All right, I'd like to welcome everyone to the KeyBanc Life Sciences and MedTech Investor Forum. My name is Brett Fishbein, MedTech analyst, and I'm pleased to be joined by the Inspire team, who today is represented by Tim Herbert, President and CEO, Carlton Weatherby, Chief Strategy Officer, and Ezgi Yagci, VP of Investor Relations. I'll start us off with some questions here, but we have an open forum, and if anyone in the audience has additional questions, you can submit them directly to me by typing in the box below the video screen, and I can relay them to the team here. So maybe just to start off, we know we're starting a lot of the fireside chats this week.
Just really asking for an update on how you're viewing the underlying environment as we kick off 2024 here, and how you're seeing broader trends progress, you know, maybe around physician contact activity, patient web traffic, and things like that, compared to the past few years?
Fantastic. Well, Brett, well, thank you very much for organizing, and thank you very much for hosting us. We really appreciate it and, and the ability to, to communicate with so many people today. So thank you very much for doing that. The patient demand for the therapy continues to be very, very strong, and we continue with our outreach programs. We know that we have changed the way that we do marketing to grow awareness of Inspire with our direct-to-consumer activities, being both social media as well as television and other aspects, and that continues to go very, very well. We continue to see a very strong demand from the web activity.
We've launched a brand-new website in December, and seeing very good feedback from that, and really helping patients take the next steps to connect with and to make an appointment with physician regarding Inspire Therapy. So continue to see very strong progress with that from the beginning of the year through the quarter, and we'll continue that activity moving forward. And then continuing with technology and awareness campaigns, just to help patients build the efficiency to make those appointments even better going forward.
All right, and then, you know, you recently hosted the 4Q 2023 earnings call, and you reiterated the guidance that you had provided earlier that month. And, you know, there was a little bit of commentary that, you know, investors, of course, focus on around 1Q-
Mm-hmm
... maybe being a little bit softer than the street was modeling, just based off of, you know, seasonality. Just, you know, as we're now a little bit later in the quarter, has your thinking around the 2024 cadence change, changed at all?
No, we're still solid with our 24 cadence. We're in the middle of the quarter. We'll be talking about that at our next earnings call on what we wanna do for adjustment of the guide going forward. But at this point, yeah, we're comfortable with the guide that we put out there, and continue to run the business.
All right, sure. And then, you know, maybe just following up a little bit on the 2024 outlook and guidance, I'd say, you know, the outlook implies a modest step up in utilization year-over-year. You know, just curious how the onboarding of, you know, the third-party vendor to help the market access team with, you know, some of the prior authorization challenges you faced last year, support that outlook and implied, you know, progression to around 2 procedures per month per center. And then just curious, you know, if you see any other opportunities for, you know, that addition of some help to drive a little bit of upside as the year progresses.
Absolutely. I think utilization is our number one focus. We know that the majority of our growth comes from same-store sales or increased utilization at existing centers, and that is complemented by us opening new centers as well. So we're gonna continue to open new centers at the cadence that we provided. We kept our guide consistent with opening of new centers. We've always tend to be a little higher than that, we realize that. But really the focus is about growing utilization and making sure centers have the ability to treat a greater number of patients. And the number one driver is we know centers that have the highest utilization, have the best patient outcomes, and so we really kind of leverage that going forward. From a prior authorization standpoint, the team is back taking care of centers.
Prior authorization program is up and active and running very, very well. No concerns over that. There were some centers back when we were teaching independents that have become independent and are doing their own prior authorizations. But for the most part, we've brought them all in, we've added staff, and prior authorization program is strong going forward, and we can work with the individual centers on: How do we drive increased utilization? Again, the new website has really helped to make the first appointments. And we're looking at the ENTs. How can we help the ENTs be more efficient and spend more time in the operating room? Couple examples are the very first appointment. Can we use a APP or advanced practice provider or a PA to see the patients for their first appointment? Do they really have to see a ENT?
That way, that makes it easier for the patients to get that first appointment and help improve capacity with the ENT. Can we train the ENTs' partners to build capacity, get them to do additional time? Midterm, we can talk about the predictor and how if we can eliminate DISE, that really can build efficiencies for the ENT as well. So really doing minimal the easy steps right now to really help grow the ENT capacity, and those are being effective. And then longer term, of course, the Inspire V will certainly improve capacity by reducing OR time.
No, certainly, and definitely looking forward to getting into some of these more interesting long-term-
Yeah
...topics in just a minute. I did have one question come in here just around-
Sure
Similar, on the guidance. Was there any change to your philosophy in terms of how you guided, either for the year or just quarterly setup compared to the past?
No, the way we do our guide has been consistent for all over the years, and we don't really tie that to utilization. I know people wanna do mathematics on it, and I credit them for doing so. But no, we set our guide consistently like we have in the past, but utilization is what we really focus on for driving our business.
Got it. Last question on the guidance, and understand utilization certainly the most important and probably most sensitive driver of the model. But just thinking about, you know, the other side of it being new center additions-
Mm-hmm.
Your guidance was 52-56 per quarter-
Mm-hmm
... which was the same range that you gave last year. Like, how much visibility do you have into that target? And then just how, like, how do you think about balancing that, you know, consistent cadence of adding new centers with also driving increased utilization at existing facilities?
Right. We do have. We can see the runway. We know for a new center, it could take six months to get them fully trained, contracted, seeing patients, and ready to open, and so that's a group of centers. There's other centers that are part of a larger organization. Let me call it the Ascension, Advocate Health system in Chicago, Banner Health in the mountain regions, right? Kaiser in California. We have national contracts with the large systems, and for us to open up a new hospital there, we can do that in just three months, 'cause we're just focusing on identifying the team and going through the training aspects, and there's, like, six training modules that centers have to go through.
So there's varying levels of, of center readiness, but we do have a pipeline that we have, visibility to, and we open centers when they're ready to open, when they have patients identified. The last training module is training the surgeon to do the procedure. We don't like to do that training longer than 2-3 weeks before they do their first case, and so we kinda, get that all set up appropriately throughout the quarter, and we're gonna continue to drive that. We like the cadence that we have set up, because we have staffed around that cadence to be able to open that number of centers, and we can only open the number of centers that we can control patient outcomes. And so really, our focus is on driving increased same-store sales and driving utilization, and complementing that with opening new centers.
Yeah, I mean, you had a couple comments already about utilization and, you know-
Mm-hmm
... touching on higher utilization, actually driving better outcomes. And we had another question come in from the audience, you know, on that topic.
Mm-hmm.
You know, just wondering, you know, what kind of metrics do you see improve as utilization gets better? And, you know, if you have maybe, like, lower utilization facilities, where are the possible areas that, like, can show improvement once they get to a better level of scale?
Oh, I think that's, that's a great example. I think, it's number one is the ENT surgeon that we focus on at centers. And what role does the ENT surgeon playing at that center, right? We... They're probably the champion, but is he, she, are they dual boarded in both sleep and ENT, such that they're doing not only the diagnosis, the surgery, but they're also doing the follow-up? Well, that really limits the individual contribution, and the surgeon's the only one that can do the procedure. So what we need them to do is really form a team and have multiple surgeons that can do the procedure to improve capacity, and really rely on the sleep physicians to do the longitudinal management.
So number one is identifying the efficiencies at the center, specifically around the ENT, so they can maximize their time in the operating room, and that's the number one factor that drives utilization, is OR time. We can find OR time at hospitals, because we just use any general operating room suite. We don't have special equipment, and so we can find the OR suite time. We just need to make sure we get enough ENT time, and that continues to improve as we build those efficiencies with the practice. We already mentioned using a PA or APP to help patient diagnosis, leveraging the sleep physicians, longer term, addressing sleep endoscopy, and certainly Inspire V.
All right, thanks. Thanks for that color. And, you know, one more, one more a little bit kinda near-term question.
Yeah.
You, you've been talking the last couple of quarters about, you know, the EU, you know, certification-
MDR
... process. Yeah, and specifically, you know, some of the country-by-country derogations that you've been trying-
Mm-hmm
... to secure. I think you mentioned Belgium, Netherlands, Germany, Switzerland as-
Correct
... you know, examples where you've gotten those specific derogations. Just curious if there's any other updates you can share, given you know, this is changing pretty quickly.
No, we have derogation in all four of those countries. Those are the predominant business in Europe right now. The UK is up and coming. We are working at compassionate use. Everybody remembers Brexit, as the rules are a little bit different there, but we're working that. We have several patients scheduled in the UK that we wanna get scheduled, but we need to get through one more compassionate use documentation there. But Germany is up and running and very strong, and we fixed that derogation in January. Netherlands, Belgium, and Switzerland, as you've mentioned. The next countries to deal with are Austria, and France is a little bit different. France is about to release their new codes, 'cause we know we've been awarded countrywide reimbursement in France.
We don't have the new codes yet, and it's probably gonna get announced at the same time we have full EU MDR certification anyways. So that's gonna allow France to come on when we launch in France, and with all the new products. So things are good. We're working with our notified body to get the EU MDR complete, and we continue on progress doing that. But in the meantime, do have derogation that's gonna carry us through until we have final approval. So become a little bit more of a non-factor right now.
All right, that's good to hear, and, you know, more to come on the international opportunity, you know—
Mm-hmm
down the line. You know, I did wanna shift to everyone's favorite topic, which is SURMOUNT-OSA.
Sure.
You know, some of the work that's being done in GLPs. You know, the question that comes up a lot, I think you've answered publicly, you know, many times-
Mm-hmm
... which is around the potential outcomes and impact on TAM. So I unless you have specific new thoughts on that, which you can follow up on, I did wanna ask just how you think about, you know, assuming this class of drugs does, you know, make its way to the market, you know, longer term, which I think would be the expectation, just how you think about, you know, the increased interest and maybe investment dollars, and how that could impact the TAM long term in the OSA space?
Well, Carlton is tracking how many shout-outs she gets today, but come on, Oprah put on a show last night to educate people about GLP-1s, right? How many people are gonna call their doctors today saying, "I need to lose weight, and I need to go on one of these GLP-1s. How much does it cost? Can I afford it?" And the doctors are gonna screen them for heart failure, for diabetes, and for sleep apnea, and they're gonna have to treat their underlying diseases as well as dealing with the weight loss. And let's be honest, these drugs have been around for 20 years for diabetes, but most recently approved for obesity management. And I know the SURMOUNT is trying to get it in the indication for sleep apnea.
That's gonna be a little bit more of a challenge 'cause they are weight loss drugs. Our position has not changed, and we will reiterate that we expect the SURMOUNT trial will show a reduction in the severity of sleep apnea. We believe it will help the TAM because the people in the SURMOUNT trial today are people that we cannot treat 'cause their BMI is too high, and they likely have complete concentric collapse, and we treat tongue-based obstruction. So we need those patients to lose weight, so they can be screened for additional therapy to resolve their sleep apnea. So again, we think the GLP-1s will be positive. It's gonna help people lose weight, help them move into our funnel, significantly greater than those patients we see falling out of the funnel.
But overall, I think the awareness of the GLP-1s and the desire for people to address their weight will increase the number of patients that will be diagnosed with obstructive sleep apnea and will increase overall sleep apnea therapy volumes.
Hmm. All right, and then, you know, maybe just as a little bit of a follow-up there, let's just assume that the headline results from this trial are, you know, relatively positive, kind of in line with expectations. I guess my only real concern would just be whether, you know, that entrance would cause some kind of near-term disruption in the market, where people-
Mm-hmm
... you know, at least wanna consider an alternative and maybe defer a decision, you know, to see if that was effective enough. Is that something that you guys think about or think could have some kind of, you know, couple quarter transient impact, like, if this does come to fruition?
No, for sure, we think about it, and I think right now, when people come in, the majority of patients are gonna come in and get screened for sleep apnea. The sleep physicians are not going to delay prescription of CPAP. They're gonna give them CPAP and a GLP-1 at the same time, and then six months later, you're gonna see, number one, are you still on CPAP? Do you need to be on CPAP? The key is gonna be, we know the compliance to CPAP is limited, and we know a lot of people are gonna fall off it, but they're already gonna be on the GLP-1s. The key is gonna be they need to lose weight to be able to qualify for Inspire.
With the amount of demand that we have, going back to your initial question, with the number of web hits and contacts and patient demand for Inspire, you're not gonna see any pocket where people are gonna stop and try a GLP-1 for a while. We know that if they qualify for Inspire, that they're gonna continue forward, and those patients that are gonna have a higher BMI, or they will fail due to complete concentric collapse, those patients we will send back to a physician to get them on a GLP-1. So no, we don't think that there's gonna be any kind of window or gap for patients trying a GLP-1. We think that we're gonna leverage GLP-1s for those patients who get screened out on a complete concentric collapse to get on a GLP-1 to lose weight and qualify.
No, sure, sure, and, you know, that's... I think, it's so similar to how I'm thinking about it, and we did have a question, I mean, a lot of, a lot of questions coming in, but we had one-
Mm-hmm
... on this exact topic, really. Is this something that you've already seen, where there's been examples of patients who didn't qualify because of their BMI, you know, went on to GLP-1s for weight loss or any other reasons, and then became eligible and actually gotten an implant?
Yes, but it's very limited today. When we talk to our physicians, it's just a few patients 'cause this is all relatively new. Even when we talk about physicians, a lot of them refer back to their old patients that had bariatric surgery, qualifying and coming back and qualifying. Very, very early stages, but we do get, physicians talking about patients who have done exactly that, but again, number is very, very small at this point.
...And then just one more on SURMOUNT. Another question came in, a little bit similar to one I wanted to ask. And you definitely have this cohort of patients who have-
Mm-hmm
... very high BMIs, who will go on the therapy and then, you know, move into the TAM. But, you know, there's also, like, maybe a group of patients who aren't starting off, like, as high of a baseline, you know, and thinking about the ADHERE, registry where, you know, the average AHI is in the low- to mid-30s. And if there's a patient who starts, you know, maybe closer to high 30s of an AHI and shows 40% or 50% improvement and gets down below 20, and I think there's some reimbursement differences around, you know, eligibility at lower AHI rates below 20, like, would you also be potentially, like, losing a certain amount of patients, you know, in that cohort?
Just how do you think about, like, those offsets at the higher and middle range of SURMOUNT?
Yeah, I mean, sure. I mean, you can play the math all you want, you can find some patients that'll lose a little bit. We are indicated, by the way, for any patient who has a AHI greater than 15. If our insurance company has a limitation at 20, we'll submit the prior authorization in anyways, 'cause it is not off label. It might be off policy, but we'll get them approved. And so unless they get down below 15, that's really what we're focusing on. There's gonna be a few patients, I get it, who will fall out the bottom. We think it'll be far superior that patients will fall into our funnel than the few that will fall out the bottom. We think that's a very limited number, but of course, you can do the math and kind of see that happening.
Yep. No, sure. And then, you know, another question on TAM is also... It's been a little while since I think we've talked about this, but you have in the past framed kind of an addressable market from a center perspective, and the number 2,400 had been thrown out.
Mm-hmm.
But I think you've also alluded to there being some additional centers, you know, maybe in the smaller to midsize, that would still be very viable outside of that core TAM. So maybe with that in mind, if you could just provide an update on how you're thinking about, you know, the TAM and then your level of penetration exiting 2023.
Right. Well, initially, the 2,400 was really kind of just a rough estimate. We used to estimate 4,000 hospitals in the United States, 4,000 ambulatory surgical centers. Of the 8,000, we're targeting about a third of them, and that would get us to the 2,400. I think now we're getting a little bit more specificity, and we're looking at the community hospitals, and we're realizing that patients wanna be treated in their community. They don't wanna drive an hour, an hour and a half to a big academic center. And we're seeing more and more of the centers that we're opening are in small communities, and they have strong utilization because the physicians there are, have the ability to show, have the capacity to take care of these patients. And so we're gonna continue to increase that, number of centers above 2,400.
We haven't put out a specific number yet, but we know we have much more area to be able to cover from that standpoint.
You know, we're also... another interesting point about the TAM from a patient perspective is that we are starting to reach the really early stages of the first replacement cycle, you know-
Uh-huh
... for the earliest patients. I guess the question for me is: Do you have processes in place to re-engage those patients, and are there any differences in, you know, re-qualifying a patient, or any differences in the economics for, you know, somebody who's coming up for a replacement versus a brand-new patient?
Yeah, Yes, we do have ways to stay in contact with patients. On the back of their remote control, there's little lights, and when the little LED light lights up that says, "You need a low battery," is when they make contact with their physician. As we move forward, patients who have the new remote and they have the app on their phone, they'll actually get a notification that it's time to contact your physician or the physicians. If the patients are in SleepSync, the physicians will start to get a notification, 'cause that data will get uploaded into SleepSync. So we have ability to stay in contact with those patients. We're targeting a 85% replacement rate. We know what our satisfaction scores are for patients. We track our patients going through, and so we're targeting a pretty aggressive number.
85%, I think, is a fair number. Obviously, with our older patients, we do lose some patients, they do pass, but we think it's gonna be strong replacement. As far as coding, there are codes in place for replacements. If a physician needs to do a revision of a stimulation lead or remove the sensing lead, there are specific CPT codes for each of those, and there's full coverage from all the payers. Those codes are in all the payer coverage policies for replacement. And one last point on that, we recommend today, we do have processes in place, surgeons are trained on this, that we have them unplug the two leads, and when we go to Inspire V, we are going to have them leave the sensing lead in the body and not remove it.
We believe it probably is more risk to remove the lead than just leave it in place. Has no impact on MRI or any other, but if a surgeon chooses to remove it, there is a à la carte code to be able to do that.
I think that's a really good segue into a couple questions around the product portfolio and R&D-
Mm-hmm
... initiatives, which has always been a great highlight of Inspire, and you know, your patient innovation.
Yes, yeah.
I think, no, I'll have a couple on Inspire V, but, you know, most recently you announced the launch of, or the upcoming launch of a new physician programmer.
Mm-hmm.
Maybe just talk about some of the biggest advantages around that update.
Well, the first thing is the SleepSync, and it's our global patient management, cloud-based system. And the new physician programmer actually logs directly into SleepSync, and all the information from the patient, all the programming settings are all automatically uploaded into the system. And the physicians can just use their own computers, their own Surface. We no longer sell a tablet for the physicians. They don't, they don't need it. We can just use any old computer they have. They just get an antenna with a Bluetooth module that communicates with their computer. We have recently enhanced that. Believe it or not, the sleep lab is a very noisy center. Not noise for sleep, I mean electromagnetic noise, and so we have a lot of buffering with our device and shielding to make sure that we protect our telemetry.
That new product is all available and being released today, and that's certainly gonna work as we go forward with Inspire V and future generation neurostimulators as well.
And then, yeah, maybe just moving to Inspire V-
Yeah
... that's the new generation device for folks who are new to the story, and you're expecting to have a limited market release, potentially around the end of the year, and maybe-
Mm-hmm
... a full market release, if everything goes as planned, next year.
Mm-hmm.
Maybe just talk about some of the features of Inspire V. And to the extent that you can, maybe put it in context with the potential competitive launch in a similar timeframe.
Absolutely. Well, I think the number one feature of Inspire that the competitors don't have today is we sense respiration, and we provide stimulation when you inhale. Inhale, exhale, inhale, exhale, and we stimulate when you inhale, and the device is turned off when you exhale. If you think about BiPAP, bilevel positive airway pressure, which is the next step from CPAP, when you inhale, the pressure is higher. When you exhale, the pressure is lower. Everybody knows that the airway collapses when you inhale, hence you need closed loop stimulation, and that's what the feature of Inspire has had from the beginning, and that's something that the competitors don't have today or in future plans. So what we have today is a pressure-sensing lead that's separate from the neurostimulator. But what Inspire V does is it incorporates that sensing inside the neurostimulator can.
That's the number one feature of the Inspire V, is the surgeon no longer has to place that sensing lead into the chest wall. Think about it, we have ENT, ear, nose, and throat surgeons, placing that sensor in the chest wall. It's the one part of procedure that's a little out of their comfort zone, and by getting rid of that sensing lead, we believe there's gonna be a host of new ENTs who are willing to do the procedure, and they're just a little shy to do that today because of placement of the sensor. Number two, the Inspire V is a platform technology. It's a microprocessor-based system, so when we go to Inspire VI or Inspire VII, it is just firmware upgrades.
One example is Inspire VI will have sleep detection, and so when the patient falls asleep, the device will turn itself on at night. When they wake up in the morning, it'll shut itself off. Think about those patients that have insomnia, and so they can relax, and when they fall asleep, they just... The device turns itself on. They don't have to worry about the remote anymore, right? And then the Inspire V, thirdly, has the ability to expand, and so it already has designed into the circuitry a separate independent output circuit that we are going to start a program to address high BMI patients. We know GLP-1s are going to help, but it will not solve BMI because if you stop using the GLP-1s, we know the weight rebound will be significant and quick.
And so we need to solve that with technology to be able to treat complete concentric collapse. Our competitors don't treat complete concentric collapse. They stimulate the base of tongue like we do to move the tongue forward. They do not address lateral wall collapse. Our dual-channel device, which Inspire V already has the technology in the can, will allow us to go to a dual-channel device to address not only tongue base, but a different nerve bundle that will address pulling the lateral walls down to open up lateral walls and address high BMI. We have done acute human work and are just about to start some chronic work, longer term project, but we know the GLP-1s has really created the need for us to address this with technology, and we have the ability to do that.
Well, it's a really interesting point. Definitely would like to follow up on that, you know, as more information is available-
Mm-hmm
... on the topic. My question would be... Yeah, I think a lot of the time people think about potential competition and look at CCC as, you know, a large differentiator, but in there also might be a little bit of a misunderstanding of the timing of when that actually becomes viable in the US, given some regulatory hurdles or processes that that competitor will need to do in the US before actually addressing it. So kind of in that line-
Yeah
... how do you think about the process toward getting, like, a CCC indication for Inspire? And is that something, you know, that you'd be interested in to open up a greater part of the TAM?
Yeah, you cannot properly treat CCC with hypoglossal nerve stimulation. Hypoglossal nerve stimulation moves the base of the tongue forward, period, right? CCC is a combination of tongue-based obstruction and lateral wall collapse. Lateral wall collapse is a result of higher BMI, as you get a higher BMI, you get a larger neck circumference, you get more lateral wall collapse. You can move the tongue out of the way all you want, but a patient's still gonna have a lateral wall collapse, and I think that's what you'll see when you have people talking about... You haven't seen any data on a hypoglossal nerve stimulation treating CCC. You gotta have a dual-channel device, and it's gotta address both tongue base and lateral wall, and that's the process that we're happening. You won't see a CCC approval on a nerve stimulator for Inspire.
We're gonna be going after CCC directly by addressing lateral wall, and we'll get that with our dual-channel device.
All right, super. And then, you know, last question here on Inspire V and the eventual rollout. You know, just when, when the release does occur, you know, how quickly do you plan to convert your customer base to the next-gen device? And, I did have a question coming very similarly. Would, would you expect there to be any possible delays or disruption as, you know, folks need to convert to, to the new procedure?
Sure, absolutely. Well, we're working interactively with the FDA right now. I think the key is we know... If you can recall back when we went from three-incision to two-incision, it was a very quick conversion to that new technique. When we went from Inspire II neurostimulator to Inspire IV, it was a very quick conversion. We expect the same to happen with Inspire V, and we're planning for that. So more so than just FDA approval, it's being operationally ready, meaning we will have our production facilities up and running. We will have sufficient inventory, so once we launch, that we can carry forward, and we won't get into inventory challenges. And because it's not approved and because it's not appropriate, we don't market Inspire V today. We don't talk about it.
Certainly, we talk about it with investor calls to keep you all informed, and certainly our doctors are very smart, and they listen to these calls and read your transcripts as well, and they're aware of it. But we do not promote it outside the community. You won't see it on our website until we're ready to go. Because of that, we don't think you are gonna see an air gap in patients waiting to receive... They're gonna wait for Inspire V. Our patients are very motivated, and Inspire IV has the same mechanism of action, with the sensing mode and treating sleep apnea in the same manner. So, no, we're gonna launch Inspire 5 when it's ready to go, when we're operationally ready, and we'll announce it to the field when we launch, and it won't be a lot of preliminary discussion.
So there won't, we don't believe there'll be any air gap there.
All right, and, you know, this has been a great session so far. We only have just about a minute left, so I'll have to-
Sure
... skip past my questions on profitability and direct-to-consumer marketing, which is okay. We'll save that for next time.
Okay.
Maybe just if there's any final thoughts you'd like to leave investors with in our last minute here?
I will grab the profitability. I think that's a very important-
Mm-hmm
... point to get to our, community, and I think that's important. What we'd like to say is that we're becoming profitable because we're maturing as an organization, and we're continuing our heavy investment in R&D. In our last year, R&D was at about a 20% part of our revenue. But that's gonna continue on, but we're getting more leverage of that as we get Inspire 5 and dual channel continuing to move forward. DTC, we're about $100 million, and we're gonna continue to invest in that. That'll be more flat because we're really getting leverage from that DTC as a maturing company, and we said we're gonna be profitable in the second half of the year, and we don't have plans to look backwards.
So we think that Inspire V is certainly gonna help 'cause it's gonna improve our COGS, 'cause we don't have to make the pressure sensing lead anymore, and it'll help some gross margins there. So I think that, we'll be able to talk a lot more about this as we get further into the year, but, we know our, our responsible, mature company will be profitable, and we certainly have that on our radar and look forward to talking about that more and more throughout the year.
All right. Well, lots of exciting opportunities ahead, as always.
Yeah
... and I think with that, we can, we can conclude. Thanks so much for joining, everyone.
Thank you very much, Brett. I really appreciate it.