Okay. Thanks everyone for being here. Hope you guys had a good lunch. My name is Allen Gong. I'm on the medical supplies and devices team here at JP Morgan. I'm really pleased to be introducing members of the iRhythm management team. We're gonna be starting off with prepared remarks from CEO Quentin Blackford, and then opening up for Q&A afterwards.
Terrific. Thanks for having me, good afternoon, everybody. It's great to be here. Just a quick reminder as we get started, I am gonna be making some forward-looking statements over the course of this presentation. I'd refer you to our annual filings, 10-K, 2Q, 10-Q for any further information that you might be looking for there. iRhythm is a company that's focused on disrupting the way cardiac arrhythmias are being detected in the marketplace today. You think about the traditional Holter monitor, it's been in the marketplace for decades, hasn't been innovated, transformed in any significant way. We are doing that with our product offering today. Today, we've now served more than 5 million patients over the history of the company, we have about 25% of the long-term cardiac monitoring representing the overall ACM marketplace.
A tremendous amount of runway continues to exist in the marketplace with respect to utilization of the device. Ultimately, I believe you're gonna see 75%-80% of this market utilizing some sort of patch-based monitoring. When we say that we're the best in the class in terms of long-term cardiac monitoring, it's not just simply iRhythm that's making that claim. There's more than 35 peer-reviewed publications that now stand behind the power of our product offering. Really what makes us unique and differentiated is the more than 1 billion hours of heartbeat data that power the algorithms and the deep learning capabilities in our algorithms that set us apart.
That's resulted in a situation where we've now delivered a CAGR of more than 30% from a revenue perspective over the last five years, and we now serve about 1.5 million patients on an annual basis that's growing at a pretty significant clip. We are intent on taking this disruptive technology beyond just the U.S. that we focused on historically and moving it into the international markets. There's about a 5 million ACM market or ambulatory cardiac monitoring market in countries that are on our roadmap that are prescribing testing like Holter monitors today. We believe we can disrupt that. I'll talk a little bit about how we plan to move into it, but we are globalizing the company. When you think about our product today, the platform really consists of three aspects.
There's a differentiated hardware, sort of wearable patient experience really tied into that. What really sets the company apart is the differentiated AI capability. When you hear companies talk about artificial intelligence, you hear a lot of them talk about expert rule capabilities or machine learning capabilities. We have spent a tremendous amount of time from the inception of the company building out a true deep neural network capability that powers our algorithms and our product. Today, we're on the second generation of that algorithm, working on the third generation that we'll bring to market into the future. In addition to that, we value the way that we show up and interact with our physicians, our customers, our patients. The digital platform that we've built out is incredibly easy to use.
The report that we offer into the marketplace is something that we continue to get high praise around and continues to set us apart. When we think about the market that we serve today, historically, the company's predominantly been focused on the symptomatic arrhythmia market in the United States. The prevalence of arrhythmias is about 11 million patients being prescribed, and the consequences associated with these arrhythmias are significant, AFib in particular. The reality is, if you're over the age of 55, there's a 40% chance that you're gonna experience AFib in your lifetime. If you do get diagnosed with AFib, the risk of stroke is nearly five times that of an individual who is not. The significance of it is meaningful, and the cost consequences are significant as well.
More than $30 billion being spent in our healthcare system on stroke alone that we believe we have the opportunity to impact. Our belief is that the market that we serve today, frankly, is gonna transform significantly over the next several years. Today, we serve a market of about 5.6 million ACM tests being prescribed in the U.S. each and every year. Again, predominantly Holter monitors. About 25% of that number is long-term patches. When you look at the opportunity, though, it starts to look very different when you get into the data. If you look at the primary care space alone in the United States, there's nearly 14 million folks that are seeing a primary care physician each and every year with cardiac-specific palpitations identified in their medical records.
We believe there's an opportunity to be monitoring that population, and we're seeing that take place in the business as we speak. We've had several quarters after quarter of record numbers of new account openings that's being driven by movement into the primary care space. In addition, there's a significant prevalence of patients who have no idea that they have these dangerous arrhythmias, that they exist at all. They're asymptomatic, they're undiagnosed. I'll talk more about what we're doing to opening up opportunities to begin to monitor that population, but you can see from the numbers, the addressable market is well beyond how we think about those devices or those tests that are being prescribed each and every day today in the U.S. We think about opportunities beyond that. Similar to what's in the U.S., I believe the opportunity exists internationally.
We're just scratching the surface with that opportunity. We do a bit of business in the UK. We're focused on building that out. We've got a roadmap in place that would open up an opportunity for another 5 million ACM tests that are being prescribed today, the majority of which is Holter monitors in these international locations that we think can be disrupted just like what we're doing in the States here. Moving beyond arrhythmias, there's a tremendous amount of overlap with sleep disease and cardiac arrhythmias. I'll talk more about what we're doing to enter into that space, nearly 40 million people diagnosed in the US alone with sleep apnea, I think there's a significant prevalence of arrhythmias, dangerous arrhythmias that we can find in that population.
Heart failure is no different, that the greatest opportunity to impact heart failure is to monitor and prolong the progression of that disease. We can do that with our device. Similar, the overlap of hypertension and arrhythmias is meaningful, and we have teams dedicated to exploring ways to open up that market. More than 160 million people diagnosed with hypertension that we think open up a really interesting opportunity for us. Of course, being able to do that requires an innovation focus, and one of the things we've been really focused on in the organization is really transforming our way of thinking to be much more innovative and sort of increasing the cadence of innovation with products into the marketplace. I'm super excited by the launch of our Zio monitor that will come into the marketplace here in 2023.
We're currently in limited market evaluation with that device as we speak that will roll into a limited commercial launch in the mid part of the year onto a full commercial launch in the back part of the year. I think this has the opportunity to be the single largest launch in the history of the company, and I'll talk more about how it's differentiated in just a slide or two. Similarly, we've done a lot of work around our Zio AT offering. We have an offering in the MCT space today. There's a few competitive gaps with it that we're focused on closing. We've completely revamped how we think about that product. We will file with the FDA from a regulatory perspective for approval of that product here in 23 and hope to bring that product to market in 2024.
Similarly, we got approval from an FDA perspective with our Zio Watch. Very excited by what this has the opportunity to do and disrupt this space, both from an asymptomatic opportunity, but also going right at longer-term monitoring. ILRs, for example, nearly 70% of all folks who are recommended to have an ILR will not take it for either cost reasons or don't wanna have an implant. We believe there are opportunities to monitor for longer duration with a product like a watch that's been developed and now approved by the FDA. We will have this in the market in limited commercial trials over the course of 2023 and look to expand that in 2024.
We're launching our Know Your Rhythm program, which is a program designed to go right after that asymptomatic space, the 12 million patients who have no idea that they might have a dangerous arrhythmia. One of the things that's held folks back historically from a payer perspective is not wanting to pay to put the device on a broad population where you don't know whether or not you're gonna find the arrhythmia. The mSToPS data that's out there, the GUARD-AF trial data that's out there would indicate that we can find this in highly targeted populations, and we're putting programs in place that make it very attractive to the payers where we at iRhythm are taking on the risk, and then their economic transaction would take place when we diagnose it, where basically we're taking the risk ourselves.
In addition, we'll launch into three new countries in 2023. I'll talk about more who those are or what we're targeting there, and look forward to where that has the potential to go. With respect to the Zio monitor, this first device is our existing product that we utilize today. It's been a terrific product, best in class, far and away. Again, 70% of long-term ambulatory cardiac monitoring utilizes this device. Our new product brings with it significant improvements. You can see the outline of the old product relative to the new product and just how much we've been able to innovate and reduce the size. Again, this has been approved by the FDA. We're in limited market release in the U.S. as we speak.
When we look at some of the data points around it, 72% smaller than the existing product, 55% lighter than the existing product, and 20% thinner. The early feedback we're getting with our trials in the marketplace are significant from a patient experience perspective, but also from a return device rate perspective, which has a direct impact on our revenue. We're incredibly encouraged by what we're seeing here and excited to get this into the marketplace. I also think with a product like this, it begins to really open up the possibilities to go broader than what we have historically, given how easy it is to use the product and to apply the product, particularly in a Home Enrollment sort of experience.
When we look at the primary care segment of the market today, there's 213 million folks over the age of 20 that are insured in the U.S. marketplace. Of those, there's about 200 million unique primary care physician visits taking place every single year. Within that population, nearly 16% of those individuals have a prevalence of heart palpitations being recorded in their medical records. Some of those are driven by things like anxiety or stress, medications, it could be pregnancy. When you strip those sort of things out and you get to the very specific cardiac-related palpitations, there's 14 million patients in the U.S. that have these identified in their medical records.
We believe we ought to be monitoring more along the lines of that population. This is why we are confident that you're gonna see this overall market expand from the $5.6 million ACM tests prescribed each and every year to something closer to that $14 million patient opportunity in time. We've talked a lot about our focus on the primary care space. Three out of the four quarters in 2022 represented record levels of new account openings, which are really being fueled by the primary care physicians' uptake of the product. We're also pleased to announce that here late in the fourth quarter, we entered into a nationwide agreement with One Medical to begin distributing the product through their channels, one of the largest PCP channels out there in the States.
Incredibly excited by the value that they see in the product and where this has the potential to go. We also entered into an agreement with another top 10 primary care physician group in the fourth quarter. I won't disclose who that is for other reasons, but certainly excited by what we're seeing in the uptake of the product in the primary care physician space. When you're going broader, one of the most important things that we need to be mindful of is access to the product. We don't want to create a tremendous amount of awareness around the product and then have patients not be able to get onto the device. We are now at nearly 100% of all commercial lives in the U.S. having access to our product.
Within that group, 93% of all patients will be able to get onto our Zio XT product without having to go through a prior auth required at all or any step therapy. It's very easy now for patients to get onto the device. We're also mindful of the cost, though, as we go to these broader populations. 70% of our commercial patients will be able to come onto our device or utilize our device with a cost of less than $50 out of pocket. Just over 25% of the total population will pay nothing at all in terms of being able to eliminate the copay.
We're making this very affordable, and it's very important as we go into the primary care space, but also as we start to go direct to patients and create awareness that they have access to the device, and we've accomplished quite a bit from a commercial lives perspective. We also were very happy in 2022 to finally get a national rate put in place from a CMS perspective. We're excited by the potential that that has to offer now in terms of clearing sort of what has been a headwind for the company historically, but also for the marketplace. I think it removes questions around, is the product covered? Is it not? Now it's very clear, and I think it becomes a nice tailwind for us into the future. In addition to that, it allows us to now start to go after the Medicaid opportunity.
Historically, it's been very hard to have discussions around Medicaid without having a CMS national rate put in place. Having that in place opens up a significant opportunity to continue to grow the potential patient population that we can address with our product. International, another area of significant importance to us. I spoke about the fact that we've put teams in place to really increase our focus here. To date, we do business in the U.K. It's a very small part of our overall portfolio. The product, again, the value of the product is being realized in the local market. Having NICE get behind the product and make a formal recommendation for it was significant. We had through NHS an AI award that we were operating as we brought this into the country as well.
Now it's about getting formal public reimbursement put in place with NHS. That is what we're working on. It's a market of nearly 500,000 ACM tests being prescribed each and every year in that market. Again, traditionally the Holter monitor, which we think will move towards a long-term patch sort of product offering. Beyond that, we have CE mark approval. We've got several countries have identified on our roadmap that you should expect to hear us talk about selling into in the back part of this year. Countries like Switzerland, Spain, Sweden, Netherlands, Germany, and France are certainly our first priorities. It'll be a dual sort of effort. We'll go into the private sectors of some of these countries while we work on getting public reimbursement put in place.
Other countries, it's a bit of an easier pathway from a public reimbursement perspective where we can go more direct into that public sector. Again, 1.8 million ACM tests being prescribed in these countries today that will begin to open up an opportunity to address in the not-too-distant future. We'll get on file here shortly for Shonin approval or regulatory approval in Japan, the second-largest ACM market in the world, with the desire or hopes that we would see our product approved and selling into that market in the back part of 2024. I talk about Know Your Rhythm, our opportunity to get into the asymptomatic population, the 12 million patients in the US. Again, this is a program designed really to go at the at-risk entities who are managing broader populations of folks who are at dangerous risk of an arrhythmia.
Going directly at the payers, if you will. We've made great progress with this. We got our first term sheet signed in the fourth quarter. We expect to launch into these pilots in the first part of this year. You should expect to hear more term sheets getting signed and more pilots getting launched. We're excited by what this has the potential to demonstrate in terms of the value of monitoring broader populations. We look at the cost-effectiveness data that came out of the mSToPS study, it's quite compelling. You look at it, we demonstrated through mSToPS that there was a cost-effectiveness ratio per quality-adjusted life year gained of roughly $17,000 related to the Zio product in and of itself.
If you go back to 2021, the USPSTF made a recommendation to begin proactively screening for lung cancer with a cost-effectiveness ratio of $72,000, just more than $72,000. Payers generally, anything under $100,000 is viewed as attractive. Anything under $50,000 is viewed as highly valuable. We believe this has the opportunity to really move the needle when we think about getting the market to move towards this position of proactively monitoring properly targeted at-risk populations. Beyond Know Your Rhythm and the adjacent markets, we continue to focus on sleep apnea.
I think there are some very interesting things that we're finding off of the patch itself in the data that we have and the ECG data coupled with other parameters that give us a high degree of confidence of what we can do in terms of identifying when sleep apnea is present or not, getting on to the potential of classifying the severity of sleep apnea, even moving to the point where one day potentially diagnosing sleep apnea off of the device. We have teams focused on this. It's a significant market, larger than any other market that we're serving today, roughly 40 million people diagnosed with sleep apnea. We believe there's a significant opportunity to get into this space over time.
Similarly, heart failure, I spoke on this earlier. One of the greatest opportunities to impact heart failure is to monitor patients and delay the progression of the disease that's best done through a device like our own. Working on programs that we can put into the marketplace that can improve the quality of life for these folks and prolong the advancement of the disease. In hypertension, again, we think there's some really interesting things we can do off the existing patch with respect to hypertension that allow us to play in a, in a unique and different market. You should expect to hear more around this, I would say, in the mid part of the year, as we have teams focused on really understanding how far we can go in that particular space.
Before I wrap up, I wanted to spend just a moment talking about 2022 and highlighting some of the progress that we've made over the course of the year. We made great progress with respect to expanding the markets that we're in today. For the year, it was another record year of opening up new XT accounts. Again, I spoke about this earlier. Three of the four largest quarters in our history were recognized over the course of this year. We've made a significant move into primary care, continuing to open up that channel and validate that that's gonna be a real opportunity for us. We've also moved into private sector in the U.K. business, recently signing a deal with Circle Health, the largest private hospital group in the U.K., for utilization of the device.
Again, demonstrating that the value of the product is being understood and seen, getting into that first term sheet from a Know Your Rhythm program was very important to us and a significant step forward of getting the first pilot launched here in 2023. From an innovation perspective, we saw the clearance of our second-generation algorithm, which continues to advance our capabilities in this space. We've got our Zio monitor, again, super excited by what this has the potential to do now in the market in a limited release fashion and getting approval with the Zio Watch here over the course of the year, I think opens up new opportunities for us in the asymptomatic market, but also going right after spaces like ILR, and you see some of the other innovation advances that we made.
We've come a long way from a financial profile in terms of making improvements there. Getting the CMS national rate locked in was a significant accomplishment by the team. They did a wonderful job of navigating through this and ultimately getting us to this point in time. We're very happy with where that rate's got established, but it opens up so many other opportunities. I mentioned the Medicaid opportunity that comes behind this, certainly something that we're focused on. From a financial perspective, we're sitting in a very strong position. More than $200 million of cash sit on the balance sheet today. We've got a debt facility in place of roughly $75 million that we have access to. We have drawn on a bit of it, but the majority is there.
Finally, as we focus on operational efficiencies and operational excellence, we're making tremendous improvements in the overall financial profile of the company. This year alone, we'll deliver somewhere around 200 basis points of gross margin improvement. Our EBITDA profile will improve by about 800 basis points, and we've laid out the pathway to get to 15% EBITDA, adjusted EBITDA margins as we approach $1 billion. I think importantly, that's just a point in time. At $1 billion, I would expect we're still growing significantly around that 20% clip. Over time, I think there's every opportunity to see the company move to a mid-20s or better adjusted EBITDA profile that we'll talk more about as we get closer to it.
When you look into the financial profile today, we still have a significant amount of opportunities to drive leverage through the P&L. G&A in and of itself, for example, is roughly 50% of every revenue dollar. That's not SG&A, that's just simply G&A. We know that peers operate down in the mid-teens investing class situations. We aren't, you know, saying that we're gonna get to that level, but I do think in our long-range plan, we've laid out get into the mid-thirties, and then we can take it on from there. Tremendous opportunities for financial leverage without really impacting the innovation cycle of the company or the way we interact with our patients and our physicians and the experience that we deliver into the marketplace. With that, I'll leave you with this.
I think iRhythm is incredibly positioned in a unique way to do some really fascinating things. When you think about the future focus of healthcare, we have a product that's positioned really, really well to address many of the evolving aspects of it. The patient at the center of everything they do, we have that device that puts that information right there. The move towards a virtual care setting, we have a terrific Home Enrollment program that allows the virtual care setting to be taken advantage of. The power of AI and data is what powers this company overall. We're perfectly positioned with the deep learning algorithms that we've put in place and continue to innovate upon. We're expanding our existing markets.
I talk about taking the $5.5 million ACM tests, moving into primary care, and seeing that move closer to $14 million over our planning horizon. All the data points are sort of aligning in a way that demonstrates that's gonna be something we see and realize over the long-range planning horizon that we've laid out. Then getting into adjacent markets, many cases bigger than the existing markets that we serve today, is exciting to us. I think that creates an opportunity where you're gonna see the company continue to deliver outpaced revenue growth relative to the broader market, but also do it in a way that allows us to drive significant financial leverage as we get focused on being operationally excellent in how we run the company, which should deliver a meaningful improvement in that financial profile. Again, thank you for the time.
I appreciate it. Allen, I'd be happy to open it up for Q&A. I will say I've got Doug, our Chief Operating Officer, and Brice, our CFO, up here with me.
Okay. Thanks a lot, Quentin. Clearly, there's really a lot to talk about when it comes to the long-term growth opportunities, but unfortunately, I am gonna take a step back and kind of, you know, focus a little bit on the near term, right? Especially with the press release that you put out yesterday, kind of walking through some of the dynamics that you saw in fourth quarter, how things have kind of trended into early 2023. If you could just comment on that relative to your expectations. You know, it wasn't exactly a pre-announcement, but you did give us some color. How should we really be thinking about that relative to the expectations you set in third quarter?
Yeah, look, I think, you know, we were very pleased with the fourth quarter performance of the company. We identified coming out of the third quarter on that call some of the challenges that we were seeing in the business, one of those being, we had to introduce a field advisory notice around our Zio AT product, which required us to be handing an advisory notice into every physician's hands as we were describing that product. We got our packaging and labeling updated that eliminates the need to do that, it did create a near-term challenge for us. We're happy that we executed on getting that completed. Now, we need to see that growth rate rebound in that business. We had been growing that business right around 50%.
In the fourth quarter, we grew at around 30%, which was impacted by this action. I think we can get that back into that 50% range over time, but we need to see it show up in the results before we're gonna come out and speak to it being completely remedied. With respect to the return device rate, we saw a bit of a challenge there at the end of the third quarter. The team's made terrific progress in getting that return device rate closer to being in line with our historic averages. We're not all the way back. We were in line with our expectations for the quarter, which again, we were happy with, but there's a bit of room to go to get it all the way back.
When you think about 2023, I think that's another one that we need to see play out early on. I believe we'll see that come back in line with this historic rate. Good progress from that perspective. In terms of opening up new accounts, if you recall, we had some new accounts that had deferred opening up over the course of the quarter. We saw great progress there in the fourth quarter. There was a couple that slipped into the very early part of this year, but all in all, we made great progress from that perspective. You know, when I think about the long term and sort of the expectation we've set out there growing at 20%, I think absolutely that is possible for the company.
I do think we wanna see AT return to those historic growth rates and get that return device rate back in line with historic averages. We're gonna see that play out before we get ahead of ourselves, but incredibly bullish on the future of the company and where we're going and the progress we made in the fourth quarter.
Diving a little bit deeper into that, but, you know, the one number that you did give us was this patient registration number, where you highlighted that it grew, you know, in excess of 20%. When we look at, you know, your third quarter commentary, that was the same, you know, I think patient registration in third quarter was on 22%.
Right.
You know, it seems like it was roughly flattish, but I don't believe that's, you know, that doesn't exactly translate straight into volumes, correct? If you could just explain, like, how should we think about that patient registration number when it comes to, you know, the modeling and just what it implies for your growth?
You know, we grew patient registrations 22% in the third quarter, which was a significant acceleration coming off of how we had grown patient registrations in the first half of the year. We saw great momentum in the business. That continued into the fourth quarter, being north of 20%, despite the fact that we really didn't get the contribution in the AT business like we had in that third quarter, right? The XT business continued to do incredibly well. Obviously, the AT business slowing a bit as we worked through that field advisory notice had a bit of a drag on that number. Overall, north of 20%, you know, in line, if not slightly better than the expectations that we had played out.
The return device rate not being all the way back to historic averages, you know, that does create a bit of a headwind when you look at the growth year-over-year. We had contemplated that in the expectation we laid out in our guidance. Relative to the expectation we had in guidance, we were actually a bit better than what we had put together there. Feel good about the momentum in the business, the progress being made around some of those challenges. I think the team's done a wonderful job getting their arms wrapped around it, to be honest with you.
I think, you know, it's pretty fair to say that one of the really big wins for you know, kind of outside of the operational side of things for 2022 was really finally, you know, knock on wood, putting CMS reimbursement behind you. When we think about the finalized rate that we saw in November versus the one that had been proposed earlier in the year, it seems like it came in, you know, modestly better, I think a couple percentage points better than initially proposed. Your, you know, your official release said that you were basically expecting more of like a neutral impact to previous expectations. Why is that the case? Especially when we also have, you know, some tailwinds from PAYGO as well on top of that.
Well, when we gave sort of that forward-looking statement around the average selling price for CMS over the course of the year, and keep in mind, you got mixed benefits that are taking place from the beginning of the year as we process more through San Francisco over the course of the year, right? We'll start out with predominant amount of volume coming through Chicago and Houston, and over time, as we build out the resource abilities in San Francisco, we'll be processing through there. That has an impact on the overall rate. What we said was the average rate for planning in 2023 ought to be around that $250 ASP for CMS. That's about on average what we processed through in 2022. Year-over-year, we said it was gonna be relatively neutral.
You raise a great point. You know, the sequestration and the PAYGO decisions, that actually will provide a bit of a tailwind, probably about 5% to that rate is how you ought to think about it. That is gonna be a benefit for us, relative to the initial expectations that we had laid out.
Kind of looking at, you know, the, I guess, the 20% number that, you know, when we look at your LRP, that basically implied from 2022 to 2027, roughly a 20% growth rate. You talked about how you're obviously, you know, not ready to comment 2023 yet. There's more that you need to see, we fully respect that. When we think about just the trajectory of growth beyond that, you know, it definitely feels like you're in a bit of a unique situation where you think that growth would normally start off high and then, you know, the denominator gets bigger, that would slow down. You have so many kind of growth drivers coming on tap over the course of the out years. How should we really think about, you know, the cadence of growth?
Should we think about that as being relatively measured over the LRP because you kind of have this, like, cadence of new catalysts coming online?
That is the way that we think about it. When we look at the opportunity for growth, there's no question in my mind that long-term patching is gonna become the standard of care in this ACM market, which is gonna continue to drive nice growth for us in the XT business. I do think that that probably slows over that planning horizon. What's happening is that's being offset by contributions from international markets, for example, getting into the three additional markets towards the back part of this year, seeing that begin to contribute in 2024, and then even more so into 2025. That offsets any slowing in the bigger market that we're addressing today. Then you think about beyond international, the AT product. We have about 5% share in the MCT space with our AT product.
I think with the new product submission that we will put forward in 2023, we significantly cover the competitive gaps that our product has today. Our product today monitors for 14 days in a space that physicians wanna see monitoring up to 30 days. We will close that gap with the next iteration of the product. Having a downgradable capability is something that's very important in that product aspect. With respect to MCT, you're monitoring some of the most at-risk patients, and nearly 70% of all patients require, their payers require a prior authorization for reimbursement of that device. A lot of times, patients won't find out until a day or two into wearing the device whether or not they're gonna be covered.
In our situation, if they're denied, we have no solution other than to remove the device, and we can't monitor that patient. In a downgradable capability, you now offer other solutions. You remove the obstacle of adoption of the technology in the marketplace. I think you're gonna see us move the 5% market share in AT to something closer to XT over time, which again, is gonna become a nice benefit to overall growth, which offsets, say, some of the slowing in maybe the bigger, broader market that we're in with XT. That is all that's been contemplated in that long-range plan. What we have not factored into the long-range plan in that 20% growth objective is progress being made in our Know Your Rhythm program, so getting after the asymptomatic opportunity.
As we open that up, I think that has the opportunity to be incremental to the long-range plan that we put out there in that 20% growth figure. If we can open up some really interesting opportunities around sleep, and how we utilize the device to better identify who ought to be maybe tested for sleep apnea or not, or even getting onto a true diagnostic, that becomes incremental as well. You have your other adjacent markets also that become additive to that growth profile. I think about it much more linearly than I do sort of starting off high coming down, just given those tailwinds that are sitting out there in front of the company.
Got it.
Just to follow up-
Oh, sorry. Could you wait for the microphone? Oh, sorry.
Just to follow up on that. I thought I heard you say at the beginning of the presentation that you thought that 75% of people in the US could benefit from ACM testing. Did I hear that right?
No, no. No. That 70% comment was specific to how much market share we have in the long-term cardiac monitoring space.
Okay.
If I misled you.
No, no, that's okay. I just misheard you. What do you think the correct % may be? Is it that buildup that you shared earlier in terms of total benefit or patients that could benefit from ACM testing in the U.S.?
I think it's. If you have my clicker, I can slide back a bit. You go to the primary care channel, which is where a patient's first seen. The fact that there's 14 million folks showing up-
$14 million. Okay.
...in that channel right now with cardiac specific palpitations, in my mind, we ought to be monitoring that. There's a question I believe of in that 14 million, before you get there. Right? There's 32 million folks who have heart palpitations identified, but that might be driven by medication or other causes. I'm not arguing that you wanna go all the way and monitor that entire population, but there's probably an argument that somewhere between 14 million and 32 million folks in the U.S. alone we ought to be monitoring. That to me is the real opportunity with this patch-based technology.
Considering how easy it is, it's perfectly positioned for the primary care space because you don't need to apply the device in the office.
Yeah.
We can send it directly home, have it applied there, have a report emailed or right through Zio Suite, put right in front of the physician and make the diagnosis.
Yeah.
Quentin, nice job. Uday. It's a nice company you built. You alluded several times, Quentin, to the possibility of monitoring heart failure patients. It's pretty hard to do with a patch. Do you have some other idea in mind than using patch technology for heart failure because you'd be the first to-
I think without getting into the too much of it for competitive reasons, I think it goes beyond patch, also into programmatic approaches that we're exploring. It's early on. Probably requires partnering in this space, but I think there are some interesting things that can do there.
Quentin, you mentioned seven out of 10 patients who get offered an ILR don't end up getting implanted. What happens to those patients today? What's the standard of care for those patients today, and how does iRhythm meet those patients with what possibly next year in AT offering?
I think it is products like AT can be utilized in that space, and repeated patching can be utilized. In many cases, they probably go without being monitored, right? That's where I think the watch can have some real opportunity. You think about on average, an ILR, you know, $5,000-$7,000 to have that take place. A watch, there's so much opportunity in there. You know, do you monitor more than 30 days? Do you monitor for three months, six months, one year? There's all sort of flexibility with the model. I think the challenge for us and why we're a bit hesitant on baking sort of revenue contribution in from the watch until we put comments out 2025. It's more on the reimbursement side.
We probably could approach reimbursement under the event monitor code sooner. I'm not sure that's really attractive to us, frankly, for what value we're delivering. You're also not gonna go under the ILR code, which means you're gonna have to work with payers to create a space there to get reimbursed appropriately.
Just a quick question. The patients who has actually already installed ICDs, after installing this particular patch, will there be no interference of data between both of them?
Yeah, there hasn't been proven to or shown any interference of the data.
Okay.
Yeah.
Thanks.
Got it. You kind of touched upon, you know, the competitive landscape on the AT side a bit already and how, you know, you're planning to kind of catch up a bit or at least narrow the gap between yourself and the competition with a unified platform. I guess, you know, one area of the story that, you know, has kind of taken, continue to take a back seat for you is really competition on the XT side. You know, there's a lot of noise over the last few years about, you know, private companies coming onto the market with their own patch monitors, with their own algorithms, with their own service models. Some of them were eventually acquired by larger competitors. We haven't really seen that impacting your growth so far, but what kind of information can you give us on the competitive landscape?
Is there a point where you think that will become a, you know, more important part of the story for you guys?
I absolutely believe there will be a point in time where that does become the case. I think what you're seeing right now, and we welcome this into the marketplace, is some of these competitors getting into the hands of a bigger player, in many ways creates opportunity because it creates tremendous awareness around the value of this product offering. As you create awareness or the rising tide lifts all boats, we're all benefiting from it together. I do believe iRhythm alone is not gonna be the only company who has success here in this space. As you get to 75%, 80% of the market utilizing the technology, at that point, it becomes much more sort of hand-to-hand combat in terms of who's gonna use the best product, the best solution, and you have to be able to sell against that.
We're not at that point today. Like, we absolutely run up against opportunities in the market where we're competing for competitive accounts, but the vast majority of folks are coming onto the technology switching from a Holter monitor. That's the value proposition we're selling against right now. In time, I do think it becomes more competitive, but I think there's a ton of runway here that ourselves along with others are gonna enjoy the benefit of seeing the market kinda move towards a better way of monitoring.
Got it. I think with that, we are all out of time. Thank you guys so much.
Thanks. Appreciate it.