Good morning, attendees. Please welcome to the stage your Senior Director of Investor Relations, Chris Ward.
Good morning, and thank you for joining us. Thank you for coming to Integra's 2023 Investor Day. I'm Chris Ward, Senior Director of Investor Relations for Integra LifeSciences. It's been about two years since we've had our last Investor Day, really excited to have everyone here today and everyone online. Thanks to you who've joined us here in New York today and everyone who's joining us virtually on our webcast. We truly appreciate your interest in Integra. For your convenience, the slides for today's presentation are posted on our website at integralife.com in the Investor Relations section under Events and Presentations. As a reminder, some of the comments we will make today are forward-looking statements. Our actual results may differ materially from those projected in the forward-looking statements. Some of the numbers in the presentations will contain non-GAAP financial measures.
Please refer to the current report on Form 8-K filed with the SEC on February 22, 2023 in connection with our annual report on Form 10-K, where we provide definitions of these non-GAAP financial measures and provide information regarding why we believe these non-GAAP financial measures provide useful information for investors and the specific manner in which management uses these measures to evaluate performance. We will discuss products in our pipeline that have not yet received regulatory approval. Throughout today's presentation, we will reference market size and market share information that reflects our internal estimates. Looking at our agenda for the day, Jan De Witte, President and CEO, will begin the formal presentation with an overview and strategic update for the company.
Following Jan, our commercial leaders for Codman Specialty Surgical and Tissue Technologies divisions will provide a detailed review of their respective businesses, followed by our leaders in Digital Strategy, International, and Global Operations. We will conclude our formal presentations with our long-term financial outlook and closing remarks. We will have two Q&A sessions this morning, one following our Digital Strategy presentation and the second following a long-term financial outlook and closing remarks. We ask that you keep your questions limited to the subjects that have been presented up to that point. For those in the room, please wait for a mic so everyone can hear your question. For those on the webcast, there is a dialog box on your screen that will allow you to submit questions throughout this morning's presentations. We will include questions from the webcast during our Q&A sessions.
At about noon, we'll end our formal webcast. For those in New York, we will break to an informal lunch where members of the Integra leadership team will be present and available for additional questions. With that, it is my pleasure to turn the program over to Jan De Witte, President and Chief Executive Officer.
Good morning and welcome to all who are joining us here in New York today, and also welcome to people on the webcast. It's great to be in person again, and I'm happy to see many familiar faces and also some new faces here in the room. Some members of the Integra board are here with us today, as well as several of our executive leaders and senior Integra leaders. As Chris said, some of them will be presenting here, others you will be able to meet over lunch. This morning, we're gonna be spending time talking about who we are, where we play, what makes us unique, where we aim to take Integra LifeSciences, and how we will get there. This is not my first Investor Day, but it is my first at Integra since taking over the helm a year and a half ago.
Before coming to Integra, I served as the CEO of Barco, a Euronext-listed specialist in advanced visualization technology for corporate, entertainment, and healthcare solutions, where after resetting some of our culture and operating excellence practices, we focused on creating shareholder value through commercial acceleration, international growth, new product development, digital innovation, and operating efficiencies. We ended up more than tripling our enterprise value over a four-year period. Prior to Barco, I spent 17 years in multiple senior leadership roles at GE HealthCare, including CEO of the healthcare IT business, and before that, worked five years in strategic consulting at McKinsey and in operations at Procter & Gamble. I'm happy to be fully back in a great healthcare technology business and an ecosystem where technology makes a difference and where the changes in the ecosystem create opportunities for growth.
We go through the presentations this morning, you will realize why I'm so excited about being at Integra and our technology. The last year and a half has passed rather quickly as we navigated through the residual effects of the COVID pandemic. This turbulent period has allowed me to learn the business fast, its operations, our broad and deep technologies, our talents, and our culture. It has enabled me to start putting my fingerprints quickly on a number of strategic and operational areas. What continues to strike me since I joined Integra and got to know our organization and our rich history, is the keen sense of purpose in the organization. You can feel it every quarter when we hold our global town hall meeting where we invite patients and surgeons to talk about our products and how they have made a difference in their lives.
Last year, we had Dr. Claire Dillingham from Moses Cone Memorial speak to us on how she used MicroMatrix and Cytal products in a traumatic wound case for a patient in a terrible tractor accident. We also had the pleasure of listening to an inspiring and brave young lady, Isabel McCune, who benefited from our Integra Skin after a severe burn accident, and where our technology enabled her to recover, and at the age of 12, climbed Mount Kilimanjaro. These powerful stories inspired us to revisit our purpose, mission, and vision so we can reflect the meaningful impact we make on healthcare providers and patients around the world. What you see on this slide is where we landed. Our purpose is to restore patients' lives through technologies that transform surgical, neurologic, and regenerative care. We will realize this by innovating treatment pathways and enabling new standards of care.
The work that we do at Integra matters to our colleagues, to our healthcare customers, and to our communities, and our aspiration is to be the first choice of clinicians and healthcare systems. This strong purpose at Integra is the glue that binds us together and instills a tremendous source of pride and energy in the organization. It is this energy that we're channeling towards realizing the many opportunities we have at Integra. Here are the opportunities we see. After having spent significant time in the field last year with our sales force and our customers across the world, it's clear to me that this strong presence in large, attractive markets is a tremendous asset to capitalize on.
Having met many of our sales teams and visited our manufacturing facilities, it's also clear that we have further opportunity to strengthen our operational and commercial excellence to drive further market and margin expansion. Last year when we did our strategic reviews, it further reconfirmed our strong position, but also the many opportunities to broaden and deepen our reach along care pathways through NPIs, digital, and international expansion. Before I joined, I had already known Integra to be an acquisitive company. Now that I am on the inside, it is clear we have the strong balance sheet and the leadership experience to act on strategic M&A opportunities in adjacencies and in high-growth segments. Finally, over the past year, we spent significant time with the leadership team laying out plans to execute our integrated strategy and to pursue priorities to achieve profitable growth acceleration.
Pulling on these key levers, we will fuel our growth and value creation now and into the foreseeable future. Before going a bit deeper into strategy, let me first ground you in our business. We spent the last several years building and refining our business into two key business segments and organizational divisions. The first segment is focused on neurosurgery and specialty surgical instrumentation under our Codman business, led by Mike, who will be speaking right after me. The second one is regenerative wound and surgical reconstruction under the Tissue Technologies business led by Bob, who also will be on stage this morning. Both segments have product franchises that leverage and market our key collagen regenerative technologies. We were founded in 1989 based on this collagen technology. Integra has proven its staying power through many economic cycles.
Today, our company has more than $1.5 billion in global revenue, with market-leading brands sold in about 120 countries. We're a player with critical scale, which allows us to innovate while staying focused on key differentiating capabilities and building commercial relationships that translate to recurring revenues. The markets we compete in and our position in those markets form a strong foundation for us to accelerate profitable growth in the coming years. These markets have significant populations with chronic diseases, with healthcare providers who demand and value technological advancements, and who reward players like Integra for innovation and value differentiation. We're uniquely positioned to take advantage of these market conditions.
As you see on the right side of this slide, Integra offers a unique breadth and depth of products and technologies, a best-in-class and trusted sales force, a track record of execution and profitability enabled by a strong balance sheet and fiscal discipline. The Integra business enjoys the presence of established M&A capabilities and practices to continue expanding and optimizing our portfolio and capabilities. Since the last Investor Day in May 2021, we have executed key growth catalysts while navigating the business through the COVID turbulence. There's a lot on this slide, but let me call out a few of the highlights on the left side of the page. Mike and Bob later on will be speaking to points on the right-hand side later.
Last year, I led two divisions and our international team through a strategic refresh, defining and activating a more focused and integrated growth strategy to maximize the value Integra can deliver to clinicians and healthcare systems. This work has also served as the basis for our future M&A activities, our M&A game board, as we call it. We sharpened our capabilities and execution excellence, specifically in commercial operations, supply chain, and quality systems. I'm proud of what the team has done here, though there is more work to be done. We also formalized our ESG roadmap, a pragmatic yet powerful framework for our sustainability efforts moving forward, and a way to make ESG and sustainability a natural part of how we do business. We published our first ever ESG report, which you can find on our website.
We also hired key executives to lead our quality, regulatory, digital, IT, medical, and international teams. Each of these leaders bring the thought leadership and execution experience needed to drive our strategy and further attract top talents. Despite the still rough 2022, we delivered solid financial results and demonstrated the resilience of our business and our teams. We've navigated our P&L well through the pandemic while continuing to invest in foundational aspects of our business. We grew 4% organically and exercised strong fiscal discipline. We drove efficiencies to offset unprecedented margin pressures, which subsequently contributed to margin expansion, though not to the level of progress that we had projected. Through 2022, we worked on redefining our integrated growth strategy and to identify gaps and areas we needed to catch up. The next slide shows the results of that work.
We've redefined our strategy into two key dimensions. The first is growth drivers, levers that directly impact the growth ambitions of the company. We will activate investments and business priorities that will drive innovation and customer outcomes, including building digital capabilities. We'll focus on how we will further expand our markets outside the United States and how and where we can invest to broaden our position and impact in the care pathways. The second dimension is key strategic enablers, foundational pillars that support these drivers, such as operational and customer excellence and cultivating a high-performance culture. There's been great progress on these drivers, and I'm excited to have our executive leaders later this morning share more details on the plans behind our integrated strategy.
Mike, Bob, and Mark, when they are up here, will illustrate the common denominator that runs through each of our divisional strategies, the opportunity to broaden our presence and impact on the care pathways by following and catering to the needs of clinicians and patients along the patient journey in order to maximize outcomes for them. The graphic on this page is rather simple, but it captures tremendous opportunities for growth for Integra. Today, Integra has a strong product portfolio and is very much present in the acute care areas of the hospital. This gives us a great starting position to add further value to the care system and across the patient journey along three dimensions. First, further strengthening our surgical offerings in the acute area, building out and innovating our product offerings. Second, moving upstream in the patient journey into surgery planning and workflow support.
Third, moving downstream from the acute area into other sites of care or into extended patient monitoring. The way we are visualizing this patient journey is guiding us in our evaluation of commercial and technological opportunities that will deliver growth. It is also guiding us in how we prioritize our investments, how we think about geographic expansion, and where we aim to leverage digital innovation. It's also helping us to define the filters for our M&A game board as we screen for acquisition or partnership opportunities. This focus on the care pathways has also guided our priorities to further build out or drive stronger end-to-end innovation and commercialization. Over 2022, we have started to strengthen our strategic marketing proficiencies. We've stepped up clinical evidence generation and clinical operations and how they connect with our selling efforts and clinical education globally.
We're also growing our R&D and innovation capacity and piloting digital capabilities. You've heard me a couple of times refer to the importance of new capability building and talents. Being able to attract, develop, and retain those talents will be a key business differentiator. Integra values have been core to our workplace culture. 2022 was another year of great milestones resulting from the efforts around building an environment of accountability, talent development, creating a diverse and inclusive workplace, and progressing on our ESG imperatives. Our people are our greatest asset. We want to nurture a culture of accountability around continuous process improvement, simplification, and ongoing focus on quality. We're committed to talent development, whether it's through formal programs or on-the-job learning and achievement. These are essential to employee engagement and job satisfaction.
Diversity and inclusion has been the cornerstone of our people strategy. We will continue to build on the momentum through our diversity programs, employee research groups, or partnerships with external organizations focused on driving inclusion in the workplace. Finally, we will execute the ESG roadmap we established last year and provide deeper and broader disclosure of our progress against our targets. I'm very proud of our executive team leading Integra. It's a team that we continue to build. Since the last Investor Day, around two years ago, half of the leadership team are new in their roles, but highly experienced in healthcare and their function. Together, members of the LT bring deep knowledge and capabilities that are critical to executing our strategic priorities.
Today, you will hear from and get to know Mike McBreen and Bob Davis a lot better as they take you through our divisional strategies and plans. Mark Jesser, who joined us less than a year ago, has an extensive career in digital innovation and will explain our thinking around digital and where it can bring value to Integra. Harvinder Singh, who joined us six months ago, built his career in healthcare technology and commercialization outside the U.S., he will update us on international strategy accelerators. Steve Leonard will highlight our operational progress and priorities. Some of our other recent hires in the ELT include Susan Krause, Jessica Smith, Dr. Stuart Hart, and Gurpreet Kaur, respectively in our quality, regulatory, medical affairs, and clinical ops, and CIO roles.
Each of them are bringing new skills and leadership in line with our market expansion, innovation, and business efficiency objectives. This terrific leadership team is highly accomplished in running complex operations and nurturing diverse and inclusive organizations, which translates to creating the high-performance culture we strive to build. Our CFO search continues, and we have a very strong slate, and together with our board selection committee, we should be very close to identifying a great leader with operational and strategic talents and the right fit to the company. We're also extremely fortunate to have the support of a strong board that has broad global experience and expertise in healthcare, executive management, finance, governance, sales, and marketing. Our most recent addition to the board, Renee Lo, is currently the CTO partner and regional director for APAC at Google.
She joined us last year and adds deep knowledge of digital innovation to the board, as well as a keen understanding of the Asian markets. Three of our board members are here with us today, let me extend a special welcome to our chairman, Stuart Essig, who's joining us remotely, and then Keith Bradley and Shaundra Clay sitting here in front, joining us here in the room. Let me close this business overview and remarks with a slide that highlights the targets we shared two years ago at our last investor day. Let me recap our long-term targets. Bring organic growth into the 5%-7% range. Further grow our gross margin into the 70%-72% range. Drive EBITDA margins between 28% and 30%, and achieve double-digit EPS growth.
Over the past year, many of you, if not all of you, have asked me if I stand by these long-term financial targets, and my answer is yes. My first month on the job was spent assessing our markets and our business strategies, and despite the headwinds from the COVID pandemic, which has derailed our timelines, these are the right long-term performance targets for Integra. Today, we are reconfirming these targets, and for the rest of this morning, we're gonna be taking a deeper dive into the growth catalyst and margin accelerators to achieve these targets and the path and timelines towards these objectives. This closes my opening remarks. Let me turn the floor now over to Mike McBreen, our President of our Codman Specialty Surgical division. With that, Mike, the floor is yours.
Thanks, Jan. Good morning. Before I dive in, let me touch a bit on my background. I joined Integra in 2017 as part of the Codman acquisition from J&J. I was there for 21 years and helped lead the neurovascular business as well as the neurosurgery business. In the last 5+ years at Integra, I was the president of our international business, and I've been in my current role since June of 2020. I'm really excited to be here today and give you an update on our business here at CSS. This morning, I'll get into all the key areas for the business and make sure I give you a flavor for our people and the passion we have for this business. We've made great progress on commercial execution and our innovation pathway.
I'll do a deeper dive into the markets we serve and walk through three case studies that show how we're executing on innovation, addressing meaningful customer needs, and ultimately improving outcomes for patients. Should be a great session, and I'm looking forward to your questions later in the day. Okay. Let me give you an overview of the key messages you're gonna hear from me today. First, we enjoy a global market-leading position and have a lot in the pipeline to drive growth across NPI execution, international expansion, and focus channels in both neurosurgery and the instrument spaces. Our global commercial teams are fantastic. You'll hear me talk about this a lot today. We have a best-in-class sales force which helps us maintain steady performance in all regions of the globe.
We are unique due to our heavy focus on neurosurgery, and this dedicated focus plays a big role in our success, attracting tenured sales reps who have built their careers in neuro, making it very tough to compete with our deep neuro-focused sales team. We love this pipeline focus and the ability to attract talent. It's really a core part of who we are. As a well-established global business, nearly 40% of Codman revenue is generated from outside the U.S. As you will hear from Harvinder shortly, we have strong performance, particularly in Japan and China. My second key message is focused on our continued investment in innovation to drive long-term profitable growth, address unmet needs to grow our base business, and provide a gateway to new market segments that will change the standard of care through state-of-the-art surgical approaches and instrumentation.
Later in the presentation, I'll take you deeper into three innovation platforms that will drive growth and market expansion for us over the next few years. My third message is focused on the strategic shift to broaden our care pathway. This expanded view is heavily built on the patient, and our market-leading position compels us to find new ways to expand how we meet their needs pre-operatively, within the operating room, or in other sites of care, such as the ICU. Our two main markets are good places to be in and really complement each other. In each of these spaces, the market rewards dedicated focus in both innovation and sales channels. Neurosurgery is highly specialized, with steady growth from demographic factors and advancements in diagnostics and imaging driving treatment growth.
Neurologists and neurosurgeons are developing new protocols to identify and treat advanced diseases, which support a consistent 3%-5% market growth rate. A great example of this is our M-MIS technology. Our AURORA Surgiscope becomes even more valuable when improved new imaging technology provides details on the bleed or tumor. I see some unique trends in our markets. Neurosurgeons are among the elite of surgical disciplines and have a strong influence in purchasing decisions within the hospital systems. This enables doctors to more quickly adopt new technologies and drive advancements in their field. This is an important driver for us. It can speed up conversion and adoption timelines. On the instrument side, these solutions span a wide variety of surgical specialties, including ENT, neuro, laparoscopic, and general surgery. This is a relatively stable market with consistent demand. We believe sterile processing departments are really underserved.
This is the engine for our hospital fuels its operating room. Our reps are locked in on this, and how can they support this area. The formula to win an instrument starts with a strong, dedicated sales force, and we have one. A broad portfolio also enables to expand our reach and generate growth through bigger alternative channels, including larger distribution partners. Customers have different buying preferences, so providing diversity of purchasing options creates flexibility and scale. This is really a scale business, and dedicated focus with efficiency across both the portfolio and the channels gives us a unique competitive advantage. We have established leadership in our served markets and are well-positioned to exceed market growth. We play in a $5 billion total aggregate market with growth between 3% and 5%. The Codman business alone is a $1 billion segment for Integra.
You can see the specific product categories at the bottom of the page. In my opening, I mentioned our people. We're privileged to serve in areas of extraordinarily high patient impact, it's a source of pride for this team. It's really exciting to see how they engage. This is a big part of the culture and drive, let me just spend 1 minute diving into this a bit more. We enable surgeons to safely access the brain through open craniotomies and allow for minimally invasive surgical approaches to address brain tumors, bleeds, or other issues. We have technology to address and monitor traumatic brain injury, which includes advanced catheters impregnated with antimicrobial agents and advanced monitoring systems to measure intracranial pressure and brain oxygen levels. Hydrocephalus is a lifelong condition for which there is no cure.
The industry-leading Codman valve portfolio provides patients with the solutions needed to live an active lifestyle, such as the Certas Plus programmable valve, which is designed to minimize unintended setting changes by magnetic interference, which can lead to adverse effects. Our employees rally around the role we play in these complex surgeries. We look at our neuro business through the lens of both disease state and product categories. We have four main product platforms composed of many market-leading brands. I'll go into some of our technology at a deeper level in a few slides. The takeaway here is, in all four of these neurosurgery areas, we have products that are dependable, so the surgical team can get their jobs done. As you can see, we have particularly strong performance in our advanced energy and hydrocephalus portfolios.
In neuromonitoring, we would historically see mid-single-digit growth prior to the CereLink recall, which we reflected on this slide. We spoke about a return-to-market plan for CereLink during last week's earnings call, and we're more than happy to answer further questions later today. Looking at our instrument segment, the market is growing between 2% and 3%, and we provide a broad portfolio of high-quality specialty in general instrument offerings. This includes Codman's Jarit brand, which is a staple instrument catalog found in most sterile processing departments. The MicroFrance specialty line for ENT, and a portfolio of surgical lighting systems, including our Duo Headlight. We continue to advance our instrument business and now have revenues of more than $200 million globally. How does this all lead to winning? We are a trusted global leader with the most comprehensive neurosurgery portfolio in the business, with industry-leading capabilities and technologies.
We command the number one or number two share position in most of the markets we serve. We have leveraged organic and inorganic innovation to build a robust pipeline to address unmet clinical needs. As I mentioned, one of our greatest assets are our global sales team and our infrastructure. Over the last five years, we've focused on driving commercial excellence within our instruments team. As a result, we've seen strong performance in our instrument revenue line. We're growing faster than the markets we play in. It's been driven by a few areas of focus. Analytics that lead to strong targeting and deal tracking, leveraging partnerships across our neuro and enterprise contract group, creative programs to align incentive compensation to the most attractive products. As Jan commented earlier, this slide spotlights our organization's ability to impact a patient's journey on the care pathway.
This is accomplished through surgery planning and workflow support, strengthening surgical offerings and site of care expansion, and patient monitoring. Today, we are focused on broadening our care pathway in three ways. We are focused on bringing more patients into the pre-surgical pathway. This is achieved by driving two areas. Number one, continuing something we actually do very well today. Disease state awareness and continuing education go hand in hand with the technology itself. We partner with patient support groups, such as the Hydrocephalus Association, to help raise awareness and bolster support for those living with these conditions. For example, in 2022, we participated in 30 walks across the United States as part of the association's Walk to End Hydrocephalus campaign.
If you want to understand the impact of this disease and the potential for new and better treatment options, spend a day with the patients, families, and physicians who live this every day. Hydrocephalus in adults is often can be confused with other neuro diseases. We're at the front line with clinicians to publish and update guidelines to treat this condition. In addition, we are using our MIS surgery platform to bring more patients to surgery and reshape the care pathway. At an industry level, clinical trials are providing more insight as to how certain diseases should be treated, such as brain bleeds and hematomas. This matters to patients because availabilities to MIS techniques positively includes the decision to take a patient to surgery. Patients now have the potential for better outcomes due to MIS surgical approaches. Number two, continue to play in our strength in the operating room.
We can play deeper, broader as well into new spaces within the neuro category. These include internal efforts and business development opportunities. We have an opportunity to expand our current offerings into new disease states. Our CUSA ablation system is a great example of this. I'll address that in a few slides. We also see several M&A areas where we have the opportunity to broaden our portfolio leverage our strong sales channel. The third is centered on postoperative care. Let's focus just for a minute on the ICU. This is a space where we see opportunity to drive digital advancement of our portfolio. We have a wide and strong product offering in this site of care. Our portfolio depth in the ICU is quite unique. We see several opportunities to grow in this space.
Our neuro monitoring platform is broad. We have innovation that will change the level of information available to the ICU team. This aligns perfectly to our focus on digital technology. We've kicked off projects to expand our current product portfolio to become better data sources. This information can be captured and shared with the ICU team, which will help them make better decisions and see better patient outcomes. I'll cover this again a bit later in the presentation. Mark Jesser will also touch on some of these innovation opportunities. For the next three slides, I'm gonna dive deeper into how Codman is executing on our innovation platform, addressing meaningful customer needs and ultimately improving outcomes for patients.
To kick off, I'd like to focus on the growth and innovation around our CUSA Clarity system, which has been one of our strongest near-term growth drivers. CUSA's longevity has given us a strong installed base for disposable and capital revenue. It's been a consistent area of growth and innovation for us. We have executed well and are building on that foundation with new products and programs. Our NPI cadence for CUSA is very consistent, with a new product being launched each of the last two years. CUSA stands for Cavitron Ultrasonic Surgical Aspirator. It uses a very specific ultrasonic profile to safely debulk fibrous tissue in delicate areas such as the brain and liver, while minimizing the impact to surrounding vessels. The ultrasonic cavitation emulsifies the tissue, while the irrigator and aspirator provides precise and localized fluid to manage heat and tissue removal.
While we have a primary focus on the brain, we have indications and specific tip offerings for other organs, such as the liver, which has a dense and complex blood supply, and delicate bone removal, particularly in facial structure. The tissue select feature is a key differentiator for us. The sensor and feedback loop helps modulate the speed of the device when it encounters high-density tissue, such as collagen that surrounds blood vessels. The best way to think about this is it's a lane assist when you're driving a car. When you get close to a line, CUSA is going to tell you and give you a signal. We see CUSA as a key technology platform for us, which offers multiple areas of expanded growth. In the last two years, we have delivered multiple tip product introductions to assist surgeons.
We're excited to see the impact these products have had in several areas, including laparoscopic and neurosurgery. Let's talk for a minute about how we translate all of this into fuel and growth for this platform. First, it's already a growth platform for us, but with this new pipeline will re-result in a cadence of new products, new indications, and new markets over the next few years. This will be heavily focused on delivering innovation on several new tip designs to provide the surgeon better access and performance. New disease state indications that will continue to use CUSA as the technology platform. In new international markets where we have not launched CUSA to date. We're also focused on the role of CUSA in robotic surgery and are well into a pipeline project that combines our technology and tip offerings with robotic surgery.
Catheters are used to manage the flow of cerebrospinal fluid, or CSF, in several applications, including external ventricular drains, also known as EVDs. For treatment of traumatic brain injuries and for shunt catheters and hydrocephalus, and where excess CSF is rooted from the brain to be reabsorbed in the body cavity. These catheters can stay in a patient's body for several days, weeks, or even years, and unfortunately, can be susceptible to potential complications related to infection or blockage of fluid flow. The good news is that Integra has market-leading advanced catheter technologies on the market today designed to reduce the risk of each of these issues. The Bactiseal antimicrobial catheter, which are impregnated with 2 different antibiotics, underpin our portfolio offerings in both EVD and hydrocephalus categories.
Codman's catheters with the Endexo additive, which was acquired in 2019, reduce thrombus buildup or clotting on the surface of the catheter. Currently, both technologies don't exist within the same device, causing surgeons to have to choose between focusing on possible infection or blockage. Our focus is making sure the market gets the best of both worlds, combining our Bactiseal and Endexo material technology so that surgeons will no longer have to make this trade-off decision. The complexity of a project like this is heavily focused on successfully combining the additive to the catheter. We have that behind us, and as a result, we're very confident we'll deliver this into the market in the second half of 2024. This new combo catheter will change the game in EVD and shunting.
It'll be a significant benefit for both patients and healthcare providers. It addresses two of the major unmet needs in this category. As a result, we'll see a share expansion across our long-range plan timeframe. Another example of Codman's commitment to innovation is the AURORA Surgiscope, which came to us through an acquisition in 2019. We've been executing very well on the commercial side today and are selling in commercial accounts in the U.S. and are also supporting clinical programs in both the United States and Australia. We've launched several new products to the AURORA portfolio and will continue to do so in the second half of 2023. 2023 and 2024 are key years for this technology as we fully launch and kick off our clinical programs.
As some of you may have heard, there was recently some positive clinical news in the area of MIS surgical treatment for hemorrhagic stroke. This news, combined with a large number of clinical cases under our belt and a growing product portfolio, really positions us well to lead in this rapidly growing and developing space. As a refresher, let me talk for just a minute on why this product is transformational. The wow factor of Aurora is really the ability to offer a minimally invasive approach to neurosurgery that's complete. It reduces OR setup time due to everything being included mostly a disposable device. There's very limited capital needed for this product. Due to its small cannula, it also minimizes collateral damage to brain tissue as you create the surgical path.
An easy way to think about the benefits are speed and safety without sacrificing surgical access or efficacy. A cannula is used to provide a clear and protected access pathway to the brain lesion. The imaging and lighting systems are mounted onboard to give the surgeon a direct up-close and illuminated view of the pathology. It's currently available in two versions, a smaller 8-millimeter diameter Surgiscope, which is used primarily for blood evacuation or taking a biopsy. There's also a larger 15-millimeter diameter version, which can be used to accommodate multiple instruments, and you can see that in the left-hand side picture. Let's talk a little bit more about what's next for this platform. We have additional development work in progress for better imaging technology and user features to improve the user experience for Aurora. Our system enables early intervention with easier and safer access.
A refresher on the disease state. Intracerebral hemorrhage is a disease with a global incidence of over 3 million, and AURORA will help clinicians treat these patients faster with less traumatic access to the brain. To date, the standard care of these patients has been medical management. We believe our platform and clinical programs will support the early studies released showing that intervention is, in fact, a better solution. Integra has a long history of growth through strategic mergers and acquisitions, and our healthy balance sheet enables us to place additional bets to broaden impact on care pathways. We have additional further focus to areas where we can bring stronger digital focus into our portfolio. We continue to evaluate partnerships or acquisitions to grow our digital footprint, whether in surgical planning, patient triage, or workflow support. We will pursue tuck-ins to expand the breadth and scale of our offerings.
This includes expanding into adjacent markets. Let me give you a bit more flavor on this. We see several areas of opportunity, including broadening our approach in the MIS area of neurosurgery. On the instrument side, we're focused on increasing our scale and efficacy with surgical instrumentation. We see a great opportunity to add scale and deeper focus on the targeted specialty surgical areas we cover. This could be targeted through distribution deals or acquisitions. Lastly, we're building partnerships to digitally enable our market-leading solutions. We have a robust capability in sensing in the ICU with our ICP and oxygen monitoring platforms. We have the opportunity to digitally enhance a number of our core platforms to improve how patients are monitored and subsequently treated.
Shifting to international, CSS has a great track record, with nearly 40% of our business existing outside the U.S., and more than 30% of future organic growth coming from China, Japan, and other growth markets. We've got plenty of opportunity to grow. Harvinder will speak about our international business in more depth later today. We continue to observe above market growth, particularly in China and Japan, and we feel really good about our pipeline in Asia, many of which we've spoken about today. Let me try to summarize the story I've told today. We feel great about where we're sitting. A strong portfolio combined with a lot of opportunities to strengthen our industry-leading global share in neurosurgery through advanced products, international growth, and focused channels and commercial capabilities.
We anticipate new products driving at least $100 million in revenue by 2027. We'll continue to invest in key clinical programs that grow our markets and support international expansion. We'll also look to expand the care pathway, accessing higher growth segments to bolster growth in our more established markets. I'll end this where I started. I really am excited about where this business is heading and the progress we've made. We've progressed our innovation agenda. We have several impactful innovation programs coming to market in the next year. I covered several of these in detail today. In addition to CUSA, we have three new growth platforms, AURORA, the combo catheter, and the relaunch of CereLink, to accelerate our growth. These technologies, combined with our broad portfolio, commercial capabilities, and M&A track record, prepare us well for the next few years.
Thanks for your time this morning. It's my pleasure to hand it over to Bob Davis.
Thanks, Mike, and good morning, everyone. It's great to be with all of you again. I've been at Integra for 12 years and leading the Tissue Technologies Global Product Division for the last seven. Since our last Investor Day, we have set a clear vision and strategy. We've also fully integrated ACell, expanded our commercial sales teams, and are also executing on a path to be a global leader in breast reconstruction with the acquisition of Surgical Innovation Associates. For the next 20 minutes, I will be talking about how Tissue Technologies can build on our strengths with our versatile portfolio, differentiated technology platforms, and investments in faster-growing markets. Tissue Technologies has the broadest set of proprietary technology platforms in the industry. These platforms give us a competitive edge to compete in attractive, high-growth markets.
Our largest global market is complex wound reconstruction, which includes products such as Integra Dermal Matrices and MicroMatrix. Today, we have a strong leadership position and scale in the acute care hospital setting. In order to shift our underlying market growth to the faster end of the larger wound reconstruction market, we are actively seeking opportunities to extend our reach beyond acute care into the non-acute segment. One of Integra's most attractive strategic growth opportunities is the breast reconstruction market. We now have two distinct product offerings with SurgiMend PRS, a xenograft, and DuraSorb, a resorbable synthetic mesh, expanding our plans to access the U.S. market with devices specifically approved by the FDA for use in implant-based breast reconstruction. To date, no other manufacturer has submitted a premarket approval or PMA.
As we work to obtain specific indications in subpectoral and prepectoral implant-based breast reconstruction, Integra is poised for a first-mover advantage. This allows us to bolster our investments with additional evidence generation, innovation, and surgeon education to set a new global standard of care. Third, we plan to capitalize on our technology platforms across these high-growth markets to introduce new products and generate evidence to accelerate U.S. organic growth and expand internationally. The two main rapidly growing markets we serve are complex wound reconstruction and surgical reconstruction. Our third market, private label, is the business-to-business arm of Integra, which I'll talk about shortly. Both the complex wound and surgical reconstruction markets are growing high single digits and above the commonly cited 5% med device industry growth rate. There are many factors driving these above-market rates.
Starting on the left, in complex wound reconstruction, the aging population and comorbidities such as diabetes and obesity result in more prevalent wounds that are more complex to treat and are candidates for earlier reconstruction with skin substitutes. Integra Dermal Matrices and MicroMatrix provide more solutions to healthcare professionals that didn't previously exist. Due to the complexity and challenges of treating these patients, surgeons have a significant influence over the choice of treatment and which product to use. The trend to treat patients in lower acuity, less costly care settings, combined with the availability of these technologies, continues to expand into the non-acute care settings. Moving over to the middle, in surgical reconstruction, especially in the area of implant-based breast reconstruction, there is significant opportunity for our surgical matrix business.
Some of the factors driving this opportunity are the high rate of implant-based breast reconstruction, driven by the Women's Health Act of 1989, which mandated insurance coverage for reconstructing following mastectomy, earlier detection and diagnosis, and the trend towards bilateral and prophylactic mastectomies. Accessibility is also made possible by more outpatient procedures, emerging techniques of the prepectoral or above-the-muscle implant placement technique, and products like SurgiMend PRS and DuraSorb, which lead to more predictable, positive outcomes. The U.S. market has been undergoing significant shifts, making it ripe for disruption as the need for cost efficiency intensifies. In addition to the high cost, the current regulatory landscape and limitations of human tissue, including the lack of larger sizes, consistent quality of the tissue, and availability of source material, are driving clinicians to seek alternate solutions.
These factors are spurring a shift in mesh preferences that we intend to capitalize on as this market is poised to favor clinical and cost-effective technologies like SurgiMend and DuraSorb. Lastly, our private label business is one of our key growth opportunities with a different set of drivers, which makes it attractive. Partnering with other blue-chip medical device companies allows us to capitalize on our technology platforms, our manufacturing capacity, and R&D capabilities to serve other high-growth market segments. Our partnership with Pfizer is a great example of us combining our engineered collagen technology platform for drug delivery. The takeaway from this slide is that we are focused on rapidly growing markets with significant upside. Tissue Technologies has global revenue of over $500 million, As I spoke about earlier, we have the broadest set of proprietary technology platforms in the industry.
Some of our leading brands include our Integra Dermal Matrices, PriMatrix, AmnioExcel, SurgiMend, DuraSorb, and Gentrix, to name a few. The complex wound and surgical reconstruction markets represent a global opportunity of over $2.5 billion with healthy high single-digit growth rates. Within these markets, there are various segments that have different growth rates. We are poised for above-market growth in complex wound and surgical reconstruction with investments in new products and indications, expansion of our geographies, and private label agreements. As a recognized market leader in soft tissue regeneration and reconstruction, Integra has established itself as an innovator in addressing unmet needs in growing therapeutic categories with multiple proprietary technology platforms. Our technology platforms include highly engineered collagen, fetal bovine dermal matrix, human amniotic tissue, porcine urinary bladder matrix, or UBM, and resorbable synthetic mesh.
We have built meaningful scale for these platforms with our R&D expertise and manufacturing capabilities. We have also developed scale with our commercial sales teams, professional education, and operations. Most companies in this space have a single platform. Integra has a versatile portfolio of differentiated products to address a broader range of these clinical needs. Similar to what you've already heard from Jan and Mike, Tissue Technologies has the opportunity to broaden our impact on care pathways to improve patient outcomes by expanding beyond our current product and acute care focus. In complex wound reconstruction, patient flow can be bidirectional, meaning that can either start with an inpatient procedure and then move to a non-acute settings, or, as is the case for many patients, start by receiving treatment in lower acuity care settings. As the severity and complexity of their wound accelerates, they move into the acute setting.
By intervening earlier in the patient's journey, we can broaden the use of our products to improve outcomes. To better understand these clinical pathway strategies, let's walk through a few examples. The first example I want to share is in complex wound reconstruction. The need for a reconstructive procedure can arise from different etiologies or causes, and can have very different goals. Regardless of etiology, treatment is often accomplished through a progression of treatments or procedures. Based on the site of care, age, comorbidities, and condition of the patient, treatment goals can change. Conserving healthy tissue and speed of closure are two key factors surgeons take into consideration. Contrast the needs of surgeons treating patients with large third-degree burns versus a relatively small but deep diabetic foot ulcer, known as a DFU.
The first needs a product to regenerate dermis and provide immediate physiological closure, essentially to buy time to let the patient recover and for donor sites to heal. The latter needs a product that can rapidly build tissue. Integra has the broadest range of skin substitutes that can be tailored to the specific clinical and economic needs of the patient. For example, it's increasingly common for MicroMatrix to be used in advance of or in combination with PriMatrix or AmnioExcel. With this versatile portfolio, we'll be increasing our emphasis on new product introductions and generating clinical and economic evidence to extend product utilization. This will help sustain our leadership position in complex wound reconstruction and grow faster than the segment in a $1.6 billion market growing at 5%-12%. The second example is in the area of post-mastectomy breast reconstruction.
As we've discussed, the U.S. market faces potential for disruption through shifting surgical techniques, value-based care trends, and regulatory actions. Today, there are no FDA-approved surgical matrices for implant-based breast reconstruction. We are well-positioned to capitalize on this disruption with SurgiMend PRS and DuraSorb. By offering these two distinct product solutions to plastic and reconstructive surgeons, we can address various clinical, contracting, and economic needs across different sites of care to help improve patient outcomes. With SurgiMend PRS, Integra is the first and to date, the only manufacturer to submit a pre-market approval, again, PMA application, for a surgical matrix for use as soft tissue support in implant-based breast reconstruction, and we anticipate label expansion in 2024. We expect DuraSorb to be a fast follower with expanded label market entry for both pre-pectoral and subpectoral reconstruction in the 2025 and 2026 timeframe.
DuraSorb is the only active enrolling prospective multi-center investigational device exemption or IDE study in the U.S. Integra's strong capabilities in soft tissue reconstruction and the addition of DuraSorb create a portfolio of solutions to set a new standard of care in this large, fast-growing, $600 million market with a 12% CAGR. Our long-term goal is to achieve approximately $200 million of combined revenue by 2030. We believe we have significant organic growth opportunities. We see additional opportunities with inorganic accelerators to broaden impact on care pathways to further support the patient journey. Starting on the left, we have deep expertise in reconstructive procedures with our current products, which provides a platform to expand into adjacent areas. Examples of this are debridement, which is a critical aspect of the wound-healing process with the application of our skin substitute products.
Related to this are opportunities to expand into diagnostics that could provide customer insights and clinical capabilities to help influence their decision-making process and choice of skin substitutes. Mark Jesser will talk more about this later during his digital strategy update. Moving on to the middle section, another opportunity is to accelerate our international and market position through acquisitions, especially for market-appropriate products in select regions and segments. We also continue to invest in and push the frontier forward, utilizing our regenerative technology platform in areas that are not strategic to our core pathways. We're engaging with potential new private label partners to present our technology portfolio for use as medical devices and as a platform for drug delivery. Finally, on the right, we are actively exploring opportunities to extend our reach into the non-acute settings through an acquisition or partnership.
Today, Tissue Technologies market for complex wound and surgical reconstruction is predominantly in the U.S. However, we have a strong global presence at Integra and footprint compared to competitors in this space. The keys to success will be registrations and market access, which will require clinical studies and health economic and outcomes research. We are in the early stages of market development and growth opportunities in Europe and China with our Integra Dermal Matrices and SurgiMend PRS and new product introductions specific to Europe. We also believe the versatility of our technology platforms can lead to globalization and acceleration opportunities, specifically with new configurations of SurgiMend PRS, the MicroMatrix launch in Europe, and our urinary bladder matrix and UBM portfolio. Harvinder Singh will talk more about accelerating international growth with sustained market development efforts during his presentation.
To summarize, we have a clear vision and strategy in Tissue Technologies to build on our strength with our versatile portfolio, differentiated technology platforms, and investments in faster-growing markets. The key growth opportunities for our business are, one, sustaining and expanding our leadership position in complex wound reconstruction by focusing on new product introductions and evidence generation in support of our global value propositions. Two is to capitalize on our first-mover advantages to set a new standard of care in the implant-based breast reconstruction global segment with the pursuit of our SurgiMend and DuraSorb PMAs. Three, we plan to capitalize on our technology platforms across our high-growth markets to introduce new products and generate evidence to accelerate U.S. organic growth and expand internationally. We are confident that we will achieve success in these three key areas.
We are targeting greater than 7% growth in 2023 and in subsequent years to move to the midpoint as we gain more scale and critical mass in the higher growth market segments. Thank you. With that, I'd now like to turn it over to Mark Jesser.
Hi, I'm Mark Jesser, Integra's Chief Digital Officer. I joined Integra about nine months ago, and I'll be sharing some of the progress we've been making on our customer-facing digital strategy. Before I get started, I wanna tell you a little bit about me. Prior to Integra, I held innovation and digital strategy roles at Abbott Labs and Becton Dickinson. At Abbott, I spent 10 years in diabetes care and led innovation work for several medical devices, including FreeStyle Libre. My team created the cloud reporting platform and apps for the device. We launched into 60 countries to support about 2 million patients. At BD, I led a team that designed an AI imaging and clinician task tracking system for medication management and bachelor care in hospitals.
Now at Integra, I'm getting a chance to leverage this experience to help expand the role of digital to support the CSS and tissue tech portfolios. Three messages that I'd like for you to take away today. First is that we're committed to digital. A big reason I joined Integra was Jan's background in this area, and it's been great working with him to start building a team and new capabilities. Next is that our approach to digital is grounded in supporting our non-digital device portfolios. We're focused on opportunities that expand market share and drive value pricing for our products. In the future, we may pursue stand-alone digital propositions, but right now, our priority is bringing digital to our core products.
Finally, we know it will take new capabilities to succeed in digital, we plan to leverage Integra's strength in M&A to partner or make small complementary acquisitions of companies that have the skills we will need to accomplish our goals. We move toward digital, we're taking 2 related approaches. First, we're exploring ways to add data-generating and cloud connectivity features to our devices. Adding new sensors to our ICP monitors so we can track a broader range of physiological conditions would be 1 example. Storing CUSA or CereLink usage data, then sharing it with real-time, remote clinicians would be another way through reports. Second, we can create companion apps. These combine data from our devices with data entered in the app itself and share it in value-adding ways with providers, patients, and caregivers.
The goal is to create new value that drives preference for our products. We're exploring several ideas in this area, and I'll provide a few examples of those later. For any of our digital products, we need to ensure that they integrate with the broader digital health ecosystem. We're not trying to create our own broad digital ecosystem that goes well beyond our products. Our focus is on making sure that whatever digital solutions we create, they integrate effectively with other digital platforms that are part of clinician or patient workflows. We ask three questions when we think about prioritizing digital plays. First, we aim to understand how the digital opportunity will support our device portfolio. This is important because we're not a software-only company. We will always have the challenge of managing both digital and non-digital products.
We can turn this into an advantage if our digital companion apps drive more revenue for our devices. That synergy creates another way of capturing value that isn't available to software-only companies. We've seen this in the diabetes space, where mobile apps and web-based reports have made it easier for patients to measure their glucose and share the data, which has increased the adoption and utilization of glucose sensors like Libre. Second, we consider the balance between how much value this play will bring to Integra and how much new cost we're adding to our operations. Digital products bring new types of ongoing development and support costs, we wanna create solutions that customers are excited about but aren't bigger than they need to be to drive value for Integra. Finally, we're focused on lower investment, faster to market solutions.
We ask ourselves, what's the smallest big thing we can do for our customers? When we talk about bringing digital into the patient journey, we are early. A recent McKinsey study ranked the top 23 industry sectors and how much they've adopted digital. IT and media were number one and two, which makes sense, but healthcare was number 20 on that list. The good news, of course, is that we beat construction, agriculture, and hunting, so we have that going for us. Otherwise, another good thing is that this does create opportunities for digital to help drive the growth and margin targets that Mike and Bob shared with you a little earlier. On the bottom of this slide, you can see some of the digital opportunities we're researching, and I'm gonna highlight a few of them.
Before I do, I wanna respond to the question that I know is coming when I start showing future digital products. This sounds great. How does it fit into your current financial plan? This is a two-part answer. On the cost side, we've included organic digital investment. We put about $2 million into our 2023 plan, and over the next couple of years, as we increase our overall R&D spend, digital is part of that. These are investments in sensors and data sharing features as well as companion apps to support the CSS and Tissue Tech portfolios. For inorganic, we have digital plays in our M&A game board. Like any acquisition, we think carefully about ROIC and don't want a long-term dilutive acquisition in this area. On part two, on the revenue side, we haven't included digital products.
We see them as potential upside. Both Jan and I have been around the block a few times on digital, and it takes time to build up digital revenue. Once you're there, you often have a solid ongoing revenue stream. For right now, we're focused on price and share capture, and later, separate digital revenue. All right, this slide is my favorite because it shows how digital can help people, both our customers and patients. There's three examples here. I can't share everything we're working on for obvious competitive reasons, but these should give you a sense of what we're exploring. The first pilot is an app to support Tissue Technologies. This market segment has a lot of products, and it's changing quickly.
Over $2 billion was raised by industry players in the past few years for regenerative technologies, and there are about 160 new tissue products in clinical trials globally. With so much innovation, surgeons want guidance to select the right product for different kinds of wounds and advice about the best way to apply them. Providers want more tracking of procedures to ensure consistent standards of care. Digital can help on something like this. We're researching app that captures images of patient wounds over time with decision support for surgeons. The goal is to educate clinicians to make it easier for them to start using our products and ultimately to improve patient outcomes. For CSS, we're looking at an app to support increased diagnosis of INPH. This is a kind of hydrocephalus that affects the elderly.
In the U.S., there is an estimated 700,000 cases, only 20% are properly diagnosed because the symptoms such as dementia and incontinence are similar to other age-related diseases. A lot of INPH goes undiagnosed or worse, gets diagnosed as dementia. People with INPH often have a shuffling gait when they walk, we're working with a clinical team in Japan to build an app that a caregiver can use to take a video of an elderly person walking. We apply AI to the video to flag for potential INPH. We're aiming to get more patients into their doctor's office for this treatable form of dementia and at the same time expand the market for our hydrocephalus valves. Finally, we're looking at opportunities in China to combine our ICP data from CereLink with other parameters such as oxygen level and blood pressure.
Giving clinicians a way to see these measures on one screen with real-time calculations can help care decisions and differentiate our device portfolio. In summary, we're committed to a digital strategy and making steady progress. We're building out the team to work with strategic marketing groups within our segments. We're exploring digital pilots globally with clinicians and patients, and we're scanning the market for strategic partners and complementary acquisitions that we can leverage to build and scale our digital offerings. We're off to a great start with digital and Integra. We're building new capabilities that will help us deliver on our vision of being the first choice of clinicians and improving the lives of patients around the world. Thank you. At this point, I will turn it over to Chris, who is gonna facilitate some Q&A.
Thanks, Mark.
Thank you.
Just a quick note on housekeeping for Q&A. We have mic runners in the room, so we'll wait for the microphone before asking a question. For those online on the webcast, please feel free to enter questions in, and we'll intersperse those into our Q&A through the web interface. I'd like to have the presenters from the first session come up on stage, Jan, Mike, and Bob to join me on stage, then we'll begin the Q&A. For your folks in the room, please introduce yourself before asking the question so that we make sure everyone knows who's asking questions. Start here.
Good morning, Ryan Zimmerman, BTIG. Two questions, one for Mike and one for.
Mark.
Mark. Thank you.
Digital guy. Yeah. Digital guy.
Mike, if I go back to the last Analyst Day, the CSS WAMGR was 4%-6%.
Yeah.
You now have the CSS WAMGR at 3%-5%. Take us through what changed and why that is. For Mark, the digital guy-
Yeah.
Why do you expect you can get more price in this market when you add digital solutions? Just given kind of the challenges we've seen in this market in terms of growth and, you know, I guess curious why, you know, what's underpinning that? Thank you for taking both questions.
Okay, thanks for the question. You know, there's been a lot of different factors you can imagine. As we think about the growth rates around the world, we've had some impact from COVID, et cetera. I think as you think about that range, there's a couple of the products that you saw today that we're still kind of sorting out. It hasn't been any big breakthrough changes for us. I think it's more timing. I think we feel fundamentally very strong about the business. You know, we'll continue to update, but hasn't been really fundamental drivers other than the fact that some of our items are a bit slower in timing for obvious reasons of COVID and some supply chain challenges. No fundamental differences, so we'll continue to update.
There's a lot of ways to get value out of digital. It doesn't necessarily have to be a list price goes up as a result of it. Some of the things that I mentioned when you have this INPH app, the market expands for something like our hydrocephalus valves, if you can diagnose more cases. It's the same pricing potentially, but you're selling more valves. The other way that it shows up is often maintaining price. If you're looking at new tenders or you're starting to bring products out to bid, for instance, digital is often a way where you can add that into the overall bundle of what you're providing and gather additional value in that way. Usually it's not, "Hey, we've got this new digital thing.
We wanna charge you more money for it." There's more strategic opportunities that you see as you start adding it in and bundling it with your devices.
Go ahead.
Good morning. Vik Chopra, Wells Fargo. Two questions for me. Jan, you know, M&A has sort of been in Integra's DNA. I'm just curious as to how you see M&A playing a role over the LRP, and whether you're open to adding an additional platform to the company. I had a follow-up. Thanks.
Okay. A lot of questions there. One, you heard me talk over the past year about our M&A game board. We have last year when we did the strategic work, translated that to the targets that we wanna go after. I mean, SIA was clearly one of those examples. We are entering over the next few years a phase where later on gonna show that in terms of capital allocation, we're gonna go back to allocating more of our capital to M&A. Given that we see very synergistic opportunities either to deepen where we are today or to broaden on the care pathway. That's on the M&A approach and the types of M&As we're gonna go after.
I think there was, Vik, a second part to that question.
Yes. The second part of that question was whether you're open to adding a new platform to Integra.
Our LRP, okay, does not account or assume a third platform. It goes back to the two platforms that we have so much opportunity, synergistic opportunities that we first need to build those pillars into real strong pillars before jumping into a third one. Okay. There's no lack of ideas of what a third pillar could be. My worry would be that we have 3 halfway pillars while we have opportunity to really build the two pillars that we have with the plans that we're showing today.
Got it. Helpful. Then just my follow-up. You know, I think you've been successful in taking price over the last year. I'm just wondering what you have baked in for price over the LRP. Thank you.
In terms of price, we assume our normal 1 point or a bit higher price assumption. We definitely last year and this year are getting more than that. I assume at 1 point we go back to a normal steady rate. I think we have one here. Craig.
Craig Bijou, Bank of America. One for Bob, one for Mark. Bob, you know, you guys have invested a lot in the breast recon opportunity. You know, you made an acquisition, you've been doing a lot of work internally. Just wanted to kinda get a sense for your confidence that that is going to materialize as a significant opportunity as you think it will.
Yeah. Look, anytime you're talking about PMAs, you have a bit of a not guarded confidence, but just understanding, as you work with the government on that. I would say we are confident, very confident in both PMAs. We will be submitting in full our submission for the SurgiMend PRS, the final submission for that clinical later this year. At that point, we're on time to look at a 2024 indication for SurgiMend. Things are going quite well there. We're continuing to build up the robustness of the clinical data that we're submitting. As far as DuraSorb goes, the final patient in that program will happen at the end of this quarter.
That puts us in line for submission in late 2024 and online with our 2025, 2026 indication. That will be for both pre-pectoral and post-pectoral. Yeah, we are confident. Again, PMA, that's the part of the work that you wanna be. I'd say commercially and from a facility perspective, making great inroads to be ready for that as well. We are excited about it for sure.
Okay. On the digital side, you know, I think some of the digital technology makes sense in the monitoring space, and it's easier to see that and probably the demand from the end user. Probably a little bit more difficult to understand the clinician demand for on the wound care side. Maybe if you could just speak... I know you said you're gonna have to convince clinicians to want the technology, but maybe you could just speak a little bit more about, you know, what you need to do to drive that, you know, that demand.
Again, it goes back to that idea of a lot is focused on driving preference for our non-digital products. When we look at the tissue side of the business, as I mentioned, there's a lot of different products. There's a lot of interest in getting support on the best way to apply them.
Kind of driving preference. We have a really advanced portfolio of products on the tissue side, and doing surgeries like a flap surgery or something like that, surgeons in our research have said that they would really like additional support, and guidance when they're doing those kinds of surgeries. To me, it's, it feels a little similar to in the robotic space, where that whole support, remote support, peer support that's provided to surgeons as they learn to use, robotics for certain techniques, is the same thing that I think could apply over in wound care, that would be interesting. Again, it's an area where it's software driven, it's going to be, you know, remote support and things like that. Those kinds of, opportunities definitely exist or an unmet need.
The trick is to figure out how to wrap that into an offering that clearly drives value for our tissue products.
Let me maybe add to that, because 1 year ago, when I was still fresh in the company and was allowed to ask whatever questions when I met KOLs. I asked many of them, say, "Look, what was the next innovation we should go after? What type of collagen, synthetic, whatever." Many KOLs said, "Look, there's so many different products in the market, and because of a lacking standard of care, I mean, there's a lot of surgeons that frankly don't really know what product to use in what specific case, right?
How to diagnose whether the wound bed is really as clean as it should be." Many came back and said, "If you could find some decision support tool to bring that knowledge to the surgeons so they can make a better choice and a better preparation of the wound." It kind of confirmed a hypothesis we had that in this type of care area where there's no clear standard of care, decision support to bring better quality and also productivity has real value. That's why we're exploring that as one option of our digital, what we call companion apps.
Thank you. A question in the corner.
Thanks. Steven Lichtman, Oppenheimer. Mike, a couple questions for you. First, you mentioned CUSA opportunity in robotics.
Mm-hmm.
Can you give a little more color on what you see as that opportunity, milestones and timing? On AURORA, you mentioned the $50 million in 2027.
Yeah.
How should we think about the ramp of that? Could we see some more material numbers in 2024 as you go full there? Thanks.
Okay. Obviously, I'll take them in the order you asked. CUSA, in robotics, you know, this is I kind of stressed in my talk, CUSA is kind of a workhorse, in neuro today, and in the United States and other markets also in liver. Robotics and neuro is very early. There's not a lot of activity going on. We've got an early-stage program. It's still early. We're through feasibility, and now we're moving to the development phase. It's really taking our CUSA technology and adapting how it would be delivered through a robotic arm. That's kind of the summary of it. As I said, milestone-wise, we just kind of passed it from early stage into development.
It's really nothing that we're gonna be able to, you know, give you any kind of detail. AURORA, just a reminder that this is a rapidly developing market. There was just clinical data released at the big neuro meeting in L.A. a couple weeks ago, that was the first positive trial on, you know, ICH. Good results, but on one side of the study, if you will. That market's gonna be slow to develop. The numbers we gave you around how big we'd be in 2027, how big we think the market would be, is really that's our, that's our guess for, you know, our estimate for today. But as far as 2024, I think we're still gonna be ramping. There's gonna be more clinical study needed in this space.
I think for now you should think about that as probably slow ramp through 2024.
You have a question in the middle?
Oh, I think right here. Sorry.
Yeah. Sorry.
Hey, this is Rohan Patel on for JPMorgan. I guess this question is mainly directed at Jan, but I'm just trying to get a better sense for the organic growth guidance and specifically some of the puts and takes. How are you thinking about kind of the bridge between 2024, 2025, and 2026 through 2027? Specifically, kind of does that guide imply reaching the low-end 5% in 2024, or do you see it kind of progressing beyond that? Then also just a follow-up on emerging markets and specifically how that factors into the guidance.
I'm gonna hold that question for the second Q&A, okay? In the deck, you will see one page that I think pretty much gives you all the numbers answers and the data answers you asked for. Then we'll talk international after the break. We'll have our vendor on to talk more about, and he'll be at the Q&A, in the second Q&A.
Okay.
Yes.
Would you be able to, I guess, more specifically than product focus, just comment on kind of the drivers within Tissue Tech and CSS that are underpinning the guidance then? Just like the key areas that we should focus on moving forward.
What I'll show later on, right? Is one, okay, there's a significant part, yeah, which gets us next year, yeah, above that 5%, yeah, is about executing to the market, yeah, both the Tissue Technologies, CSS market. Then you get the acceleration international, yeah, the NPIs and so on top of that. We'll again, we'll break it out in the second half of the presentation.
Okay, great. Thanks. We'll come back to you.
I think we have one in the, in the middle.
Hi, Sam Brodovsky from the Truist Securities team. I'll just ask first on the margins, when we think about new product contributions, how much of them is factored into the margin guidance? If timelines get pushed out, whether it be AURORA or on SurgiMend, can you still hit the margin targets? I'll just ask the second question now. You were pretty open about being interested in partnerships on the Tissue Tech side. What's, what's missing there? Is that more of a distribution item, or do you think you need new products? When you're looking for a partner, is that more the interest when you're thinking about M&A and/or distribution there? Thank you.
Again, on the numbers and the margins, we'll talk in the second Q&A, and you'll see some in the presentation come there. The second question to partnerships in Tissue Tech, you've talked and that to you, Barker.
Were you specifically talking about partnerships related to private label?
You mentioned you wanted to be more out of the
Sam, could you use the mic please?
She post acute.
Okay, we can clarify the question.
Yep.
For Tissue Tech, getting out of the acute care setting and more.
Understood. Okay.
Does that need to be just a distribution partnership, or do you feel like you need new products to be-?
Look, I would say, you know, as I stated, we have a very strong leadership position in the acute side of that. As we look for opportunities that are in that higher single-digit growth, that's where the non-acute segment and setting come into place. We most definitely have the right products. Again, there's a lot of disruption, as you all know, relative to reimbursement and pending changes. As that model goes from a, what I call a financial model, to more of a value-based reimbursement platform, where providers are rewarded for wound closure and timing, we most definitely have products today that allow us for an organic opportunity into that and channel straight to expand that. There's obviously also inorganic opportunities as well.
Hi, Drew Ranieri, Morgan Stanley. Just a question on CSS for Mike. You talked about 40% of the business is U.S. today. Japan and China is going to account for about 30% of your organic growth over the LRP. Maybe just walk us through some of that plan. Is that going to just be taking existing products and registering that, or is it really gonna be some of the new products that are coming along? Just second to that, maybe I'll have to wait until the next session, but how are you kind of thinking about the international margin profile as you're further developing that as an opportunity for the company?
I suggest you take it from a product perspective, and then later on, I think when Harvinder will be up, yeah, can go more into how do we develop the market.
Okay.
I'm sorry, Long question, could you repeat the part that I'm covering now?
Yes. Essentially with Japan and China-
Mm-hmm.
driving 30% of your organic growth.
Yeah.
What are kind of the drivers for that? Is that new products registering.
Yeah. Okay.
existing products?
Obviously, Harvinder will cover a lot more in this section, but I can take this for kinda two reasons. One, global CSS question. Second, I ran the international business for a bunch of years, so can cover that as well. When you think about international for us, we talk a lot about Japan and China because of their size and scale and their growth, but it really is a mix of all the things you would expect it would be, right? It's innovation that's born through my global business. It's also business development deals done in local markets around the world. You get innovation mix from those two. Obviously, there's a price impact, there's a share impact.
Harvinder will get into a lot of detail on work he's doing, particularly in China, around tier two and tier three markets. It's just real strong commercial execution. It's kind of all of the above is what fuels that. Harvinder will get into those two countries, but specifically, it's because of their size and scale and growth rates that fuel that. A wide range answer, but it really is a mix of a lot of things that drive that growth, including, we have a large group of products that we have not launched in the international markets, that we have queued up for registration. One that would fit that bill very much is CereLink, which is out in 2025, is the mark.
There's an opportunity there, but I'm sure Harvinder will, you know, give you a walkthrough on that.
Just two product questions. On CereLink, you didn't discuss it much today so far, but how are you thinking about the opportunity? Can you give us a little bit more...
Yeah. No, happy to. We had covered this pretty extensively in earnings, as I said in my script, was welcoming questions today. How we're thinking about it is. I'll just let me reiterate what we talked about in earnings, just so we do this for clarity. We feel really good about the solution. We have root cause identified. We feel very good about the solution. During the final validation, we saw some data that led us to, we think, a solution that is very excited about, and that was the decision we made. It also is doesn't require a change to the box or the monitor, which is very attractive to us for several reasons. It also makes our regulatory pathway, particularly outside the U.S., less complex.
For all those reasons, we made that call. Timing-wise, I think you'll start to see, revenue commercialization late 3Q outside the US and select countries. The US is really dependent on FDA regulatory pathway.
We're actively into discussions with the FDA. We've met with them, shared our preliminary data. If we get, if the FDA is aligned to a special 510(k), you'll see it late 3Q. If it's converted to a traditional 510(k), it moves into 4Q. We continue to be incredibly excited about CereLink. I think if you look at the recall, the vast majority of customers had really good experiences. We feel really strongly that this is a product that the market needs and the market wants, and our customers have stayed with us. Very strong outlook.
Matt Mc? Matt O'Brien, Piper Sandler. Question for Bob. Can you talk a little bit about SurgiMend and the expectations for that product? You'll be the only one with an actual indication for breast recon, you know, fingers crossed with FDA. You know, how are you gonna take that product, dislodge so many entrenched competitors? How quickly can you do that? How are you gonna price the product, given again that you're gonna be the only one with the PMA clearance for it? Are you gonna price at a premium? Are you gonna price at parity? How do we think about that?
Yeah, no, it's sounds like an operating review. no, listen, I would say first off, fingers definitely not crossed here, right? We're working weekly and frequently with the FDA on both these PMAs. just to make sure that I'm very clear about that. the other thing I just need to reinforce, in the U.S., no company, no vendor has an indication for safety and efficacy for implant-based breast reconstruction, including us. we focus very much around not the indication, but the product itself, as we promote our products. we are enjoying very nice double-digit growth above market in both products, but I just have to make sure that I say that correctly.
As we set ourselves up and do a lot of the work, right now, the market itself in the U.S. is predominantly with a strong dominant leader in the human allograft aspect of that. What we're looking to do is around the disruption with both xenograft SurgiMend and a resorbable synthetic DuraSorb, they have made great strides over the last couple of years, which really drove us to make that acquisition of CSF. Really, as you think about it in five years, it's a portfolio that talks about, you know, xenografts, a bovine ADM, and a resorbable synthetic for a global presence there.
9As we get closer to that, what that first mover allows us to do, of which we think we'll have anywhere from a two-five-year lead here, based on what we can tell today, it allows us to get in there and meet with surgeons and actually promote the product. It actually allows us to teach them procedures for subpec and also with DuraSorb for sub and prepec. It really allows you to get in there and develop those relationships with the surgeons at the procedure level and at the account level, where we can help them build up in the OR, promoting breast reconstruction.
From a cost perspective, I would say today, if you had, you know, human allograft here, you know, xenograft, our price positioned appropriately, and then with a resorbable synthetic less than that's how we're looking to position it and that portfolio play that we'll be promoting, contractually once we get the approvals.
Got it. That makes a lot of sense. Question for Jan. You talked a little bit about M&A, you know, it's been, you know, throughout this entire presentation on the M&A side of things. Can you just maybe level set us as far as what you're looking for, you know, revenue size, you know, size of deal? Are you looking for smaller tuck-ins? You know, what kind of return timing are you looking for? Things like that, just so we have a better sense from an acquisition perspective. Thanks.
Yes, we're looking for tuck-ins. Yes, we're looking for larger, more strategic deals. If you look at the tuck-ins that we typically are $50 million or less, type volume deals, we are looking at other larger deals which come at $200 million-$300 million revenue points. Both are important, both in Tissue Tech and CSS, right? If you look at our M&A game board, you will find that mix, and I will never show the game board, of course, but you can find that mix of deals there. I show later on some of our filters, return on invested capital, 10% or more, within 5 years or less. That remains an important financial filter.
Yeah, we are careful with, yeah, deals that are, yeah, too long, dilutive, yeah, to EPS. That's. I mean, Mark touched some of those. That's kind of, yeah, the financial filters we apply on top of our game board.
Those are the questions we have now. We'll, we'll pause now. We have a break scheduled, for right now before we start our next session with Harvinder on international. We'll resume at 10:20.
Okay.
We'll have a few minutes, and then, we'll get everybody to back together at 10:20 to kick back off. Thank you.
Perfect. Thank you.
Once again, good morning, attendees. Please go ahead and take your seats. Our program will resume in about two minutes. Once again, please welcome Chris Ward.
Thank you. If everyone could come and take a seat, we're gonna get started with the second half of our program. We have a couple more presentations from our leaders from international operations, and Jan will conclude with a wrap-up of our financial overview and long-term outlook. I would like to introduce, for our next session, Harbinder Singh, our Corporate Vice President and President of our International Business. Harbinder, the floor is yours.
Thank you, Chris. Good morning, thank you for joining us after the break. My name is Harvinder Singh, I guess you heard the name probably 17x since morning. I'm the Executive Vice President and President for Integra's International Business. I am based out of Singapore, I have responsibility for the business outside of the U.S. I joined Integra about six months back in October of 2022, but I've been around the block. I've been in the healthcare and med tech space for over three decades. I have lived and worked in the U.S., in China, in Japan, in India, Hong Kong, Singapore. Before joining Integra, I was part of Abbott Labs for more than 20 years, where I held several leadership roles in the vascular business.
Before joining Abbott, I was part of Guidant Corporation and Eli Lilly in sales, marketing, strategy, and general management roles. During my career, I've been involved in successful launches of new products, market development for new therapies, integrating newly acquired companies. Business turnarounds. To quote some examples, I led the launch of a new drug-eluting stent in Japan and attained market leadership position in that market. As a result, that business grew over 3x and I've been involved in turning around businesses in China, in India, and the United States. Today, I will share with you why I'm so excited about Integra's international business and talk about the tremendous opportunities that are ahead of us. I'll provide you with an overview of where we are in the international business, where we are headed, and the strategy to get there.
Six months in, I see a great opportunity to transform this business by building on a solid foundation that already exists. To begin with, let me share with you the key messages that you're going to hear today. In this role, I look at my goal as to work with our international teams and transform this business into a key growth vector for Integra. Today, international business contributes about 28% to Integra's global revenues. The plans you're going to hear today will help us advance that contribution to well north of 30%. We will do this while improving our margin profile. As you heard from Jan, Mike, and Bob earlier, Integra is a recognized leader in multiple proprietary technology platforms.
I see manifold opportunities to leverage this differentiated portfolio beyond what we've done so far and drive the penetration of these technologies and bring these products to more patients and more markets around the globe. With the help of our international leadership team, we've carefully crafted a clear set of priorities that we are now working on to drive accelerated growth and capture market share across international, but with a specific focus on key emerging markets such as China. I will talk more about these priorities in a little bit, but before I do that, let me start by sharing with you our position in the international markets. Integra has a global footprint with direct presence in multiple markets across Europe, Asia Pacific, and in Canada. This map on the right indicates Integra's presence in countries shaded in green.
Countries shaded in blue are served by over 200 Integra distributor partners. Together with our distributors, we cover over 120 countries and generate more than $400 million in revenue. While we've done well in international markets, we just get 28% of our revenue from these markets. Thus, we are significantly under-indexed in these markets. If you compare that with the med tech industry in general, you will see that international markets can contribute as high as 50% to global revenues. We do not see any reason why Integra cannot achieve that with a much higher contribution, cannot achieve a much higher contribution with an empowered team, a strong strategy, and the strength, the depth, and the breadth of our portfolio.
We are targeting greater than 30% contribution from our international business by 2027 and aspiring for 35%-40% in longer term. Let's take a look at the markets where we play. Currently, the total accessible market in international is about $1.5 billion. Europe represents about half of it. Asia Pacific and China are the other significant contributors. The critical difference that you see between these markets is the growth rates. China and Asia Pacific are growing faster, and as you can see, Integra is growing faster in these markets and is taking share. The critical question that we've asked ourselves is, how do we continue to win in these markets in the post-COVID world as the case numbers, as the procedure numbers come back to normal?
The answers lie in finding more ways to accelerate this growth that we've experienced even further. In previous presentations, you've seen that we win in markets where we play. Our game plan to win in international is built around three key themes. First, productize the fundamentals. It is all about enhancing capabilities and building internal expertise that helps us capitalize on key growth opportunities associated with new product launches, geographic expansion, and leveraging the portfolio. These capabilities include local knowledge, better understanding of the markets, talent, and the customers to enable us compete successfully. Next, we see opportunities in driving commercial execution to expand our footprint and grow above market to capture category leadership. As they say, all ideas and strategies are a commodity till you execute them successfully. Execution is going to be our singular focus.
The third one is about leveraging our comprehensive portfolio to accelerate organic growth. We plan on bringing our market-leading products to more customers and more markets around the globe. Let me walk you through these key themes in more detail now. As I mentioned, Integra wins in markets where we have the local leadership, talent, and expertise. Markets such as Japan, Italy, and Canada are some great examples in that direction. We are looking at replicating those capabilities across different markets and develop deeper local regulatory reimbursement and market access capabilities. These capabilities will elevate our ability to anticipate emerging market, competitive, and policy trends. Earlier, you heard Mike and Bob talk about how surgeons play a vital role in purchase decisions in our business. We believe that winning in international business also starts with a strong customer focus.
This means engaging with our customers and understanding and fulfilling their needs better than anyone else does. In Europe, Integra is a market leader in partnering with customers through industry-standard professional education programs. We are building those capabilities in other markets to enable us to work with our customers in advancing therapy adoption for highly under-penetrated disease states, such as INPH. The next theme is in driving commercial execution to register double-digit growth in key emerging markets. When we compare ourselves to the market, we see many growth opportunities by expanding our geographic footprint, particularly in markets such as India, Southeast Asia, Middle East, and in Latin America. In addition, in China, we are over-indexed to Tier 1 cities. Thus, expansion into T ier 2, 3, and 4 cities represents a unique opportunity for Integra to redefine our presence in China.
This picture on the right is from March this year when we opened our new office in Shanghai. This celebrates our continuous success in that market. We are highly optimistic about our growth prospects in China and other emerging markets. From a cultural standpoint, we will infuse sense of agility, accountability, and a growth mindset in our international teams. This is to ensure that all our teams are pulling in the same direction and driving towards our growth aspirations. We will do this while supporting our team's development and delivering on our employer value proposition. We are proud to share that Integra China has been awarded the great place to work in 2022. Globally, just 15 markets offer a compelling opportunity as they contribute to greater than 80% of the international markets.
We will focus on these markets with a renewed sense of urgency and priority. You heard earlier today that Integra is a global leader with highly differentiated product portfolio. We have a number one or number two position in many neurosurgery and tissue reconstruction markets. Building on this comprehensive portfolio is a unique opportunity to accelerate international revenue growth. In the EU, our focus is on delivering on the MDR approach for continuous market access. In Japan, our goal is to build on our already strong position and continue growing above market and drive category leadership. In China, our goal is expanding coverage and bringing our highly differentiated portfolio to more patients and more physicians across the country and ensure continued access through changing policy environment in the country.
Another way to drive international growth, is to leverage innovation and introduce our new products and technologies over the next five years to as many international markets as possible. In this slide, you see a strong cadence of new product introductions that equip us, and our commercial teams to seize that opportunity. Finally, we are utilizing the M&A game boards that Jan talked about to identify inorganic opportunities, for international markets and drive business development in both the neurosurgical as well as the tissue tech areas. Talking about China is one of our key strategic product is shared across the organization, and that is because you would agree with me that, China is the largest, med tech opportunity outside the U.S. and continues to grow double digit. Integra has done well in China and has grown double digit.
Our history in China highlights that once you have a product that performs clinically, revenue growth in China can be rapid. This chart on the right demonstrates exactly that. We established direct presence in China in 2014, and drove performance through DuraGen and CUSA, and more than doubled our business in the next three, four years. Post the Codman acquisition, we continued footprint and portfolio expansion in China and continued our double-digit growth trends. Our team in China has shown the ambidexterity required to win in that market. In next few years, we are bringing multiple new technologies such as DuraGen Plus, Certas Plus, CereLink to the market, and that augurs well for our aspirations in the China market. Having said that, despite all this success, Integra is still under-indexed in the Chinese market.
Less than 5% of our total revenue comes from China. If you compare that with the industry, if you compare that with medtech in general, you will see that China revenue contribution can be as high as 10% or more. To help us move in that direction, in 2023, we will add 200 more new accounts in lower-tier cities in China. When I look at the next five years, there are 1,000 more accounts in China in Tier 2, 3, and 4 cities that we can add by 2027. In addition, we have the opportunity to drive portfolio penetration in accounts where we already have Integra presence, but with only one or two products. We are looking at launching CereLink Monitor in China by 2025.
This is an attractive opportunity to build on the position that we already have in that market with ICP Express and gain further market share. While China is an exciting opportunity, there is environment of policy change under the Made in China initiative. More and more hospitals are moving towards buying locally manufactured products. We are cognizant of this change and are preparing ourselves by building our local manufacturing capability for some of our key products. This will enable us better alignment with the local policy and help us with accelerated approvals for these locally manufactured products and with continued market access. Finally, to summarize, this is my favorite slide, as it embodies my personal optimism and enthusiasm about our international business.
It sums up the magnitude of all the opportunities that are ahead of us in the international business and clearly states, our priorities and actions to realize those opportunities. Today, we are poised to accelerate the expansion of our international business. I can share with you that all my colleagues at Integra are deeply engaged and fully committed to our priorities. Let me reiterate. In international business, we will grow revenue contribution to be above 30% in the next five years. We will do this by addressing the fundamentals and the foundational priorities, such as building local execution capabilities and leveraging our portfolio. We will also strengthen our presence in China and establish a culture of high performance. I'm sure all of this will yield in positive results and will help us move our international business forward.
Thank you very much. With that, I'm pleased to introduce Steve Leonard.
Thanks, Harvinder. Good morning. It's great to be here with all of you today. I've been leading our global operations and supply chain since 2020. Before joining Integra, I spent 10 years in the pharma services sector in similar roles with two different companies. Both were large, global, complex supply chains with an acquisitive track record where I led operational transformations, improving customer service, and creating a culture of continuous improvement and productivity. Before that, I spent just over 20 years at GE, most of it in their healthcare segment, in multiple operational leadership roles. When I started with Integra, we dedicated extensive resources to reinforce our core operational competencies of global scale and deep technical expertise and strengthened our foundation by adding structure, processes, and focused investments. In my relatively short tenure here, we've experienced multiple industry headwinds stemming from the COVID pandemic.
While working through the various challenges, we've taken this opportunity to learn, adapt, and position ourselves for success. We accelerated our continuous improvement actions and operationalized broad countermeasures in our factories and upstream in our supply base. We invested in strengthening our foundation of safety, quality, and compliance. Emerging from the pandemic, our supply chain is more resilient and better prepared to deliver to clinicians, healthcare systems, and patients in this rapidly changing environment. Under my leadership, we now have a clear game plan to deliver the growth and margin expansion. Our primary objectives across the supply chain are clear and simple. Reliably supply safe and effective products to clinicians and patients with a cost position that allows for continued margin expansion. We are here to support the growth you heard Bob, Mike, and Harvinder talk about. Today, I will provide an overview of Integra's global operation strategy.
Includes three key points. One, adapting our global network and capacity to support our broad technology portfolio. 2, create a scalable, resilient supply chain to deliver on our strategic growth objectives. Three, focus on productivity and cost management to support margin expansion. I'll spend the next several minutes walking through these priorities in further detail and articulating why we are confident that we can deliver on our growth plans. This slide provides a snapshot of our global operations footprint. Our network supports our broad technology portfolio throughout the patient journey to reach healthcare systems and patients with our products when and where they need them. After multiple consolidations and divestitures over the past several years, we now have a network configuration that is better focused and supports the breadth of our technology. We streamlined our manufacturing sites to focus on our market-leading products and best serve the business.
Most recently, we divested our traditional wound care products and manufacturing facilities, and our Biot France site has been closed, discontinuing products that no longer meet customer demand and transferring the production of profitable products to other sites. We've established centers of excellence in various locations globally. Building on Harvinder's commentary, we're adding manufacturing capability in China to improve local market access and our cost position. Our key manufacturing sites each focus on one or more of our core technologies. These range from converting bovine tendon into pure collagen in Plainsboro, New Jersey, precision machining of titanium in Cincinnati, Ohio, electromechanical assembly in Tullamore, Ireland, to fine Swiss watch-like assembly of our hydrocephalus shunts in Le Locle, Switzerland.
Beyond commercial production, we're excited about our new regenerative research and development lab located in Plainsboro, New Jersey, next to our Collagen Manufacturing Center and just down the street from our corporate headquarters. The lab boasts 14,000 sq ft of space dedicated to new product development and evidence generation activities. Combined, these sites offer the deep technical expertise to manufacture products addressing the unique needs of clinicians and provide the platform and know-how to launch new products. Our repair and return centers have been centralized with a single point in Europe and another in the U.S. to offer faster service at a lower cost. Through our partnership with world-class third-party logistics providers, we can provide high service levels with next-day delivery to our key markets and have the scalability to integrate future acquisitions easily and quickly.
In summary, we now have a network configuration that is better focused, more efficient, has deep domain expertise, supports the breadth of our technologies, enables customer service, and provides scalability. Now I'll lay out the framework for supporting the company's objectives. First, we will build upon and further invest in our competitive advantages. We are a global leader with unparalleled advanced technologies. We have the manufacturing expertise, geographic footprint, and specialized workforce to support it. Our robust sourcing and risk management resources, sophisticated technology centers of excellence, and scalable distribution network positions us to provide excellent customer service. Our global scale and efficient network differentiates us and primes us for growth acceleration. Our actions as we continue to enable growth are aligned to these critical priorities. Number one, invest in long-term supply resilience. Number two, elevate the speed and quality of execution. Three, expand margins.
Our global scale, industry-leading manufacturing technology platforms, all sitting atop common scalable platforms, gives us the ability to strengthen customer service and to generate productivity. I'm excited to share with you the ongoing actions to improve the resilience of our supply chain, as it's such an essential element of our growth story. As demographics, comorbidities, advancements in diagnostic imaging, and our focus on accelerating international growth increases the need for our products, we are making significant investments in infrastructure for both reliability and capacity. We will ensure our capabilities to supply meets these increased levels of demand. As I mentioned earlier, it's been a challenging time in our industry, and COVID has exposed where we had some gaps in resiliency. We are facing these challenges head-on and have taken accountability to address them.
Supply interruptions, whether from our suppliers or driven by internal matters, have increased our sense of urgency and level of commitment to implement lasting corrective and preventive actions. A different level of leadership, acting with increased intensity and velocity, has been required. We have redefined what good looks like and put the foundation of people, process, and systems in place to get there. We are standardizing our key processes, further driving the scalability of our network. We are investing in our infrastructure to enable reliable supply and address the ongoing challenges as the world emerges from the pandemic. By the end of this year, the final site in our network will be migrated to our single global ERP. Rapid access to information speeds decision-making and action. We have adopted a single common global quality management system and digitized many of its components.
The ease of tracking and trending key metrics at our sites and in our post-market surveillance all fuels our continuous improvement processes. We are also improving the robustness of our quality and regulatory systems, assuring compliance. Our processes around regulatory, internal quality auditing and supplier quality have been similarly strengthened with centralized common processes, streamlined information flows, and accountability to assure compliance drive improvement. Last year and this year, we made significant investments in quality across all of our manufacturing sites with a focus on accelerating our quality project in Boston, involving testing, infrastructure, and physical layout changes. We are on a path to reach world-class quality assurance across all manufacturing sites by the summer. This further enables reliable supply and availability of our PMA products. Lastly, we are optimizing key tools and systems to simplify the complex.
Our investments in supply reliability go beyond digitizing data and improving decision support information. We have a structured process to continuously evaluate our key manufacturing assets and strengthen their resilience through either replacement or enhanced preventive and predictive maintenance processes. As shown here, roughly 40% of capital is allocated to improving reliability and resilience. The balance is allocated for increasing capacity and creating new capabilities to support the long-range growth plans of the business. To highlight a few impactful projects, a new clean room in Le Locle, Switzerland will double our bacitracin capacity by year-end. The relocation of our Boston facility to a new PMA-ready site in near by Braintree will more than double our capacity for SurgiMend and PriMatrix in 2025. The final validation of our collagen expansion in Plainsboro, New Jersey, will increase DuraGen capacity by 75% by mid-next year.
This structure will allow us to continue to meet long-term demand forecasts and build adequate safety stock, assuring supply reliability. In addition, they provide a strong backbone supporting organic and inorganic growth. You know, investing in the systems and equipment gives us the hardware we need to be successful, but the software that makes all this come together is our people. One of our key priorities is to elevate our talent and capabilities to improve resilience in this uncertain macro environment. In a competitive labor market, the opportunities to learn, grow, develop, and contribute at Integra are compelling, and I'm excited about our efforts to continue to build the leaders of today and tomorrow and be an employer of choice in the med tech sector. We are elevating leadership and skill sets, emphasizing Lean, continuous improvement, customer excellence, and reliability to manage our complex and challenging environment.
We've updated our organizational design and redefined what good looks like as we invest in capability building and bringing the best talent to Integra. In our manufacturing sites, we are investing in key talent with a focus on leadership that drives and accelerates change. These expanded capabilities support local execution, growth, and retention. We are simplifying metrics with a robust operating cadence that drives rapid escalations. We have multiple operating mechanisms to drive improvements in all aspects of safety, quality, delivery, and cost. This goes beyond the shop floor and applies to our transactional processes in the supply chain, procurement, quality, and regulatory. All of this focused on driving accountability and rigor, extending deep into the DNA of our culture. We're tackling key issues with agile problem-solving techniques.
Collaboration across our network both speeds improvement and creates opportunities for our colleagues to broaden their responsibility and impact on the company. To share a couple of examples, the engineers at our sites with machining capabilities collaborate on equipment maintenance and programming techniques. We frequently have a safety leader from one site take a role as an auditor in another site. As a result, best practices not only get shared, but they get quickly adopted and put into action. We have been pleased to be recognized as a top employer and best place to work in New Jersey, and we aspire to be that everywhere that we operate. With a focus on speed, simplicity, Lean principles, and empowering our people, I'm confident in our ability to win and grow as the external environment evolves. Most businesses have seen input cost increases over the past two years.
You know, inflation in raw materials, energy costs, transportation, outside services, and labor have persisted over the past several quarters. A key priority in operations is to find creative ways to mitigate these trends and find offsets that allow us to continue to drive margin expansion. Our investments in Lean, Six Sigma, and process improvements are beginning to pay real dividends in operational improvements, customer excellence, and conversion cost productivity as key margin drivers. We have created a culture of continuous improvement that's led by me personally from the top and supported by a newly rebuilt central continuous improvement team. We've established effective cost management practices, including materials management, debottlenecking, yield improvement, waste elimination, supplier risk management, just to name a few. In our procurement organization, we are aggressively developing additional sources for key materials, negotiating contracts, and selectively taking advantage of the spot market.
Our raw material stocking strategies are continually refreshed while we build more agility and planning into our scheduling process. In our factories, we are focused on minimizing any unplanned downtime, cross-training our workforce, and accelerating our ability to implement countermeasures in real time. As you can see here, our Tissue Technologies operations have created capacity and reduced costs through an intensive focus on yield improvements. Improvements of between 10 and 15 points across multiple of our key franchises allow us to meet growing demand and deliver productivity through better labor and equipment utilization. We are focusing on excellence in quality and compliance as a key element of our competitive advantage. As mentioned earlier, achieving world-class quality assurance in all manufacturing sites further enables reliable supply and the availability of our PMA products. Finally, continued investments in our foundation of quality go beyond just assuring compliance.
Being audit ready every day and using the feedback from external and internal audits as an input to our continuous improvement process delivers real productivity and allows our key talent to focus on improving how we deliver safe and effective products to our customers on time, every time. I'm excited about these improvements and optimistic about how much more we can accomplish. Every manufacturing site and production line has a productivity target to deliver, and I'm confident that we can meet these goals. The key takeaway from this slide is that we are creating a culture and a mindset of continuous improvement across the company. To wrap up, I'll go back to where I started. Our primary objectives across the supply chain are clear and simple. Reliably supply safe and effective products to clinicians and patients with a cost position that allows for continued margin expansion.
We are positioned to meet the long-term growing demand for our products that you heard Mike, Bob, and Harvinder talk about. We're very optimistic about strengthening our competitive advantage through the strategy and target investments that we continue to make. We have key metrics and operational rigor around everything we do. To highlight a few key milestones that we plan to achieve here. One, we will increase capacity by 30% over the next three years through targeted investments, through new plant, equipment, and talent. We're aligning our capacity creation investments to the long-range plans of the business, and it's a continuous process. With a focus on resilience in our factories and upstream throughout our supply chain, we are committed to achieving and sustaining 98% service levels for the clinicians and patients that depend on our products.
A broad average across the medical device industry benchmarks on-time delivery at around 90%, and surpassing this mark will create a real competitive advantage for us. By improving process yields, focusing on speed, simplification, and waste reduction, we will deliver 5% productivity annually across our manufacturing network. Strengthening the culture of continuous improvement and accelerating change enables us to deliver on this objective. The foundation of standardized simple systems and metrics, combined with greater financial and operational accountability and a real sense of purpose, will continue to fuel our progress. The roughly 2,000 colleagues working in operations and quality across Integra are excited about our future and prepared to support the growth and profitability objectives of the business. Thanks for your time today. I'll now pass it back to Jan to cover our long-term financial outlook and closing remarks.
Thank you, Steve. During this final part of our prepared remarks, I'm gonna sum up the messages and information we provided to you today and share our excitement and plans over the long-term prospects of Integra. I'll provide you with an overall P&L picture that shows you how executing on market growth drivers, delivering on the catalyst translate to a growth rhythm of this 5% to 7% organically. I'll also show you how volume growth mix and working a broad set of efficiency levers translate to significant adjusted gross margin improvements, and how our strong balance sheet and further growth in free cash flow enables us to enhance our organic growth profile with further profitability and growth acceleration through M&A.
I shared this slide in my opening, briefly looking back over the past years where we effectively had navigated our P&L during the pandemic while investing in our strategic drivers. With organic growth of around 4% and responsible management of our costs to offset margin pressures, we delivered sound profitable growth, though not to the level of progress that we had projected in 2021. During the COVID pandemic, as procedures slowed down and got canceled, we did not see the full potential of our business, in some cases, supply challenges kept us from fully capturing the market growth that was there. While we managed OpEx responsibly over this period, it became too much of a lever to drive EBITDA accretion, as we did not have sufficient operational efficiency and pricing dynamics to offset inflation and drive further margin accretion.
As I indicated before, despite the timelines being off, the long-range targets we communicated during our May 2021 Investor Day still are the right targets. Just let's go deeper into how and when we will get there. Let's start by looking at our revenue and organic growth performance in the next coming years and walk to where we see growth in 2027. In 2022, we ended up with growth at approximately 4.2% in a market that was not at entitlement yet, and with still opportunity to improve our own execution to achieve full market potential. Looking forward, we do see our markets back at entitlement growth, as Mike, Bob, and Harvinder described earlier.
A strong position in our markets, reinforced by stepped-up focus on supply chain execution and further building out commercial coverage and effectiveness, will allow us to take that market growth and potentially more with share gains. The dynamic of growth with our current portfolio in itself translate into around 100 basis points as a midpoint of growth acceleration over the LRP horizon. This gets us above the 5% growth threshold, which is in line with the weighted average growth of the markets where our segments are playing. To this acceleration then, we will add new products that will launch and grow over LRP. Mike and Bob talked about some of these main catalysts. We also add in the international growth potential, which may be offset by some additional portfolio rationalization resulting from EU MDR.
These will bring us into the 5%-6% range as of next year and into the 6%-7% organic growth range in the out years of our LRP. Looking now at our gross margin. Over the past year, driven by our focus on execution excellence and the need for productivity to counter higher inflation, we have initiated improvement initiatives on a broad set of margin levers. The main one being in our manufacturing operations with a focus on conversion cost productivity, yields, and structural optimizations. This will be a key driver over the next few years to increasing our gross margins. The second important driver of gross margin accretion will come from favorable product mix through NPIs and our higher-margin Tissue Technologies business growing faster than our Codman business. We also expect to further achieve margin leverage through volume and continued focus on net price capture.
We do expect some pressure from margin dilution related to accelerated international growth, where we operate at somewhat lower gross margins. These factors will walk our gross margin towards the 70% level by 2025, and further into the 70%-72% range by 2027. Looking now at cash flow. Currently, our strong profitability is not fully translated yet into free cash flow, with a conversion below 80%. This is driven mainly by investments in EU MDR remediation and catching up on manufacturing infrastructure investments and footprint optimizations. As we move past these important investments and changes in external regulations, we will see the revenue growth and margin accretion translate to stronger cash generation. We're committed to achieving free cash flow conversion at or above 90% during our LRP horizon.
This solid and further improving free cash flow performance adds to the strong balance sheet that we enjoy today. With currently total liquidity above $1.6 billion and leverage at 2.5 times the low end of our target leverage ratio and no debt maturities until 2025, we have significant capacity to reinvest in our organic growth opportunities, but even more in M&A. We have historically run a tight and rigorous ship in how we manage our financing and how we allocate capital. Where we allocated capital has shifted over time in function of the economic environment and business climate.
If you look at the two bars on the page, you'll see the clear difference between the couple of years before COVID hit, with significant strategic M&A activity, and during the COVID period, with lower M&A activity and a relatively more conservative posture with debt reduction and share repurchases. Going forward, we project to be back in a more active period with stepped-up focus on M&A as we explore strategic acquisition and tokens in alignment with our strategic and M&A game board. Mike and Bob gave you an idea of the areas we are exploring for our M&A game board. In general, we aim for targets that broaden and deepen our position along the care pathway, and of course, preferably in higher growth and higher margin segments.
Within these targets, we will pursue opportunities that are both more growth-oriented, as well as opportunities with strong accretive profit profiles and cash generation. We're also looking at targets to build out our international portfolio and channels to accelerate our international ambitions. We believe there are targets that are accretive to growth and/or earnings and meet our minimum hurdle rate of 10% ROIC by year five or sooner, and that is what our M&A game board is made up with and targeting. The recent examples of two acquisitions I believe are representative of the type of deals we are aiming for and the strategic approach we are taking. In terms of size, we'll also have larger targets on the game board.
We acquired ACell, a company specialized in porcine collagen technology in early 2021, later Sia, which sells and manufactures DuraSorb, a resorbable mesh in December 22. Both of these acquisitions met our criteria and are currently on the path to delivering to our targets. ACell has deepened our portfolio and opened up new procedure and international opportunities. While ACell went through a tougher transition than planned in its commercial organization, it is now well on the path to steadily catch up to its deal plan. The Sia acquisition, which sells a resorbable synthetic mesh, is a good example of a deal that resulted from our M&A game board in the first half of last year. It got on the game board as a result of our strategic work and ambition in the breast reconstruction segment.
DuraSorb strengthens our future value proposition in the high-growth breast reconstruction segment, brings a new technology platform to Integra, Its integration is off to a great start. This page summarizes on the right-hand side the key strategic vectors around organic growth, profitability, and cash flow and inorganic growth, Reaffirms our long-term targets on the left side of the page. Entering the low end of the 5+% organic growth range with double-digit EPS growth in 2024, Further working our operational efficiency and EU MDR remediation to achieve gross margins of 70% with cash conversion at 90% by 2025.
In closing, when I gave my opening remarks this morning, I mentioned that what struck me the most during my first months at Integra, as I got to know our people, values, and culture, was this sense of purpose across the organization. As I got to know the business and our markets better, as we worked to define and refine the strategic direction for Integra, the second aha moment for me was opportunity, which is what attracted me to Integra in the first place. Integra has tremendous opportunity. Opportunity to leverage our strong position in soft tissue regeneration and neuro. Opportunity to broaden and deepen this position even further within and beyond the care pathways and care areas where we play, and opportunity to fulfill our purpose of restoring people's lives.
We will realize these opportunities and achieve value creation for our shareholders and stakeholders by capitalizing on our strong commercial presence in large, attractive markets with stable growth, through the pursuit of operational and commercial excellence to support stronger market capture and margin expansion. We'll broaden and deepen our reach and care pathways through transformative NPIs, digital and international expansion, and in parallel, leverage our strong balance sheet for strategic M&A and care pathway adjacencies and higher growth segments. These will be guided by focused strategy to achieve profitable growth acceleration. These are opportunities that are driven by a clear purpose of restoring patients' life. Okay. We believe this is work that matters to our colleagues, our customers, and our communities, and will deliver compelling shareholder value. With that, I wanna thank you for your time, and we're now gonna open up for our second Q&A.
I'm gonna hand it back to Chris, who organizes for that.
Thank you, Jan. For our final Q&A, again, please wait for microphones in the room. We'll also take questions from our webcast. For this round of Q&A, I'd also like to introduce Mathieu Aussermeier, our Vice President of Finance, Corporate FP&A, Treasurer, and Investor Relations. He'll be joining us on stage in addition to our previous presenters. Now I would like to invite our other presenters on stage as well for this round of Q&A.
All right. There you go, Bob. Close.
Sorry.
I had there, Chris.
We'll start with in the back.
It's a full lineup up there. Thanks for all the time today. Jan, just real quick, just clarification. That 5-7 is not including any acquisitions, just what you have today, right?
Yeah. That is not including any acquisition.
Okay. As I look at the 2026 and 2027 out year growth numbers, you know, to get there, I think you need Tissue Tech, which will still be about a third of revenue to be growing low double digits at that point, and Codman's probably more like mid-single digits. You know, can you just give us a sense specifically of the products that get you to that level of growth, the investments that you need to get to that level of growth within Tissue Tech? Then I do have one more follow-up.
Let's maybe, right, hand it back to Bob and Mike, right? In terms of their portfolio translating these growth drivers. I mean, they touched some of these products, but I think you'll get the right details from them. Let's maybe start with you, Mike.
Yeah, sure. I think the question was a little more heavy focused on tissue, so I'll be a little bit more brief on CSS. you know, many of the drivers are what I covered today and what Harald covered today. Internationally, we've got a lot of portfolio that's still flowing into the international markets. We've got a lot of growth opportunities there from commercial execution. I covered a lot of the drivers in my presentation today, right? We've got very good ramp on CUSA, we've got two newer technologies that we really think, you know, have great capability to transform the market and drive growth for us in AURORA, and in our combo catheters.
I think those are the big vehicles on our end on top of just, you know, continued commercial execution that we do very well today.
Well, I'd say on our end, you know, again, the growth drivers that I referenced today to be within that, you know, high single-digit guidance are our Integra Dermal Matrices. Some of the ACell portfolio MicroMatrix, in particular, is growing toward that higher end. Obviously with, you know, today with both, SurgiMend PRS as well as DuraSorb, they're growing above their segment growth greater than 12%. With PMAs, that will accelerate that growth beyond the current growth rates today. They're the primary growth drivers.
Okay. Got it.
Maybe one thing to add, right? If you go back to that walk, which is in the document. There's a first significant block which is a mix of two things. One, getting our markets back to the growth where they have not been over the COVID period, and us capturing that growth, okay. We have not, over the past years, fully captured the market potential, okay, in part with supply challenges, I mean, with CereLink, for sure, we have not captured the potential over the years. There's an important element, basic good execution on the market opportunity that we have, and then enhanced with several of the focused NPIs that we're bringing to markets, and growing above average, well above average over the next couple of years.
Got it. Then the follow-up question's for Steve. Just as I look at the gross margin expansion you're expecting, seems like about 300 of the 400 basis points, you know, through the projection period's coming from footprint and manufacturing efficiencies. Can you talk about, you know, some of the levers there that you're expecting? I don't know if there's extra cost you've been eating here the last couple years you can point to, but a lot of it's coming from that component of the business. Just, you know, our comfort level in getting that level of expansion. Thanks.
A lot of them are the key things that I referred to in the presentation. A big lever for us is the focus on yield improvements across the tissue business. We were fortunate to enjoy really good margins in that business. The, you know, there's more juice to get out of there. We've been living with yields that I think are, you know, are not as good as they could be. You know, I mentioned in the presentation, we've redefined what good looks like, and having good margins isn't good enough. Driving those yields up is a big lever for us in the tissue business. Just a lot of basic blocking and tackling on the Lean front that we're in the early phases of at the sites, and there's opportunities there really across the network.
It's, it's definitely what Steve describes. It's, it's a new muscle that we're exercising, right? The, the notion of every year deliver yield improvement and conversion cost productivity is something that we really put in place last year, okay. It took us 9 months to kind of put all the mechanisms in place, but also to put the leadership, yeah, in place in our factories that know how to drive that continuous improvement, okay. It's, it's an untapped opportunity that we're mining over LRP.
Okay. The next question come, Vik, right?
Vik Chopra, Wells Fargo. Just to follow up on the gross margin question. I think you said about 100 basis points of expansion this year. Should we think a similar cadence over the next couple of years to get to that 70% range by 2025? I had a follow-up.
Ajay, you wanna go a bit deeper there?
Yeah. Again, I mean, the fundamentals of the 100 basis points that we're gonna deliver this year is kind of a mixture of getting rid of some of the one-time inefficiencies that we had, the growth, the mix that we can deliver this year, the price component. I think all those factors that we're working on right now are gonna continue into the outer years. As to what to expect into 2024, 2025, 2026, I think the cadence is gonna be right around there. I would say it's probably, you know, if you were to put a range, I would start slightly below to slightly above, but it's really gonna be based on the various factors that we started to develop right now that Jan also showed on his slides, and many of them are on the way.
That's helpful. A question for Harvinder. How are you guys thinking about margin dilution as you expand your international footprint? Is the plan to go direct in key markets, or is it more of a hybrid model? Thank you.
Yeah. Thanks. Thanks, Vik. That is the obvious tension as you grow international contribution 28% upwards, and U.S. being higher reimbursement rates. There's a natural pressure. We are looking at various initiatives, how to minimize that impact while we continue to focus on the growth. We've taken targets for ourselves in terms of price capture. That's already starting to happen this year, starting Q1.
We are also looking at which products to bring to the portfolio, so managing the portfolio mix, and making sure that the teams are incented on matrices that are important to minimize that dilution, whether that's portfolio mix or that's inventory management of obsolescence and how we manage our contracts in terms of return policy, et cetera. There are multiple ways we are managing that.
Yeah, Vik, it also the question on direct, indirect.
Right. Direct, indirect, about 70% of our business, is direct, is markets, where we have presence, and 30% is pure indirect. 30% is where we have distributors, but we leverage their capabilities, their relationships.
We think we're not in a hurry to change that, but wherever the opportunities come up, we are looking at those opportunities. Like examples that we are working on is Korea and Taiwan, which we are currently prioritizing.
Maybe to clarify that further, Victor, I think today we are direct where we need to be direct. I mean, those big markets where we build that, and we're indirect where we need that leverage of distributor scale to have an efficient position in the market. Where we can and are focusing more is we can do a better job in managing our indirect partners. Enabling them more with our capabilities, whether that's ProFat-type capabilities, but also holding them more accountable, managing them closer. That's where the focus on indirect is today.
I'll take, Jayson, and then we'll come back to Ryan.
Jayson Bedford from Raymond James. Thanks for all the detail here. Maybe to follow up on the last line of thinking. I realize that international gross margins are lower, but is there any way to give us a little color on the difference in op margin between US and international?
I mean, if we start with gross margin. I mean, you should think about international as being gross margins below the corporate average and the U.S., above. In terms of the EBITDA margins or the operating margins in general that would be coming from the international markets versus the U.S., I would look at it in a similar way. In terms of how they're contributing. Again, you have two different models. You have those where we have a direct presence and those which have indirect, and you're gonna have a different profile between cost basis and gross margin contribution in general as well.
Okay. That's helpful.
I look at international growth, right, essentially as accretive to our bottom line, right. It's about selling more of technologies we have developed. It's a bit a question, how and where do you allocate R&D to that. The opportunity we have is we have great products, we just haven't commercialized them. In some cases, the investment is about building out our footprint and some of the clinical research and data and the regulatory to get into the markets. In my book, selling more of what you have in international has always been an accretive activity for the business.
Okay. Jan, you mentioned potential portfolio rationalization as a result of MDR. When do you get better clarity on that? I'm over here, if you can...
Either way.
Yeah. Saturday, I have no idea. Sorry for that. We're with the EU now having adjusted some of the timelines and stuff, we are, yeah, updating some of our NPV, yeah, calculations on where it makes sense and where it does not make sense to do that. This year we'll have clarity. It's important for next year. We flagged it there, right? We don't think it's gonna be very material, but, yeah, at the same time, yeah, wanted to give the signal that we'll continue to, yeah, think about what fits in the portfolio, what makes sense, yeah, to focus on and to invest in.
Okay. just maybe...
I'm sorry.
Last one, I'll be quick here. We're ahead of schedule. Just, Integra's always been pretty active on the M&A front, I'm just wondering what's the right level of R&D spend to kind of fund this growth? I guess specifically, R&D as a % of sales assumed in the LRP.
Yeah, very good question. Last year we were a bit above 5% R&D as % of sales. This year, 2023, we're more towards that 5.5%. In our LRP, I see it go to 6.5% over LRP. There's definitely an ambition and opportunity to further take some of our OpEx productivity and redeploy it to R&D. Okay. Overall, I don't see our OpEx grow faster than our top line. Okay? We'll drive that productivity to have that leverage. Within our OpEx, we'll feed our R&D more given already today the amount of opportunities we have. Ambition to bring more digital innovation to our products. At the same time, we're also ambition to invest in the clinical data to accelerate our access to markets.
Okay. We'll take Ryan, then we'll come over.
Yeah. Ryan.
Patiently waiting.
...a few times, so you kind of...
Thanks, Jan.
All the time.
Thanks for taking pity on me.
Yeah.
A couple questions on capital allocation. You guys have done some ASRs and share repurchases in the past. The PowerPoint, I think, is calling for about 5% of capital allocation to share a purchase just to offset, you know, dilution a little bit. Can you just talk about kind of any interest beyond that, for, you know, share repurchases or ASRs instead of M&A?
I mean, when over the past years we did share repurchase, it was primarily driven by the fact that, you know, we have this rigor with our, with our leverage. Okay? I think it's one of the strengths of the company that we don't let cash hang around if we don't have clear, medium, short-term purpose for that. Looking forward, with a full M&A game board, and clearly priority number one to make sure we use that. Now we don't fully control the timing, so there may be timings where, because we hit the lower end of our levers, that we still do some share repurchase.
In the plan, that 5% is essentially, you know, to manage some of our equity, compensation, and the dilution that comes with that.
Okay. Two other quick ones. You're targeting two and a half to three and a half times leverage ratio. You're at two and a half times right now. Is there any scenario in your mind from an M&A perspective where you'd go beyond that initially for the right transaction? Are you comfortable with that even without, you know, a CFO announced at this point?
The answer is yes, and we've done that.
Yeah.
Right? With the Codman acquisition, we went above the four.
Right.
Then within the 1st year, brought that back to, yeah, within the range. Again, it goes back to the rigor that we have with the company. We're not afraid to go over, but yeah, we'll get back to our range within short.
Okay. Last quick one for me is for Bob, private Bob Shank said no. Private label didn't get much airtime today. It's been lumpy, you know, historically. When do you think that starts to normalize? Because I think some of your customers were sitting on a lot more inventory. You know, how do we get comfort with private label? 'Cause it feels like, you know, trying to predict it is tough. I mean, we fly blind kind of with some of those orders quarter-to-quarter.
No, it's I would say from private label perspective, as we hopefully reinforced, you know, from a revenue and a margin or margin perspective, it is dilutive. From a profitability perspective, it's a very, very profitable business, not just for the division, but for the company. We remain committed to continue to grow it. I would say, look, this year, did we anticipate EU MDR getting moved out, whatever, three to four years? Absolutely not. There is some of that give back with those inventory builds with our partners, and that's the primary reason for that. I think if you can look at it and say, you know, look at the last 3-4 year average, it's in that 3-5% window.
If, you know, if you take that, I'd be very comfortable with you doing that. You're right. There's just some things out there this year that weren't anticipated. You know, on the good news front, you know, we have very strong demand on both complex wound and surgical recon, which will help to offset that.
Okay. Question.
Hi, Rohan Patel from J.P. Morgan. I guess two questions from me, one on international and then one on the LRP organic growth guidance. I'll start with international for Harvinder. I guess just curious about your strategy in emerging markets, ex China, specifically Southeast Asia and India. I think probably from a population perspective, offer similar opportunities and scale there, but maybe from an infrastructure regulatory standpoint, it could be a bit of a costly investment. I guess, what's your strategy behind that? How much of a contributor do you see that being overall within the LRP, and then longer term beyond? The question on guidance is, I saw that entering 2024, low end of the kind of 5%-7% range.
Does that imply like 2024 will be as a full year at the low end, or like exiting this year and then into next year, we'll kind of reach 5% and then beyond at the end of 2024?
Thanks. Thanks, Rohan Patel. You're right. When we compare ourselves, as I mentioned in the presentation, when we compare ourselves across international markets, not just India, not just Southeast Asia, Middle East, Latin America, compared to an industry benchmark of, let's say, take example of APAC. If APAC is about 20% in general, contribution to global revenues, that number for us is almost half. Similarly, I'll give you an example. The experience I have in India, you will generally have India at 3%-4% contribution to global revenues, depending on the maturity of the business. In our case, it is kind of a fraction. In our case, it is 0.3%, 0.4% of the total revenue.
Purely from the point of view of that benchmark, we are at the low end, Southeast Asia is no exception. That is because we've depended on very light infrastructure in those countries. We've gone to those markets with the help of distributors, we've been limited in terms of developing those markets. As we go in, purely from increasing awareness about the disease and supporting infrastructure development in terms of physicians who can treat those conditions like INPH, we think there is headroom for growth in those markets. That's what drives my optimism. Again, it is not just India, Southeast Asia. It is Middle East, Latin America.
Do you mind reasking the second question?
Yeah, yeah, sure. I guess it's just more related to kind of the bridge with guidance, and specifically on the slide, it says, "Entering the low end of the range, in 2024." Just it's more of a clarification point, but does that imply kind of 2024 will be as a year at the low end of the range, or does it imply that we'll reach kind of the low end like within, some time within 2024?
2024 year-over-year organic growth will be 5+%. We'll get over that 5%. When last week at our earnings, I think the prepared remarks where we talked about the first half, second half, right? First half, around 3% growth with, you know, I mean some, you know, complex comps. Second half, more 6%, also with some comps in there. What we said is that second half is more representative of who we are, right? Who we will be in 2024. You will see some of that momentum over the second half really start to be projected into the 2024.
Thanks. Okay, we have Asti.
Thanks. Oh, hi.
Hi there.
Joanne Wuensch from Citibank. In China, there's a lot going on, based on what you said. It's new product approvals, it's manufacturing, it's feet on the street, getting into the tier 2, 3, and 4s. How do you do all of that, and how do you budget for all of that? It just seems like a lot. Maybe I'm listening or don't know the market well. My second thing is on that 5%-7%. What gets you to 5, and what gets you to 7? If at the end of the LRP were above or below that range, what do you think that would be that would get you there? I mean, excluding another pandemic or some other horrible thing.
Yeah. Let me just jump on that second question, first. What gets us, yeah, above the 5, okay, is, yeah, executing to our markets. Okay. Our markets, yeah, which have a weighted average market growth of 5+%. Executing to that, okay, taking share, okay. Definitely, I mean, relaunching CereLink is part of that. That gets us above the 5. What gets us towards that 7, okay, are the NPIs and the international acceleration. Okay. That, yeah, further, broaden our markets, okay, and bring, yeah, new high-growth, products into the portfolio.
China.
Yes, China, there's a lot going on. China, if you look at neurosurgical business, there are about 3,500 hospitals that are doing neurosurgical procedures. When we compared that with our presence in China, we are in about between 20-25 cities in tier one and tier two cities, and covering, even with our distributors, covering about 1,000 of those hospitals. While that represents perhaps about half of the market, there is still the other half, which is very attractive and available, and which is why that's something that we are eyeing starting this year and start to expand there.
On the manufacturing question, it is more of a market access question because we see that with the changing policy, access in China could become difficult. What we are doing is more of a proactive step to make sure that we are aligned with that policy and are ready for that change.
I think, Joanne, you also had a question related to costs, yeah, of doing all of that. I mean, first, I mean, today we have a very decent sales force there, but this broadening into tier two and tier three is pretty much a variable cost, a feet on the street execution, with a quite rapid return on that investment, okay? Plus leveraging, you know, of logistic partners. It's mainly a variable cost, yeah, extension to kind of just broaden our footprint in China.
Steve?
Thanks. Steven Lichtman, Oppenheimer. Appreciate the visibility on the timing of the, of the targets, you know, obviously good to see north of 5 next year. How much does the CereLink relaunch play into that? Maybe you revisit the opportunity with CereLink here once we move past the relaunch timing and what it could mean over the next few years with the installed base that's out there.
We'll get a little tactical on this year for CereLink. As you think about CereLink, you know, the timing that I talked about earlier, whether it's 3 Q, 4 Q, that's worth about just shy of $3 million to us. That's what it is, and we talked about that in earnings. You know, the opportunity, you know, we've just scratched the surface. I mean, we've only launched in, you know, the United States, Canada, Australia, kind of the Big Five, if you will, in Europe. We've still got plenty of landscapes, right? I think you need to think about this as a new product launch as far as its revenue potential, not the work we've done so far.
You know, we've outlined in the past that we've got all this runway to launch this product all the way out through 2025 when we launch in China. There's a big pathway here. You know, from a scale perspective, you know, I think we'll continue to update you. I think it's, you know, job one right now is get this product back on the market, get revenues going. I think you'll see us hit the ground very quickly in the countries we've already launched on, when we launch in either 3Q or 4Q. I think you're gonna see us go, you know, ramp pretty quickly. To give you a little bit more scale, since we've launched CereLink, total sales were $12.6 million.
I think we're in the baby stages of this. I don't know, Jan, if any additional comments or?
Yeah, I mean, we've shared it in calls too, right? That number was over 12-ish.
It was at 12 months before the recall.
We've been one year in the market.
Yeah. Yeah.
$13 million revenue, that's...
I think my comment would just take away would be, although we have launched, and we had good momentum in the countries we launched, I would view this as a clean opportunity for revenue, except we've got a lot of equity in the marketplaces we launched already. I think you'll see us go quick when we go.
Yeah. I think the timing also for some of those additional countries, that has not slipped out.
No, not at all.
They'll, yeah, they'll get there sooner now, yeah, than originally.
The also, I touched upon it earlier, but Jan talked about, I think in earnings as well, the fact that the change we're making is not box related allows us to go much faster as we go. We're sitting on very good inventory position as we sit today. We could supply all of our markets with what we have built today as far as boxes. You know, we're, we'll go fast.
Great. Just to follow up on gross margin, sound like you're pretty confident another 100 basis points potentially next year with the error bar, as you mentioned, coming off of, you know, 100 basis points this year, how much in inflation headwinds are you absorbing this year, so that, you know, things don't get worse, you know, that also gives you sort of that line of sight into 2024?
I mean, we're definitely absorbing some of the inflationary, but I would put it in context, right? I mean, it's nothing compared to what we've seen during the Covid years. I would look at 2023 as more being a tail end of the inflation and more of a normalization going forward, which is what we're kind of including in here.
Okay. Yeah, Sam?
Samuel Brodsky from Truist Securities. I'll ask one on organic revenue growth in the LRP. Should we think about that being linear? There's some comp items that probably benefit 2024 with CereLink. Can we think about linear improvement from the 5%-6% in 2024, 2025 to the 6%-7% in 2026 or, yeah, 2026, 2027. On China, with that being such a big part of the international growth story, can you talk about has VBP been an impact for that business at all yet? Where do you think that could potentially impact the business going forward? Thank you.
Matteo, you wanna cover the linearity?
From an organic growth perspective, again, you know, one of the good benchmarks for 2024 is gonna be a little bit more of a normalized situation than we're gonna see in the second half of this year. When you take kind of the second half of this year from a revenue perspective, growth perspective, that's what I think will translate into 2024. The acceleration after that is gonna come from the various opportunities that Jan discussed in the waterfall, which is gonna be those NPIs. It's gonna be the breast opportunity. I would say, you know, relatively linear into 2024, and then I would say there's gonna be a slight step up into 2025 and beyond. That's how I would look at it.
On the V-VBP part, that's a collective concern for the industry. Having said that, if you look at parts of the industry, med tech industry, which has been impacted by VBP, is where there is large spend by the government and where there are multiple competitors. If you compare that with Integra's portfolio, we have very differentiated products and there are parts of the portfolio that have limited competition. So far there's been some provincial VBP that has impacted part of the portfolio, but largely there's been no national VBP that has happened on any of our products. One of our key products has not even been talked about on the VBP.
While we share the concern but we are optimistic that we are in a position that with that differentiated product and limited competition, we are in a good position.
Do we have any questions from the room?
Is there any online coming in or no?
None online. We have the questions in the room with the current audience. Well, this has been great. Wanted to thank you guys for joining us. Thanks to the presenters for joining us on stage. I'll just wrap up with a few housekeeping items. We have a lunch scheduled at 12, that's gonna be for everyone to join us, so that's gonna be with our Integra management team and our Integra leadership team as well will be joining us. That will be in the dining room next door. We'll do that from about 12- 1. We have assigned seating. You'll actually notice on their name lanyard on the back, there's a number with a table assignment.
We ask that you join there, and we'll fill in if we have other space and opportunities. We have a little bit of a break, and we'll start back up at 12:00 P.M.
Good. Thank you, Chris. I mean great master of ceremonies here and the past two months as we prepped for this, great job there.
Okay. Thanks everyone for joining.
Thank you. See you at lunch.