.
We have over 900 in Gaza and Israel. We have thousands in Africa helping midwives diagnose fetal position for childbirth. So these are all in areas that are necessary and that wouldn't have ultrasound as easily in these difficult environments. And Butterfly has a cloud, as I mentioned, has a middleware, and we have over 21 million images right now in our cloud, and it's growing by 30,000-40,000 a day.
It's the largest private database of ultrasound images, and it's an anonymized vehicle, and it allows us tremendous power for AI development. This just shows our cloud architecture and our ecosystem. Just like your iPhone, every month, once you buy a Butterfly, it's not the best day of Butterfly, and then every day goes by, it starts to deteriorate. Every month, we push new software updates to it, and it's connected.
Just like your iPhone, you get the next version of your operating system. It debugs this. It adds that. Well, that's what Butterfly does. It's a dynamic, living, breathing, improving product. Our semiconductors, as I said, this is our first, second, and third generation. Our third generation semiconductor, as you can see, it's a little bit bright, but that second column says data rate.
Our data rate doubled between our second and third generation, and that's what gave us such incredible processing power. But we're not stopping there. We are in development of our fourth generation semiconductor and our fifth generation semiconductor. Because our desire is not just to be equivalent to other handhelds. It's to change ultrasound. It's to change how ultrasound is done in the hospital and also in the home.
We're now leaving the era of trying to be equivalent to the rest of ultrasound and entering the era of changing imaging for the rest of the world. Because think of that digital camera. What digital camera do you use today? Now, if you're an enthusiast, maybe you have a unique camera. If you're everyone else, you use your phone. Use your phone because that digital processor not only is so good at producing image quality, but it could be miniaturized.
And that miniaturization is now something that also can occur with Butterfly, with wearables on patients in the home. And having advanced semiconductors that are not only more powerful, but can be smaller is a way to get there. So our fourth generation device is something that we would see come out in 2026.
We just saw the images, which we doubled the mechanical impedance capability, which now allows harmonics into imaging where all of the analog companies never thought digital would get to, but we are getting to now. And then our fifth generation device is a paradigm shift with 20 times the processing power of our current device. So we will change this market. And this is basically, with services, about a $12 billion market, but a $9 billion market in general if you're just looking at devices around the world.
And as our semiconductor gets more and more powerful, we're not only building out the handheld ultrasound market, but we're moving upstream with our processing power to take more and more of the existing market. And that's how Butterfly is going to grow exponentially. So it's not just about point-of-care ultrasound, the first circle, but it's also about getting into the hospital ultrasound market. And as we get into 2026, we will have our own cart.
But it won't be a cart. It'll be a workstation. And in the future, over the next several conference calls, we'll start unpacking our vision as to how we're going to completely disrupt that market. And then in the future, we're going into the home because patients will wear a device that can self-scan them and help these chronic care patients get more rapid diagnoses so they can get more rapid intervals of care.
And then that market opportunity for us will completely explode where we don't think our competitors can operate in this space in this manner. What's exciting is about 70% of medical schools are training on Butterfly today. And I just want to show you this one-minute video real quick.
We don't want the education that we give our Lewis Katz School of Medicine medical students to be obsolete on the day that they graduate. So we need to make sure that we are well ahead of the curve and that we prepare them to face and be a part of the technology that's coming. The future of. Your very own point-of-care Butterfly ultrasound. Now look under your chairs. See those bags? Open them up and unwrap what's inside and show everybody what you have.
So what's so exciting about that video for me is, first of all, all the kids knew what a Butterfly was. I thought that was awesome. But all the medical students today want that capability. They want to learn ultrasound. They want to go into their practice being better clinicians. Clinicians want to be better clinicians. They want to have that capability. And now medical schools are demanding, or medical students are demanding that medical schools provide this education.
And we're starting to build campus stores now at medical schools that, just like Apple, new medical students go into school, they'll get their computer, they'll get all their supplies, and they'll get their Butterfly at a student discount. And they'll start off their education with it. So this is inevitable. This next generation will have Butterflies.
And the future of ultrasound is a one-to-one model where that ultrasound in their pocket will be the same as the stethoscope. And probably the biggest barrier is to deal with those who did not go to school and were educated, which is this generation. And so we've invested heavily in AI with that database that we talked about.
And we have an AI tool where you can now. It shows you where to place the probe, what the image will look like. And then when you place the probe and plug it into this AI tool, it'll show you the image that you're looking at. And AI will then label the anatomy and tell you, that's the mitral valve, that's the aortic valve. You're looking at the left ventricle or you're looking at the right ventricle.
Now this is such a powerful tool that Kansas City University, their first-year students who are being trained on ultrasound are actually going to be trained on ultrasound using that tool. They put a press release out to say, because there's not enough doctors to look over the shoulders for every student, for every scan, every day, but they can self-teach themselves with these AI tools.
They just put a press release out that they're using this for first years for their curriculum. That's how we get the flywheel going in point-of-care ultrasound. As I mentioned, we are now entering in the next evolution. We've proven that we're equivalent to everyone else. Now we're going to become better because ultrasound is the hardest thing to interpret. You sit there and you put it on the body and you see this white cloud.
And then you have to really understand what you're looking at. If you're getting a CT/ MRI, what they do is they take slices. I don't know if anyone else in this room has had one of those. But you sit there and it just goes bop, bop, bop, and it's slicing your body into individual slices. And then no one's interpreting, or the person who's acquiring the image just tells you to get on the table and don't hit your head as you're sliding into the machine.
Then they do an automatic algorithm in order to do it. Well, we said to ourselves, can we do the same thing with ultrasound? Can we make it easier for someone to be able to acquire an image and then allow an expert to sort through the image in the same way?
Because we have a semiconductor, we can keep the device still and we can move the beam. Only company in the world that can do this. So we do what's like a burst photograph on an iPhone. So you press the button and it'll take 42 images within a couple of seconds. It'll go right through the organ. And then after it does that, it gives you all the images just like you would see on a CT/ MRI.
And then you can then determine and decide which image you want. So to show the video again, now you see the beam going through it on the right. You can see how the image is cycling and there's all the ones on the bottom. So you don't have to be the expert to go find the one image and then select it.
You can just take a whole scan, and then that image can, a nurse can take that, for example, send it over to a cardiology clinic or any type of other clinic, and then they can interpret the image. Only Butterfly can do that, and that's the beginning of us changing the workflows and changing the world of imaging.
The biggest way for us to drive this business will also be AI. Because AI, the easier it is to acquire an image, the easier it is to interpret an image, will grow the amount of users that can use ultrasound, and we made a decision to build an SDK and then create partnerships to allow all the ultrasound developers in the world to then come into the Butterfly platform.
We've signed 17 deals so far with 17 different companies and, like an app store, they can put their app into the Garden and the Butterfly customers can buy their app. So we have a store, we take a toll or we get a percentage of that revenue that comes into Butterfly. And the first one has just launched a Think Sono, which is an education tool and a bunch of clinical tools. By next year, we'll have regulatory approval and we'll have another way to amplify our revenue.
The last two businesses which are new is Butterfly Home Care. We are now partnering with the largest at-risk provider in the country to deliver services for congestive heart failure patients and skilled nursing facilities as a service. So we're not just an ultrasound capital company. We're building a virtual care product to help manage these patients.
And we're very excited about that. And then that semiconductor we were telling you about, we've learned that that device is a foundational semiconductor. It's not just for point-of-care ultrasound. And we've learned that it has many applications outside of point-of-care ultrasound. So we're going to be licensing it to other companies and we're spinning out a wholly owned subsidiary called Octiv that's going to monetize this business in wearables, implantables, and therapeutics, which is in consumer products, in military, nautical, and others.
So that'll be an entirely new revenue opportunity for Butterfly. We only have a few minutes left, Richard, so I might stop here. And if you want to do Q&A or you want me to just finish the last couple of slides. Go ahead and finish. Okay. So we had an investor day in March.
At investor day, we launched these strategic pillars, which had to do with growing our core business, but then growing each one of these individual businesses. If you're interested in Butterfly, I'd encourage you to listen to it. It's four hours and 200 slides, but it is the business plan on Butterfly. And that is how we are growing. And so it is about growing new businesses. So this is our core business.
They're just assuming that it straight lines at a nice growth rate, but we layer onto it our international markets, our home care, our other home care and bladder, our powered by and our garden business, and then our vet business. And that gets us to, in five years, $500 million in revenue and break-even cash flow at the end of 2027. So with that, thank you very much for your time. Richard, now I'll answer your questions.
Just a quick one. You mentioned the hospital market is insatiable. Are you going to need that workstation in order to scale it or the hospital market?
The question is, are we going to need the workstation to penetrate the hospital market? We are in the hospital market today. We do sell individual probes to doctors, and it's mostly in emergency room, in anesthesiology, and in ICU. And then we sell into primary care practices. But one of the ways that we've endeared ourselves to health systems has been through middleware.
About the only 35% of the scans, not just with Butterfly, but with any handheld ultrasound, get to become reimbursed. Because a lot of people just pick an ultrasound device up, they'll do a scan, put it down, they won't go through the effort of reimbursement.
When you use our software, you're going to get reimbursement up to about 68%-70% of all scans. So hospitals see a massive ROI when they put our software in place. So between having now our third-generation product with awesome imaging, having our middleware that helps capture the scans, we're building a nice presence in hospitals like Rochester and others.
When we come out with our workstation, we think that's going to allow things to really come full circle and really amplify our one-to-one model. Yes.
In terms of your technology portfolio, it seems like the semiconductors are very innovative and have a lot of value. Are the sensors in the handheld device also innovative? And then with an eye towards the wearable technologies, what is the barrier in terms of technology? How do you guys start looking at that?
So right now, there's actually so the question is, what are the sensors like inside of the ultrasound and what are the barriers to going to a wearable? Basically, the wearable is taking the chip out of the ultrasound device and putting it into something the size of your AirPod case. So this is the ultrasound device of the future.
You just put it on the patient and it'll do a lung scan, it'll do a cardiac scan. And the sensor is actually built into the chip. The chip actually has the MEMS wafer on the chip. So it's just the chip and the size of the chip that'll determine, but even a wearable of this size, our current chip would work and we can then put it on the patient's body. So that's just about creating the use case, getting the regulatory approval.
There's no technical barrier for us to get to that wearable. It's just us now believing we have a market, which is why we're building the home care business. Because as we build the home care business and teaching people how to use ultrasound and building that use case, it builds the market opportunity for the wearable. Yes.
Can you just help us understand the competitive landscape and kind of how we should think about large incumbents reacting as well as other smaller emerging players?
So as far as we look at it right now, it's semiconductor or MEMS-based semiconductor versus piezo crystal. There's one other company that built a hybrid that is a piezo crystal on a semiconductor, and they're very early in their evolution. We don't see much of them actively, but we were early too.
So we'll see what happens and we wish them the best of luck. All the other companies that use piezo-based crystals, they at some point in time are going to have to make a decision to depart that technology. You're only going to win with film for so long. And the film improvements are moderately incremental improvements where the digital improvements are exponential.
So it cost us $300 million to develop that semiconductor. It was a huge lift on the Butterfly investors. And now they're getting some of the benefit of that. Now Octiv will get the benefit. But for someone to compete with us, it's probably five years of development. They have to get around 600 patents. And they have to go through the learning curve of not just creating a semiconductor on a bench, but how do you productionize it? How do you build it at scale?
If we had to sell a million of these tomorrow, we could. We have no scaling issues whatsoever.
Do you have any additional questions, Joe? We'll be out here, I guess, in the hallway.
Yes, sir.