Hello, everyone. We're going to get started here. Hope you had a good lunch. I'm Robbie Marcus, the MedTech Analyst at JP Morgan. Very happy to introduce CEO of HeartFlow, John Farquhar. John wi ll give a presentation followed by some Q&A. John?
Thank you, Robbie. I appreciate the time today. Great to be here. Good to see everybody. So I'll jump into this. I'll give everybody an overview of HeartFlow, and then I think we've got some time at the end for Q&A. So just to set the stage here, and these are all themes that you'll hear as I go through the presentation. But we are a software company. We use AI in everything we do. We deploy that software and that AI to the treatment, diagnosis, and management of coronary artery disease. The company was founded in 2010, just down the road here from Stanford University. We had our first FDA clearance in 2014. And I've been the CEO for about four and a half years now. So great to be here. We currently target the symptomatic market.
So these are patients that have some form of symptom for coronary artery disease. We calculate that at a $5 billion TAM. Very pleased to announce we had tremendous progress in 2025. In the U.S., we now have an installed base of 1,465 accounts. We define an account as any hospital or clinic that has a coronary CCTA image or coronary CCTA piece of capital in it. And I'll talk through in a minute what our model looks like. But this was the biggest fiscal year we've ever had relative to adding new accounts. It was also the best Q4 we've ever had. In total, for the year, we added 340. So that was a record for the team. Really pleased with the execution there. As I mentioned, we've been at this for a while. And from the very early days, we've had a commitment to generating clinical evidence.
We have over 600 peer-reviewed publications. And this really is the tip of the spear in everything we do to help change physician behavior. We've also, over the same time period, acquired what we believe to be the world's largest proprietary database of coronary CCTA images. We have over 160 million annotated coronary CCTA images. I'll talk about the benefits to us and how that helps the business. Great financial performance. These are numbers through Q3, but we're starting to get good scale. Trailing 12 months of $162 million, 41% growth. Very pleased with that, but equally pleased with our margin expansion. We're not giving Q4 results this week JPMorgan. we wanted to keep the focus more on the strategy. But what I can tell you definitively, we had a very strong Q4. There's no bad surprises. We beat consensus. I feel good on that.
And we're also right on the doorstep of this next wave of growth. So we've got this subscription-based durable business. But what is coming now is the next wave. And that next wave is coming through our Plaque Analysis. I'm very pleased to share we are, as of January 1st, or actually New Year's Eve, in 489 accounts live with plaque. So that's tremendous. And I'll talk about what the pipeline looks like in the future. But I'm confident by the end of 2026, we'll be in over 1,000 active accounts with plaque. And just for frame of reference, it took HeartFlow originally eight years to get in our first 1,000 accounts. And we'll do it with plaque in less than two. So we're excited on that. And then lastly, we're going to initiate some new RCTs that expand into the asymptomatic market. We're going to do that in 2026.
And we're going to be into these markets before the end of the decade. So lots of great things going on for the company and, most importantly, the patients that we serve. Obviously, we're at JPMorgan's healthcare conference. I won't belabor the problem, but heart disease is the world's number one killer more than all cancers combined. So it's a huge issue. Every 40 seconds, somebody's having a heart attack. And obviously, the cost to societies is staggering. The root cause of this is really the current standard of care is inaccurate. And the reason it's inaccurate is because it does not measure the actual disease itself. It only measures surrogates. Because of this inaccuracy, the outcomes are as bad as they are. Half of all heart attacks occur with no prior diagnosis.
30% of the time, when a patient goes to a physician and tries to get diagnosed for having chest pain or what have you, they're sent home, told they're okay, when in actuality, they're not. They need treatment, and 55% of the time, they're sent downstream into the cath lab when they don't need to be there. And obviously, there's costs and risks and waste associated with all that, so we address this problem, and I think the paradigm shift that's occurring here in coronary artery disease with AI is very analogous to the shift that's already occurred in some forms of cancer. If you think about legacy standard of care for breast cancer or lung cancer, it started with sort of remedial measurements. In the case of breast cancer, it's a physical examination. Lung cancer, chest X-ray, then over time, advanced imaging came online. Earlier diagnosis occurred.
Outcomes got better, and then more recently, all of that's being augmented with AI. That's a similar arc that we believe is occurring in coronary artery disease, and that's happening with advanced imaging in the form of coronary CCTA and our AI platform. This pathway is endorsed around the world in society guidelines ahead of the original legacy standard of care. There is indisputable clinical evidence that it's more accurate, that it's a better patient experience, that delivers better outcomes, and takes cost out of the system, so we really like to say we're on the right side of history here. We play a leadership role in creating this standard of care, and that really is the company's mission. I'm very pleased with the progress that we've made. This last four and a half years, essentially, since I've been here, has been tremendous relative to the results we put up.
But we are just getting started. Our mission is to create a new standard of care. We're less than 2% penetration right now. So there's a lot of growth and a lot of runway ahead of us. Just to sort of ground everybody in our strategy, HeartFlow has had a consistent strategy over the years. We've started with the most diseased patients first. These are patients that have symptoms that need our. When we started our first technology, FFRCT, we're now launching within the symptomatic world the plaque technology, a little less disease, a little less urgent need, but still highly important. And then we're moving upstream into the asymptomatic world. And I'm going to talk about what that pathway looks like here in a minute. But we're excited to expand into the new TAM that I mentioned. We do this by virtue of our platform.
Our platform is an end-to-end platform. We think we need to provide value all across the continuum of care from detection to diagnosis to management to treatment. We use AI in every component of the platform. We're clinically proven in everything we do. And as I mentioned, that's really the tip of the spear in driving adoption and changing behaviors. And we've learned, and we do this, we seamlessly integrate into EMR and PACS system because workflow really, really matters. So I'll take you through each component of the platform here. The first relative to detection, this is our HeartFlow Roadmap Analysis. We provide this on 100% of all the CCTAs that are sent to us. The easiest way to think about it is this is a GPS for the coronary tree. It helps a CCTA reader read a CCTA faster.
We have clinical data that shows you can read a CCTA 25% faster. It reduces variability across a pool of readers. If you're a health system and you're looking to adopt this for your entire program, you want to make sure that you have consistent reading results that achieve that end. Lastly, it increases confidence. Very analogous to if we walked out of this building and said, "Somebody get us to the Golden Gate Bridge." If we had a map, we'd have more confidence that we would end up there. This is on every CCTA that happens. We provide this free of charge. It's our way of helping with the workflow of our customers. Next, we have plaque. What plaque does, it takes a CCTA image. It measures the plaque burden down to the cubic millimeter.
So whether or not it's calcified, non-calcified, low attenuation, it measures that. We are proven to have accuracy with published prospective data to be 95% accurate against the invasive gold standard. We're the only play on the market that can say that. When you have accuracy, you've accomplished the first conversation with physicians. You've got to prove that accuracy. We've also proven that this analysis is useful. So when you give plaque to a physician, more than 50% of the time, they change their management plan by virtue of having the insights that come with plaque. As I mentioned, we're the most adopted plaque platform in the market, over 489 live accounts right now. From a patient applicability standpoint, this is applicable to basically twice the population that FFRCT was. This is 60% of the patient population are applicable to that.
It's covered and paid for if a physician has any visible plaque up until a 70% stenosis. As of January 1, very happy, there's a Category I CPT code in place, and then we're making great progress relative to driving coverage. We now have over 70% covered lives with this plaque, so we're really excited with this, and we view this as our next wave of growth. Next, we have, and incidentally, that's a separate revenue stream for the company, and it's a separate reimbursement stream for the customer. Next, we have our FFRCT technology. This answers a fundamentally different question than plaque. This answers, is the disease that's found, that specific lesion, is that significant enough that it warrants an intervention. We have accuracy proven against the invasive gold standard of FFR to be as accurate or 95% as accurate as that.
We're the only player in the market that provides lesion-specific FFRCT values. And that's very important. We have RCT-level evidence that's published that proves with this pathway, physicians and health systems can find more treatable disease. They can reduce the number of false positives going downstream. And they can increase the economic profile of those cath labs. Whereas plaque is applicable to 60% of all patients that come through, FFRCT is applicable to 33%. Any stenosis between 40%-90% is covered. This is fully reimbursed. There's a Category I CPT code in place. We've treated over 500,000 patients around the world in over 1,800 accounts. And this is really the cornerstone of our platform. Next, we provide a staging system. So not all plaque burden is created the same. There's different stages. Again, you can think of the analogy here to cancer.
Unfortunately, if a patient were to get a cancer diagnosis, you would go to stage one, two, or three, etc. We provide the same here with our proprietary staging system. This is the largest risk stratification system on the market, over 8,000 patients, and you can see the spread of the curves that occur. If you're in stage four, you have a 5x increase of risk. With that, we've also developed with a cohort of preventative cardiologists a personalized medical management framework that informs physicians on how to treat their various cohorts of patients in each stage. We've got 90-day data showing that when followed, LDL reduces by about 19 points. At the end of this second half of 2026, we'll have one-year data on the same registry. We continue to drive the education in the market on how to use this tool to better treat patients.
And then lastly, if the patient has a positive FFRCT and it's known that an intervention needs to occur, we've created the HeartFlow Navigator tool. And what this does is this allows interventional cardiologists to plan for a PCI procedure before the patient is on the table. And that's very analogous to how they plan most every other procedure in the cath lab, like a TAVR, mitral, left atrial appendage. And that takes effectively all the best things from plaque, all the best things from FFRCT, a couple of new metrics that help interventional cardiologists plan. And it allows them to do that before the patient is on the table. This is going to be available for all FFRCT patients. We're going to launch it in the first half of this year. We're going to initiate a 5,000-patient registry as well.
There's also randomized controlled trial data that's coming out in the second half of the year from the P4 study in Europe. So in totality, the platform matters. Each component of the platform provides a very complete picture and very complete toolbox for our customers. With that, just a quick video on how it all kind of comes together. There's a case list. When a physician wants a Roadmap, click of a button. A plaque, click of a button. FFRCT, click of a button. And Navigator, click of the button. Every new product we launch is literally just a next button on the case list. All of this is done seamlessly and integrated into the EMR and PACS systems. Now I'll talk a little bit. Kind of that's the portfolio of technology. Let's talk a little bit on how the model works.
So we go out. We go to accounts that are already up and running with coronary CCTA programs. And we bring them into the installed base. Once we connect, we automatically connect and bring every CCTA that they do into our cloud. At that moment in time, the algorithm starts its work. In a couple of steps early in that process, we have a human-in-the-loop quality control analyst. They make changes to the algorithm really around the development of that 3D model to make sure that no markers are missed. So for instance, if they need to change the centerline of the lumen or if they need to tag a vessel that wasn't tagged, they make those little changes. Every change they make is recorded. And we use that for future versions of the algorithm.
The analogy I always like to make is if you're a Waymo taxi cab driving around San Francisco and you run through a stop sign, next time you come through the same neighborhood, hopefully, you're not running through that stop sign. Once that occurs, the algorithm takes over. And the Roadmap is delivered directly back to that same case list. And then the plaque and the FFR analysis and the Navigator analysis are ready when they order them. All of this sits in our database. Now we've accumulated over 160 million annotated CT images. And we use that to continue to refine our algorithm and produce more technology. So we believe this model has a lot of benefits for our customers. One, it allows us because the minute we get the CCTA, we start the Roadmap. We're able to give that on every CCTA.
The HeartFlow analysis is ready when the physician needs it. So when they sit down to read and they want to order it, the next click of the button, they get a HeartFlow analysis. We don't ask them to order it, wait, and then come back and pick up the work again. As we deliver our results, because we have our human in the loop, the results that we deliver require no extra work at the point of the customer. They can take our analysis and make their decision. They don't need to validate it to be accurate. I mentioned we integrate into the workflow. And then obviously, this is all click as you go. We don't ask customers to sign up for long subscription models where they can't foresee costs. And there's no capital required either.
From our standpoint, we think this model really helps us acquire new accounts and maintain market share within them. And I'll show you in a minute what that looks like. It also allows us to, because we've consumed all of these CCTAs, it allows us to monetize new products as they become available. And plaque is the best opportunity we've had yet to do this. I'll share with you what that looks like. And then this 160 million database we have, we use that to expand our gross margins and produce new technology. And I'll show you what that looks like. First, relative to the installed base, I mentioned we're at 1,000 excuse me, 1,465 right now. From an account penetration standpoint, that's 46% account penetration. There's 3,200 accounts out there right now in the U.S. that are doing coronary CTA. That number grows by about 10% a year.
Within our installed base, we're 85% sole vendor. On the hospital side, we're 98% sole vendor. So we think we have a good thing going on that front. We initiated this new workflow where we consume all CCTAs. We did that at the start of 2022. Since then, our process case volume has almost 100% CAGR. And obviously, the billed case or the monetized case is a bit less. But we've been able to expand margins in spite of the fact we've been consuming and doing the work on all these consumed cases. And we think that's an investment that was a wise decision to make at the time. And we think it's going to start paying off very nicely in 2026. The process cases that we've consumed right now in 2025. We've run the algorithm already on 60% of the CCTA market.
60% of the CCTA market has already done our algorithm. It's already reflected in our gross margins. But we've only monetized about a third of them. So what that means is as we launch new technology, as we farm from this 160 million database and produce new technology, we're launching them into this kind of captured cohort. So we're excited about this. And we think this is going to pay dividends not just with plaque in 2026, but down the road from there as we continue to bring new technology to market. But relative to plaque, that is the opportunity that's on our doorstep right now. Great work by the team. Close to 500 as of New Year's, December 31st. I actually checked earlier this morning.
We are now active in more than 500 because we had some that went live in the first couple of weeks of the year. Equally importantly, we have 200 other accounts that have signed and are waiting to go live. And we've got about 500 right past that in the funnel that I would describe as in a very healthy funnel position. So because of this, I've got high confidence that by the end of this year, if not sooner, we'll be in over 1,000 accounts with plaque. And again, by frame of reference, it took us eight years to do that with FFRCT. We're going to do it in less than two with plaque. So that's one really, really important step in the process. And I feel great about where we are. But an equally important step is we need to educate the market and keep bringing evidence.
I think everybody probably saw in November, ACC and AHA put out scientific statements on plaque that I think substantiate the value and the utility of plaque for cardiologists taking care of patients. We have now fully enrolled our DECIDE prospective registry, close to 22,000 patients. We're going to read out the one-year data from this registry in the second half of this year. That's going to be really important relative to continuing to educate the market, and then lastly, from a coverage perspective, that's important as well, and we're ahead of plan on where we thought we'd be on that front, but I'm very pleased it's occurred. We, over the past year, have been taking the DECIDE data to payers, and then from there, they've been bringing coverage online. Aetna was the most recent that came in just at the end of December.
United and Cigna came in in October. So we're in a really good spot there. And of course, with the Category I CPT code effective with RVUs January 1, we're really setting up 2026 to be a big year for plaque. So I'm super excited about what's in store there. Next, relative to gross margins. So I mentioned we have the human in the loop. That human in the loop is making annotations every time we release a new gross margin or excuse me, a new automation algorithm. The time that that human is spending in the loop is coming down. As that occurs, margins expand. And we have a long history of doing just that. And that's one really important driver. The next driver, as I mentioned, this Plaque Analysis, that work's already been done. So as plaque is starting to monetize, it's monetizing with zero incremental COGS.
That's our second driver of margin expansion. Of course, volumes help. Volumes, as they continue to grow, will also expand. That's a long way of saying I've got really high confidence that we can be kind of top tier from a gross margin standpoint. We're going to have an eight in front of it. We're not guiding on to when that's going to occur. I've got high confidence that it will occur. Lastly, that same database, not only are we using that to refine our algorithm to expand our gross margin, we're also using that database to produce new technology. We've got a good track record of every year, if not more, delivering new technology to the market. In 2025, we did that with our second-generation plaque algorithm. In 2026, we're going to do that with our PCI Navigator tool.
And then in 2027, we're going to put out a plaque tracking analysis, which will allow customers to compare scan A on plaque to scan B on plaque. We'll co-register both of them. And hopefully, if treatment is going well, we'll see regression in soft plaque for those patients. So that's coming in 2027. And again, a lot of the patients that hopefully are going to get the plaque this year could be good candidates for that down the road. All right. So that's kind of the model as it works. The other thing I'll say is earlier, I said standard of care is our primary competition. And we're less than 2% penetrated against that. And that is the company's North Star. That is the company's mission. That is where we source volume.
Literally, not a week doesn't go by where I don't hear from somebody that, "Hey, I tried to get my brother and my mom a HeartFlow, and I couldn't. They ordered a SPECT." That's the focus of the team. That's how we're going to be successful. But I also recognize that this is a really attractive category. AI plus CCTA is attracting new entrants. I don't think we're going to be a winner take all in this market. But I think we're very well positioned to be a winner takes most. And we're going to compete with clinical data first and foremost. And we stand by the accuracy. And we stand by prospective published clinical data. We're going to win with workflow and help physicians. We're going to meet them where they need to be with their workflow. We're not going to put extra steps into their day.
And then lastly, we're going to win with scale. And we've got a team right now around the world, over 250 field-based team members. Not all of those are sales and customer success, field reimbursement, medical education, obviously sales as well, that are helping customers learn how to adopt HeartFlow and grow a CT-first pathway. And we're dedicated to do that. And of course, last but not least, we've got a very strong IP portfolio that we think gives us some additional barriers to entry. Okay. So next, let's talk about TAM expansion. And then I think soon Robbie will be ready for questions. I mentioned from a near-term standpoint, everything I just talked about is happening in the symptomatic world. It's a $5 billion TAM, 8.6 million patients.
We want to take a stepwise approach, which we think has a lot of advantages, to enter into the asymptomatic opportunity or the asymptomatic market here. And that's about a $6 billion TAM. Now, we think there's patients that are already in the healthcare system that have already been diagnosed with coronary artery disease that exists right now that if we design and deliver on the right RCTs, we can expand the current codes to include them. And we've got three separate subpopulations here, one being patients with prior heart attacks or PCI, the other being patients with an elevated calcium score, and the third, most logically, are patients that have already had a plaque. We're going to initiate three separate RCTs against each one of these populations. The endpoints won't be hard MACE outcomes. They'll be plaque regression and LDL.
And we think with those RCTs, we'll be able to take those to payers and expand the coverage for these. We spent a lot of time in 2025 getting smarter on what the right entry is. There is a path of entry where you could go and go to patients that aren't already in the healthcare system, try to screen them and find them and bring them in. We're not taking that off the table long term. But from where we sit, this is a much more capital-efficient way to get into this market. And it doesn't make a lot of sense to walk past these captured patient populations to go chase a screening opportunity. So we're super excited about this. The other thing I'll note is in probably Q1, if not early Q2, we expect to see new guidelines for prevention and lipid management come out.
That's really important for us to see because we'll match the control arm of each of these RCTs to that. This is all with our existing technology. So we don't think there's technological risk in this strategy. And as I mentioned, what I'm most excited about is it allows us to help these patients before the next decade. So this is going to happen before 2030. Excuse me, 2030 will be in these markets. So we're excited on that. And then last thing I'll say, just relative to financials, these are Q3 financials. So everybody's seen it. My message on this is I look forward to sharing both full year 2025, Q4 results in our upcoming earnings call in Q1. Just to reiterate, no surprises. We're going to beat consensus for sure.
And I look forward to continued success on the financial side, both in the next earnings and many more to come on that. Okay. And then lastly, and then I think we'll go to Q&A. Just from a team standpoint, I feel great about the team. We got a good team in place. Everybody here, not just on this slide, but across the company are committed to creating a new standard of care. And we had the IPO in August. And I really think as great as the first chapter of HeartFlow's growth story was, I really think 2026 and beyond is going to be even better. So with that, thank you for everybody's time. And I think, Robbie, I'll turn it over to you for some questions.
Where do you want to stand?
I can stand. I stand back here.
Yes. Well, great. Since you started with fourth quarter and you beat consensus and had a good quarter, how good was fourth quarter, which is really all we want to know?
I'm going to let my CFO answer that. No, but fourth quarter was strong. I think we shared the installed base numbers. That's the biggest year we ever had. Within Q4, it was the best Q4 we ever had. We shared some of the plaque metrics. Phenomenal work by the team in that regard. So I feel really good there. And most importantly, I just feel really good about where we are as we start 2026.
Great. Maybe just on 2026, I believe the street's right around 23% sales growth. Obviously, you beat fourth quarter. But any early thoughts on how you feel about where the range sits and if you're comfortable with that?
Vikram, how do you want to answer that?
Yeah, absolutely. So a little premature to talk about 2026 in detail, but we're pleased with the setup as we approach 2026, especially based on what we saw in Q4. The install base expanded meaningfully. Utilization at both existing and new sites continues to be consistent and predictable on the FFRCT front. And then plaque is generating a lot of interest. And as John shared, there's strong momentum in pulling the plaque product through our install base. So we're excited to get that through our install base in 2026. We'll exit 2026 with north of 1,000 accounts, as John mentioned. All told, you've got FFRCT being the first building block, very predictable, very consistent utilization. On the plaque side, as we've talked about, a couple of the key drivers there. First is coverage getting to 70%, which we've already achieved. But the second component is really driving medical education.
And so that's going to be the huge focus of the team going into 2026. We've got more data readouts coming out of DECIDE, which will help. But inherently, our expectation is utilization on plaque will ramp gradually through the course of the year and really be more back-weighted from a revenue standpoint in 2026.
Maybe we could touch on plaque because you've checked the box on coverage here north of 70%. Medical education will obviously probably be the most important component of the launch in 2026 here. But I hear a lot from investors, "Why shouldn't every account that's using HeartFlow today also use plaque given such an easy cross-sell at checking a box and reimbursement is favorable?"
No, that's a great question. So what I'll say is it's too early to tell what that plaque utilization is going to be.
I mean, the full applicability of plaque is 60% of all CCTAs. It's a very reasonable assumption that as a new plaque user comes online, they're going to use it in a much narrower range. And that's the same thing they did with FFRCT. So it's probably more likely going to be the first usage pattern is patients with more plaque. And those physicians are going to get comfortable with that. And they're going to learn how to interpret it. They're going to learn how to manage patients on it. And then they're going to expand to maybe patients with a lot of plaque and medium plaque. And then ultimately, we hope they go to the full extent of the range. It's too soon to tell what that looks like. But as Vikram talks about the need for medical education, that's what we need to do.
Far and away, the number one question I get when I talk to a physician about plaque is everybody's excited for all the obvious reasons. The first question is, "How do I use this?" There is no ground truth right now on what to do with a patient with 248 cu mm of plaque with 170 of them non-calcified. We don't know that. The medical community needs to be educated. We'll be a part of that education, but we're not the only one that needs to educate them. So that has to take time. I think when it gets back to controlling what we can control, I think the team has done a good job doing that. We have gone to our existing accounts with the plaque opportunity and sold contracts into them.
And as we go to new accounts, which we did, we're including plaque in virtually all of those as well. So that's step number one. Step number two is you got to make sure the coverage is there. And we started the journey generating the DECIDE data years ago, more than a year ago. We're taking that data to payers, and we're getting coverage. So that's step number two. Now we're in the market. And they got to try it. And hopefully, they got to use it again. And hopefully, they're going to tell their colleague about it. And hopefully, their patient that has it will tell one of their family members. And from there, we'll see a ramp.
And I know you're not suggesting this, but the last thing I want to do or we want to do as a public company is call a number and not deliver it. So our guidance is nothing material on plaque until the tail end of 2026. We're going to do everything we can to get patients or physicians to use it. But again, it's just too soon to tell.
When you think about the addressable market and the real addressable market, do you look at just how many CAD tests there are, or are you firmly looking at CCTA and then what percentage of those you're capturing? I guess, do you look at it as just people should be using HeartFlow and that's the bottoms-up driver, or do you look at it as a percentage of the modality being used?
Yeah. Our North Star is to create a new standard of care. And there's 8.6 million patients every year that get tested non-invasively for coronary artery disease. And we want to do everything we can to shift them to a CT plus HeartFlow pathway. So as we think long-term over the course of where the company is going to go over 10, 15 years, that's our North Star. And then we're doing the same with asymptomatic as we spoke about. Now, much more tactically, every 90 days when we go out and execute, we only go to accounts that are up and running on coronary CTA. We help them grow their programs. And that's what the teams are doing on a much shorter time horizon.
How are you thinking about profitability? Obviously, you're a new company. You just IPO'd last year and grown strong double digits, but everybody wants you to grow strong double digits with the drive towards profitability. So how are you thinking about when you can cross the threshold of cash flow break-even? And what are some of the puts and takes as you think about that?
Yeah. We're consistent with what we'd communicated before at the time of IPO. We see profitability as a choice. We have plans to get to profitability within three years of IPO, which puts us in the middle of 2028. We've got all of the building blocks with consistent, strong revenue growth, margin expansion courtesy of the investments we made in the automation of the algorithm, volume leverage, as well as plaque being a tailwind not just on gross margins, but also operating margins.
And we've got a very capital-efficient commercial model, which enables long-term, strong operating margins to be had. But ultimately, we want to be growth-oriented here. So we'll continue to invest and not walk past those TAM expansion opportunities that we just walked you through. But we'll be disciplined here. We'll continue to look at EBIT metrics year over year and ensure we're on that glide path to profitability and get that profitability in 2028.
As we think about top line, there's obviously volumes and there's pricing. You've been using volume-based discounts to help drive volumes and ultimately revenues. How should people think about pricing going forward, I guess, both for plaque and for FFRCT?
Maybe I'll share some commentary and then Vikram, you can tie it out. So first, drivers and pricing right now. We have volume-based discount, which everybody knows is very common in med tech. These are large customers that are growing. We give incentives to continue to grow, and if they hit them, there's a discount in that regard. There's also roughly two segments to the market. There's a hospital-based segment where I think when you look at the full value from a HeartFlow platform, there's a lot of value accruing across a CV line administrator's line, so to speak, but then you have outpatient imaging centers, which are much more, they're governed by the PFS side of the house, and they're much more price-sensitive.
We're seeing a little bit higher growth in that segment, and because they get a little bit lower ASP, that's what's driving the pricing mix. Longer term on plaque, we see opportunity to raise it. Now, I don't think 2026 is the year to do that because these contracts are kind of baked right now. But as we think in the out years, we think there's certainly opportunity. Maybe Vikram will let you.
Yeah. Short answer on FFRCT is the more recent trends we saw in 2025 will persist for the reasons John mentioned. Continued growth out of the PFS segment as well as volume-based rebates. The reason for these volume-based rebates is because CCTA is only 10% penetrated into the NIT. So that's the North Star getting category conversion. We'll continue to deploy those structures to drive top-line growth. And then to John's point, longer term, given where coverage is coming in, higher than expected, we do see upside in the longer term, but near-term, we'll be more disciplined.
Great. We're unfortunately out of time. Thanks for a great discussion. Thank you. Thanks, everybody, for coming today.
Thank you.