Not a tone, though.
Okay.
Thank you, both of you, for being here, and really looking forward to the discussion. Anyone in the audience has questions, please feel free to raise your hand. We'll try to get your question in. I'm going to direct this to both of you, but maybe, you know, Joe, any initial comments to start us off? Timing of the kind of the reign pass? Why don't we just start there, and then we can get into the business?
Certainly. I am excited because I am retiring at the end of October. Payman will be taking over as CEO at the end of October. I think most investors probably know Payman. You certainly know the results of what he has done during his time at Integer running the cardiovascular business since early 2018. Three of our four targeted growth markets are in cardiovascular. All of our acquisitions have been underneath Payman's business. I believe, and the board believes, he is already now CEO. The six months that we have during this transition are to get Payman exposed to the public company CEO activities like these meetings. I have been trying to shield him from those activities so he can focus on driving sales and profit growth and taking care of customers. He will now have to spend a little bit of time doing other things like that, but excited for that.
I'll be around until the end of March as an advisor or consultant for anything that Payman and the board and the company might need.
Great. Payman, anything that you've been obviously part of the formation of the firm's goals and strategy, and so this is almost like a question I'm setting you up for, but anything that you envision doing differently, anything about the targets, goals, strategy that you think can be improved or not, or however you'd like to answer that question?
Yeah, great question, and good to meet all of you. It's good to be here. Look, as you kind of alluded to, I've been part of the team, the leadership team at Integer, you know, for quite some time. I joined Integer in early 2018, and I've been working with Joe and the rest of the leadership team to develop the strategy, develop and execute the strategy that we have in place. I believe in that strategy. I mean, you've seen the results of that strategy. It's working. We set out to really focus, you know, going back to 2017, 2018, really brought laser focus to those core markets that we want to be successful in and that where most of the innovation happens and that they're vibrant spaces. We created a structure that we call the growth teams.
You know, and these growth teams are a group of highly experienced and talented, you know, marketing, product management, R&D, and operational folks that really focus on those specific growth markets. They develop, refine, and execute the strategy. That has really allowed us to be very focused on those core markets. You know, the capabilities that we have built have allowed us to develop a very strong pipeline of products that we have been launching in recent years. That is what has really contributed to us being able to outgrow the market. You know, we said the target is to grow the market, that 200 bps , and we have been delivering that. I believe in the strategy, I very much intend to continue that just in terms of growth. For profitability, we said that we want to grow the rate of profit growth at 2x the sales growth.
That too is something that I believe in, and I believe as a target we can drive to and aspire to through the execution of what we call the Integer Production System. We obviously have made token acquisitions. You know, that's been part of our strategy. I very much plan to continue doing that. That's a core element of our strategy to continue building critical capabilities that then also drive and fuel the growth that we have, all the while staying within the leverage of 2.5x-3.5x that we've talked about.
Great. Maybe just to start us off on the business side a little bit more. You have a growth algorithm that's been working for you. Your end markets are, I think you said, 4%-6%, right? And you intend to and have been generally growing 200 basis points above those end markets. Can you just walk us through the subsegments, what's falling in the 4%-6%, and where kind of you have the most visibility over the next, call it, 12 months-24 months on your ability to grow above those end markets?
Sure. Maybe I'll start the high-level growth algorithm. What gives us confidence in our ability to outgrow the markets, which is our stated strategy, really is the strategy, the process, and the people. The strategy is to get designed into our customers' most important programs that are bringing innovative therapies to the marketplace to treat patients who are either untreated or undertreated. We are going where the innovation in the industry is, which is being defined by our customers and where they're innovating. Everything we do and everything the growth teams that Payman talked about are doing is to understand where is that innovation, where is their unmet patient need. Our customers are the ones defining that because they're the ones developing the therapy.
What we're doing is ensuring that we're identifying and building capabilities, vertically integrating them to be able to help our customers bring those therapies to the market and bring it to the market quickly so that they can get first-mover advantage. At a macro level, that's the strategy piece. The process piece is the growth team process that Payman talked about that didn't exist prior to 2017- 2018 timeframe. We weren't as clear and focused in our strategy of getting designed in, and we weren't as focused on the four targeted growth markets, which is something we did in 2017- 2018 timeframe. You've heard us talk about these: electrophysiology, structural heart, neurovascular, neuromodulation. Those are the fastest-growing markets where the industry is innovating the most. We're working to support and enable the industry holistically to bring those therapies to the marketplace.
Some evidence that we've used to track our progress in doing that is since 2017, we've increased the amount of development work we're doing for our customers by 270%. We've been updating investors every year in.
That's the PMA?
That is all the development work. Think of it as the revenues that we're generating from the customers are paying us to do development work to get designed into their products. That is a 270% increase in the amount of development work from 2017 to 2024. That was 2024 actual against 2017. 2017 is kind of the pre-strategy year. 2018 was the first year of the strategy implementation.
That's inclusive of, but not only the PMA?
Correct. It includes the emerging customer PMA, but it also includes everything else in the business. That's one measure. We think of it as kind of shots on goal or 270% more. There's a quality of those shots on goal. We measure that by what percent of that development work is being done in those faster-growing end markets where the innovation in the industry is occurring, and 80% of that development work is being done in markets that are growing above the market average. That's where we get inherent tailwinds based upon the products that we're getting designed into.
Interestingly too, you get to increase your exposure to the fastest-growing pieces of that, right? You know M&A has played a role in that, but so has your internal development. Maybe talk a little bit about how much control you have over the growth of the end markets that you're in, your [WAMGER]. And how should we think of your [WAMGER] increasing as a potential catalyst for growing?
Sure. Yeah, so we've modeled out the changing composition of our sales as we grow faster in these four targeted growth markets. The WAMGER absolutely does increase. Obviously, in any one year, the percentage change is small, but cumulatively over time, it does grow, and it increases the end market growth rates of that 4%-6% that we serve. As we continue to ensure those shots on goal are 80 %+ in those faster-growing markets, that just keeps compounding over time. That's what we started back in 2018. Everyone knows in this industry the development cycles can be long. You know, for maybe a 510(k) program, it can be three to five years; for a pre-market approval program, 5years-9years or even 10+ years from start to finish, which is why it's important that we started the strategy of getting designed in back in 2018.
We're now in year seven or eight of focusing on getting designed in, and we have a pipeline of programs that are coming into the marketplace that is the fuel for that sustained above-market growth.
Yeah. Maybe you can just tell us why you're particularly well-positioned in this, where you sit in the supply chain to pursue a kind of M&A strategy. You know, why are you uniquely positioned? It seems like a fragmented market still, and the cottage industry of more family-owned businesses to roll up. You know, is it as simple as that? What else can you tell us about why that M&A strategy is potentially you're uniquely positioned to execute?
Yeah, let me take that. Let me maybe just a little bit of a context, you know, about how we target M&A, right, and how do they come about. The acquisitions that we've made are all a direct result of the work that our growth teams have done. What our growth teams have been doing is that they've been identifying what are those critical capabilities that we need to be really successful in the four growth markets that we've identified. We take those capabilities and then go refine potential targets that could fit the criteria. Those are typically tokens, right? You know, we look at those specific capabilities. Now coming a little bit to your question, it takes time and it takes years to kind of foster those relationships with these.
These are, generally speaking, smaller businesses that have those critical capabilities, but they're founder-led. Your question was, what makes us unique? They see Integer as a company, just because of our track record, we made a lot of acquisitions throughout the years. They see Integer as a company that buys businesses and invests in them to grow them. You know, these are people that have put their blood, sweat, and tears in developing their businesses. They care about their employees. They care about the communities that they serve. They care about the success of the company in general. We do not buy companies and slash SG&A day one and try to get cost synergies. We obviously look for cost synergies, but we buy them so that we can get growth synergies and commercial synergies, right? You know, while we work on the operational.
This gives us a little bit of a unique advantage in that, you know, when we say, hey, we're going to invest in the businesses, there's some credibility there. Look, the acquisitions that we've made, including the two most recent ones at the beginning of the year, I mean, we've been talking to these companies, you know, one of them in particular for a better part of five, six years, right, just to foster those relationships. That all helps in the process.
Yep. That's helpful. Thank you, Payman. Maybe just digging deeper into the segment, C&V. That had a very impressive 11% organic growth rate, I think, in the first quarter. Would love to just hear you talk through a sustainable kind of that low to mid-teens growth rate that I think you've been talking about for this, the outlook for that business for some time. Can you just maybe build that up for us? I know electrophysiology is a big piece of it, but build that up for us.
Yeah, let me take that. C&V, three of the four growth markets that we have, electrophysiology, structural heart, and neurovascular, are in cardiovascular, you know, in the C&V business. We have been building a pipeline, as I mentioned earlier, in those segments. Let me just highlight something. We talked about this business growing at low double digits. You know, for us, that includes mid-double digits, mid-teens, excuse me. We clarified that, right, in a subsequent conversation that we had in April. We said that we believe the C&V business can grow at mid-teens this year, just to just kind of talk about the numbers in general. We have had a very strong presence in electrophysiology for many, many years, you know, long before PFA was a thing. We have participated not only in all the legacy ablation technologies, but also the whole procedure.
I mean, if you think about a typical procedure, I mean, you first have to access the body. You have to navigate it, you know, with guidewires and sheaths and transseptal crossings. And then you need mapping devices for diagnostics, and then the ablation itself. We participated across the procedure, and we have content at different levels with different leaders in the industry, anywhere from high-value components to sub-assemblies, in some cases, finished devices. When you think about EP in particular, what's happening in the industry with PFA, it's creating a lot of momentum in the industry, but also by extension to us, just because we've had such a strong presence in that industry for years. We believe that that is a contributor to, and that's a tailwind for us in terms of growth.
In structural heart and neurovascular, those are smaller businesses that we've been working on for years to build pipeline and capabilities. In structural heart, we are less indexed in TAVR, but we are more indexed towards mitral and tricuspid. Neurovascular is also another area where we see growth potential, and we've been building a lot of capabilities. Those two are smaller from smaller bases that are growing, you know, through our pipeline, and EP is a larger base that's also growing. It gives us tailwind.
On the EP side, obviously, PFA is the big new product category there. You know, I think over the years, there's been different levels of understanding of how you can tap into and benefit from that specifically. There's clearly an overall acceleration in the EP market, and you're benefiting from that. You say that you are and will continue to grow above the EP market. Can you talk to us a little bit about how you're exposed specifically to PFA, especially as we start to see more players coming into the market beyond Boston?
Yeah, let me take that as well. Without being specific, which I'm sure you understand, our OEM customers do not want us to talk about, or they do not want the market to know who is making the products for them. I'm sure you appreciate that. I'll be a little bit less specific. Given just maybe some statistics, you talk about the market growth in general. Some players in the industry, you know, have recently mentioned that they believe that the EP market in general, you know, can double in size over the next five years to $20 billion. That is a total addressable market for the OEM. Obviously, that creates a lot of momentum and tailwind. Just for a company like us that participates in that, that is incredibly helpful. Then talking about.
Can I? Sorry.
Of course.
I mean, that includes price, right? There's a certain component of.
That's a total, absolutely.
Where you potentially don't have the same kind of tap-in potential as your customers. I guess what you're saying is even still, there's more than price to double, right?
Yeah, absolutely. I mean, when the market is projected, at least according to some of these key OEMs, to double, of course, an element of that, but even if you take that out, I mean, there's a lot of momentum in this space. Obviously, that itself creates opportunity for us. Secondarily, just given the breadth of our capabilities and the level of vertical integration, this creates a unique competitive advantage to us to be able to participate with the largest OEMs, right, at a different level. Because we can manufacture a bigger part of their devices for them just because we're vertically integrated. We can make different components. You know, we can make sub-assemblies that are different manufacturing facilities. Instead of them having to deal with, say, two, three, four suppliers, they can just deal with one.
They are all looking to consolidate, you know, their supply base. Obviously, that gives us a competitive edge just because of our breadth, scale, capabilities, which is very important.
As we, you know, one of the things that struck me when I launched on coverage last year was just how you can participate in growth markets without being overly reliant on, you know, a specific player, right? PFA seems like it's just a great example of that. I know you're not going to say who or where you're specifically involved in the supply chain, but we're getting to a point now where there's going to be multiple players and everyone's going to effectively be there. Can we assume on some level, whether, you know, it's the sheath or some portion of the supply chain that you're involved with every major player in this growing category?
It's fair to say that we have broad participation with the key players in the industry across the procedure, yes.
Okay. That's a good rephrasing. Got it. And then as we kind of think about other, well, let me take a step back. PFA is one growth category. You mentioned a few others that are potentially in the early innings, like in structural heart, you have you're over-indexed to the faster growing emerging categories, tricuspid, mitral, a little bit less to TAVR. That actually is probably a good thing, right? Because that's a slower growing piece. Can you talk about, in a similar fashion, kind of how you are involved in the supply chains for those products? Is it a little bit more vertically integrated there than it is for PFA, or it's the same concept and you'll benefit more broadly from various pieces of supply chains across different companies?
It's more the latter. Let me explain. A key element of our strategy, as Joe talked about, has been to get designed in, right, early in the key products that our customers, you know, are talking about and they want to bring to market. In structural heart, you know, just maybe covering each individually, in structural heart, we have built, we have focused on over the past many years to build and work with, you know, some key industry players in helping them bring products to market faster. For example, I can talk about delivery systems. That's something that we've been focusing on in mitral and tricuspid. And we built capabilities on pipeline, you know, to be able to be successful there. It's obviously development cycles are very long, as you know very well. We believe that that mitral and tricuspid, you know, become more and more adopted.
You know, that gives us, you know, that gives us some tailwind. Neurovascular, obviously another fast-growing, we made an acquisition in this space in October of 2023, a company with the name of INNERCO . So they have deep design and manufacturing expertise in neurovascular, which is a very unique set of capabilities. If you think about just the size and the maneuverability needed, it's a very unique skill set and experience. That company has a lot of expertise, you know, specific therapies, which is ischemic stroke and intracranial aneurysm. Those are, you know, some fast-growing therapies. So there's expertise there. And they also have and manufacture, which is now part of our portfolio, both radial access catheters and also aspiration catheters. Those are things that now we have expertise in-house, which is complementary to the expertise that we have built ourselves, built ourselves.
We believe that we can continue making advances in that growing market.
CRM and Neuromod, those are growing, but they're kind of at the lower end of your divisional growth in the low to mid-single-digit rates. I guess, what can get that higher over time?
Cardiac rhythm management is a large, slower-growing segment. It's an important segment for us because we've been in it for decades, and the capabilities that we have there have proven the test of time. They're also the foundational capabilities that enable the neuromodulation capabilities that we have. The Neuromod is an emerging customer. PMA is where we're going to be able to accelerate the growth. Maybe pointing to a couple of things, we share at the end of every year the number of customers and programs that we're working on within the emerging PMA as we've defined it. We're at 39 different customers, different programs in one of the five stages as we've defined it of starting with development all the way through to commercialization. Contrast that with when we shared where we were in late 2020, we had 27 customers and products.
We've grown that 40 %+ in the last five years. Again, pointing back to the broader strategy of getting designed into our customers' innovation. What's unique in Neuromod for us is we have the underlying core technologies, whether it's battery speed through cases, the lead systems. We have that capability that we developed as part of serving the cardiac rhythm management, large established, slower-growing industry or marketplace. We're applying that now in a fully vertically integrated manner in neuromodulation. Most of the customers we're serving in our emerging PMA group, as we've defined it, they're single-product companies that are getting funding as they make progress on their development. We're helping them from the initial development stages through clinical, regulatory, and then the commercial launch. We can offer a fully vertically integrated on the implantable pulse generator and the lead system.
We can do the complete device for them if that is what they are looking for and if that is what they need. We feel like that is an area that is getting tremendous amounts of innovation and focus. It has been growing very strongly for us and nicely. We have laid that out since 2018. The outlook going forward, we think, is about 2x the underlying market growth.
I guess, you know, as we think of those 27 customers as the base five years ago, and then you've added, you know, more than 10 since then, you know, do we think of that PMA portfolio kind of starting to hit a sweet spot where all those projects kind of really start to kind of show up in the numbers, whether it's now, two years out, three years out, or is it really just layered? It's a steady, you know, it's a steady cadence from what we can see from the contribution from those. I know it's Neuromod heavy, so.
Yeah, so it's very specifically Neuromod. There's other pre-market approval activities in cardiovascular that we didn't put in that particular, the way we defined this back in 2020. Think of it as layers. Think of it as things come in over time because it's a funnel. We know that the 39 that are in the funnel now, all of them won't actually become products that commercialize in the marketplace. I'd have to go back and do the math, but it went from 27 to 39. There's more churn in there than just that 12 because there are some that fall out. There's others that come in. In the early development stages, when something doesn't prove out to be viable, then it drops off and there's other things that fill in.
Think of it as we've been building this pipeline, this funnel over time, and we expect to continue to grow it. For the therapies that truly do deliver differentiated outcomes for patients, they're going to get the funding and they're going to be brought to market. Our goal is to ensure that we're doing as much of that for those customers as we can. You know how sticky it is in this industry when you're starting with customers like this who are getting funding at each phase. Once they identify that they've got a viable product in a marketplace, they get all the funding they need, and then it's a race to commercialization. Our ability to support that ramp is also what we're investing to ensure we can do as we continue to grow that pipeline.
The short answer is it'll layer in over time based upon the success of those shots on goal.
You know, it deserves more than two minutes of remaining time here, but the margin of profitability is arguably one of the most impressive kind of parts of the story in my view. You know, your algorithm includes a 1.5x-2x kind of growth rate on the bottom line versus the top line. What are the key drivers of that leveraged growth, earnings growth, and, you know, anything that we should be thinking about in 2025 from a cadence standpoint as you walk through those drivers?
The biggest driver is we manufacture products, and so we have to be great at manufacturing products. You know, we spent most of the time here talking about innovation and talking about design and development and helping customers bring innovative new therapies to the market to treat patients who are untreated or undertreated. But we build products. And so we deliver great quality to our customers. They tell us that our quality is differentiated. That was one of our goals from the outset, on time, efficiently. And so we have to continue to improve in our manufacturing operations. We've built out what we call the Integer Production System. It's a lean manufacturing system that's leveraging tried and true improving manufacturing processes, building a culture of continuous improvement at all levels of the manufacturing plant.
We still see tremendous opportunities to improve yields in our manufacturing process that reduces the amount of material waste in our manufacturing processes, finding ways to continuously be more efficient with our direct labor utilization. There are opportunities in automation and collaborative robots. There are opportunities for us as we eliminate the paper flowing through our systems using ERP systems, manufacturing execution systems, MES systems that drive more efficiency. As we look at our manufacturing footprint, we continue to see significant opportunities. We think we've got a great manufacturing footprint that's co-located where customers want to do design and development side by side. Those tend to be higher labor cost environments. We've got a great footprint in lower labor cost environments where customers can take advantage of that lower cost and transfer products there when they're ready to.
Just on backlog, it's a question we sometimes get asked. I think you have $800 million in backlog, but you expect that to come down through the year. Just explain why and what, if anything, does this signal about future demand trends?
Sure. I would not think about book to bill as something that's relevant for us. It's not how to think about our backlog or our order book. We were about $300 million before the pandemic, and we're closer to $800 million now. We were at $728 million at the end of last year. What we said is we expect that to come down to around $600 million by year-end. Two primary factors: the exit of the portable medical business we had last time by orders that inflated the order book. We expect that to come down. We made a big investment in our Ireland facility that manufactures primarily guidewires. We had asked customers to place orders more than a year in advance so we could manage the allocation of that capacity. Now that that facility is up and running, we're not doing that.
We know those orders are going to come down in the backlog due to that. You should look at our backlog as an indication of we've got really good visibility to at least the next couple of quarters. Thinking about $700 million-$800 million of order book now, that's a couple of quarters' worth of sales. It gives us really good visibility for at least a couple of quarters. We're going to, even at $600 million, we're double where we were pre-pandemic.
Great. Thank you very much.
Great.
Thanks for having us.
Great to be here. Thank you.