Good morning. I think we'll get started here. Welcome to the 46th Annual Raymond James Institutional Investors Conference. My name is Jayson Bedford. I cover the medical device sector here. It's really our pleasure to have with us Vivek Jain, who's the Chairman and CEO of ICU Medical, who's been a loyal participant at this conference for many years and is new and improved one-handed backhand is making me feel really sore today. But with that, I'm going to hand it over to Vivek.
Good morning, everyone. Thank you, Jayson. Thanks, Raymond James, for having us. It's a fun event. It gets a great turnout, so we're happy to be here. Thank you for your interest in ICU Medical. We've been on our own journey the last two or three years, finally turning the corner on a number of things, which I'll talk about today. I think fundamentally, even before I get into the presentation, last summer, as ICU started to emerge from some of the things we did to ourselves, we talked about what we viewed as the risk-reward getting much more tilted in the reward sense. And we were saying that last summer before we had another couple of good quarters under our belt and better predictability going forward, and I hope my job today is to illustrate that to you.
There's some copies of the presentation up here if you're interested, and I'll go quickly and make sure we leave enough time for Q&A. ICU Medical, if you're not familiar with it or new to a story or new to the story, is a focused medical device player largely in the infusion therapy space, and you can think about infusion therapy as essentially the plumbing in the hospital, the items that deliver a drug to a patient, a liquid drug. If you've seen sort of a medical TV show, you'll see that pole next to the patient, and you'll see a device in the middle of it grabbing fluid and medications and having those fluids and medications flow through that device and ultimately into the patient. That's an infusion pump. Above the pump and below that pump are consumables, and those consumables come in different forms.
Those consumables are our core business. They are those consumables that are non-dedicated, meaning they are the pipes that can sit between the medication and the pump or the pump and the patient that are not lock and key. They're open, so our business is the largest in the world in that arena. It's been historically about 44% of our company. I'll describe a joint venture partnership we just made, which makes us smaller from a revenue perspective, and when that transaction takes effect, consumables, those consumables, open consumables will be half of our business. Our second business is the motors themselves, the pump, and we have the broadest set of pumps of any player in the market, and those pumps, while they report as a segment, I'll show some numbers in a second, around $650-$700 million.
The majority of that segment is also consumables, high-margin individual pieces of plastic that are razor blades, dedicated lock and key to that pump. And so in the pump segment, it's hard for people to follow, but about 1/3 of the pump segment is really capital sales, 1/3 or less. 2/3 are dedicated razor blade disposables. And then we have a third segment, which is items related to critical care and infusion therapy that we call Vital Care. This is the segment where we participate half of this segment, we participate in IV solutions. That's the fluids above the pump. That's where there was a national shortage in Q4. That's really been a traditional manufacturing business, high capital intensity, high cash consumption. There's been some windfall moments in it, but ultimately it's a different business than a technology business of selling software in the pump, et cetera.
We made a joint venture last fall with a Japanese company called Otsuka, who's the global leader in this product in Asia, and so they're the main provider in Japan, Thailand, Philippines, India, Vietnam, Pakistan, Egypt, et cetera. And they make an enormous amount of these pieces, have never participated in the world's most valuable healthcare market, the United States, and the partnership with us was a foray into doing that, and so post the JV being consummated, 90 days or less from now, that Vital Care business will only be 16% of our revenues. At a glance, we're just under two point. W e announced last week we are just under $2.4 billion in revenue. $1 billion of that is in that consumables segment, which consists of four different businesses. About $650-$700 million is the pump business, which is really three different pump modalities.
The Vital Care segment was $600 million and will get cut in half as IV solutions is deconsolidated from our income statement. 88%-90% of what we do are single-use consumables. 10%-12% is capital equipment, and that's small capital. The largest deal is maybe $10 million on the infusion pump side, maybe. Most are in the three to four range. We're about 2/3 U.S. business, 1/3 OUS business. We have about a three and a half, $3.6 billion equity value. Net debt today is $1.3 billion. As we said in our call last week, by the end of this year, we'd expect net debt to be $1 billion, maybe less. That equates to an enterprise value of under $5 billion today.
As we detailed in our call script last week, as we wrapped up last year, there's a number of things that we feel very proud about as we've kind of worked our way through this tougher transaction we did called Smiths a few years ago. The first and most important point is it starts with revenue growth. Across all of our businesses, all geographies, we had strong revenue growth for five or six quarters in a row now. Really, it's been a good, it's an interesting time in our industry. A lot of the companies are undertaking various kinds of transformations and asset divestitures and spinoffs, et cetera. But fundamentally, the underlying market has been pretty good and continues to be pretty good. We think we have the ability with the guidance we provided to do that again for 2025.
The second thing we did, we've been spending an enormous amount of cash on quality remediation, and slowly that grinds its way to closure here. We have an FDA warning letter that we had received from the acquisition a few years ago. We had a successful inspection or awaiting closure of that letter. We cut over our IT systems, which is also a huge consumer of cash. And it was a really important activity because it allows us to get another wave of synergies that's ultimately about driving our gross margins, which is why we think we can create value and the risk-reward is attractive today. Same goes for a bunch of plant closures and really reducing our manufacturing network. Obviously, it's a little tricky right now. We're moving some of the production to Mexico. So we're obviously monitoring what's going on there very closely.
We did get the most important portfolio move done with that joint venture I just described with Otsuka last year. There are maybe some other things in Vital Care. If the right situation was to present itself, as again, we said it on the call script, we would undertake it if it was value-creating. And maybe, you know, as we think about the right long-term leverage for a company, we ran with cash for many years without a question. We levered up to do this transaction, got more than we felt comfortable with. We're maybe $100-$200 million away from being two times levered as we start next year if things go according to plan, which we think is kind of the right amount for a company like ours.
And then we can talk about how do you give capital back to shareholders as some of our cash costs come down as we help ourselves. And so the long and short of it, it is a good time in the underlying market. Even if things get harder between what we have going on operationally from fixing ourselves in the integration, what we have from an innovation standpoint that I'll get to, and what we believe is the revenue growth we're capable of, we think we can create value independent of what's going on in the underlying market. Industry structure matters a lot for us. It's a very consolidated industry. Lots of regulatory. We were joking at dinner last night, different amounts of regulatory. And it's certainly not a political statement, but if you read our 10-K, you'd see three pages of U.S. disclosure on regulatory.
You'd see 10 pages of European disclosure, and you'd see zero on Asia, right? And that's sort of indicative of where the energy is spent. But all those pages of risk factors are there essentially to say it's not easy to get into these markets. And the products we sell are deeply regulated. They're deeply ingrained into people's workflow, and they require huge manufacturing investments, and they're hard to reproduce. And making a mistake in the use of them leads to really bad things in a hospital. And so for us, that brew of inertia and regulatory and manufacturing makes the products very sticky. You make money in maybe 10-15 countries in the world. You get to participate in lots of places. 10 or 15 places really drive value. We're focused on those. I think we are in the early days.
These pumps have been sold traditionally as a razor and razor blade model, like many industries, and it happened already in healthcare and in big imaging and other areas. We need to transition that from selling a box to selling software, so we're in the early days of that, and our new innovation has a whole bunch of software modules that add more value around the device approved, and then there's some very unique things that have been going on for a while in the pumps, and it's taking, frankly, longer than I would like, but the U.S. industry really has an overhaul going on, and that's a good opportunity as we're holding innovation cards there. We are the vertically integrated pure play company. We're the only one in the world. Everybody else participates in this market. There's only one Asian, two Europeans, three of us in the U.S.
They're all multi-line kind of conglomerates. This is all we do. We have chosen a heart. We've chosen a path by default originally, and then by choice afterwards, of buying things that needed repair. It's a hard way to make a living, and for the most part, we've come through that, and we've rebuilt customer trust, rebuilt our operations. It's really hard to do that when revenue was shrinking. Our revenue shrank 2023 over 2022 or flat, but at a moment where costs have been going up, it's unsustainable. We finally have had revenue growth to offset that, and we started last year talking about, we started the call script last week saying we've been under-earning relative to what a healthy company in our space should do. There's not a nice way to say that, and we have targets.
And all those things I mentioned about integrations, et cetera, allow us to address that under-earning problem over time. And then a little bit of optionality around the balance sheet, et cetera, if we can get a few things done. Talking about our businesses more specifically, not really talk about the first two, which are our core businesses around infusion consumables. So the consumable stack and infusion pumps. If you look a little deeper at our consumable stack, even before our most recent acquisition, these businesses are where we were originally and the innovator hold the best brand, lowest cost manufacturing, highest global market share on needle-free connectors, extension sets, et cetera. Those businesses have been growing five, six, seven% compounded for many years in a row.
If you read about us as a company, even before we did some of these acquisitions the last four years, when we only did this, you can see what our margin structure was versus what it is today, and so these are really important in terms of cash generation, connection to the customer, and sit hand in hand with ultimately the pump sets and the other items that go through there, and so for us, infusion therapy is really about the plumbing in that infusion chain that's closest to the patient. We make little connectors that keep those pipes open, and if those pipes block, bad things happen. You have to take out a catheter, a patient has an adverse event, et cetera.
Our Clave family of products has been the innovation there, and we continue to incrementally innovate, incrementally figure out how to put into new workflow, new use cases. And we control everything about it from basically other than we own the land, we own the machines, we own the building, we own the sterilization. The only thing we don't have is the actual resins ourselves and the electricity. And so we don't leave a lot to chance in that business. It's made us very reliable for the customer. An outgrowth of that was really oncology. Oncology is essentially the same types of products in somewhat different configurations for dangerous drugs.
And so as you sit in all these meetings where biotech and pharma have increasing drug complexity and increasing use of hazardous drugs, we make the parts and pieces that make sure that stuff is delivered safely to the patient and doesn't hurt anybody along the way. The person who mixes it, the pharmacist, the pharmacy tech, the nurse who delivers the drug, the patient, or anybody in that care environment. That business was great for the first five. When I got to ICU, I think it was $15 million. It's probably with a little bit of help from the Smiths acquisition, maybe close to $200 million this year. It's largely due to our innovation, but also largely due to regulatory guidelines called USP <800>, tailwinds around drug complexity, tailwinds around the notion of safety. It's actually a bigger business outside the U.S. than in the U.S.
Other countries have adopted these guidelines a bit faster, and we continue to innovate, and the core assets of Smiths, which was really their CADD infusion pump, that was the last deal. That pump is used largely in oncology, and a synergy that's finally coming to fruition is taking our parts and pieces and attaching them to some of the Smiths items on the CADD sets, et cetera, and so we continue to innovate here. These two pieces are 65%-ish or more of that consumable segment. The other two pieces are the vascular access business and tracheostomy. Vascular access is tighter to our infusion business. If you think about it, we had the water, the pipe, the motor, more tubing, and we were missing the last mile, the catheter into the patient, and our acquisition, Smiths was the only independent player in that catheter area.
That turned out to be a very tricky business for us because of some of the things that had gone on. We were losing market share. At a minimum, we've turned that around. We had the first growth last year. It was a key portion of our consumables growth. We think that will continue, and we think it's an area we have a very logical right to win in. It literally, physically attaches to our products. Tracheostomy is a little bit of an outlier. It's also about keeping pipes open, but it's more airway pipes than vascular pipes. Trachs are a very attractive market structure. There's only really two players of consequence in the U.S., maybe one player, OUS, and it's a product that addresses a chronic patient population that some of these patients can be on these products for 20 or 30 years.
It's a very attractive structure, limited players, and really changes people's lives and delivered in a very customized fashion, the same way we run the IV business. A couple of slides on pumps. We have a long history of pumps. Our history goes back to a company called Abbott, where we were the supplier to Abbott on certain parts. We ultimately wound up acquiring via Hospira, Pfizer, the legacy Abbott pump portfolio, which was called the Plum family of pumps. Abbott was the more clinical company many years ago that invented interoperability, bidirectional connectivity, and actually, if you went way back, had number one market share in the country, but it had become part of Hospira, had become part of a drug company and lost its way.
We've refocused on that, on the core value drivers of Plum that made it so attractive, which were safety, the ability to manage air in line because of the cassette and the way the pump delivers, and that's what the ICU parts were originally there for. Today, we've recently got approval, maybe a year ago, a little more than a year ago for a pump called the Plum Duo that has all the guts of what made the Plum attractive, but has the fit and finish of a 2025 medical device, instant on, flat panel, touchscreen, safety, cybersecurity, et cetera, and we're taking that now, also simplifying into a different version called Plum Solo, which I'll get into in a second, and making sure we have the best of breed connectivity solutions around it, and the future is also around the software that sits around the pump.
Our messages on the pump are breadth of product portfolio, connectivity, and ultimately safety. Until recently, we're truly the number three player in the market in LVP. We've become, with the last acquisition, the second largest pump company in the world. But even as a smaller player, even as the second player, we have the mindset of a smart player. We have to connect to more software offerings. We have to be more flexible. We have to be more customized. We've been very focused on development of our LifeShield performance platform safety software. It has individual modules that offer everything from alarm forwarding, third-party connectivity, biomed services, analytics, et cetera. Ultimately, we want to sell these as individual modules once the pump gets established.
And we want that same software package to connect to the most third-party vendors, back to the point of being a small guy. And we want all of our different pump modalities to connect to a single instance of software to speed onboarding, minimize training, minimize workflow for the customer. Over the next number of years, we should, next year and a half, we should have a series of new pumps launched into the market. The Plum Duo on the left-hand side in the dark blue area has already been approved. We are within days of filing, hopefully the final submission for the Plum Solo. To make it really simple, why do we need both? The Duo addresses really the competitive opportunity against the market share leader out there who has 55%-60% of the U.S. market that has to remediate its own pump platform.
The Duo addresses some of the feature defects that the Plum 360 had against that positioning. The Solo gives us the opportunity to refresh our own install base. So part of the way people make money in infusion pumps, companies make money, isn't just the most valuable thing is competitive pumps where you get the razor handle placed and you get blades for the next 10 years. And takes on the other competitor. And so we have an offering that addresses a full 100% of the available market. And then our rationale to take on the pain of the last acquisition was to get the other two pump modalities. So the LVP, the one I talk about the most, is the largest dollar market around the world. But in the United States, there are two other important modalities.
One is an ambulatory pump that's used in home care, where a lot of these expensive biologics are used, and it's used in pain management, and the other is syringe, which is used largely in pediatrics and NICU. The company we bought, Smiths, was the number one market share player in those categories, and so for us, our competitors, the joke I'd make internally is our competitors offer an all-in-one system. It's a Ginsu knife . It slices, it dices, right? And our story is we're the Home Depot. We have the right tool for the right job, the most precise, accurate motor delivery system software for the specific use case, and what really matters is a software that connects all of them together. We will have new software, and we'll have a whole series of new motors that all connect to the same system over the next.
The most important one is done already. The rest are coming over the next 18-24 months. A little bit back to value, and I'll wrap up. It's been hard to understand what's happened with us from a gross margin perspective, and the reason I'm belaboring this is because addressing our under-earnings fundamentally starts with our gross margins more than anything else. When we closed the last transaction in early 2022, just about everything that could go wrong went wrong across our manufacturing currencies. The peso, colón strengthened dramatically against the dollar. Rates went away from us, our selling currencies. The dollar was stronger against those, and we, frankly, were losing business at a rate faster than what we thought, and therefore we were overproducing in our factories, et cetera, and the confluence of that was very, very painful.
It led us to take a pause on manufacturing, really drove down our gross margin. We didn't understand that really well until a year into the acquisition. It takes a lag time for you to slow down production. That is what you see in 2023, where gross margins started to deteriorate rapidly, and over 2024, we've been building back, and it's really important, and all of those activities I talked about, closing factories, factory consolidation, which is brutal, and there's real humans at the end of that. Factory consolidation work, IT system consolidation work, real estate work, logistics work, those are all implicit in the gross margins, and we said when we started talking about under-earning, we said we were at 36 at that moment. Our goal was to get to 40 organically.
Those four points is this missing $80-$100 million of earnings we felt like we've been at a gap to. Gross margins go a long way to address that, and of course, price. And then the transaction we made with Otsuka, which takes IV solutions, which is a very low gross margin item, de-consolidates from our P&L, immediately brings 3-4 points of improvement. That doesn't create cash. That's just optics. And ultimately bring another point or two over time as that JV stands up its own functions. But for us, when we look at ourselves versus our peer group and why we don't make as much, it fundamentally starts with the gross margin line. And so we're very, very focused on the operational aspects of that. And then I'd close with, you know, if you follow us, we don't invent a lot of new slides.
It's the same slides year in and year out. This is the exact same slide that we've been saying since the beginning of 2023. The items we think we checked off in 2023 and 2024 was important for us to get all parts of the portfolio. This was last year's slide. We said 2024 and beyond, beyond is now, get all parts of our portfolio growing. We got a little bit to. There was a national shortage in IV solutions in the fall of 2024. Right now, that did help us accelerate our contract renewals on the best terms possible and get our transaction done. We, generally speaking, with a few bumps and bruises, have a fully stable supply chain.
This year, we await the unchecked box, which is get the new products done, finish the rest of the synergies that drive self-help across all these things I'm belaboring in manufacturing, real estate, IT, et cetera. We thought rates would be better. Obviously, that one hasn't gone our way. We have to continue to be patient, but at least the Mexican peso's in the right spot. Cash flow has been improving. Ultimately, we want to turn debt into equity, right? I recognize that people have had to have been patient in waiting for that. We don't need a lot of organic M&A capital because of the innovation we're holding. We're very focused on, even though the items report below the line in terms of adjusted add-backs, they're really consumers of cash.
We're trying to finish that work so it can turn into free cash flow. We provided this exercise. It's a little hard to follow with our joint venture on how our numbers shake out for the year. The joint venture isn't something that's put into discontinued ops where it's just separated. It's de-consolidated. So we still have it. We have our IV solutions business for a portion of this year. And sometime in Q2, we will de-consolidate it. Q3 this year will be the first full quarter where you see the impact of that de-consolidation on our income statement. And we tried to provide this bridge so it's a little bit easier to follow as the year goes. So that's it. That's the story of ICU Medical. Hopefully, I've made a compelling case on the risk-reward. And again, Jayson, happy to be here and happy to answer any questions.
Sure. We have a few minutes, so maybe a couple of questions. Maybe just on the top line to start. Infusion and consumables, your two most important segments grew roughly 7% last year. The guidance implies about mid-single digit in 2025 with some contribution clearly from new products, Duo. Can you just talk through why the deceleration implied this year?
Yeah, I mean, I think it's probably, you know, again, it's hard to follow when you look at the companies out there, but things have been pretty good. I mean, there was a step up in utilization last year. It's hard to, the comps are tougher, but it's hard to imagine that type of step up occurs again, right? Employment's as good as it's going to get, et cetera. So I think it's been a little bit cautious on that. We probably got price. I think we were earlier because we were the healthiest in consumables. We were more focused on getting IV solutions price for this year. And consumables pricing was last year. So the pricing tailwind, which again is a positive, but probably isn't as big this year as it was last year. So I think it's probably a combination of those three factors.
Okay. Just on the margin opportunity here, because I think it's an important part of the value creation story. IV Solutions' op margins are probably in the high teens. You've expressed comfort in taking that to the low 20s. Can you just, is it all gross margin? And if it's largely gross margin, can you just walk through and bridge some of the components there?
Yeah. I mean, again, everybody talks their own book. We talk EBITDA margins, right, which obviously would be higher at consumables-only companies. I think for us, it's the biggest chunk of getting to where we want to be is in the gross margin line. OpEx for us has essentially been flat for years. The only volatility is really bonus funding. It ticks up a little bit this year because we've been skimping in a few areas. It's the largest drivers of gross margin improvement for currency. And so our production, the cost of producing in our production geographies and inflation, there's been a lot of local inflation with salary increases in Mexico, Costa Rica, et cetera. And so does that stabilize a little bit? Second is plant consolidations. It takes time for those to get into the income statement because you build up bridge inventory.
So you're still running through the P&L at yesterday's cost, even after you've closed the doors. So that takes a little bit of time. Even if we close the doors midway, third quarter this year, it takes time to get that fully in. Real estate, you know, like everyone, we have tons of unoptimized real estate. Those leases have been all addressed, and they're rolling off at various points this year. Duplicative IT systems, duplicative logistics. For us, all those items are in the gross margin line. And so the synergy capture of the second wave, which is why I was harping on the order to cash systems in North America, there's a lot of value in all of those. Those are the biggest drivers of gross margin.
And then just maybe with the last minute here, the deal with Otsuka on the IV solutions, why is that the right deal and what does it give ICU going forward?
I think it was just. It's hard for us. The software development and IT development and systems for everything in the pump business requires a lot of R&D investment. I think it was hard for us to afford that and to try to be an innovator in IV solutions. Innovation in IV solutions was around formulation, not formulation so much, but packaging, configuration, production technology. And that production technology also requires a lot of CapEx. And we felt like they brought innovation to the party, capital to the party, and redundancy. The criticism of ICU, given the hurricane that happened in the fall, was as much as customers are like us. We too were a single-site manufacturer. That will now rapidly be backed up by the newest bridges and tunnels, the new core infrastructure anywhere in the world. We would have never been able to get there on our own.
Okay. Vivek, thank you so much.
My pleasure.
The breakout will be downstairs in Amarante 1 , I believe.
Thanks.