Good morning, everyone. Welcome again to the Stephens Investment Conference. Excited to have Health Catalyst joining us here today, and Bryan Hunt, the Chief Financial Officer, and Jack Knight from the investor relations team. We'll just jump right into the questions. Bryan, maybe we'll start on the, the end market and just, you know, the, the talk of a stabilizing end market with some green shoots on the last call. Can we start with discussing the, the core problems that Health Catalyst solves for healthcare provider organizations, and the, the benefits those clients derive from deploying Health Catalyst solutions?
Yeah, good question, Jeff. Thanks for having us. Yeah, so Health Catalyst, just, just in terms of use cases, is essentially a provider of data and analytics technology and services to hospitals and health systems. The core offering that we provide is called our Data Platform or the DOS platform, D-O-S. And it's essentially a way for health systems to manage their myriad sources of data that are flowing into their system in a single source of truth, in a harmonized way that enables analytic use cases and better decision-making. So it's managing your data for clinical use cases, financial use cases, operational use cases. So it is very broad in terms of the value proposition to clients. But really, the end goal is to drive what we call measurable improvements through the use of data.
Those improvements are both financial, so they could be cost savings, revenue enhancement, or they could be clinical outcomes, so lower length of stay, lower readmission rates, number of lives saved, kind of enhanced clinical outcomes as well. That's our core offering. We do complement that technology with services. We provide consulting services that help you make better use of the technology and insights that you derive from the platform, and actually operationalize those changes to really drive that lasting improvement.
More recently, we've offered what we call outsourced or tech-enabled managed services, which essentially are a way to offload some of your non-core hospital functions typically within IT, so your chart abstraction or your analytics functions, to Health Catalyst as a way to drive a deeper partnership with our clients and really further provide additional ROI by operating that function at a lower cost profile than what health systems would do on their own. Those are the kind of core offerings that we've seen and deployed over the last several years, but more recently, a lot of interest in this tech-enabled managed services offering, as well as some of our platform use cases that drive hard dollar or financial outcomes.
Excellent. Excellent. A lot for us to dig into there. Good and helpful overview, and we'll dig more into the measurability of everything and across the spectrum of value that you deliver for your clients. But to kind of stick on the end market topic and what you're doing from a new business win perspective, should we—we think about the market potentially coming back to some of the larger software platform engagements that you've been known for more traditionally? What's changed about the competitive environment since 2019 or even 2021? And how do you make sure that the evolution of the business over the last two years helps improve your win rate in the kind of next cycle for health system and other provider organizations purchasing data solutions?
Yeah, great question. Yeah, so, in terms of those offerings that I mentioned, the core offerings are our DOS platform, and then we couple that with some analytics or applications that sit on top of the platform, that are typically web-based tools for clinical, financial, and operational improvement. Those do have a little bit of a different competitive dynamic or competitive set. So on the data platform side, we're primarily competing with, what we call cross-industry solutions. So they're, non-healthcare specific data warehouse technologies, things like IBM's, Oracle's, kind of Snowflake's, even some of the, you know, larger cloud providers that have, data warehouse technologies. Oftentimes, we'll see health systems, and this is kind of the majority of what we see in the market, building their own analytics infrastructures on top of those cross-industry tools.
And that's been a similar competitive dynamic for the last several years. And so where we differentiate and excel there is, we partner with those same kind of cross-industry vendors for the lower levels of our tech stack. So we're not trying to recreate the wheel on the best use of database technology, the best use of cloud technology. We partner with vendors like Microsoft and Snowflake for that piece of what we do. But where we invest and where our R&D goes is to the healthcare-specific content and logic that really meshes that data together, for healthcare use cases. So it's pre-built data models, source connectors, it's pre-built dashboards, it's kind of pre-built machine learning and AI algorithms as well, and that's really where we excel.
So you kind of get the best of both worlds of, you know, strong, robust, kind of cross-industry technology, coupled with healthcare-specific use cases that enable you to do analytics on a much faster basis than what you would do, and on a cheaper basis than what you would do if you were building that yourself. So that's really the main competitive dynamic that we've seen, and we do have strong win rates. We are very competitive in those situations where a health system is looking at, you know, moving to a commercial-grade partner for their analytics. We also compete with some point solution vendors on the application side. So in those use cases that I mentioned, clinical, financial, operational, there are hundreds of kind of healthcare-specific apps or point solutions that we compete with.
And really where we differentiate there is we start with our platform, and so we offer a broader set of data and insights to our applications than what you'd find with kind of a single point solution vendor. We're kind of an enterprise partner, and so compared to, you know, smaller point solutions, it's easier for us to kind of break in and have that trusted relationship than it would be for a point solution vendor. So I would say that's all pretty consistent over the last few years of what we've seen from a competitive standpoint, but we've made some changes that I think enhance our competitive dynamic moving forward, could lead to stronger win rates. So we've launched—we have a couple different versions of our data platform that we can offer. So we have our enterprise DOS™ platform.
We also have kind of a DOS Lite or modular DOS option, where you could start small if that's all you're kind of ready to do from a health system standpoint, and then migrate up the stack from there. And we've seen some good traction on that this year in 2023. I think that'll lead to, you know, some stronger win rates in the future as well for us, just having multiple offerings. We've invested, you know, over the last, call it, two years or so, in some additional platform upgrades, where we're integrating further with Snowflake and Databricks, kind of building out some more multi-tenant capabilities, shared compute capabilities for big data use cases. I think that would will also lead to a stronger offering in the market, moving forward.
We've got a few clients kind of on that platform upgrade today, and it's going well, and I think that'll be, that'll be relevant moving forward. We also have, I mentioned our, our Tech-Enabled Managed Services offering, but we're starting to kind of experiment more with that as kind of a, a potential lead to new DOS platform wins, where when we offer that service, we offer cost savings to the client, when they essentially outsource their current team. And that savings can, in some cases, you know, pay for or help fund the technology deployment as well. So those are all things that I think kind of lead toward, you know, stronger kind of win rates and, and a more competitive, differentiated set in the future for us.
Makes sense. Sounds like best of both worlds and multiple on-ramps, all part of, of trying to, to help build the, the pipeline.
Yeah.
I want to follow up on the discussion of TEMS being a bigger part of new deals. It's interesting after, you know, the last 12 months, we've heard about existing client growth, we've heard about the mix shifting towards services. So how are those discussions progressing in terms of just the kind of volume of them and progressing through the pipeline to have TEMS be part of the solution from the start, rather than something that's added on later?
Added on. Yeah, exactly. Good question. Yeah, so, essentially, almost all of the deals that have included TEMS have been upsell opportunities to existing DOS clients. That was our, I'd call it, 18, you know, 12-18 months ago, that was kind of our, our primary focus when we saw health systems really under significant financial pressure in the, you know, second half of 2022. One of the tools in our toolkit was to provide cost savings to them by upselling TEMS, and so vast majority of our time and focus has been on that as an expansion play versus as a new client kind of win play. And I think that's been helpful.
So we've signed multiple deals over the last several quarters that have been meaningful expansions, you know, in some cases, 2x-5x expansions of ARR with those existing clients. And we think that's a really positive kind of leading indicator to the future of our dollar-based retention rate over the long term continuing to increase, because these are just meaningful opportunities to expand. So we'll still spend a lot of our time on that expansion play moving forward, but we do think that it could be relevant-
Mm-hmm
... to new relationships as well. So our time and resource allocation has shifted as we've seen a little bit of some kind of green shoot activity in the new market seg- or in the new client segment.
Mm-hmm.
We've shifted more of our time toward that, and we do think that TEMS could be kind of a driver of some additional adoption of new DOS wins. For right now, Jeff, that's been pretty early for us. So we have some early-stage opportunities, I would say-
Mm-hmm
... that include that as kind of a leading new land mechanism. But it's not yet been a major driver of the new wins that we're seeing this year. I think that could be, you know, different as we move into 2024.
Understood. Maybe one more on the bookings front. Any thoughts on how investors should think about the cadence of bookings over the next 12 months? Just thinking about, you know, kind of somewhat cyclical behavior by health systems-
Yeah
... in terms of what they're, they're purchasing and what they're willing to spend capital on. Traditionally, Health Catalyst has seen a, a couple bigger quarters in the year of bookings activity.
Yeah
... based around, you know, I think, the hospital health system fiscal years, and probably more even within that kind of back half weighted. So on the rebound, does that change at all, or should we still be thinking about a kind of a longer purchasing cycle and some seasonality to it?
Yeah, great, great questions. Yeah, so we have seen typically a longer sales cycle for our new client opportunities. That's been around a year on average, historically, over multi-year periods, that's been fairly consistent. So it is a relatively long sales cycle because it is a higher kind of purchase price. It's not an insignificant amount of kind of new capital to allocate. And then similarly, on the TEMS expansions, over the last 18 months or so, it's not a huge win yet in terms of the number of wins, but we've had several, and they've been around that one year sales cycle as well on average.
So we've seen some that have really accelerated and been a good bit shorter than that, and then we've seen some that have just taken longer, in that these are even kind of an order of magnitude larger, capital allocation and decision that health systems need to make, in that these are typically five-year locked-in terms, and so it's a meaningful increase in kind of the locked-in contract value that they're allocating to Health Catalyst, and they're meaningful expansions. And so that's our best sense, Jeff, is around that kind of one-year sales cycle. Probably applies to both new client wins as well as these TEMS expansions. And remind me, Jeff, you asked about sales cycle, but what was the other piece of your question?
Around seasonality.
Seasonality.
Yeah. More importantly, you know, should investors have any expectation of a bigger return to bookings growth until the fourth quarter?
Yeah
... of next year?
Great question. Yeah. So this year, our actually, I'll start with historically. Historically, our bookings cadence has aligned pretty closely with most of the kind of budget cycles and fiscal years of our health systems, which most are kind of July 1 or January 1 fiscal years. And so what we've seen kind of pre-2023 is about 50% of our new client and expansion wins have come through in the first half of the year, and about 50% in the second half of the year, but with a heavy skew toward Q2 and Q4.
This year, we're even a little bit more heavily skewed toward Q4, so we had planned kind of coming into the year that TEMS would make up a large portion of our bookings, and we just started focusing on that kind of in the back half of 2022, and so we wanted to build in some time, you know, around that one-year sales cycle to get those wins across the finish line. So for us, it's even a little bit more skewed toward Q4. This is kind of our biggest bookings quarter for the year.
I do think, like, moving forward, now that we've kind of had TEMS, you know, in our pipeline continuing to grow, and we're seeing some positive signs on the new client side as well, I think you'll start to see, you know, just a more typical seasonality to what we've seen historically, which is around that 50% first half, 50% second half. But I, I do think it'll likely still skew more toward Q- Q2 and Q4, just in that there is some, there is some positive dynamic of just aligning new client opportunities, as well as even some of these large expansions to just fiscal years and budget cycles, and we've just found that that's often when folks are in kind of the decision-making mindset, kind of leading up to, to those, to those quarters.
So I think we'll see a little bit of some movement back toward what we saw historically in 2024, but not likely a big shift in that annual cadence.
Understood. Makes sense. So we'll switch maybe from bookings to revenue, and, you know, certainly acknowledging the challenging financial environment for many of your clients, but a little bit surprised to see a lower utilization of your more traditional consulting services in recent quarters. And, you know, I guess specifically given the effort that Health Catalyst gives towards measuring tangible return on their investment from both the software and services side of things. So any specific drivers or areas of that lower consulting revenue?
Yeah. Over the last 18 months, it's really just been a tougher financial environment for hospitals, and so we've seen within their IT kind of analytics functions that they've oftentimes been tasked with budget reductions. So they're kind of evaluating and contemplating, "Do I reduce my existing staff? Do I reduce, you know, some of the consulting services that Health Catalyst provides to me, or do I do, you know, a mix of both?" Things like that.
And so we've seen the impact of that over the last 18 months or so, in that there's been some downselling, kind of some lower utilization of our consulting services that are usually, you know, kind of a staff augmentation model, or an ability to kind of tap into data scientists, data engineers, even some kind of clinical and administrative SME, SMEs, or experts, for certain projects. And we've just seen those projects, you know, in some cases, just be delayed or kind of put on pause while they work through these budget reductions. So I don't think there's a kind of a long-term impact to the competitiveness of those consulting services or the value that can be had from those services.
I think there is a lot of value in health systems being able to tap into experts who can help them make positive changes and not have those folks kind of on staff. And so I think we'll see some uptick in that as we move forward, as we start to see the end market kind of improve, and health systems kind of rightsize those teams and really rebalance moving forward. So I think we're getting through some of that headwind, but really, it's just been kind of over the last 18 months that we've seen some of that impact. So we've needed to kind of rebalance our staffing as well to kind of align with that demand over the last, you know, year or so, and we're working through that.
That'll actually be a positive impact for us on the gross margin side as we reduce some of our team members there. But I think we'll be well set up for an uptick there, in that we have some capacity that we can redeploy, or we can kind of quickly ramp up those services again if the end market continues to improve.
You know, sounds like your clients are just kind of forcing their teams to try to do more with less. And I'm curious a little bit more on the... again, the kind of the other side of things, if demand for those services ticks up, if kind of utilization of those resources needs to go up, where's the capacity to be able to handle that kind of, you know, rebound in-
Yeah.
-demand and consultant utilization after reducing staffing on that front?
Yeah, good question. Yeah, we basically try to target a certain level of kinda over, you know, well above that target over the last few quarters in terms of the overhead. So we've-
... And in what areas are customers deploying it currently?
So the TEMS, or Tech-Enabled Managed Services offering, is a way, like I mentioned, for clients to outsource a function that is non-core to their operations. So enables them to focus on driving clinical value, actually treating patients, and the like. You can think about it as somewhat related, somewhat similar to what you've seen in, like, the revenue cycle space, where hospitals, for the most part, have kind of accepted the concept that it may make sense for a partner or a vendor to take on a lot of that function, in that they have technology, and they do this across, you know, potentially hundreds of clients like me, and can do it more efficiently. It's very similar to that for us. And the three offerings that we have in Tech-Enabled Managed Services all leverage our data platform.
So that's a requirement of these relationships: you must be subscribing to the data platform because we need the technology infrastructure to optimize the cost footprint of those teams and to drive margin up over time. So the three areas we do it in are analytics, so it's like, you know, data management and analytics, kind of like our core use case that we've done for 10+ years. Our first client that outsourced their analytics team to us was Allina Health, around eight or nine years ago, and that's been a great relationship, and the margin profile has migrated up over time as we've operated that team more efficiently than what they had in-house. So that's one offering.
The other is called chart abstraction, which is essentially health systems who are abstracting data, mostly from the EMR, mostly in kind of notes within the EMR, for specific patient cohorts, that then get populated into registries, that are then submitted to third parties. So it's metrics around, for example, oncology statistics, cardiology statistics that go to payers or go to, like, industry associations. And so that's an offering that we've done for several years, and the data platform essentially automates some of that abstraction, and we're able to do that more efficiently than what they have in-house with clinical abstractors, nurses who are kind of hunting and pecking and doing that a little bit more manually with the data abstraction. And then the third offering is our most recent offering.
We just announced a quarter or two ago, which is called Ambulatory Operations, and it's essentially operating the non-clinical staff of outpatient clinics for health systems. So it's things like patient account reps, patient schedulers, and the like. And the real goal there is to make those outpatient clinics more productive and enhance the profitability of those clinics, where typically they are negative from a margin standpoint. They're losing money, and there's an opportunity for them to improve that financial outcome.
So those are the three areas that we've done, and all of them have a similar contract structure, in that you're required to subscribe to the data platform for a multi-year period, which is a little bit different than what our structure is today, where most of our DOS™ contracts have an annual out in them, where you can renew and expand. These are locked in for typically five years on the contract side. And then we also rebadge the team members of that function, and we essentially fix a price for that team that is usually at or slightly below their existing cost today, and that price kind of gets locked in over five years as well.
The margin profile of the tech segment on those offerings is very similar to our overall tech gross margin, and potentially a little higher, on the tech side, so that's pretty normal course. On the services side, the margin profile starts out at roughly 0%-10% for those additional services because we're basically pricing in a little bit of a discount to their existing cost and kind of locking that in. It takes us a little bit of time to drive the efficiencies in that team. So that's the initial margin profile. It expands over time, though, to around 25% services gross margin over four or five years as we drive out some of the inefficiency in that labor footprint. So that's the contract model and structure. The positives of it are very meaningful expansion potential.
So these can be, like I mentioned, you could, you could move from spending $2 million a year with Health Catalyst to $8 million or $10 million a year or more with Health Catalyst. Our average TEMS client spends about $8 million a year with us. Our average DOS client spends about $2 million, so it's an order of magnitude larger kind of expansion potential. It's a strategic relationship, so they're very deep partnerships. It enhances the stickiness of that offering, both tech and services. They're locked-in contracts, which is kind of, as I mentioned, in contrast to our typical model. And you see, you see that actually in our, our remaining performance obligation metric that we publish in our, in our quarterly filings, where that RPO metric is a measurement of kind of visibility over the next several years of locked-in contract values.
And it's improved over the last year, almost 2x, so it's nearly 100% growth. It's very meaningful in terms of that benefit as well, of just having more long-term visibility and stickiness of the contract. So that's really the model, and we think about it as an incremental market that we haven't really pushed hard over the last few years for, and a new TAM that we can really penetrate and really strengthen our long-term growth and profitability prospects. So that's kind of a quick summary of those offerings.
Excellent. That's super helpful. And maybe just to choose chart abstraction as an example to dive a little deeper on. You know, I think it kind of surprises people to hear about the number of resources at a health system that are performing you know, mainly manual chart abstraction tasks. So if you could describe what a typical team is at per 100 beds or at a you know, 500-bed or so-
Yeah
... health system, and, and then how Health Catalyst's platform and your continued innovation, this is where we can, you know, drop in AI as one of everyone's favorite-
Yeah
... hot topics these days-
Yes
... as an opportunity to-
Yeah
... to automate some of these manual tasks outside of just... You know, I, my understanding is currently, you're, you're helping teams use existing technology more efficiently versus the ability to, and, and automate some of these functions.
Great question. Yeah, so Chart Abstraction's a really good example where, like I mentioned, the offering is essentially abstracting data for specific patients and measuring specific outcomes for those patients, and then submitting that to a third party on an annual basis. What we've done in that space is, we've invested in the data platform that enables automated abstraction of some of those key data points. Typically, they're in notes or like written form, and we can automate, you know, some of how that is abstracted from the EMR. And it's more of a way for the clinician or the nurse abstractor to essentially validate the data versus needing to actually abstract it and put it into a system. So that's kind of the first step. We then have acquired a couple of tools.
One's called ARMUS, one is called ERS, that are for specific domains within data abstraction. One is for oncology, and one is for cardiology, and they have pre-built kinda registry dashboards and tools that not only help with the abstraction, but also the submission of those registries to third parties in the right format, 'cause they are often different formats and SKUs of how you'd actually lay out the data and calculate the metrics. And so, what we've essentially done is automated some of the abstraction and the submission of that to enable the clinicians just to act more as like a validation or kinda quick tweaks to the data and formatting, and then that gets submitted. So, that does enable, you know, 30%, 40%, 50% more efficient deployment of those resources.
So they're able to spend a significantly lower portion of their time on those cases that they're abstracting, and they're able to spread that time over multiple clients, versus they were previously staffing just their existing health system, organization, or employer. And so that, that's what leads to really the gross margin improvement for us over time. We are investing in some additional machine learning and AI capabilities, like you, like you mentioned, Jeff, on how can we further automate that abstraction? How can we further automate some of the validation steps to make that even more efficient? We're in kind of the earlier phases of that, but, but those are areas that we're investing in within kinda DOS™ and, and our AI tooling to further automate the steps of that process.
And so I do think there are some long-term opportunities for us to either improve the speed with which we drive gross margin enhancement, or and/or improve the long-term gross margin profile of those deals as well, to a higher kind of perpetuity rate, if you will. So, those are some of the... They're not, you know, the most crazy, sophisticated kinda AI use cases in the world, but they are kinda the just blocking and tackling, simple use cases that I think can impact healthcare positively.
Makes sense. And one more on the TEMS topic, on the financial side of things. Could you just quickly give the mix of TEMS for revenue in 2023, and any color on how we should think about the run rate for that mix as we enter 2024?
Yeah. So our services segment, so as of Q2, our TEMS ARR within services was about 50% of that services revenue footprint. So for 2024, it'll be a little higher than that, 'cause we're selling some meaningful deals in Q4 and in Q1 that are TEMS-focused. So you could think about that as the majority, a little over the majority of our services revenue next year, will be this TEMS-based revenue, so kinda long-term, locked-in contracts. And that will continue over time, so that'll become a larger proportion of our services mix. Depends a little bit on what we see, to your earlier questions, around kinda uptick on the consulting offering as well. Like, we're seeing some positive signs, like I mentioned there. So does that rebound more meaningfully? We'll see.
But right now, it's a little over half of our services revenue is this TEMS model.
Makes sense. And last one on revenue. You guys have talked about revenue re-accelerating, or revenue growth re-accelerating in FY 2024, and getting back towards long-term target levels. Maybe you could discuss kind of what you're seeing in the pipeline and typical bookings to revenue conversion, to help investors understand whether a best-case scenario for bookings would yield a step function up higher in revenue growth in FY 2024, or even in that, you know, kind of best-case scenario, if we should be thinking about a more gradual re-acceleration?
Yeah, good question. Yeah, I think it will be more gradual. We do anticipate that our revenue growth rate in 2024 will be, will be higher than what we're seeing this year, and that's been consistent with what we've shared over the last, you know, year or so, where we viewed kinda 2022 as the bookings trough, and thus 2023 as the revenue growth trough. We think that, and we kind of have guided to this, you know, even most recently in our earnings call, that our dollar-based retention rates, so our existing client expansion bookings metric, will improve compared to 2022, as well as our new DOS client wins will improve compared to what we saw last year.
So those bookings metrics are what lead to faster revenue growth in 2024, and so we feel confident there. There is still a bit of a wide range of dollar-based retention rate that we could see this year, which will lead to some variability on revenue growth next year, depending on how Q4 kind of shakes out, in that these are just large, typically these large TEMS deals can swing things a good bit on a dollar-based retention rate standpoint. They can be, you know, three or four points of retention rate impact, depending on when they sign. So there's a variable that we'll work through there, but we do anticipate that will re-accelerate.
We have shared that we don't view, like, 2024 revenue growth as, like, a 20% growth year, organically, because the bookings metrics this year don't quite lead to that range. But as we see the end market continue to improve and some of our clinical, some of our kind of core technology solutions get more traction in the market next year, and we'll couple that with having this tool in our toolkit of the TEMS offering, which will continue. We don't think that will slow. We think that'll also be relevant next year and in the future, just in that it makes sense long term for these hospitals to move away from doing these things in-house and finding a partner like us to do them with.
So we'll have kind of, you know, both of those areas, working, in conjunction. We think that 2024 bookings will improve compared to 2023, and that's what leads to, you know, that, that growth rate moving back toward that 20% level. But that'll be, you know, in 2025 and beyond, and we'll, we'll obviously kind of give specific color there as we get closer.
Well, understood. Let's, let's give some time to the profitability profile. And, you know, wanna ask, with the, you know, mix of bookings, at least recently, coming more from existing clients and more towards services, should, should investors think about your R&D and sales and marketing spend as a percentage of revenue shifting from, you know, what you've talked about historically to reach your long-term margin profile?
Yeah, it will shift a little bit. So, there's some moving pieces, but right now, we have visibility into kinda next year, and a little bit less, obviously, in terms of the long-term, long-term profile. But what we're working through is, we enacted some reductions kinda late last year or early this year on SG&A, so that's actually come down on a meaningful basis in 2023. We just recently announced on our last call a reduction in two areas in terms of our headcount. One is on the consulting services side, just as I was mentioning, kind of right-sizing that team and utilization base. One is more on the R&D side.
So we do anticipate next year that our R&D, on an absolute dollar basis, will come down in 2024, and that's really driven by us kind of starting to complete some of the investments that we've made in this Snowflake and Databricks enhanced kind of platform offering. That's starting to wrap up. So we'll see an absolute dollar decrease there. SG&A, you know, probably flat-ish, maybe slightly up. But as we move into kind of 2025 and beyond, we may see some further reduction in R&D, some further efficiency, as we kind of finalize that data platform investment.
But kind of from then on, we'd expect, you know, slight upticks on an annual basis, but meaningful operating leverage on all of those OpEx segments as we drive toward our midterm EBITDA target, which is 10% EBITDA margin in 2025, and our long-term kind of EBITDA target of 20%+. So I think we're in a good spot of kind of rebalancing some of that investment to put us in a spot where we can kind of just leverage that moving forward.
So. Let's see if there are any more questions from the audience before I try to slip my last few in here in the last few minutes. Guys, please.
Maybe a tactical question. Just like, as you work with your sales force and your sort of payer account managers, would you say that kind of the pipeline is simply building in terms of new projects and new opportunities to add existing and new customers during this period of relatively weak sort of bookings growth? Or do you feel like... Yeah, I would [inaudible]
Yeah, good question. Yeah, over the last, so, on the pipeline over the last 12-18 months, there were quite a few puts and takes, and that's a little bit different than kind of what we're seeing kind of moving forward. But over the last, you know, recent time period, some of the puts were, we had some positive momentum on our pipeline related to our financial offerings, so things like Vitalware, which is in the rev cycle space, things like our costing and labor modules, which are kind of in the expense management space. Those pieces of our pipeline have continued to improve. They improved over the last year or so.
And then also on the TEMS offering, so our tech-enabled offering, where it provides cost savings, that was the fastest-growing segment of our pipeline over the last 18 months. It's making up a larger proportion of what we do. But we had some offsets to that around just a little lower adoption of some of our clinical solutions, lower adoption of our and interest in some of our consulting services and the like. So overall, the pipeline has continued to grow with those puts and takes, but certainly a little bit different mix and kind of profile than what we'd seen historically.
As we kind of look forward, more recently, what we're hearing and kind of seeing from our growth teams and in our interactions with clients is some green shoot opportunities on the earlier stage pipeline from some of those offerings that we saw some headwinds in over the last 18 months. So things like, you know, more of an enterprise DOS opportunity that's a larger starting price, was a little tougher over the last 18 months, and that's starting to get a little bit more traction in the early stages of our pipeline just as the operating margin profile improves in the industry for health systems. And then some of our clinical solutions, potentially even some of our consulting services, are starting to improve a little bit. We think that'll be a medium-term benefit to us.
Then, like I mentioned, we'll also still have that robust TEMS pipeline as well, that we don't think will go away. So that's kind of what we're seeing as we move forward.
And then maybe, I think this was touched on a little bit earlier, but I'm just kind of curious as to if you guys are seeing any potential eventual competition from Epic or from Cerner. I think you're kind of adjacent or-
Yeah
[inaudible]
Yeah.
[inaudible]. So just, just kind of curious, like, how do you position yourselves [inaudible]
Great question. Yeah, great question. Yeah, so for the EMRs, so Epic and Cerner, they have been kind of... Obviously, we've been operating, you know, in conjunction with those vendors for 10+ years. We are different and distinct than those vendors, so we play in kind of different spaces. They tend to have some capabilities in analytics, but tends to be focused on just clinical data within the EMR setting, and less robust in terms of the ability to integrate data across disparate sources, across the ERP, across your staffing data, across your accounting systems, your HR systems, and the like. And that's really where we're kind of purpose-built. So we're meant to be an open platform, a self-service platform that integrates data across multiple sources.
The analytic use cases that we serve typically require a myriad of sources to actually execute against. We tend to, when we do, point clients to using the EMR for those use cases where it makes sense. Like, if there's a pre-built report or a dashboard that we don't need to recreate, like, that's great. Use the EMR. That's perfectly fine. We encourage that. But for the other use cases where, you know, 80%-90% of the time you need cost data, you need that coupled with clinical data, that's where we excel. And so we do play well with all of those partners.
We often see that our health system clients oftentimes actually have multiple EMRs, certainly different outpatient EMRs, inpatient EMRs, and with the M&A that they've done, in some cases, different inpatient EMRs as well within the system. And so, yeah, so we encourage kind of using both. We don't see them as, like, the major kind of competitive threat. It's really more of those cross-industry solutions that I mentioned that we're typically kind of selling against when we sell an enterprise platform deal.
Awesome. I think that's all that we have time for, unfortunately, today. But again, really appreciate Bryan and Jack from Health Catalyst joining us today.
Absolutely. Thanks for having us. Thank you, all.