Perfect. Good morning, everyone. This is Rachel Vatnsdal with the Life Science Tools and Diagnostics team here at JPMorgan. Today I'm joined by Jim Davis and the rest of the Quest Diagnostics team. Similar to most of the other sessions that you've been attending, this will be a 40-minute session. First half being a 20-minute presentation by management, followed by 20 minutes of Q&A. For those of you listening online, feel free to submit a question via the webcast function. Otherwise, for those of you in the room, if you have a question, please raise your hand, and we have mic runners throughout the room. With that.
Thank you. Good morning, everyone, and thanks for getting up early to join us here. As always, our safe harbor disclosure that I'm sure you've read 30 times through the conference today or yesterday. We're here to talk about four things today. One, for those of you that don't know us well, just to describe our essential role as a leader in the diagnostic information services industry. Second, we're about growth, and we're gonna talk about the levers of growth and what we're doing to drive growth in our business. Three is, we'll talk about operational excellence. When you process 170 million requisitions a year, you have to be very efficient, you have to be very effective, and we'll talk about ways in which we continue to do that.
We have been very disciplined about our capital deployment over the last 10 years. We'll show you some data on that, and we'll continue to do that as we go forward. First, a little bit about our business, for those of you that don't know us well. You know, we serve over 50% of the U.S. hospitals and physicians in this country. Every year, we serve about 1/3 of the U.S. adult population. About 50% of all U.S. adults come to Quest Diagnostics over a period of three years. We have over 60 billion patient data points. We believe we are uniquely qualified to answer questions that federal agencies like the CDC, HHS ask on a routine basis, given the depth and the geographic breadth that we have across the country.
We have over 7,100 retail and patient access points, about 2,100 Patient Service Centers, 4,500 IOPs. We're in Walmart stores. As you know, Walmart sees over 100 million customers a week, and we wanna be where the people are. We have 24 phlebotomists, paramedics and health and wellness professionals that are able to make mobile visits. They staff our PSCs, they staff wellness events, they do drug testing across the company. On average, we process over 2 million tests a day in the company. Now, I think as many of you know, there's been a transition in Quest Diagnostics. I came into the CEO role as of November 1st. With all transitions, there's been some movement. I wanna just point out a couple of people. We brought on Sam Samad.
Sam was the former CFO of Illumina, joined us in July of this year. With that, yes, we recruited someone from the genetics and life sciences industry because it's a focus point of Quest Diagnostics, and it's a way that we're gonna grow in the future. We've also recruited Mark Gardner, you may see on the page here. Mark spent most of his career with Invitrogen, then Life Technologies, and then spent some time with Thermo Fisher Scientific before doing a couple of entrepreneurial things and then coming back to Quest Diagnostics to lead our cancer and genomics business. Then Richard Adams, who happens to be in the audience today. Richard leads our consumer-initiated testing business. That's our consumer direct business where we go direct to consumers without any intervention from physicians.
This is a framework that Steve introduced about 10 years ago, our guiding principles for our employees and for the external market. We called it our new Quest, but that was 10 years ago, so we will evolve this. We'll tell you more about this at our Investor Day in March. I can tell you a few things that won't change. What won't change is our overall purpose of this company. Our overall purpose of this company is to help create a healthier world. That won't change. What won't change is on the left. We're in the diagnostic laboratory industry, and we believe that when we provide these diagnostic insights, it can help people lead healthier lives. What will change is some of the things in the middle, the strategy.
The strategy has to evolve as our market structure and the players in our industry continue to evolve. I'll talk about that more in a few minutes on some of those structural changes that we are seeing in the industry. First, just for a moment about the overall lab industry. Again, for those of you that are new to this. We participate overall in an $82 billion industry. Now, about 36% of that $82 billion is work done in health systems for patients that are in bed. Now, we can participate in that market, and we do today. We have just under a $600 million professional lab services business where we run hospital labs. Quest employees inside the hospital that are doing that testing. In addition, a portion of that 36% is referred out to laboratories like Quest Diagnostics.
We think that's about a $4 billion chunk of that $36 billion, and we get over $1 billion of that, just under $1.1 billion today. We participate in that light gray area. Quest Diagnostics has largely been centered on the physician lab services business, which is about a $52 billion segment. You can see that hospitals also participate in that outreach business. They wanna get that work from their physicians that are stationed out in the world. The independent labs, you know, gather about 53% of that. You can see that 53%, about $28 billion, and we've got about 24% share. We are the largest market share provider in this industry today. As I mentioned, the healthcare landscape continues to change and evolve.
We grew up in a very simple industry where a patient went to a provider and a health plan largely paid that bill. It was a very simple, nice business. We were called an independent lab, and we were an independent lab because we called on independent physicians, and there were a lot of independent physicians out there. Today, a lot of those independent physicians are now working for someone else. As I walk around the circle, important to note that every one of these other participants in this industry is a customer of Quest Diagnostics today. Let's start with the patient. Patients are customers. They pay a portion of the bill. Sometimes they are consumers, and they come directly to Quest Diagnostics without going through a doctor. We've committed to building a $250 million business by 2025.
Health plans, which one thought of as largely contracting entity, is no longer. Health plans are customers of Quest Diagnostics. Health plans own providers. We're seeing that with UnitedHealth Group, Aetna, Humana, Cigna, all organizations that own providers. Employers. We call directly on employers today for prescription drug, for drug monitoring, drug testing of new employees, for wellness, but we also go into employees and get them to understand that if their employees use independent laboratories, it can save them a lot of money. Retailers. You've seen what CVS, Walmart, Walgreens, and even Amazon are doing in a primary care space today. In life sciences. Life sciences is actually generates more than $100 million of revenue to Quest Diagnostics. We provide pharmaceutical industries and CROs with data to help them do clinical trials better, faster and more efficient.
Obviously, providers and health systems are a big portion of our business and will remain. Our commitment is to remain at the center of this ecosystem. We a $45 average requisition in Quest Diagnostics unlocks a lot of vital information for every member of this ecosystem that I show on this page. Through the pandemic, you know, we established many, many new relationships. With hospital systems, Mercy, we recently purchased their outreach book of business and now serve all of the outreach physicians in Mercy across the Midwest. Hackensack Meridian Health, as I mentioned, our professional lab services business, we are inside the four walls of their hospitals. Northern Light Health up in Maine, Summa Health. We did an outreach deal in Akron, Ohio. We work closely. We have our PSCs in Walmart.
We enjoyed a wonderful relationship and still do with CVS from a COVID testing standpoint as well as Rite Aid. Through our Quest for Health Equity, we're working with organizations such as Choose Healthy Life, STM, Bread of Life, to help provide lab testing to underprivileged people in parts of this country where lab testing just simply isn't accessible. Through the pandemic, we developed deep relationships with the CDC, HHS, and the FDA to again answer questions from a COVID standpoint that we were uniquely qualified to answer. Let me now come back to the four levers of growth that we've been driving through the company over the last four years. Health plans, a focus on hospital, a continued commitment to drive advanced diagnostics, in particular around genomics and cancer, and then our consumer-initiated testing business.
First with health plans. You know, as I mentioned, health plans are no longer. We don't view them as contracting entities. They are real customers here in Quest Diagnostics, and we've established what we call value-based contracts, meaning we get paid a fee-for-service rate for most of our customers. Beyond that, what we're trying to do with these health plans is move requisitions from expensive hospital-based laboratories to independent labs like Quest Diagnostics. We're focused on quality, we're focused on an incredible patient experience, we're focused on an incredible physician experience, and when we do those things for these health plans, we can earn extra value. When we move reqs out of high-price systems to our system, it's a way for us to generate incremental value beyond the fee-for-service rates that we get paid.
We're enhancing these partnerships through value-based services, population health initiatives. As I mentioned, we are going directly to employers today. Employers today are still paying the preponderance of healthcare costs in this country. When we can help employers educate their employees that when they come to independent labs like Quest Diagnostics, it can save them a lot of money. Our focus on health systems continues. I'm sure at the conference, at this conference, you've heard about some of the turbulent times that health systems face today. Margins pressures, labor cost pressures, and a shift to home-based care. We can help with that.
Our lab management offering, our mobile services, our population health analytics that can help these health systems target patients that are most critically ill, and our ability to monetize their outreach book of business when they choose not to participate in that outreach business anymore. Finally, our advanced diagnostics business. We brought in Mark Gardner to really help us focus on our genomics offering as well as our cancer offering. It's a bit of a secret at Quest Diagnostics in the industry today. We have over $1 billion in cancer testing today. That's some routine testing like PSA and Pap smears, and we have a very, very strong anatomical pathology business where we get tissue samples in our labs every single day. Where we're not so strong, but where we're building capability is everything post-diagnosis.
That includes prognostics, it includes therapy selection, and it includes minimal residual disease. When you come back and join us at our Investor Day in March, we'll get very, very specific about what we're doing to develop tests to partner with others in the industry so that we're participating in this high-growth market. We control the specimens today. It's just a logical next step to be able to do that testing as these tests continue to emerge. Finally, from a consumer-initiated testing perspective, we believe it's a $2 billion market. We believe there's consumers out there that wanna come to Quest Diagnostics and other labs. They do not wanna go through a physician. These are people that are seeking privacy. These are people that are worried well.
These are people that may be chronic diabetics. A payer may only pay for two A1C tests a year. Why go to a doctor, spend $100 just to get a lab order written, only to get denied by the payer? It just is much easier to come directly to Quest Diagnostics. We launched a new platform over the summer. If you haven't seen that platform, take a look online. It provides an easier, simpler, more intuitive purchasing experience. Based on the analytics that we've seen thus far, we're off to a great start. As I mentioned, we've committed to building a $250 million business by 2025. Finally, our productivity program. In the past, you've heard a lot about Invigorate.
We certainly didn't pause Invigorate during the pandemic, but I can tell you any available resource in Quest Diagnostics from 2020 through the better half of 2021 was highly focused on helping us respond to the pandemic. We're now taking those resources in what I call reinvigorating our Invigorate program. Our commitment has always been to try to use our Invigorate program to offset the impact of prices and the impact of wage inflation. While the impact of price is less on our business, we talked about PAMA, about a 50 basis point reduction in price last year. The impact of inflation has grown as it has hit everyone here in this audience, and as it's hit businesses across the U.S. We are reinvigorating our Invigorate engine.
The piece I'd like to talk about in a little detail is what we're doing around automation and artificial intelligence. Many of you may have seen our laboratory in Marlborough, Massachusetts, in Clifton, New Jersey, and we've made a strong commitment to automating many of the manual processes that exist in the laboratory today. From an artificial intelligence standpoint, we've partnered with companies like Copan in the microbiology area. When I walk around the laboratory, if I see somebody looking into a microscope, it represents to me an opportunity to digitize a slide and let something else read that slide. It's not just about productivity, it's also about quality improvement.
Our early stage development with some partners around digital pathology, especially of prostate images, has really started to prove out that the quality of the reads is actually better with the use of artificial intelligence. As I mentioned, from a capital deployment perspective, when Steve came into the company, he made it his mission to be much more efficient with the capital that we deploy in this company. We're proud to say over the last 10 years that we've returned over 60% of our cash to shareholders in the form of share repurchases and dividends. We've spent about $3.4 billion of capital to upgrade our Patient Service Centers, modernize our fleet of logistics and the analytics we use to guide that fleet, to modernize our laboratories and to modernize and to continue to digitize all processes within Quest Diagnostics.
In addition, we've used about $3 billion for accretive growth-oriented mergers and acquisition, and we will continue to be opportunistic about that M&A going forward. Just the key takeaways that I'd like to leave you with, I think we're well-positioned for growth in this industry. We've committed to 4%-5% revenue growth on a long-term basis. We'll continue to invest in the growth drivers that I spoke to, and we are reinvigorating our Invigorate program to really make a bigger chunk into the inflationary impact that we're seeing on our business. We will generate strong cash flows and continue to return the majority of our free cash flow to our shareholders. I'd like to end with two important dates.
First, we are going to report our Q4 earnings and our total earnings on February 2nd of this year. We'll also provide full 2023 guidance to you at that point. On March 16th, we're doing an Investor Day where we're gonna go much deeper into our strategic priorities. You'll hear from me, you'll hear from Sam, you'll hear from other members of our management team. Since that time, since our Q3 earnings, you know, there's been a couple of significant changes in this industry. First, as you know, Congress delayed the Medicare reimbursement cuts called PAMA. We were not successful in getting SALSA over the goal line. We'll continue to try to do that. The impact from that delayed cut should have somewhere between an $80 million and $85 million positive impact on this business.
As many of you know, CMS increased the Medicare reimbursement for draw fees for the first time in nearly 40 years. That fee is going to go from roughly $3 all the way up to well north of $8. We feel good about that. That will add another $40 million of incremental revenue and margin to this business next year. While our expectations for 2023 have improved, we don't expect all of that upside from these new tailwinds to hit straight to the bottom line. We continue to face a challenging, yet improving, inflationary environment. Labor inflation is still high. It is going to be in the 3%-4%. While our turnover has lessened, it's still not back to the turnover rates that we had in 2019.
There continues to be a lot of uncertainty around both the COVID demand as well as the COVID pricing. We know that when the PHE ends, the COVID pricing that CMS is committed to will be $51. What we don't know is what the commercial payers will pay us. We're gonna argue strong for $51, we may not get that rate. There'll be uncertainty around what are the coverage policies regarding COVID testing going forward. With that, we will give you full year guidance on the impact of that roughly $120 million improvement. We'll be delighted to discuss that with you on our February second call. With that, We're ready for some Q&A.
Perfect. I'll invite the rest of the management team up as well.
I get to be next to you.
Perfect.
Good.
Great. Thank you. As a reminder, if you have a question, please raise your hand. We'll have mic runners pass you a microphone. Kind of to kick it off here on the base business volumes, you grew that just over 1.5% during 3Q. Can you just walk us through some of the drivers there? Really what was driving some of that growth, and if that's continued into 4Q. Are we at pre-pandemic levels or what should we expect from that volume going forward?
Yeah. We're better than pre-pandemic levels overall. The drivers of that volume growth, number one, it's share gain. Working with these health plans, we're motivated to move the work. The health plans are motivated to move the work, and employers are motivated to move the work. I can tell you, as we enter into a more inflationary environment from a healthcare cost standpoint, it's hitting employers' bottom line. They're very motivated to work with us directly to help educate employees that using labs like Quest Diagnostics, it's good for them, it's good for the patient, it's good for the payer, and it's good for Quest Diagnostics. We'll continue to do that. Combination of share gains, you know, moving high cost recs from health systems and other out-of-network plans. Our focus on health systems.
We have some, you know, very nice growth in health systems this year, both on the PLS and our reference book of business.
Perfect. That's helpful. Also just kind of following up on that, on the mix side of things. You mentioned during 3Q that better fee for service performance was one of the drivers of some of that mix. Can you kind of dig into that? How are you being able to compete in that fee for service performance, and then how sustainable is some of that?
Yeah. There's a lot of things in this thing called mix. Let me just walk through a couple. First, test per requisition, test density. We've continued to see slight increases in test density, test per req. Some of that could have been because of delayed care, people coming back to the physician office. Physician hasn't seen you in two years, and maybe he's gonna order more tests than he would've if he'd seen you once a year. That's part of it. Clinical mix. Our focus on our advanced diagnostics, molecular testing, genetic testing, some of the things I talked about in cancer, that mixes up the book of business. There's always a mix of fee for service and capitated work, we just saw in the quarter more fee for service work and less capitated work.
That can fluctuate from quarter to quarter. All of those things drove improved revenue per recognition. Obviously less price headwinds also helps us, right? As the price per test declined, the rate of decline year-over-year was an improvement.
Great. Then maybe following up on that, but just keeping on the mix topic. Can you talk about how mix has shifted within that clinical piece? You talked about doing more on the molecular side of things, the genetic testing. How do you think about that shift moving forward, especially as we have respiratory season being on pace here in the recent weeks as well?
Yeah. Well, obviously, we're seeing a massive increase, set aside COVID in RSV cases and in flu cases. That has an impact on our business. You know, there's rapid tests for flu. Sometimes, those rapid tests could be negative, but the patient has symptoms, so the physician reflex to a molecular test and we do that work. Now, obviously, when a patient presents today with flu-like symptoms, the doctor may order three tests. The doctor may order a COVID test, a flu test, or an RSV test. Some physicians order a COVID test. If it's negative, then they reflex to a RSV or flu test. That has been a very positive impact on mix for us. Flu testing, they're molecular tests. The combined panel is $142, but the reimbursement just on straight flu or straight RSV is very good.
Maybe just as a follow-up to that on the respiratory testing, how should we think about Quest competing with some of these at home tests? Especially once, you know, COVID has become more pronounced and everyone is getting used to some of these at home testing modalities. How does that, you know, play into your share shift when it comes to COVID?
Well, first, antigen testing is an at-home test that has had an impact on the PCR industry. I mean, you know, the positivity rate in this country right now is running at 25%. When it was 25% a year ago, the industry was doing three million, you know, two million, 2.5 million tests a day, substantially down. Antigen test is clearly having an impact. We send kits to people's homes today. You can order a kit from Quest Diagnostics for COVID, you swab yourself, you send it back to us. I think going forward, what we are going to see is an increase in home-based tests where the patient swabs himself. If you can swab your nose, you can imagine swabbing other parts of your body, STD related, we'll participate in that market.
We will have kits going forward that allow patients to swab themselves, do it in the privacy of their own home, and return those tests to Quest Diagnostics.
While we're talking about COVID, maybe just talking about the pricing of COVID right now. The $100 COVID PCR reimbursement. Can you talk about what's the latest on that? It sounds like the public health emergency may be getting extended again here today. How should we think about that, especially as these shift more towards some of these combo tests in light of the tripledemic and flu and RSV being there as well at that higher price point.
Yeah. We're optimistic that the PHE will be extended. The White House and CMS have committed to always giving us 60 days notice prior to it ending. Feel good that it'll at least go to, let's say, April 1st of this year. As you know, the reimbursement through CMS is $100. That's what we're charging most of our commercial payers, given the readiness response that we've been asked to carry as an industry. Post-PHE, CMS has indicated that they will drop the rate to $51. What remains unclear is what we will get paid through some of the commercial plans. We're obviously gonna negotiate $51. As you know, some of the plans may have ideas about paying us a percentage of that $51.
I think the other issue that we've gotta get our arms around is what will be the coverage policies of the commercial plans with respect to COVID. Today, basically 100% of all COVID tests are covered. Not 100% sure that that will be the policy going forward. We'll argue, obviously, from a national health perspective that that should be the policy.
Helpful. Maybe just going back to your comments on shared gains there. Obviously, you know, throughout the pandemic, you've had some of these smaller hospital labs and regional labs have really struggled. You know, that could be a source of share for you guys, but also on the other side of the coin, you've had some of these other labs invest pretty heavily in some of their capacity. There's still some debate going on on how that share shift is gonna happen going forward. Are some of these labs going to continue to run on, you know, the instruments that they invested in over the course of the pandemic, or will they shift back to send out? Can you just kinda walk us through your perspective of how you're thinking about those dynamics and how it'll shake out for 2023?
Yeah. First, it's not clear that everyone in this industry can make money at $51 or a percentage of that, depending on what the commercial payers do. Number one. Second, you know, there's been this concern that there's a lot more equipment out there, a lot of Hologic Panthers, a lot of Roche equipment that can do this molecular testing. In particular, going after STDs and STIs, which is one of the big things that is done on a Hologic Panther. Remember, having the presence of equipment does not guarantee commercial success. What's required to compete in that STD, STI market is First, you need relationships with OB-GYNs. You need a sales team to call on them. Second, we've got connectivity, you know, with hundreds of thousands of physicians today.
You need electronic connectivity with them. The third and most important thing you need is you need to be in network with the payers. I don't think all the payers are just gonna instantly put in-network these commercial laboratories just because they have equipment. If it was that attractive of a market to them, they could have gone out and bought that equipment long before the pandemic. Not actually worried about that equipment and the excess capacity that will exist.
Got it. Helpful. Then maybe just shifting over to PAMA. You mentioned obviously some of the PAMA and SALSA updates here. How are you thinking about your conversations with the government around SALSA heading into next year?
Well, it's our trade association gathered on January 3rd. We celebrated for about two minutes the fact that there was a PAMA delay. We fought hard for that in 2022. And a real big call-out to our trade association, ACLA, for getting that done. After that two-minute celebration, we started talking about SALSA and what it's gonna take to get a permanent fix in this industry. We still support SALSA. We know there's members on the Hill that still support it. There's some changing of the guard, as you know, some retirement, some new people coming in, committees changing. So I can tell you that there'll be maniacal focus on getting a permanent fix in this industry, and we'll push hard for SALSA in 2023.
Helpful. Consumer-initiated testing is another area that you've spoken about a fair amount recently. Can you walk us through, you know, what's the CAGR that you guys are assuming to be able to reach that $250 million in revenue by 2025 on the consumer-initiated testing? How much higher is the revenue recognition, or rev per rec for CIT as well versus your standard business?
Yeah. I'll let you do the math on the CAGR. Maybe Sam knows it off the top of his head. You know, we did $70 million last year in 2021, not 2022. We will tell you in a few weeks what we did in 2022. We did $70 million in 2021, $250 million in 2025. I don't know if you can do that CAGR off the top of your head. You know, it's a good CAGR, okay? You know, the reimbursement for direct-to-consumer testing, you know, it's obviously better than commercial rates. It's slightly better. It's better than our Medicare rates.
We're actually having a lot of fun playing pricing experiments in this business. It's easy to play price experiments and see what it does to your demand. There's some segments that I would tell you that are price insensitive. STDs. When a patient wants to know if they have an STD, they generally don't shop around for price. They shop around for quality, they shop around for access. The wonderful thing about our access is these 2,200 Patient Service Centers. You know, most of America can get to a Quest PSC within 20 minutes. We can provide that answer the next morning. We talk about kits and shipping kits to homes. If you have an STD, it's gonna take a couple of days. You order the kit, it's gonna take a couple of days to get your home.
You got to do the test. It's gonna take a couple of days to get the answer. That can be a five-day waiting period. You can come to Quest, order at 9:00 A.M. in the morning, do the test at noon, and have the answer by 8:00 A.M. the next morning. We're also gonna experiment with point-of-care devices. We can put these point-of-care molecular devices in our Patient Service Center, and we think there's patients that are gonna be willing to pay a premium to get an answer in one hour. We're really optimistic about this.
Great to hear. Maybe shifting over to 2023 expectations. I understand you're not giving formal guidance today, but can you just walk us through that $8.50 EPS target that you laid out in your, you know, most recent analyst day. Obviously, there's been a fair amount of changes in this market since then. You highlighted some of it at the end of the presentation as well. PAMA, SALSA not coming through at the end of the year, that's drop fees as well. You know, with all these puts and takes and inflation, how are you thinking about that $8.50 EPS target and the achievability of it for next year?
Sure, yeah. Why don't I take that? We talked about the $8.50 on our Q3 call, and we said that, you know, we expected to be around the number that was the consensus at the time within a certain range of outcomes. I think it's important to note that. But that the $8.50 was achievable, essentially. Again, we will give formal guidance on our Q1 call in February. We'll talk about 2023 guidance. Talk about the puts and takes there, you know, in terms of what drove that confidence around the $8.50 and, you know, in terms of potential, you know, what's driving the P&L. I'd say on the top line, first of all, you know, we have confidence in that 4%-5% revenue growth, mid-single digits.
We talked about our ability to achieve that over the long term. We have confidence that we can achieve that in 2023. We have confidence that the pricing environment is improving for us, that, you know, we've talked in Q3 about 50 basis point headwind from price, and we think that's gonna improve in 2023. That's another thing. On the, you know, expense side, we're still facing a challenging inflationary environment. We're not saying that it's gonna increase in terms of severity of inflation, but we're still cautious in terms of what inflation is gonna bring to us in 2023. We see labor costs still being in that, you know, the wages and benefits are still in that 3%-4% range.
You know, we see obviously turnover has improved, but it's still high, so productivity, it's still not where it was pre-pandemic. You know, in terms of growth investments, we talked in Q3 about doing $160 million worth of investments in advanced diagnostics and CIT. We're still gonna continue to do investments in those areas. The dilution from those investments is gonna improve this year because of the fact that we see revenues increasing, we see less dilution. You put all that together, it gives us confidence about the 850. There's been a couple of changes since then that Jim talked about in his prepared remarks.
One is around PAMA, that's good news, that we have this $80 million-$90 million potential. Now it's concrete that we get this upside from PAMA in terms of revenue and margins. The draw fee reimbursement, which is another $35 million-$40 million, positive as well. Again, per Jim's comments earlier, don't expect that that's all gonna flow to the bottom line. You know, there's still uncertainty about inflation. There's uncertainty about COVID, because, you know, we're assuming 10,000-15,000 tests a day this year, that could be lower. The reimbursement post the PHE could be lower as well from the $51. I would say, you know, obviously there's been some changes, both positive, but at the same time, you know, I wouldn't take all that to the bottom line. We might also make more investments towards some of our growth initiatives as well.
Awesome. Maybe just as a follow-up on that, how should we think about that $80 million PAMA delay impact kind of walking through the P&L and hitting the bottom line?
It's a straight revenue benefit, and it's a straight margin benefit. I mean, it all drops down to margin. It's about a $0.50 EPS benefit. But ag ain, don't assume it all going to the bottom line.
Maybe just talking about some of those investments. You've laid $160 million investments into advanced diagnostics and consumer-initiated testing. Can you just walk us through, you know, why are you confident that that's gonna be able to reduce those expenses this year and then maintain your growth projections in those areas?
Yeah. Well, I think Sam said what we're doing is largely keeping those investments flat. We're just going to start to see better payoff from the investments that we've made over the last couple of years and will make next year. The dilution will be less. We may not yet be at break even for our consumer-initiated testing business, but the margin as the revenue grows, the gross margins are very good, so again, it'll be less dilution. The areas where we are investing, specifically, we're building out an entirely new genomics and genetic sequencing platform, automating many of the manual interpretation steps using artificial intelligence to help with the interpretation, and this takes time, this takes money.
The benefit is, as genetics and genomic testing continues to explode, we're gonna have an incredible cost position, we're gonna have an incredible efficiency and turnaround time position. We're going to continue to invest there. I mentioned all things post-diagnostic, from therapy selection to therapy monitoring. Whether we partner with Roche or Thermo Fisher, whether we joint venture with one of these small companies, whether we license the IP or whether we make an outright acquisition, we will be a player in all things post-diagnostic, and we're going to continue to invest in multiple areas to ensure that we have a leadership position there.
I'll add one thing as well on consumer-initiated testing. The nature of the investments that we make there is slightly different in 2023 versus 2022. We invested in the site, in building up the questhealth.com. Now we're gonna be making more investments towards marketing expenses as well to promote the site and get patients onto the site.
A question from online. It appears that the gains in value-based care seem to be a result of the UnitedHealth contract that you signed a few years back. Can you comment on expectations for the UnitedHealth renewal in 2024, 2025, and whether we can expect that same level of value-based care upside when targets on moving racks out of hospitals reset under this new contract?
First, UnitedHealthcare is not the only commercial payer that we have, what we call value-based contracts with. In fact, as we renegotiated these contracts over the last several years, I would say more than 50% of these contracts now have some value incentives in there when we help the payer on what we call, you know, these four key areas: quality, cost, the patient experience, and the physician experience. As we get into the middle part of this year, we'll sit down with UnitedHealthcare, we'll have thoughtful discussions. We fully expect to renew that contract. We fully expect to enter into more value-laden types of incentives that are good for UnitedHealthcare, good for the employer, good for the patient, and good for Quest Diagnostics.
Maybe shifting over to capital allocation priorities. You know, obviously you've been focused on some of this M&A with an estimated $1 billion to spend this year. Can you elaborate on that current environment, both on the hospital consolidation side as well as other businesses, maybe even in different verticals that you may go after? And then also, you know, you recently appointed a new head of molecular genomics and oncology. Is that an area of focus from an inorganic perspective as well?
Yeah. From an M&A perspective, you know, a couple of broad categories that we're always trying to do. Number one, hospital outreach deals. Given some of the financial pressures that hospitals are facing today, you know, maybe they're just gonna choose to not go after this outreach business anymore. It's capital intensive. It requires you to continue to invest in your laboratories, and it may not be the 1st priority of a hospital CFO is to invest in a laboratory. We're pursuing, and the funnel looks good right this moment for many hospital outreach deals. It helps them monetize that asset and provides, you know, financial assurance to them. Second is, there's still small regional laboratories that are out there that are choosing to sell, get out of the business.
We always look for these regional opportunities, especially in areas of the country where our share might be a little bit weaker. Then there's a whole class of acquisition candidates we call capability building. Yes, we are looking hard in the genetics and cancer space, but there's other areas as well. Metabolic types of diseases, Crohn's, IBD, things where diagnostic laboratory testing still needs further development. So neurological diseases. So anything capability building that we think, you know, can help the company, help patients, we'll look at.
Perfect. With that, we are out of time. Thank you so much for joining us today.
Thank you.
Thank you, Rachel.