Okay. Welcome back, everyone. Rich Newitter here, Truist Securities, and we have iRhythm now. We have iRhythm CFO Brice Bobzien and Executive Vice President, Corporate Development and Investor Relations, Dan Wilson. Just as a reminder, if you have questions, feel free to come up to the microphone, or you can scan the QR code that you see on the presentation screen, and we will try to get to any questions that you might have we're not asking up here. Gentlemen, welcome. Thank you.
Thank you.
Then starting off these discussions with kind of high-level views of the market for each company, I thought that that would be a good place here as well. Maybe break down for us the, you know, the Long-Term Continuous Monitoring and MCOT kind of segments of the market, and maybe just give us a sense for what the share and, you know, and penetration components are, and how fast each of those are growing. I think that would be a good starting point.
Great. Happy to. Thanks for having us, Rich. Good, good to see you all. I can start, and Brice can chime in here. So starting maybe with the full market, we operate in the ambulatory cardiac monitoring market, 6.5 million tests per year. We estimate growing kind of mid, mid-single digits. You asked about the, the two segments within that market where we operate, and that's kind of where really the excitement is from our standpoint. So long-term continuous monitoring as 2.5 million tests per year of that 6.5, that is the segment that we pioneered, you know, a decade ago when we came to market. We maintain about 70% share of that market today and actually estimate that we regained a couple points of share last year.
That is the fastest growing segment in the market, growing mid- to high-teens year-over-year, and continue to take share from short-term Holter monitors, which you know is a legacy, you know, technology, that's been on the market for decades, hopefully not decades more, but yet still 1.5 million short-term Holter tests are done per year. So still, quite a bit of opportunity to continue to convert those to long-term continuous monitoring. And then MCT is the second segment that we operate in, with Zio AT, the mobile cardiac telemetry market. We estimate that's about 900,000 tests of the 6.5 million tests and growing, call it high single digits.
We also are taking share in that market, so growing our share year to year, but only 7, we estimate 7% of that market is our share of that overall market, which compares to the 70% long-term continuous monitoring, and clearly shows there's an opportunity for us to continue to grow our share in that market. Pretty much the same prescriber base across those two segments, so clearly have a right to win in that segment. We'll, I'm sure we'll talk about our next generation MCT device, Zio MCT. We believe that will start to really catalyze some good growth for us in that segment.
That's a great overview. And then just to remind people on the line that are listening, so you've got AT right now that's going after the MCT.
Correct.
Patch portion of the market. That's the portion of the market that's growing fastest. And then you have the largest percent share where Zio XT is, and that's growing, but that's growing a little bit slower.
So the reverse. So Long-Term Continuous Monitoring i s the fastest growing segment.
Oh, so sorry. Yes.
Yep.
So sorry.
There we operate with or serve that market with Zio XT, now Zio Monitor. That market segment, 2.5 million tests overall growing high single digits, mid to high single, sorry, mid to high single, let me try again, mid to high teens, long-term continuous monitoring, Zio - MCT segment growing high single digits.
Right. And you're gaining share.
Correct.
In that, and that's why that's a higher growth segment for you. Got it.
Yes.
Okay.
Yeah.
Apologies for the confusion there. You're basically, you know, growing 20% now. I guess, you know, it feels like we have an even better way to go after the MCT business on the horizon with kind of your next-gen MCT device, hopefully at some point in 2025 timeframe. We'll get there in a minute. I guess, you know, can you walk me through if that is the thing that gets you to, you know, something higher than 20%, or what is the growth algorithm to kind of continue to move higher than 20%? If you're already there, it sounds like components in the markets are there and your share gain within those components is there.
Can you bridge me to kind of how we can see that 20% kind of accelerate over the next several years with MCT next-gen and, and whatever else you're looking at?
Sure. Yeah. So it's a good question, Rich. I think, you know, for me, there's a few different things that are tailwinds and/or growth drivers for us on the horizon. Maybe the first one that we're going to start to see, really play through is the international business. Plan to launch in four new European markets in the back half of 2025, which is Netherlands, Switzerland, Austria, and Spain. We have Japan launching either at the end of this year or early next year.
So the international component of our business, which is about 1% of our total business now, we think that becomes a really nice, you know, contributor to growth over the you know, short to midterm and then certainly long-term as well. You think about MCT coming in the back half of 2025 being a nice contributor to growth.
As Dan mentioned, 7% of our, or around 7% of our total volume comes through that channel. And whereas 70%, we have share of 7%, 70% share, in the long-term ECG. So, you know, us just making nice progress is gonna be a huge contributing, contributor to growth over time. And then, you know, you talk about PCPs continue to be a larger percentage of the total, and I know we'll talk more about that in the coming questions as well. Epic Aura, there's a lot of different contributors that are gonna play through, and frankly, 2025's setting up to be a really nice year for us, as we continue to see beyond growth of just what the market's happening, but our new product portfolio as well.
Maybe, maybe just on PCP, what percentage of revenue or growth is that right now?
Yeah. So we put out there about 21% of our total registration volume in 2023 came through the primary care channel. And what we've said is it's growing north of that of the rest of the business. So it's becoming a larger and larger percentage of our total. And it's contributing nicely to growth, certainly in the first quarter of 2024, and we expect that to continue in the back half of the year as well.
Maybe elaborate a little bit more on the partnerships there, Signify, Epic, you know, what have you seen? What's still out in front of you? How should we think of, you know, how should we size the incremental revenue opportunities from those collaborations?
Yeah. I can start. So, two partnerships we're very, very excited about, maybe starting with Signify. We're in a pilot phase now. The exciting thing about Signify is, you know, they are really an enterprise network of primary care physicians or in-home clinicians, and they are taking Zio into, you know, the patient's home. They serve, we believe, three million patients per year.
A good number of those are candidates for Zio. What they are doing is actually, you know, proactive monitoring. So these are not patients that are having symptoms going into the clinician, and getting prescribed Zio. They are proactively identifying patients that are at moderate to high risk of undiagnosed arrhythmias and proactively prescribing Zio. So we're really excited about that. We're in a pilot phase.
We believe they have intentions of taking that into a commercial program, and we are seeing good results in the initial phases of the pilot. We have factored in the pilot in our guidance in 2024. We're holding back in terms of building anything else. We wanna see how the pilot progresses through the year and kind of what that phase of commercial launch may look like if we ultimately get there. Epic Aura is another very exciting partnership.
And kind of both of these are kind of represent a model, a selling model of one to many. So we're selling into these institutions, and they're helping drive, you know, Zio volume down through their networks. And Epic Aura is similar in that way. We've talked about EHR integrations and how important that is to our business.
Integrating into the workflows of our clinicians is a key, really a competitive advantage. We see volumes increase when we get an account that has been an account or a customer for years. When they turn on EHR integration, we see that volume tick up nicely.
Can you quantify that, even if anecdotally?
I don't think we've ever quantified it, but it is notable. It is an inflection point when they get EHR integrated, which makes sense. They, you know, oftentimes will open an account through cardiology or electrophysiology. They're the clinical champion. They adopt it, you know, throughout their department. When you turn on EHR integration, every physician in that, you know, in that account, in that network now has access to Zio, and it's integrated very clearly into their workflows.
Has that led to share capture, or is that driving market expansion, or is it a combination?
That's a good question. I would, I would probably say a combination.
I think it's definitely a combination, Rich. And the other thing is the stickiness of the business. Once it's EHR integrated, it becomes incredibly sticky. I don't know that there's more than, you know, two or three accounts that we've lost since we've integrated. So that's where the contribution of the existing account growth comes from. And we talk about that each and every quarter where how much of our growth is coming from new accounts and how much is coming from existing accounts. And you've seen that existing account growth becoming significant over the last several quarters. And I think a lot of that is because the EHR is there, and it becomes easier for them, and frankly, they stick around.
Yep.
And maybe back to Epic Aura to bring it back full circle. So each of our EHR integrations today are one-off integrations, which require resources on our side, but also resources on the account side. And it's, you know, you're competing against a number of priorities in their IT departments. And sometimes these integrations can, you know, take months.
With Epic Aura, we're essentially integrating with Epic, their new, you know, cloud-based solution, Aura, which will then be, as that is adopted by accounts, Zio is essentially automatically integrated. So kind of a, we like to say kind of a backdoor way to access accounts. You know, obviously we're going through the front door today with our sales reps, but Epic Aura provides another, another point of access to customers.
And then the MCT. Can you talk a little bit about, you know, how that differs from AT and why and where that's gonna provide you the incremental share capture opportunity once that's live, hopefully next year?
Yep. Yeah. So, we expect to put that on file, Zio MCT on file with the FDA, by the end of this year, guiding to second half 2025 commercial launch for Zio MCT. Zio MCT will be a meaningful, you know, really step change from Zio AT. First on the form factor, that'll move, from our old form factor Zio AT to our new form factor, which is the same form factor that Zio Monitor is. and that's, that form factor is 72% smaller relative to XT and AT, 55% lighter, and an improved, more breathable adhesive.
So a better, better patient experience. I would, I'd like to make the point XT and AT are already best in class from a form factor standpoint. So this isn't necessarily closing a competitive gap. It's really raising the bar on ourselves from, from a form factor standpoint.
The other aspects of Zio MCT relative to Zio AT will move from 14 days of wear to 21 days of wear at launch and look for opportunities to extend that, beyond 21 days. There are some clinicians that believe MCT needs to be a 30-day or a close to 30-day experience. We can serve that with essentially two Zio ATs today, but it's a bit of a, a clunky process. So 21 days will really start to address, you know, that group of clinicians that's looking for a longer.