Good morning. My name is Lisa Gill, and I'm the Healthcare Services Analyst with JP Morgan. It is with great pleasure this morning that we have with us Cardinal Health. Presenting for Cardinal Health is CEO, Jason Hollar. Post Jason's presentation, he and I will sit down for a quick fireside chat. Jason.
Thanks, Lisa, and good morning, everyone. Thanks for joining us today. Let me get a few things out of the way here before I begin. I will be making forward-looking statements today. These forward-looking statements are subject to certain risks and uncertainties that may cause actual results to differ materially from those projected or implied. For a description of these risks and uncertainties, please refer to our investor relations website or to our SEC filings. Let's get started by going through a little bit of background for those of you that are a little bit less familiar to Cardinal Health. We are essential to healthcare, and we have the privilege of serving one of the broadest, widest range of customers and partners in the industry.
We are a crucial link between the clinical and operational aspects of the healthcare ecosystem and deliver end-to-end solutions to our customers that advance healthcare and improve lives of people every day. We have scale across the spectrum that you see on this slide being relevant in each of these categories. Whether you're talking about the several thousand manufacturers that we work with every day, or the, you know, tens of thousands of pharmacies that we provide products to, or the millions of patients that are in the home, we have scale across the spectrum. In addition to the scale, we're also aligned with a lot of the key secular trends in our industry. Let's start with patient demographics. We all know the stats.
You know, Americans over the age of 65, the real sweet spot of the healthcare industry, is expected to increase by nearly 50% from 2020 to 2040. That creates an interesting opportunity for us. Obviously, there's a lot of volume that comes along with that. What's also terrific about that volume is that it's much more resilient, stable, and predictable than what we see in other industries. This is a real boon to our underlying volume across many of our different business segments. At the same time, we're seeing unprecedented levels of scientific advancement and new drug development. This, of course, creates opportunities for us.
Again, volume is a key driver of that, but also brings with it other service and support beyond just the delivery volume into higher margin, higher value categories for our customers. Some examples of that would be, of course, new biosimilar launches as the biosimilars move into new therapeutic areas and sites of care. We're well-positioned in these areas as well as other novel therapies such as cell and gene. Underlying all these growth areas are the service and support that I referenced earlier, such as our industry-leading 3PL. Whether it's that aging population or COVID-19 or other value-based care models, we do continue to see the site of care shifting as well. This is often to lower-cost settings such as the home or ambulatory surgery centers, both areas that we have good scale in.
Specifically to our at-Home Solutions business, we're now a nearly two and a half billion dollar business and growing that top line very consistently at 10% per year as we continue to benefit from that shift of care into the home. Finally, as with other industries and accelerated by the pandemic, we're seeing technological advancements result in the increased digitization of healthcare with a specific focus on creating a tech-enabled supply chain which provides new data and analytics capabilities for both ourselves as well as our customers. Stepping back.
As a result of these specific capabilities for Cardinal Health as well as those secular trends throughout the industry, we've benefited from this growth over time and are now exceeding $180 billion in revenue per year while operating in more than 30 countries throughout the world and a team of more than 46,000 people. We're organized into two key reporting segments. The largest by far is our pharmaceutical segment, representing about 90% of our revenue for the enterprise. The earnings for the medical segment has been adversely impacted by inflation and supply chain constraints throughout the globe, and I'll get into some detail shortly on the initiatives that we're working through to improve those results. Let's start with a deep dive into the pharma segment.
Within the pharmaceutical segment, I'd like to start with just reminding you some of the recent highlights and some of the changes that we've made. Soon after my appointment in September, I appointed Debbie Weitzman as the new pharma segment CEO and also announced the corresponding restructuring of the organization. We brought the specialty and pharmaceutical distribution team together under one umbrella, which reduces complexity, improves both the speed and the quality of decision-making, drives productivity, and importantly, provides an environment for direct accountability within the business. At its core, the pharmaceutical and specialty distribution business distributes branded, generic, and specialty pharmaceuticals as well as over-the-counter consumer healthcare products. As I mentioned before, we have a strong, broad customer base from the largest retail chain customers to the smallest retail independent customers.
Specialty is a critical growth area for us, both in oncology as well as the other therapeutic areas such as rheumatology. In addition to distribution services, we have broad other service capabilities to support our customers, offerings such as our GPO services as well as technology capabilities like our Navista TS technology platform. As part of that restructuring that I've referenced in the pharma segment, we did create a more focused team for creating the sourcing and manufacturing services organization. This takes a holistic approach with manufacturers from the development to commercialization and distribution, more of the full-line supplier there. From a sourcing perspective, of course, we have our Red Oak Sourcing joint venture with CVS Health that has the dual mandate not only of controlling costs, but also to maximize the service delivery for our customers.
Beyond that, we also support biopharma manufacturers, the full range of other services, such as the 3PL I mentioned, as well as other services like data and evidence solutions, commercialization support, and others. Within the nuclear business, we do operate the largest network of radiopharmacies in the United States. Our core business here is getting those radiopharmaceuticals to the end user, but we've also recently extended that to be more of an end-to-end innovation partner with our manufacturing customers. This is primarily through some significant investments that we made in our Center for Theranostics Advancement in Indianapolis, and we support these manufacturers through contract manufacturing and drug development. This is a key part of our growth strategy for the nuclear business, but we also invest in other areas like our PET capabilities and other innovation.
A combination of all those items is why we have confidence that we can double the profits of the nuclear business from fiscal 2021 to fiscal 2026. Final business there, our Outcomes business, is that digital ecosystem that's designed to build that connectivity across the industry landscape that I referenced in the first slide, connecting the manufacturers, payers, pharmacies, and patients. Moving on to the Medical segment. Let's start with the medical products and distribution. Here we manufacture, source, and distribute our Cardinal Brand portfolio products, a $4.6 billion portfolio, focused on medical, surgical, and lab products. They range from consumable products like PPE, all the way to more clinically differentiated products like operating room and recovery room products, surgical gowns, nutritional and enteral feeding products, as well as compression devices, just to name a few.
We support an, again, another broad range of customers, large hospital systems, ambulatory surgery centers, clinical labs. Next, we have our at-Home Solutions business. I already referenced that a few times on those secular trends. This business delivers products and serves customers and patients directly in the home and is on that key trend. A lot of products here include ostomy, nutritional and diabetic supplies, and it is a key strategic area of focus for us, not just because of our right to win there with our capabilities, but also again, with those secular trends. The final businesses there, the medical services. These are businesses that capitalize on the trend of digitization of healthcare and include our OptiFreight business is by far the largest within that.
This is providing data-driven supply chain solutions. Just another way of saying that we help our customers reduce their freight costs, which of course, is even more important in this environment. Over the last 18 months or so, the medical business has been dealing with the effects of the global supply chain constraints and inflation, and that was largely on the Cardinal Health Brand products. A lot of the national brand products get passed through at cost plus. Our own brands, we tend to have longer-term contracts in place, which means it takes some time before those price adjustments can occur.
With that challenge, and in conjunction with my appointment as CEO, I announced a detailed medical improvement plan, a couple of quarters ago, targeting at least $650 million of segment profit by fiscal 2025. You know, given the importance of that set of initiatives, let's go into that a little bit further. The key driver of the challenge is the global supply chain constraints and the inflation. That's the number one area of focus for us is to mitigate that, to eliminate that $300 million headwind that first originated in fiscal 2022. It's a similar size headwind for us in fiscal 2023, and our objective is to eliminate that by the time we get to fiscal 2025. This is through pricing actions as well as other commercial strategies to offset.
We are making good progress. I referenced last quarter, Q1, that we had mitigated 25% of the gross impact of inflation, and that we expect to exit fiscal 2023 mitigating 50%, and then further mitigation to eliminate the entire $300 million by the time we exit fiscal 2024. Outside of our mitigation actions for inflation, we expect the next largest contributor of growth by 2025 to be optimizing and growing our Cardinal Health Brand portfolio that I already referenced earlier. This is to be achieved through new product innovation as well as increased product availability through targeted capital investments. Next is accelerating our growth businesses, back to that at-Home Solutions business there, continuing that 10% top-line growth to drive value over the next few years. Finally, driving simplification and cost optimization.
This is beyond just the Medical Segment, but it is a component of our turnaround plan here. One example is the medical, non-medical grade gloves portfolio that we recently exited as a good example of our actions to not only reduce the impacts of those issues, but also to de-risk our operating model going forward. Now at enterprise level, our key strategic priorities, as you can imagine, you know, first and foremost, is executing upon that Medical Segment improvement plan. I think we've been through that enough, but that is not only important for the Medical Segment, but clearly the top objective for the enterprise given the magnitude of the inflationary impacts.
We can't look past the fact that our Pharma segment is by far our largest business, 90% of our revenue and a substantial part of our profitability. Here, we're very pleased with the ongoing stability that we're seeing in this business, not just with the underlying volume, but also with consistent dynamics of our generics programs. We did see some volatility in this business over COVID, specifically in our fiscal 20 21, and we have seen that over the last 12 months, really get back to much more normalized levels.
To build upon that momentum, we continue to focus on the core operations of this business, driving improvements through investing in and prioritizing our customer experience as well as reducing the organizational complexity through the restructuring I referenced and driving other productivity and efficiency gains. Within our growth areas, we're focused on our specialty business. It's by far the largest and still growing very strongly. Mentioned earlier the organizational changes. I'm very much focused on getting more effectiveness out of that organization and more access to the investments necessary to grow. But we also do also continue to look at other growth areas such as inorganic investments and downstream. One good example would be our recent acquisition of the Bendcare GPO.
Lastly, through the new sourcing and manufacturing services organization, you know, we're building that end-to-end manufacturer strategy to ensure that we deliver terrific value to those customers. Finally, certainly not the least, is the relentless focus that we have on shareholder value creation. You know, it all starts with the first two strategic priorities in driving the appropriate growing profitability and cash flow. It's reinforced by the responsible return of that capital to our shareholders. For example, we continue to guide for $1.5 billion-$2 billion of share repurchases this fiscal year, and that's on top of last year's $1 billion of share repurchases, and in addition to the $500 million per year in dividends that we pay.
Far for this fiscal year, we announced that we had initiated a $1 billion ASR in the first quarter. We did increase that with another $250 million in the second quarter. In addition to all that, we've also further enhanced our governance structure with four new independent directors as well as the creation of the business review committee focused on both the operational and strategic aspects of our business and of course, the portfolio review. We do plan on having an investor day by the end of the fiscal year to take you through some of those aspects further. I'm sorry, I missed a slide there. Before I wrap up, one important note as it relates to ESG.
You know, we are committed to a more sustainable and equitable world. We've established our ESG initiatives accordingly, and that's depicted here in front of you on this slide. We're making progress against these targets, which we'll detail in further ways with our new ESG report that will come out in just a few weeks. What you'll see in this report and how we're approaching ESG is that we do believe that we can simultaneously drive improvements in these ESG initiatives in support of, and not in conflict with, our overall business transformation. We believe that can be win-win. Let me just close by explaining further why I'm energized about my role here at Cardinal Health and why I believe that we're a compelling investment opportunity.
First, you know, we continue to see stability in our largest business. That pharmaceutical distribution and specialty distribution business continues to have tremendous stability, much more predictability than we've seen more recently. The, again, back to the generics program, continuing to see consistent market dynamics. This was off of a pretty good year last year. Even in spite of the inflationary pressures we saw in fiscal 2022, for the pharma segment, we were able to grow that business bottom line by 5%. We had similar growth in the first quarter of 2023, and we have guidance for fiscal 2023 that is consistent with our long-term financial objectives of low to mid-single digit growth there.
And importantly, we have a very clear, robust plan to mitigate the impacts of inflation on the medical business through the medical improvement plan and to deliver at least $650 million of profit, segment profit, by fiscal 2025. We have the secular trends that I referenced before in healthcare that provide long-term tailwinds to our businesses. Notably, our growth businesses are on those secular trends. For the pharma business, that's primarily the specialty business, and for the medical business, that's the at-Home Solutions business. We expect that as these businesses continue to grow, that they will be a larger and larger contributor to our underlying earnings. We also continue to operate with urgency as it relates to the simplification of how we operate as an organization. You'll hear me talk a lot about efficiency versus effectiveness.
Most all these reorganizations or restructurings do bring with it some level of cost savings and efficiency. But I believe firmly that we get at least as much value as it relates to the effectiveness of these changes back to this quicker decision-making, better decision-making, and holding ourselves accountable to those results. We are clearly focused on cash conversion and continuing to generate that robust cash flow to provide the financial flexibility for that capital deployment. Here we continue to look at those various alternatives. You can see that the share repurchase I referenced earlier have been a key component of that, and we'll continue to look at those priorities. Overall, proud of the progress to date. Recognize that we still have some work to do, but really excited about what comes next for the organization.
Great. Thanks, Jason, for all the detail. It's nice to finally spend some time with you.
Yeah. In person, right?
In person. We've done a number of calls together, over the last couple of years, but, you know, it's been a few months since you took the lead role as CEO of Cardinal.
Mm-hmm.
Maybe just reflect on, you know, a few things. One, what have been some of your biggest takeaways sitting in this seat versus the CFO seat? Secondly, from a strategic standpoint, where are you most focused?
Yeah. There's not as much different as what perhaps there would've been the perception of, because some of these initiatives, I'd already had the momentum going in the, in the old role. The medical improvement plan is something that, right out of the gate, was really important.
Yeah
For us to not only put a clear line in the sand as to where we're going, but make certain that we have the resources and the attention to it. That was a key component. Of course, we've streamlined the organization in a number of ways. The internal organization hears me talk a lot about simplification, prioritization, everything that we do to, again, not just take cost out, but to ensure that we are moving with speed. I think where we go from here, I'm really proud of the fact that we made a lot of those changes very quickly.
Mm-hmm.
Within the first month or two, there was a lot of change. We had some organizational changes. We chose to exit some product lines in the medical business, but the pharma business continues to operate quite effectively with strong volume. Those organizational changes happened quickly, and then we all got focused to getting back to business as usual. We'll have to make tweaks along the way, but I think what you're gonna see is that we've clearly defined where we're going, what the objectives are, what the plan is, and it's really, at this point, all about execution.
You talked about capital allocation and talked about the $one and a half billion-$2 billion of share repurchase.
Mm-hmm
As we think about the assets that you have today. Do you feel like you have everything that you need? Is there areas that you would think about from an acquisition standpoint? You know, beyond share repurchase, how do we think about the capital allocation priorities that you have in place?
Yeah, I think we have, in the first slide I showed-
Mm-hmm.
Demonstrated that we have really great breadth in the industry. There were some things that we had to divest in the past, and we had three divestitures over several years-
Right.
That generated $3 billion of proceeds. There were some things that did not fit. You know, we'll continue to look at that. At the same time, there's nothing that we are missing that we need to be successful. There are going to be areas that we'll want to augment.
Okay.
More recently, you saw that we did a relatively small acquisition in the specialty space with the Bendcare GPO.
Right.
That's a good example of the type of opportunity we have that can accelerate further. When I look across the spectrum, it would be plugging into those growth areas.
Mm-hmm.
And not taking us down a different path. We are going to be very focused on what we do and what we do well, that core. When we grow, we are going to be really, really focused on very few areas, but prioritize those areas and invest more heavily, both organically as well as inorganically.
That makes sense. I followed Cardinal for a long time and watched them veer down that path, whether it was to China or to Cordis, that we didn't always think were the best things.
The phrase "focus on the core" comes up every single day in this organization, and that is, you know, it can evolve and morph a little bit, but we will-
Yeah.
We have $180 billion+ of revenue. We have enough customers, enough products. What we need to do is be more effective and efficient at delivering those products and services.
As we think about the medical improvement plan, you know, what are the factors that could impact you reaching that $650 million of segment profit by 2025? I think, you know, if there's one area of pushback, I'm sure Kevin tells you this, you probably hear it from investors as well.
Mm-hmm.
Is just, you know, really getting our arms around that and feeling comfortable and confident around that number, even though it's a few years out.
Sure. Yeah. You know, it's materially different than where we're operating today, so we understand that, and that's why we laid out the detail we did, the four-point plan to get there. Of course, within that two-thirds or so of the actions are in one category, which is to ensure we get the pricing and other commercial actions to mitigate that inflation. That's the biggest point is, you know, we are in the middle of this supply chain, and there's no reason that the inflation should stick with us. It needs to get pushed down. There are reasons why it's not simultaneous, and we are working on more permanent changes to the contracts to ensure that that's the case. In the meantime, we are working with the GPOs and our customers to find the right path.
We're confident that's the right answer long term, and that's why it's a key tenet of that plan. There, within that, to get to your question, there's things that can change with inflation, right? None of us know exactly where inflation is going. What's important is we have a process in place that allows us to pass through those impacts more quickly.
Right.
Of course, the first and foremost, to make sure we get this first $300 million remediated. Having the right structure there is important. Within the other key pieces, the next largest is, of course, Cardinal Health Brand volume. You know, that's a component that the innovation and the investments in the products completely dependent upon this management team to get that done. There's an underlying volume utilization that is going to be component of that. That's about half and half. Half of it is the mix that we're driving, and about half of it is just underlying volume. Over longer periods of time, given the demographics, we think that there will be that tailwind there.
There's always been a focus on the Cardinal brand product, right? Since buying Allegiance all those years ago.
Mm-hmm.
The penetration of Cardinal Brand products have never really dramatically increased. Is that because Cardinal just didn't make the investments needed for the next generation of private label product? Or was there something else that is changing now that you feel like that penetration can increase?
Yes. There's very specific things that we are doing to drive that. The innovation is part of it.
Yeah.
There's innovation, there's also capacity. Especially with the pandemic, there was a delay in terms of what we were able to execute. Our customers didn't wanna talk about transitioning to our own products.
Right.
They wanted to talk about just, "How do I get product?" Now that we are through the worst of that element of the supply chain constraints, now is the appropriate time to again, sell that concept to our customers. There's value for them to have those products. We also need to invest in the capacity because especially with the supply chain constraints.
Right.
you know, part of our challenge is then we've not been able to deliver as much product as what there's demand for, and then combine that with further innovation to further spur that demand. Remember, we're talking about a 3% annual CAGR. A couple points is the market.
Right.
You know, one to two points is that mix. We're not talking about dramatic movements that are needed, but an evolution and given the fact that we are under-penetrated, we believe right now, that's a real opportunity for us.
You know, there's been some question in the marketplace around, Now destocking for these hospital systems that they were taking hotel rooms and other places and putting as much PPE as they possibly could get their hands on. I know talking to yourself and your predecessor, sir, et cetera, that, in many cases that wasn't Cardinal's product because you were in a position that you were having difficulty getting product as well. What are your general views on destocking in the marketplace right now? Does that view change versus my perception of what has been said before around how much of your product could potentially be in the channel today?
Yeah. There's a lot there. PPE there's not any new news here as it relates to PPE. What we said last quarter is that we believe that the low point of the demand pull from our customers-
Yeah
To us was at the bottom in the fourth quarter. You heard us talk, fourth quarter 2022, you heard us talk about some volume challenges...
Right
With PPE in Q3 of 2022. It got worse in Q4 of 2022. It got a little bit better last quarter. What we're seeing is that our customers probably in the fourth quarter of last year finally started to hit those restocking points.
Yeah
You know, they were using PPE.
Right
Consistent pace. It's just that they didn't need as much of it.
As much as they had.
That destocking is happening very consistent to our expectations. We expect it to be a slow improvement. You know, different customers, different products, right? They may have enough of one but not enough of another. Generally speaking, they're still holding more than pre-pandemic, but it's also getting the pendulum swinging a bit back the other direction. The other key thing as it relates to the Cardinal Health story here is remember that PPE's never been a category that we've ever made a significant amount of money on. It's not a category, it's a commodity product. It's one that's important to our customers, so we wanna support them. We need to have the full line. As that volume fluctuates, it was really more of a challenge because we had volume fluctuating, price fluctuating, and cost fluctuating.
Mm-hmm.
It created, wild swings in profitability quarter to quarter on a product line that typically had very little difference.
Mm-hmm
As it relates to, those types of margin swings.
Do you feel that coming out of the pandemic, the competitive market has changed at all, when we think about being a medical supply? I agree with you that, you know, when you look at Cardinal historically, a lot of your medical supply business was not just that traditional PPE, but rather the surgical kitting and other higher margin types of products. Do you feel though that relationships have changed at all, or the competitive market has changed at all?
Well, you're asking the question to someone that wasn't here pre-pandemic. What I can tell you is.
Sure
That, even in the time period I've been here, the relationships, you know, they evolve. You know, where the medical healthcare industry is right now is where I think most industries are. Customers want product at a great cost.
Mm-hmm
At great value and delivered on time and.
Right
Derisked. With the pandemic, it threw a lot of things upside down, where you could get the one of those, but not all of those at the same time. It's, it's up to us and the industry to continue to demonstrate to our customers that we're focused on our core.
Right.
We're focused on investing in our distribution channels, our products, to ensure that they have access to the products that have great value for them.
Kind of switching gears a little bit to talk about the pharmaceutical side of your business, which has been nicely stable.
Mm-hmm
Which has, it's been a great business. Just really a few questions here. Generally this week we start to hear price increases for the pharmaceutical manufacturers. I know not as big of a swing factor for drug distribution these days, but has that come in largely in line with your expectations?
Yeah. I think the words largely in line is right. The main point is exactly how you framed the question, Lisa, is that this is, you know, certainly less than 5% of our brand margin, and it continues to be a smaller and smaller part. We continue to go to more and more direct fees. It's relatively small, and it's in the ballpark of what we expected.
Has it surprised you on the generic side that we've seen inflation everywhere but in generics? When we think about generics, I just really question how these generic manufacturers make money.
Mm-hmm.
Like, just given the amount of pressure we continue to see on pricing...
Mm-hmm
And the overall cost environment that we're in today. You know, what are your more broad thoughts on generic pricing? Could we potentially see some level of inflation in 2023, calendar 2023?
Well, you know, it's not something that we spend a lot of time thinking about, 'cause Red Oak Sourcing is absolutely focused on driving down costs.
Right.
Also remember, it's the dual mandate. It's driving down costs. It's also maximizing that service delivery and having the best service possible to our customers. What we see is they continue to find opportunities in the marketplace. It's a large industry, large market with a lot of very capable suppliers. You know, we wanna continue. We want to see them healthy, we wanna work with them. Ultimately what we see is still some opportunity to always continuously improve. When we look at the underlying performance of our generics program, we don't like to break it apart into the pieces because what Red Oak's performance is very much based upon how well they're doing relative to others in the industry, which is more the spread.
Right.
We continue to see, and that's why we use the reference, consistent market dynamics, is to indicate that that spread continues to be as expected.
Any surprises or any updates on the Red Oak side? I mean, if I remember, I think that agreement was signed long before your time, 2013, right?
Well, we renewed it, about a year ago, year and a half ago.
Yeah.
it took it through June of 2029. it is a longstanding relationship, so no, there's no surprise or changes. I think the fact that we renewed it more recently.
Right
Well in advance of, when it expires, just highlights that it's working for certainly our organization.
You know, one of the things that we've written about recently have been flu.
Mm-hmm.
We've been tracking the flu pretty closely. My understanding for drug distribution is that any incremental volume is good, but flu is not a huge driver of volume. Maybe can you just talk about what we've seen more recently for volume overall?
Yeah.
Assumption correct?
Your assumption is correct. It's really not a needle mover for us. It's one of many different products and product categories. Overall for volume, you know, as my prior comments were, we're pleased with the stability that we're seeing. That's the most important thing for us, so that we see predictability, consistency within that demand. Overall, there's pluses and minuses...
Mm-hmm.
Any particular quarter. This, what we're seeing for the last 12 months really is some pretty consistent levels of demand. Not just quarter to quarter, but even month to month. We're just not seeing the variations and fluctuations that we had, certainly during fiscal 2021. Back to flu, you know, it's, you know, even with a little bit higher volume there, you know, we don't know if it's just early volume or more volume at this point.
Right.
It may not be much different for the full year, but the main point is, it's a very mature set of generic products.
Mm-hmm.
that go along with that, which usually mean it's lower price point, lower margin points, and so it's not something I would expect to be material.
The big opportunity was a few years ago when Tamiflu.
Yeah, right.
Went generic the first time, right?
Yeah.
Like that was the opportunity.
Early sort of stories I've been told, yeah.
The stories, even if they're true. Let's spend a couple minutes on your specialty business, 'cause it's smaller than your two peers. You talked about it today as a growth opportunity. Maybe start with how these services have changed over time, and hopefully you have.
Mm-hmm.
Historical perspective-
Sure.
On how they've changed, and where you think the future is going and how Cardinal will play a role
Yeah.
in the future of that.
Well, as I commented earlier, you know, we have a very broad level of services that go along with our.
Mm-hmm.
Specialty business. By the way, we are very large and very relevant. This is by far our largest growth area, and it has grown consistently at double digits over the last several years. It's a space that we are very relevant and we continue to see the same type of opportunities in front of us. To ensure that we continue to evolve and provide the most relevant services to our customers, that's where we're making both the organic as well as the inorganic investments. Whether it's the technology, even the restructuring that I talked about. That was very much focused on ensuring that the specialty business, the distribution, and the upstream have the right leadership resources in place to drive that given the importance of that on our organization.
Again, back to our inorganic, types of opportunities, this is an area that, is, you know, M&A in general for Cardinal Health is not the highest priority.
Mm-hmm.
Of capital deployment. Within M&A, one of the highest priorities for us would be the specialty business. It's an area we would definitely continue to look, but there's a lot of factors that would go into that.
I think you mentioned this in the presentation, the Bendcare GPO acquisition. Are there other opportunities like that in the market, or was that more of a unique type of asset that was available?
There, you know, the downstream side is, you know, completely crowded and been, you know-.
Yeah.
Consolidated some time ago. On the the upstream side, assets that are generally like BendCare and, you know, there's lots of other different services too, so I don't wanna talk about just, you know, GPOs. In general, the upstream, assets are much more fragmented, growing very quickly, tend to be, you know, good margin-
Mm-hmm.
Types of opportunities, that's where we would be most focused for inorganic.
When we think about, you know, beyond specialty, where you talked about growth, you've talked on other calls about other growth areas within Cardinal, upstream opportunities. I think you've talked about nuclear coming back. So maybe can you spend just two minutes talking about maybe some of those other growth areas and the opportunities that you see?
Sure. Within the pharma business, the largest by far would be nuclear. Outcomes is a great business and growing, but it's relatively small. When you talk about what could move the needle over time, the pharma business is still only, you know, it's all relative to everything else, it's still only a billion-dollar top-line business, but it's a higher margin business. As I mentioned in my comments, we are investing heavily into that with the Center for Theranostics Advancement, as well as other capacity in our ecosystem and other innovation. That's why we. The good and the bad with the pharma business is the pipeline's long.
Okay.
Which means that, you know, it takes a while for those investments to pay off, but when they do, it's very predictable and, you know, we have the confidence, which is why we can have a five-year plan.
Mm-hmm.
-and to have confidence in committing to a doubling of that business over that 5-year period through fiscal year 2026. On the medical side, the primary other growth business that I referenced is, of course, At-Home Solutions. You know, business that's, again, also been growing very consistently, and we are also making investments here, not just in brick and mortar distribution capacity, which is needed-
Right.
'cause it's a two and a half billion dollar business growing at 10% per year. That's $250 million of product that's gotta get pushed through that pipe every year. We're gonna have to have some additional capacity there. But also in terms of some of the systems and processes that go along with that, to ensure a good customer experience as well as an operational experience.
You know, we touched earlier on kind of destocking of PPE, et cetera, but, you know, I said some of your bigger products are gonna be like surgical kits, et cetera.
Mm-hmm.
We always get the question around how do we think about the current environment for elective surgeries? Again, I know you're not reporting.
Mm-hmm.
The December quarter, how has it compared versus pre-COVID levels? Do you feel like we're finally back to kind of more normalization?
Yeah. It's, it's a little more clear to me on pharma that we're.
Back.
To the pre-COVID. With medical, it's even hard to define what pre-COVID is anymore. I mean, we're talking three years ago. But with medical, it was, I guess, early 2022, we had talked about. Well, fiscal 2021, the early part of that was when it went down faster than pharma did, but then it came back pretty quickly. It came back in the ballpark of where we were before. Always a little bit depressed, so it
Right.
We haven't always gotten, like, all the way back, but we got nearly all the way back.
Yeah.
Since then, the volumes have kind of bounced around a little bit. I'd say it's a little bit more of a, little bit of lack of growth as opposed to having an actual reduction.
Right.
Versus that pro, pre-COVID. The key with utilization, though, is PPE. That's, that's the part.
Yeah.
That's been most volatile. Again, there's no new news here because these comments are very similar to what I said this last quarter, where it's been much more predictable also for the medical business in the last couple of quarters.
Yeah.
That's why we feel, you know, certainly pleased with the underlying volatility in the business because both of our biggest businesses.
Mm-hmm.
Are showing that, as we get farther and farther away from the depths of COVID, that those volumes are a lot more predictable.
It, you know, the managed care companies have talked a little bit about the acuity level maybe being a little bit higher for surgeries. Again, they're projecting for the next calendar year, and they're looking at this and saying, "Let's say you were supposed to have a knee surgery and you didn't do it, did you pull an incremental ligament or something so that now it's gonna be a little longer surgery and a little more complex, so a higher cost?" If that is the case that we see things that are a little more complex, not saying that there was pent-up demand, but more complex type surgeries, is that something that's good for CAH?
I really don't know. I think I'd need to spend a little bit of time on that.
Okay.
That's, I think the key with our product line within medical is it's very diverse. As the tide rises and falls, you know, that business will rise and fall with it.
Right.
We do have a very diverse across the surgical room, the recovery room. I think that as there's more activity, there's more patients needing more procedures, that will be a good thing for us, generally speaking.
You know, you've mentioned in the past the newly formed review committee, which you also talked about today, will present its findings and recommendations at the Investor Day.
Mm-hmm.
the first half of the calendar year of 2023. Any idea, or you wanna kinda maybe talk to us about in terms of focus and scope of those recommendations and what we might hear, would be my first question. Secondly, it's been a while since Cardinal sent an Analyst Day.
Mm-hmm.
Anything else that we should really be thinking about going into that Analyst Day?
What I'll tell you here is that, you know, we are already in the first half of the calendar year.
Mm-hmm.
I would expect it at by the end of the first half of the calendar year. You can think of it more in the June type of timeframe is what we're kind of penciled out at this point.
Okay.
Within that, I would expect it to be a fairly traditional type of Investor Day. We're gonna talk about the business, the operations, the strategy, and of course, there's going to be a portfolio component with that. That's, you know, several months in front of us, so we need some time to be able to scope that out a little bit further before I can go much deeper now.
Well, I look forward to it.
Yeah.
As we have about a minute left together here, you know, we started this discussion with you're fairly new to the role, but a year from now, when we're sitting here together, what do you hope that investors will appreciate about Cardinal that perhaps they don't appreciate today?
Well, a year from now, I think that the... I think it's something you have to talk about each of the different components of our business. I think the short answer is, what I hope investors see is that they think back about what we said today, what we've been saying pretty consistently the last couple of quarters, they see a continuation along that journey. A year from now, when you think about the medical improvement plan, you know, we're going to be, you know, pretty deep into that, and we're gonna have some very key data points. We share every quarter our progress on the pricing initiatives.
Right.
When you think about, you know, being halfway through our fiscal 2024 at that point in time, we're gonna have most of those or a lot of those prices in place. We may not be in the run rate yet, but there's gonna be a lot of data points there. You're also going to see, you know, the growth of the growth businesses.
Yeah.
You know, whether it's at home within the medical business or specialty within the pharma segment. As it relates to pharma, I think what I hope and expect we'll all see is that we'll be another year into what is, I expect to be a pretty resilient, predictable demand pattern. While I think our industry and our pharma business has that reputation to some extent, we've also been shocked a little bit here the last couple, several years. Adding one more year to that, I think, just gives further weight that that's a fairly resilient business. Finally, I'd expect you to have another year of credibility about our capital allocation.
When we talk about responsible, focus on that deployment, I think you're gonna continue to see that and that investors will say, "Yeah, that's what they said they'd do, and that's what they did." It's consistent with the philosophy. We'll have to make adaptations along the way, but we think it'll be very consistent with how we've laid out the plan.
Great. We're out of time. Thank you so much.
Thank you, Lisa.
Good to see you, Jason. Thanks, everybody.