Welcome everyone to Labcorp's 2023 Investor Day. My name is Christin O'Donnell. I am the Head of Investor Relations. Before we get started today, please note that presentations may include forward-looking statements. These forward-looking statements are subject to change based upon various factors, many of which are beyond our control. More information is included in our most recent annual report on Form 10-K and subsequent quarterly reports on Form 10-Q, and in the company's other filings with the SEC. We have a great agenda for today, so we'll kick it off with CEO and Chairman, Adam Schechter, talking about how we're poised for strong growth, followed by business reviews of Diagnostics, Laboratories, and Biopharma Laboratory Services . We'll have a short break. Following the break, we'll go into Science, Innovation, and Technology, and then a financial outlook, followed by some Q&A.
With that, I'd like to welcome you again and intro our CEO and Chairman, Adam Schechter.
Thank you, Christin.
Thank you.
Good to see you. Thanks, Christin, and good afternoon. For those of you joining us by webcast and for those of you in the room, it's really a pleasure to spend this afternoon with you. This is our first Investor Day since 2018, and it's time. We're excited about the future, we're excited about the opportunities before us, and we're excited to share with you where we see substantial growth opportunities. You see, we have members of our executive committee with us today. We also have several members of our leadership team. You'll get a good sense of the strength of leadership that we have and the deep bench of leaders that we have. And you'll see, we have significant, I believe, very significant, both short-term and long-term opportunities for growth that we'll be sharing with you.
But frankly, I'm excited about our long-term growth strategy because we are positioned so well, positioned as the global laboratory service leader. We have tremendous ability to operate with excellence, but frankly, it all starts with Labcorp's mission: to improve health and to improve lives. We do that by ensuring that our customers, whether they be consumers or patients, physicians, providers, biopharmaceutical companies, have accurate laboratory information so they can make better decisions about their health. Now, when I started as CEO in 2019, I began just before COVID. COVID occurred about 3 months after I started, and I got to see the mission in action. To see our scientists during COVID create so many innovative tests, to see our laboratory technicians working 24 hours a day in order to do as many tests with as fast a turnaround as we possibly could, was nothing short of remarkable.
I remember one day I was working in a laboratory because we asked for volunteers. We had so much work. We had over 3,000 people that volunteered to help in our laboratories. I was standing in the line, I was actually opening up Pixel boxes, and to my left was a sales rep from our biopharma services, biolaboratory services area that drove 2 hours to help with the laboratory. And to my right, was one of our heads of legal. To see people live the mission, you understand the passion that the organization has. In our biopharma laboratories, our central laboratory in China, when China locked down, we had to continue to do testing for clinical trials. We had several hundred laboratory employees live in the laboratory for months. We had to have people go in there to help cut their hair. We had barbers go in there.
We had to bring washers and dryers in there because literally, we had tents in the foyers of our laboratory so people could be there to meet the needs of their customers. We see every single day at Labcorp that people live the mission to help people improve health and improve lives. I think that's part of our secret sauce, part of what makes Labcorp so special. When you look at Labcorp, we are the largest laboratory provider in the world. We focus on science and innovation and technology in every single thing we do. Science is at the forefront of our thinking. Being at the forefront of science is the way in which we stay ahead of competition, and we continually look for new ways to innovate across our business. You're gonna hear a lot about the innovations that we have today.
We have two complementary businesses, and they provide substantial operating efficiencies. And we are scale. I mean, we have scale, not just in the United States and Canada, but we have scale in many markets around the world. In addition to that, our breadth is unparalleled. We have over 6,500 unique tests on our test menu. We perform more than 600 million tests per year. We have a database, a single database, with more than 45 billion lab results. We work with almost every large pharmaceutical company and just about every biopharmaceutical company as well. I think it comes from our strong scientific presence. As I mentioned before, we focus on science, technology, innovation. Every year, we have a significant number of scientific publications that our scientists are part of.
We have more than 50 years of laboratory service experience, and we're organized by our diagnostic laboratories, of which we have routine testing, and we also have our specialty testing or esoteric testing. Separate and distinct from that, we have our biopharmaceutical laboratory services business, and there's two parts to that, the early development research laboratories and our central laboratories. In each and every one of those segments, we are a market leader. Everywhere we compete, we are a market leader. We have an extraordinarily talented, diverse, and strong leadership team. We have members from the team that have spent a lot of their career in healthcare, a lot of them in the United States. We have members of our team that have been outside of the United States working, and they have been in other industries outside of healthcare. I continue to believe that talent is a differentiator.
When you are in a scientific business, your talent differentiates you. This is the team, this is the team that led us through COVID, and I think we did remarkable things during COVID. This is the team that enabled us to take 5,000 people from Ascension in more than 90 laboratories and hospitals and assimilate those into Labcorp in almost a seamless way. I believe that we have an extraordinary leadership team, and that this team will enable us to deliver our short-term and long-term objectives. But it's not just this team. We have greater than 60,000 employees around the world. We have more than 15,000 phlebotomists in the United States and Canada. We serve patients in more than 100 countries.
We have more than 1,200 PhDs and MDs, and as you can see in the bottom of this slide, we are recognized as a leader in employment by many different global organizations. We operate at scale, and I believe that that scale enables us to have significant global opportunities, and we have multiple tailwinds that are actually working in our favor. We see significant therapeutic advances in very complex diseases like cancer, Alzheimer's. We excel in those areas. We see increased detection and diagnosis at the earliest stages of disease. I believe that every country in the world is struggling, as healthcare costs are too high as a % of the GDP. Doesn't matter if it's the United States, if it's across Europe, if it's in China, Japan, they're struggling.
Earlier detection and diagnosis is a way to help reduce overall healthcare costs, and we're a big part of that. We see a significant acceleration in companion diagnostics, and I'm going to talk more about that in just a moment. There's no doubt that we're seeing more and more innovation in diagnostic testing in everything that we do. Each and every one of these tailwinds work in our favor. It works in our ability to use science, technology, and innovation to differentiate ourselves. Each of these areas, you have to have scientific excellence, operational excellence, and scale, and Labcorp has that. In addition to that, the trends are going to help lead to strong growth across our businesses. If you look at our diagnostic business today, it represents about 75% of our revenue.
If you look at our central laboratories, they represent about 18% of our revenue, and our early development research labs represent about 7% of our revenue. If you look at our longer-term expectations, we expect overall enterprise revenue growth of 5%-8%. Diagnostic laboratories, we expect to grow 2.5%-4.5%. Biopharmaceutical laboratory services, we expect to grow 4.5%-7.5%. And we continue to look for ways for inorganic growth, and we expect that to add 1.5%-2.5% of growth. These are all on a CAGR from 2023-2026. When you add all together, we'll have over $14 billion of revenue in 2026. Our roadmap to growth will lead to value creation and differentiation.
There are two very significant opportunities that I want to talk about that go across both Biopharma and Diagnostics. The first is to be the partner of choice for health systems and local or regional laboratories. The second is to develop, to license, and ultimately to scale specialty testing, including companion diagnostics. Let me start with partner of choice for health systems. I have never seen our pipeline for these types of deals as bright as it is today. We have more opportunities today than we've had, that I've ever seen since I've been CEO or on the board of Labcorp. It represents a tremendous opportunity for us. When I sit across the table from CEOs of hospitals and health systems, they continue to talk about how they're struggling to find ways to be profitable.
They look at us as a partner that can help them be profitable, and they see our expertise and realize that working together, we will be better than them trying to work alone. We continue to see hospital and health system consolidation, and I don't expect that to change. We have momentum. We have real momentum. We've closed 12 deals in the past three years. When I sit across from the hospital CEOs and I think, why do we differentiate ourselves? Why are we doing so well in this area? It's for multiple reasons. One, we have innovative product offerings. If you look at what we're doing in the high-growth specialty areas, many of these hospital systems want to be at the forefront of their offerings to their patients. They want to have the best, newest, latest specialty tests.
If you look at what we've done with PGDx in oncology or OmniSeq in oncology, it gets them excited to see that we can keep them current. Number two, we do have an industry-leading test portfolio, and we have a national presence, and as they expand and as they grow, they want to know their partner can be there for them no matter where they grow and how they expand. We have unique data and analytic systems. You're going to hear more later about some of our artificial intelligence capabilities. But most importantly, they want to know that we can integrate the hospital seamlessly. Their patients are our patients. If we do a good job with their patients, their system performs well.
They need to know that they can count on us, and when they see our track record of successful integrations, it really does make a significant difference. The second opportunity I'd like to talk about is specialty testing. As I already mentioned, they are interrelated a bit because specialty testing is important to the hospital systems. We're focused on four primary areas: oncology, women's health, autoimmune disease, and neurology. We believe that these four specialty areas represent significant growth, but also disproportionate growth. We expect that these four areas could grow 9% over the foreseeable future per year. The development of specialty tests and companion diagnostics makes us not only attractive partners to health systems, but also to biopharma.
As they continue to develop more products in higher specialty areas and in areas like cell and gene therapy that we'll talk about in a moment, they need to know that we can develop these important, difficult specialty tests. In fact, more than half of our clinical trials that we do in our central laboratories are in these four areas. Now, our geographic presence is truly differentiating for us because our biopharmaceutical companies want to know that when they do their clinical trials, we can recruit patients in 100 different countries, and that we can run the same laboratory tests in our laboratories around the world. I'm going to give you an example of how this all comes together using oncology. It all starts with great biology, chemistry, and science to identify new targets to help cure disease or treat disease. We can be part of that science.
Then you want to develop the tests or companion diagnostics that enables the pharmaceutical companies to find the right patients that the target will work on. We can do that. And in our early development research laboratories, working with our diagnostic laboratories, we are excellent at creating companion diagnostics and personalized medicine types of tests. Then we use our central laboratories to help perform the trials to see how these products work in clinical trials. Ultimately, when the product's approved, you want to make sure you have the tests available everywhere around the world, so patients can be identified to be treated. We can use our registry programs to help identify, are the right patients being treated?
So from the beginning, with the science to the companion diagnostics, to the central laboratory work in clinical trials, to having the diagnostic tests available in the marketplace, Labcorp is there, and Labcorp will meet our customer needs. In addition to those two shorter-term opportunities, there are additional opportunities for future growth in the long term. I'm only going to mention three of these. There's more, but these three, I believe, are the most important right now. Cell and gene therapy, consumerism or consumer-centric capabilities, utilizing our global network for targeted international expansion. We believe that these areas can represent significant growth in the future. Cell and gene therapy is an important emerging opportunity. There are more than 2,000 trials right now, more than 2,000 in cell and gene therapies globally.
If you look at pharmaceutical companies' pipeline, cell and gene therapy makes up about 20% of the pipelines and we believe that these areas will grow between 15% and 20% per year. What you will see in a few minutes is that we have strong scientific expertise and a fast-growing infrastructure in cell and gene therapy. Dr. Maryland Franklin will be here to share why we are uniquely positioned to be the laboratory of choice in this important growth area today and in the future. Our consumer-centric capabilities are continuing to grow. We all know that consumers are playing a more active role in their healthcare. They're more active in their healthcare today than they were yesterday, and they will be more active tomorrow than they are today.
Today, we have more than 160 million customer interactions per year, whether that's people getting their lab results from us, people going to our websites, people ordering online, Labcorp OnDemand . We have more than 160 million customer interactions already today. We offer more than 50 health and wellness tests online through our Labcorp OnDemand , and we've completely digitalized the patient journey, where a patient can go online to make an appointment. They will be texted when it's time for them to come in for their appointment. You'll see the artificial intelligence that we use in order to help make it an easier experience for them, and then they get their results in a very user-friendly, easy-to-read way.
As patients play a more active role in their healthcare, we want to provide more tests, help them make better decisions, and we want to play an active role in helping them. Lastly, international expansion of tests, specialty tests and companion diagnostics around the world is an exciting potential opportunity. We're gonna pilot launching specialty and companion diagnostics in parts of the world using our biopharmaceutical laboratory services footprint. For example, things like PGDx, we're already beginning to see how we can bring those to other markets around the world, including China, and we're gonna continue to find ways to do that. I know when I was in pharma, I was always looking for one partner that could help me bring my companion diagnostic or my specialty test to the most important markets around the world. We are developing those capabilities, and we want to be that partner.
Right now, more than $500 million of our book-to-bill is already with a companion diagnostic. There's more than 150 studies in the pipelines that have a companion diagnostic component. As these personalized medicine tests and these companion diagnostics become more and more important, we have unique capabilities to bring those to market. So our roadmap to strong growth, we believe, will deliver value to patients around the world and to shareholders. We are going to execute on this growth strategy. We have the right team, we have the right leadership, we have the right mindset. We're going to drive scientific and technological innovation, and we are going to accelerate our operational excellence. This leads to longer term guidance from 2023-2026, that is very robust.
5%-8% revenue growth, margin improvement of 100-150 basis points, EPS growth of 8.5%-11.5%, and our free cash flow will grow in line with our earnings growth. So in summary, I hope you can tell, I am excited about our long-term growth strategy. Our differentiators in science and technology and innovation will make a big difference for us, and our ability to execute with scale, with precision, and with operational excellence is also a differentiator. So with that, it gives me great pleasure to introduce Mark Schroeder, who runs our diagnostic business, Dr. Mary Williamson, who runs some of our largest labs, and also Bryan Vaughn, who's responsible for our hospital and provider organization. Thank you.
Thank you, Adam, and good afternoon, everyone. It's great to be here. It is really, really exciting to see the momentum we have behind our growth. There's tremendous opportunity across the diagnostic marketplace in the United States, a market that we estimate to be $85 billion. As you can see, the largest segment in that $85 billion market is hospital labs, and Brian will focus on that and give us more color in a few moments. The diagnostic industry only represents roughly 2%-3% of healthcare costs domestically, but informs over 70% of healthcare decisions. At Labcorp, we're more than a lab. We're a leading partner in patient care and are becoming a partner of choice. Our lab network allows to serve a broad, growing, and global customer base and we're winning. We're winning in the marketplace.
We see positive growth trends across the board and a disproportionate growth trend in two areas: specialty testing and hospital labs. When we think of growth, we think of three buckets: mix, reimbursement, or price, and volume. On the mix side, our focus on specialty testing helps. It gives the physician a broad array of choices to treat their patients, and we're continually, on the science side, bringing innovative new tests to the market. The rise in personalized medicine, companion diagnostics, all of these factors tend to make a richer accession or increases PPA, price per accession. Additionally, our healthcare strategy and servicing our healthcare, our hospital clients, requires we continually innovate on the assay side. We need a broad test portfolio, and this also has another outcome. It, as it tends to increase TPA, and that is tests per accession.
On the reimbursement front, our discussions with our commercial payers are progressing, and I am confident when we're finished, that our unit price will be neutral to slightly accretive. There are some headwinds in the industry, PAMA, and we continue to lobby Congress through ACLA to pass SALSA legislation, which would minimize the impact that PAMA has currently. The FDA is also talking about further regulation in the LDT space, lab-developed tests. While we disagree with that approach, as it could add expense to the industry, certainly will add expense to the agency and may actually slow down innovation. Our scientific differentiation will have us in great shape, regardless of what incremental regulations that may come.
On the volume side, we're seeing a growth in volume on the accession front and on the test front, being driven by a continued return to healthcare, increased utilization of specialized tests and technologies. These broad capabilities allow the physician to treat their patient as they see fit on one req, which makes testing faster and results back to the patient and the physician faster. Another trend that's impacting volume is the continued outsourcing of hospital lab work. Labcorp has demonstrated strong revenue growth. Our base business - onset of the global pandemic. Our emphasis on volume growth, on volume growth, ensures that our growth strategy isn't solely reliant on increased unit pricing. Our revenue profile is characterized by a diverse payer mix, which contributes to our financial stability. Our largest payers are clients and third parties, and within that third-party bucket, it's primarily managed care.
Medicare and Medicaid make up a smaller portion of our revenue. As I just previously said, the discussion with our commercial payers, I expect to yield neutral to slightly accretive unit pricing. Our 2023-2026 outlook, organic revenue growth of 2.5%-4.5%. Our diversified payer mix, strong payer relationships, and an emphasis on volume growth, position us well for continued revenue growth in the years to come. Labcorp has the world's largest laboratory network with unparalleled patient access. We have thousands of access points in the U.S. with our PSCs, patient service centers, in the physician office with our IOPs, in-office phlebotomy, at retail settings with our relationship with Walgreens, and our on-demand test collection at home utilization. Our access points are designed to serve rural populations, hard-to-reach patients, and those with a busy lifestyle.
Approximately 95% of the population in the United States is just a short distance away from a Labcorp phlebotomist. Our supply chain flexibility and standardization give us the capability to shift testing around our entire network, to balance demand, volume, or react to weather with minimal or no impact to service or patient care. Our in-network coverage covers approximately 90% of all insured lives. We're a company based on deep scientific capability. Our focus is on providing the highest levels of patient care, and we're constantly looking at cutting-edge ways to advance our capabilities with new testing technology. As Adam said, we're staying current, and in many cases, we're out in front. We also operate at scale. Labcorp owns its own robotics company, and this robotics company purpose-builds automation for our laboratories, such as Propel, automated splitting and sorting, and PPA autoloader. Dr.
Williamson will talk about that in more detail. We also use technology to improve quality. We developed AccuDraw, which gives every one of our 15,000 phlebotomists on their terminal visual instructions on the draw, the needles, the tubes, the quantity. Since its inception, we now have Six Sigma draw quantity. Quality, excuse me. And our access, thousands of points, 45 billion tests that result in consistent reference ranges, and we have thousands, thousands of EMR interfaces. All this helps us with clinical decision reports, gaps in care identification, population health metrics, companion and complementary diagnostics, and clinical trial recruitment. But it all gets down to the people. Doris, phlebotomist, 26 years with Labcorp. And when I think about our phlebotomists, 3x or 4x an hour, they're sticking a needle in someone's arm, and they're trying to make it as pleasant as possible for the patient.
That's a tough job. One day, Doris was working at a PSC, and a mom brought her child in. The child was very upset, tears streaming down the face, did not want to get a needle stuck in their arm, and the mom's anxiety was also up. Doris took the time to calm the pediatric patient down and also calm the mother down, and they had a successful experience. As a result of that act of compassion, that mom always calls Labcorp for an appointment and requests Doris to do the draw. Nicholas, a courier, 15 years with Labcorp. Now, he may make 20, 25, 30 stops a day, picking up 150, 175, 200 samples or specimens. But to Nicholas, he doesn't use the word sample or specimen.
Nicholas refers to them as his patients, and he appreciates the responsibility of transporting each of those patients to the right place. Then there's Donna, 30 years with Labcorp as a lab tech. Her relentless focus on patient care was the first documented link of an autoimmune marker, PCA-2, with a neurological condition, justifying the use of that marker in more comprehensive spectrum of symptoms. Just think about that. The results came out, didn't make any sense. They just could have released the result. No, she pursued it. She pursued it internally with one of our pathologists and then with the attending physician, and now it's become an additional, screening benefit in healthcare. These examples exemplify the relentless commitment of our employees have to patient care and improving health and improving lives.
In summary, the diagnostics market is strong, and Labcorp is poised to grow and advance our leadership position. Our science, innovation, technology, along with scale, serve as a foundation to our success. Our access and patient-centric talent impact patient care. It really impacts patient care. We will continue to grow and focus on specialty testing and hospitals and health systems. Each test, each clinical trial, each person, we are in pursuit of answers. Now, I'd like to introduce Bryan Vaughn, who will give some color on hospitals and health systems. Bryan?
Thank you, Mark, and it is a pleasure to be with you this afternoon to share a little bit more about our health system strategy. I'm Bryan Vaughn, Senior Vice President for Health Systems with Labcorp. When we think about our health system partnerships, we have a very broad lens, a broad aperture. We often, when we announce these relationships, we may talk about an outreach acquisition, we may talk about an agreement to manage the hospital laboratories, and an agreement to become the hospital's primary reference lab.
Those are the three business lines and the three main rocks in many of these relationships, but there's so much more that we end up doing with our health systems. For example, a number of our health system partners own health plans, so we know it's really important to provide a value proposition to those health plan members with our specialty test menu, with all of our access points. We have a great value proposition for those members to use Labcorp as well. We've also announced several academic partnerships, several of those recently, and our ability to partner with those health systems in the realm of residency training or research collaboration are really important ingredients to those health systems for their choosing Labcorp.
So if you take that broad aperture and you stand back and think about our target market for health systems, it's really the very large health systems that are out there in the country, many of which are academic medical centers. It's also an executive management team of the health system that's open to long-term partnerships and really thinks about partnerships with the long term in mind. And then they have to meet our financial criteria and our growth targets, which Glenn will get into in a little bit, but that often means that there's an outreach acquisition component of the deal as well. Mark and Adam have already alluded to the momentum that we have. We're really proud of the relationships that we have announced lately. We're extraordinarily excited about the pipeline of opportunities. As Adam mentioned earlier, it's incredibly, incredibly robust.
We're also, while we don't always announce them, also very focused on renewing relationships with health systems. The health systems, maybe we did an initial partnership with them 5 or 10 or 15 years ago, are also really important for Labcorp. It speaks to our track record and our strategy of being the long-term partner of choice. Adam hit on a few of the reasons that health systems are choosing Labcorp. I want to go deeper into three of them so you understand what some of our conversations are like when a health system is talking to potential partners and thinking about a laboratory partnership. One of the areas we spend a lot of time on is how we can help manage the hospital labs.
If you're the chief operating officer of a hospital laboratory, that laboratory in your hospital running well is one of the keys to the entire hospital running well. If the lab is running well with good turnaround times, it leads to better patient care, better clinician satisfaction, better discharge and movement of patients, so that average length of stay and other things work well for the whole hospital. So when we talk about our ability to manage labs, of course, there is a cost savings component that's interesting to the health system, but there's so much more in what we can bring in terms of data and quality and expertise to make that lab run at its best efficiency and its highest quality.
We manage about 200, a little more than 200 hospital labs around the country, so we have deep, deep expertise in what it takes to run a hospital lab. It's also about a $900 million business for the company, so a meaningful portion of what we do, as a company. Second, and this has been alluded to as well, health systems are investing deeply in oncology, in neurology, in their key service lines, and they want to know how, Labcorp, are you keeping up with the innovation in these fields? How are you going to help my oncologist? How are you going to help my neurologist, who have very high expectations from a diagnostics point of view, from an innovation point of view?
So we spend a lot of time talking about our test menu, what it takes to get on our test menu, how our scientists and physicians follow all of the trends in medicine, and even hardwiring into our governance structures, relationships with our scientific and medical leaders so that those innovations and relationships stay current. And third, and Adam hit on this earlier, integration. Unlike a traditional M&A transaction where a seller may hand, you know, business over and not have a lot to do with it after the fact, as soon as we go live with a transaction, we're taking care of that health system's patients. We're working with their physicians, who are now our customers.
So as we've done more of these transactions, we've developed and got more reps, we've developed better playbooks, we've learned lessons, and we're getting better and better at this all the time, and we remain very focused on integration excellence so that that experience is seamless for the health system. So speaking of a large integration, I wanted to give you a little bit, more color on how Ascension's going. So last year, we announced the Ascension relationship. We're so proud of the work that the Labcorp leaders that are dedicated to Ascension and all of the Ascension associates, nearly 5,000 of them, that came over to the company. We're so proud of the work that they're doing in moving our partnership forward. So we had almost 5,000 associates join Labcorp.
Over 97% of the associates we made offers to decided to come and join Labcorp. We've had great results with the managers and the supervisors all staying with us and being excited about being part of a laboratory company that's partnered with their health system. As a reminder, we touched about 10 states with Ascension, over 90 hospitals. We also acquired the outreach business in those states. We've recently opened a new laboratory in Michigan and in Wisconsin. They'll take some of the testing out of the Ascension hospitals to free up capacity and space. Those will also give Labcorp an opportunity to grow our infrastructure and presence in those markets. Our initial cost savings, we're not quite through year one yet, are on track. We've had great success in moving the reference work from outside reference labs into Labcorp at a lower cost, better efficiency.
We've focused very intently on contract labor and travelers and temps to try and get in not only a more cost-effective workforce, but a more stable workforce in Ascension's laboratories. We're working very closely on the supply chain conversion to move everything over to Labcorp's supply chain. In addition to that, we've put our proprietary analytics tool in all of the Ascension labs, so different systems, different hospitals. Our tool is now in all of the Ascension laboratories, so that no matter what facility, what market, or if you're a national, leader with our partnership, you can see the KPIs, you can see the quality, you can see the service metrics. Not surprisingly, as we've given visibility to those, we've been able to improve those metrics on a material basis and make them better so that their service and quality inside these hospitals is outstanding.
And lastly, the outreach business is going well. The service metrics are really strong, and we remain very optimistic about our ability to grow that business in the coming months and years. So I just want to say one more time how appreciative we are to all the employees that are out there and helping drive these results. A lot more to do, but exciting progress with Ascension. Stepping back from Ascension, one of the key elements of our strategy, we know when we can execute integration and service the business, execute with great quality. That gives us the opportunity to go deeper with these health systems, to do research, to do innovation. And when we successfully try something out with a health system, we can take that innovation to other health systems. And I want to give you three examples of those.
One, I mentioned that we manage a little over 200 hospital labs. We also have a couple 100 hospital labs that utilize our analytics platform, and that gives our team and our operators deep expertise into what it takes to run a high-quality, efficient 30-bed hospital lab or 300-bed hospital lab. Those look very, very different. Our ability to benchmark and understand those situations is incredibly deep and nuanced now. Second, I love this example. A couple of years ago, a health system came to us and said, "Could you utilize your microbiology data to help us understand resistance patterns in our community?" And we said, "Sure." So we iterated on an analytics tool with them, got it in a way that they could utilize it, and they started utilizing it to change their frontline antibiotic recommendations for their providers.
So we built that tool for one health system, and I'm proud to say any health system partner of Labcorp can have that tool free of charge now. So there, we have many, many hospital systems utilizing it and hopefully helping improve antibiotic resistance in their communities. And then lastly, last year, we acquired PGDx, Personal Genome Diagnostics, that had several NGS-based tests for oncology patients. We're taking the FDA kitted solution that can be run at hospital labs to all of our health system partners now, especially our academic partners are really interested. Their departments of pathology, their oncologists are really interested in bringing up this assay and excited about this innovation that could go across multiple health systems. So in conclusion, we're very excited about the opportunity that we have. It's a remarkable one. We're proud of the momentum that we have in this space.
We remain very focused on executing at very high levels of service and quality, and we know that earns us the ability to innovate with our partners. With that, I'd like to introduce Dr. Mary Williamson, who will talk a little bit more about execution within our laboratory network.
Thank you, Bryan. Thank you, Bryan. I'm Dr. Mary Williamson. I'm the Vice President of Laboratory Operations for the Northeast and North Central Divisions. You just heard Mark and Adam talk about the benefits of operating the world's largest laboratory network and our unique ability to improve access to care for our patients. Now I'd like to take a deep dive and explain how we can leverage our infrastructure and capabilities to achieve both scale and continuity across the system. We have an extensive footprint with multiple access points, along with a network of laboratories so that we can meet patients where they are. We have a broad specialty testing menu, and we've standardized our equipment, methods, and reference ranges to ensure continuity of care. Our scale creates efficiency.
We have the ability to provide the most cost-efficient care for our patients while giving us the flexibility to move testing along the our network without sacrificing quality. Some people think that biopharma and diagnostic labs are different. Well, I have experience working in hybrid labs that perform both clinical trials and diagnostic tests, and I would argue that there's actually a whole lot more similarities than differences between the two different labs. If I put you in a lab, you really wouldn't know where you were. Both types of labs look the same, they both have the same equipment, and they even use the same talent. Now, you can imagine that these synergies give us competitive advantage. We have the ability to leverage those capabilities across business segments.
A real-life example of how we put this into use was during the pandemic, when we were able to utilize our biopharma labs to bring up COVID-19 testing. Another key differentiator that helps us achieve both scale and continuity across the enterprise is our proprietary automation. We are committed to accelerating innovation and technology through the use of robotics and artificial intelligence. Mark mentioned, we have our own in-house team of engineers that build proprietary platform. They've been doing this for us for nearly 2 decades. They build platforms that improve our quality and reduce our labor costs. The picture on the right is of our PPA or Propel Plate Accelerator platform, that has the ability to decap and aliquot high complexity molecular tests into 48- and 96-well amplification plates.
As you can imagine, having this type of capability at our fingertips during the pandemic was extremely invaluable when we needed to scale our testing capacity. Just one of these PPA platforms has the ability to perform the work of nearly 60 FTEs. While we are heavily invested in automation, we cannot be successful without the people who make this possible. We are committed to and taking innovative approaches to attract, retain, and develop a diverse global workforce. We have a growing recruitment pipeline that's made possible through our DE&I initiatives, our expanding college university affiliations, as well as our global recruitment efforts. Recently, we created technical float roles, where we have the ability to deploy highly skilled technical labor across the country based on our geographic needs, all made possible due to our standardization. We also provide our team members with a robust selection of developmental opportunities.
Earlier this year, we launched our very own NAACLS-accredited histotechnician training program. We are the only commercial lab to have this type of program, where we have the ability to grow our own technical staff to meet our needs. As our partnerships with hospitals and health systems have grown, so has our resident training programs, where we give medical students an opportunity to learn from our scientific experts and rotate through our many labs. Loyal team members are those who take advantage of our tuition, assistance, and tuition reimbursement programs. We want all of our team members to have an opportunity to further their education and recognize that financial constraints exist. That's why we offer the Labcorp Education Advantage Program, where our team members get to go to college with no out-of-pocket expenses. I'm happy to report that we've observed a 30% promotion rate amongst these graduated learners.
It's so important to mention that we're constantly looking for opportunities to drive the business forward, ways to improve quality and identify efficiencies. That's why we launched our Lab Exchange program. This is an innovative program where we move some of our team members across business segments, where we create a culture of collaboration and cross-pollination of ideas. In this program, we give our team members an opportunity to go to another lab, sometimes in another country, where they get to learn more about our company, but they also share best practices. It gives them an opportunity to also identify workflow optimization opportunities that they can bring back to their home labs so that we can be more efficient. We also encourage the sharing of scientific and technical expertise through our business advisory teams.
These teams are made up of members from around the globe on both the biopharma and diagnostic business lines, where they're sharing insights on emerging technologies and the future testing needs. I think it's also really important for us to mention that you can never underestimate the importance of creating an inclusive culture where everyone feels valued. That's why we have a number of employee resource groups, where we give our team members an opportunity to network with others, as well as participate in community outreach programs. These community outreach programs not only improve the lives of those in our communities, but it also helps us with promoting brand awareness and potentially attracting new team members to want to join our organization. Many of these programs, especially the ones like the NAACLS-accredited Histotechnician Training Program and the Lab Exchange Program, are not available anywhere else in the industry.
These programs give us great flexibility to be able to cross-train our team members and give them very strong developmental and growth opportunities for our people. It really is the power of our dynamic workforce that's coupled with our proprietary automation and global scale that fuels our innovation. Now I'd like to show a video that highlights some of our capabilities and cutting-edge technologies in the lab.
Thank you, Bryan. Thank you, Dr. Williamson. As many times as I've seen these videos, I'm just so impressed every single time. And again, you won't see it anywhere else, in any other laboratory, anywhere else in the world. It's ours. We own the IP on it, we designed it, and it's really, really a big advantage. I'd like to welcome to the stage Jon DiVincenzo, who runs our central lab business, and Dr. Maryland Franklin, who leads our cell and gene therapy work. Welcome.
Thanks, Mark. Well done.
Thank you. Good job, you guys.
Good afternoon. My name is Jon DiVincenzo, and I lead Labcorp's Central Labs business, and I'm delighted this afternoon to share with you how we apply and leverage the science and operational excellence that Mark's team just described as it applies to the drug development process. We have a hyper-focus on the biopharmaceutical clients that are looking to bring innovative new therapies to patients around the world. O ur Biopharma Laboratory Services segment, it comprises of two businesses. We have businesses which actually span capabilities across the entire drug discovery journey, starting with our early development research labs, or ED. Our central lab services, or CLS, comprises about two-thirds of the revenue overall. These are strong, market-leading businesses, which have driven growth over the last few years, of which we forecast continued growth.
The customer base, although it's heavily weighted for the early development towards biotech clients, actually, we share about 90% of the clients by the time they come to central labs. There's a normal attrition rate for those molecules that are not making it into human trials, of course. So there's a lot of synergy between the customer base, how we approach our customers, work with them, think about their scientific strategy when they think about bringing the molecules to the marketplace. A lot of opportunities for these groups to collaborate together at very different phases of the drug development process. As I said, these businesses are market leaders, and they've driven growth 7.5% CAGR since 2019. We forecast, in fact, continued mid- to high single-digit growth for these businesses, driven by a very strong core business, very global business.
We are supporting patients in over 100 countries around the world. I'll show you our global footprint. We are, we are present in three continents across the globe, and we have identified clear growth drivers, which has already started to accelerate our growth as a business around precision medicine. And precision medicine is all around the right drug for the right patient, better outcomes for patients. So we'll hear a little bit later from Dr. Maryland Franklin around cell and gene therapy, and the investments we've made there, and the experience we have in bringing those novel modalities to, patients around the world. We have incredible scientific capabilities to, to develop biomarkers. These biomarkers are used to identify which patients are appropriate for which therapy.
They're used initially for screening, patients to see if they'll be, participating in a clinical trial, or they'll be used to monitor the health of that patient throughout that clinical trial. So there are genomics platforms, there are antibody pathology platforms, there are flow cytometry platforms, all the specialized testing that Adam talked about that we apply to the clinical trials. Ultimately, one of those biomarkers can become a companion diagnostic, and by working with the pharmaceutical companies early on, we have the science, we have the qualified and validated assays that we can have available on a global basis to provide day-one support to those therapies as they come to market and require on-label testing to ensure that it's the right patient for the right drug.
Companion diagnostics continues to be a natural extension of what we do within the biopharma relationships, and many of our clients, particularly the large pharmaceutical clients, see this as a unique opportunity to build relationships, build scientific alignment, if you will, with their teams, and then bring that to market when the product is available for patients around the world. Finally, one of the newer areas, particularly through the acquisition of PGDx and OmniSeq, 2 next-gen sequencing platforms, the application of liquid biopsy . Liquid biopsy is a blood test where you're looking for cells or circulating DNA associated with cancer, sometimes before a tumor, even a solid tumor, is even present within or detectable within a patient.
So great opportunities for us to leverage that unique capability, leverage the relationships with our biotech clients, and bring those new capabilities to those clinical trials around the world. We've said it a few times, and it's clear, the basis of our business is strong science. People not only with strong technical capabilities, but experience, and experience in developing drugs, experience in thinking about how you're going to design the various assays required to bring the capabilities, and results to regulators around the world, and get that approved, either through an IND process, through our early development, or eventually to commercialization. So precision medicine capabilities, the innovations we've talked about, we're proud that, in fact, we've participated and supported 100% of the oncology therapeutic area, cell and gene therapy drugs that FDA has approved.
100% through either early development, central lab, or the combination of the two. We also talk about operational excellence, and certainly, as Mary described, we have a lot of automation of handling the specimens or aliquoting the specimens. But when you're supporting clinical trials, there's also the complexity of data. Data coming in from different sources, data in different formats, and often it takes a team of people to be able to transcribe that information, which slows the process down, or in fact, could be inherent in quality concerns. Well, over the last four years, we've developed a dedicated team to develop bots, which use computer learning to actually do those tasks. So SEPA or Software Enabled Process Automation has been deployed across our organization.
In fact, it's a big driver, or at least one of the major levers of our LaunchPad initiatives, to find efficiencies in the organization and to improve quality to a Six Sigma level. So a great opportunity to see how do we leverage scale, how do we leverage artificial intelligence and the tools to automate some of the complex handling of this data across the clinical trial. These are just so the footprint, similar to what Mary had shown. These are dedicated to drug development, where we either have organizations that are focused on the early development portion of drug discovery, which are about 20 different sites around the world.
We have five main central labs across the globe, with a few centers of excellence, such as our anatomic pathology lab in Los Angeles, our flow cytometry labs in Tennessee, that partner together to deliver clinical trials, and it also represents about 15 diagnostic labs, specialty labs, such as Monogram Biosciences or our Colorado Coag, that are able to conduct certain testing that we don't have available in central labs, but as part of our network, we manage the logistics of getting specimens to those labs, and then we handle the data, incorporate that data into the data package for our clients and conduct the clinical trial. Very efficient for our clients, saves time, and certainly saves money and logistics and workload on our clients' clinical operations teams.
Also depicted here are a few other sites that are associated with production of the collection kits. So in order to assure data which is combinable across the world, we work with our sponsors to design unique collection kits for every patient visit, for every clinical trial. That means that we have, within that kit, everything the physician needs to collect the specimens required for that visit, for that clinical trial. It also is the standard operating procedure, so it's all done consistently across more than 200,000 investigator sites across the globe, across 100 different countries. We're able to then take those specimens in, run the test at the appropriate laboratory across the globe, and combine that data. Combining data might sound easy, but actually very, very difficult.
It takes years of experience to understand how you find concordance of that data from one lab to another. We are experts at it, and it's one of the reasons clients come to us, is because our expertise in developing those collection kits and the SOP, and finally, handling the logistics of getting those the right kit to the right physician to meet the patient visit, and also, of course, to return those kits to our labs. So we hit key turnaround times for the assays. And finally, we also depict here in Bangalore, India. We have over 1,000 people in Bangalore, India, helping us support these trials back-end, whether that's data management or overall protocol development, et cetera. A very strong team.
We started this in 2017 and have an experienced team that are either coming from pharmaceutical industry or other industries that help us support our clients and part of our LaunchPad initiative to drive efficiencies in delivering high quality at the right cost for our clients. So in early development, this is really where the science starts. A lot of times we're asked, you know, "Well, how does this fit in?" This is when we start to engage with our biotech and pharmaceutical clients and think about what molecule they have. For that molecule, what is the appropriate testing menu for that particular molecule? And importantly, how do we guide that client through the regulatory jungle, if you will, to get that to an IND status or Investigational New Drug?
So we actually have, within this organization, a team of consultants, if you will. They're scientific experts, they're drug development experts. We call part of our early phase development services, where they're marrying together science, regulatory expertise, and project management, to take even the smallest biotech molecule through this process, bring the decades of experience to the fore and to shepherd that molecule through that process and hopefully get that through an IND process for the client. So really important initial discussion with our clients starts in early development. And then, hopefully, this is successful, and only about nine out of ten of these projects that we work on are actually bringing it to human clinical trials.
But then we then engage with our essential labs teams, where we're able to then say yes, as Mary said, a lot of the science at the bench can be the same, but the context of how these clinical trials get executed can be quite different than in diagnostics. So we work early on, on the procedure by which an investigator would follow in order to have a consistent patient visit, that we understand what testing can be done. We have a medical affairs team that works with our medical affairs teams and our sponsors, to design the right testing protocols at the appropriate visit and conduct that testing. And then we have a team of project managers, over 1,500 project managers, that are either at global level or regional level.
They're supporting those trials, supporting investigator sites, and ensuring that a patient visit then results in specimens coming back to our lab and adequately being conducted testing. Here's an example: We had a client come to us with a pretty complicated oncology-targeted therapy, and it was a small organization, and they came to us, saying, "We would like to understand how we can take the funding we have and get this through the process by using your resources." So they engaged with our early development team. We developed kind of efficacy models, testing. We completed some lead optimization testing for this client, and finally had a molecule to go through the process, and we successfully drove that through safety and toxicology testing. We actually accelerated what their original timeline was. Speed is money here.
You either want to fail fast to save your resources, or to find ways to navigate the scientific and regulatory complexity to get through the IND process. We then, as we were, we saw success in the horizon, we worked with our central labs team, and our central labs team has decades of experience working with various investigators. And we monitor which investigators are really great at recruiting patients, keeping patients on trial, and we use that database to help our sponsors design their clinical trial, to say which investigators they'll target to bring patients into their trial, and we conducted that test, and it had project management oversight. And ultimately, we're able to bring this molecule through the process, get it commercialized, which obviously means it's helping patients with cancer.
But it also means, monetarily for their client, that they extend the amount of time that their patent is generating revenue for them. So time is money. Every quarter that goes by, you're eating into the time that a patent is available to them for exclusivity of that therapy. And that's really the story that you heard from Adam, that there's a continuous loop here, where our diagnostics teams are monitoring patient health. When patients have an illness or disease, we can identify them potentially for a clinical trial, help our sponsors select which patients would be available for their clinical trials, and then conduct the testing, either early on science within our ED teams or with the CLS teams to conduct the clinical trial itself and then monitor, of course, the patients afterward.
We're going to hear from Maryland Franklin, who will talk about cell and gene therapy. Because these are new modalities, regulatory bodies would like us to be able to measure and monitor the health of that patient over a very long period of time, 10-15 years. That means a lot of diagnostic testing over that period of time. So it's this marriage and continuum of science and intimacy with our clients to be able to provide value that no other organization can provide. So before I hand it over to Dr. Franklin, just a moment on cell and gene therapy. Why such attention? Well, as Adam said, about one out of five programs in the pharmaceutical pipeline are associated with cell or gene therapy.
It's a large opportunity for us, at $2 billion, growing 15% per year, so certainly above what our average CAGR is of the businesses. We have unique scientific capabilities that allow us to help these companies with these unique therapies, bring it to market and to understand how we can access as many patients on a global basis as possible using our infrastructure. So with that, Dr. Franklin, thank you.
Thanks, Jon. Hello, everyone. I'm Dr. Maryland Franklin, Vice President and Enterprise Head of Cell and Gene Therapy at Labcorp. I'm delighted to be here today to speak with you about why cell and gene therapy is so important. Cell and gene therapy, we say it sometimes as if it was just one word, but it's really two distinct areas of research that have intersecting needs along the development pipeline. The industry has been studying cell and gene therapies for over 40 years, but the first truly transformative products came to market with FDA approval in 2017, making it still a relatively nascent area of research. Under the umbrella of cell therapy, shown here on the left, which uses live cells as the therapeutic, the most predominant form still being investigated is CAR T-cell therapies.
Today, there are 6 approved CAR T-cell therapies by the FDA, all of them in certain types of blood cancers, and all of them approved within the last 6 years. For each of these approved products, the cell that becomes the therapy comes directly from the patient. That material is then modified and manufactured in a laboratory setting and can only go back into that individual patient. So you can see that there are very strict logistical and manufacturing complexities associated with these types of products. On the gene therapy side, on the right, there are also a multitude of approaches being investigated. The approvals today are in rare diseases. There are more than 6,000 identified rare diseases that impact over 300 million people cumulatively across the globe.
When you put that all together, you can see the depth of the impact that these types of therapies will have. Rare diseases make excellent candidates for gene therapies because they're caused by a single gene mutation in one gene of that individual patient. The gene therapy then aims to add, delete, or correct the genetic material in order to treat a disease. While conventional therapeutics primarily manage symptoms of disease and require chronic administration, cell and gene therapies aim to cure disease through a one-time treatment regimen. Cell and gene therapy is a fast-growing industry, and the science is rapidly developing. You heard both Jon and Adam talk about it representing 20% of the drug development pipeline. About two-thirds of that is still in preclinical research and development. They're all considered emerging or advancing therapeutics because there are still a limited number of approved products.
But the cell and gene therapies of today that treat rare diseases and certain types of oncology, that's today. Tomorrow, we're advancing rapidly towards utilization in more prevalent disorders like autoimmune disease, a vast array of solid tumors, type 1 diabetes, and many others. Before I leave this slide, I'd like to mention one of the emerging categories of therapeutics, in vivo gene editing. In 2019, in the United States, the first CRISPR gene editing product was used in a clinical trial. Later this year, in both the United States and in the EU, there are decision dates by those regulatory agencies for what could be the first approval of a gene-edited therapeutic with CRISPR technology. When you compare that to 10 years clinical development timeline, on average, for other therapeutics, you can see just how quickly this industry is moving.
Labcorp has market-leading momentum to support cell and gene therapy. You've already heard Jon mention we have helped support 100% of the cell and gene therapy products that are approved in oncology. We've helped support seven of the eight gene replacement gene therapies, and 2023 is poised to be a pivotal year in cell and gene therapy. We've seen six approvals so far this year, which equals all of what we saw in 2022. In addition, there are a number of programs that are in later stage regulatory review, four of which have decision dates already listed by the FDA for later this year, and one product also has a review date, decision date in the E.U. In 2019, the FDA was predicting that by 2025, they would be approving 10-20 new cell and gene therapy products every year.
You can see that we may get to the low end of that spectrum, even later this year. Our complementary capabilities, our ability to help serve customers across the development spectrum, and our expertise in complex science and technologies, positions Labcorp as the partner of choice for cell and gene therapies. In our early development laboratories, we're working closely with cell therapy developers. We're helping bring some of the newer generation CAR T therapies and other cell therapies into models that are useful in efficacy and moving those programs through early discovery and preclinical work. In our central laboratories, we are working on cutting-edge assay development and capabilities. We're looking at approaches for molecular biology assays, flow cytometry assays, and our specialty genomics labs are helping advance those gene editing technologies that I just mentioned, and we do so much more in between.
But my favorite examples are when we can work hand in hand with our customers to help them solve some of the most complex scientific challenges that they face. And those challenges sometimes require specialty skills and specialty facilities. And so we do some of that work in our recently renovated cell and gene therapy space in Madison, Wisconsin. One example, we're using MRI to guide delivery of a gene therapy into precise locations of the brain. This is helping bolster advances in neurodegenerative diseases like Parkinson's disease. Another example, we're helping in sophisticated model development. We're working to deliver pluripotent stem cells directly into the heart to help advance cardiovascular research and help cell therapy companies that are looking to do replacement, tissue replacement, following cardiac events.
The science is fascinating, and I could talk about it for a long time, but our driver in all of these efforts is really the impact that these therapies have on patients. Patients, their families, and caregivers have urgency for these new and transformative medicines. The work that we do at Labcorp is saving lives and curing people of disease. If we look at one example of how Labcorp could be involved in this process, I'll point you to Matthew's story here on the top left. Matthew's parents had been genetically tested and were known to be each a carrier of a gene mutation that could result in a disease called spinal muscular atrophy, or SMA. SMA is a devastating diagnosis and a devastating disease. These children generally do not live to see their second birthday.
Matthew was tested in utero and unfortunately found to have both mutant copies of that gene rendering him diagnosed with SMA before he was even born. But that allowed his parents time to find and enroll him into a clinical trial, and he was able to receive a gene therapy before he was one month old. Today, Matthew's in school. He runs around, plays with his friends, and he tells the world he's going to be a firefighter someday. Carrier testing, prenatal testing for diseases like SMA are one of the 6,500 diagnostic tests that Labcorp supports. Studies in our early development and central laboratories that Jon just elaborated on, help bring these transformative medicines from ideation into a true product that can be treated with to a person in a clinical trial and ultimately through a marketed product.
We are so proud to have supported and continue to support so many cell and gene therapy programs. I'm excited to be leading the success of cell and gene therapy at Labcorp, but even more importantly, I'm so excited to be part of bringing these transformative medicines to patients who so desperately need them. Thank you, and I'd like to turn it back over to Jon DiVincenzo.
Thank you, Maryland. Clearly, you know, what's at the heart of what we do, what motivates us is the patient. And I hope that you see here through Mark's presentation on diagnostics and my presentation on the biopharma labs, these businesses work together to solve problems that could not be solved without us. So we are delighted to have the opportunity to present that to you today. We're gonna take a short break, I think 15 minutes, and then come back to hear from Dr. Brian Caveney and Lance Berberian. Thank you.
Hi, everyone. If you wouldn't mind taking seats. For those of you in the room, if you wouldn't mind taking your seats. Thank you. All right, welcome back from the break. I'm excited to kick off our science, innovation, technology, and hand it over to Dr. Brian Caveney, our Chief Medical Officer, and Lance Berberian, our Chief Information and Technology Officer.
Thank you, Christin. All right, welcome back. Thank you for joining us today. I'm Dr. Brian Caveney, our Chief Medical and Scientific Officer here at Labcorp. Lance and I get to talk today about how science and technology drive every decision that we make at Labcorp. I get to hang out with some of the smartest people in the world, and our global scientific community is fantastic. Over 1,200 people with advanced professional degrees. We have almost every single aspect or subspecialty of laboratory science and pathology covered, so that we can always stay on top of what's happening, whether it be at scientific conferences, academic journals, working with academic labs around the world, other scientific collaborators. We talk to almost every startup in the diagnostic science space around the world.
We stay on top of everything so that we can deliver whatever our customers need across the continuum: early development, central laboratories, and of course, clinical diagnostics. Even through the pandemic, we continued to add about 100 assays to our clinical menu per year and continuously work with our biopharma clients to add whatever assays and biomarkers are necessary to watch them bring therapies through the different clinical pipeline across the world. We can work on almost any type of assay type or instrument in our laboratory network around the world, whether it be early safety assessment, optimization programs, toxicology testing, even aquaculture work, and then, of course, whether it be licensing or commercializing someone else's test onto our clinical menu. Our amazing R&D team bringing up a laboratory-developed test and then continuously iterating and innovating on it.
For example, as we identify new genes with enough evidence to add it to a new panel, we can continuously update those. We have the whole complement of research-use-only assays that exist for any clinical trial that already is underway. And of course, we can work with our global industry manufacturing partners around the world to offer any of their IVD tests around the world. And as we bring new things to market, we also, in the new regulatory environment, can work, whether it be with the FDA or get CE Marking in the EU to be compliant with IVDR regulations for either a clinical trial test or clinical diagnostics, as we continuously expand our menu and go forward.
While we think we have a terrific laboratory team around the world, we also want to continuously add to the scientific knowledge base that exists out there, whether it be peer-reviewed publications with academic collaborators and others, but also, we co-author publications with scientists from our competitor labs. Because the one way that we know in the U.S. we can expand market access, work with commercial and government payers to make sure that we can understand the reimbursement landscape and commercial coverage policies, is to demonstrate that we're advancing the standard of care, and that there's clinical adoption among physicians across the U.S. and abroad to produce better clinical outcomes and demonstrate the clinical utility that will help make sure that we can bring that access to patients here and around the world.
We've mentioned a few times today that having the most comprehensive menu is one of the most important things that we can do across the entire continuum of care, and we have over 6,500 clinical assays on our diagnostics menu. Many others that we do de novo or bespoke for clinical biopharma partners for particular assays that they're working on across the entire spectrum.
Again, whether it be anything in the research space, whether it be in the clinical diagnostic space, a risk prediction, such as a germline genetic test, whether it be a screening test, like a colorectal cancer stool test, whether it be diagnostic, like hemoglobin A1C, to definitively diagnose somebody with type 2 diabetes, whether it be to monitor the treatment and the, the metabolic pathway of a particular drug that a person is taking, or monitor the condition itself, or recurrence of a disease, such as when cancer eventually comes back in certain cases. And then, of course, we have forensic testing, whether it be genomics, paternity testing, and of course, drug testing in a variety of different mechanisms as well.
We do all of this in our nationally standardized, high-quality, fully calibrated network of laboratories here and around the world with consistent and identical reference ranges, so that those numbers can be utilized by clinicians everywhere, relying on the laboratory work that we do. While we want to have a comprehensive menu, and as Mark and Brian have described, our primary strategy in diagnostics is to make sure that we expand our health system capabilities, as well as focus on specialty testing. We have an enormous menu, and we continue to push that forward in all different areas of medicine. We have multidisciplinary groups that work in over 50 areas of science and medicine to make sure we're continuously bringing new technologies and innovations forward. However, there are over 135 subspecialty certifications of specialists just in the U.S. alone.
Most of them work in the context of a hospital or a health system. Therefore, if we're going to be the partner of choice for health systems and have broad specialty testing menu, we need to continuously innovate in every area of medicine to make sure that we have that we're the one lab of choice, so that any clinician in any of those health system environments can take care of whatever patient walks into her clinic today and only need one laboratory menu to take care of all of those patients.
Given all of that, though, as we've described earlier, there are a few areas of medicine that are at sort of a confluence that make it a ripe opportunity for us to spend extra focus and investment. Whether it be because the biopharma pipeline and investment dollars are heavily moving towards certain areas of medicine, particularly oncology, neurodegenerative diseases, and neurology, as well as the pure epidemiology of these diseases. As people get older and as demographics are what they are, people are more likely to get certain cancers as they age, now that we've reduced the likelihood of cardiovascular events being the cause of death in most people. They're more likely to get a cognitive impairment, such as Alzheimer's disease. They're more likely to get an autoimmune disease from the environmental exposures that we've all had during our lifetime.
So we know that these are the areas of medicine where we have the most opportunity. There's the greatest scientific frontier. There's also the most ability for new therapies coming to market to require a precision diagnostic for us to be able to help that clinician make a faster, more precise diagnosis, and then match it with the right therapy to deliver a better outcome for that person. In the area of oncology, we work across the entire continuum, whether it be our preclinical oncology assay capabilities, particularly our Ann Arbor, Michigan laboratory is top-notch in the world, to a host of other types of both tissue and blood type testing that we can do for clinical trials as well as for clinical diagnostics.
We have the full complement of oncology testing, whether it be all types of anatomic pathology, IHC stains, flow cytometry, FISH, you name it, we've got it at Labcorp. And we're continuing to push the boundaries of the next-generation sequencing-based tissue and liquid biopsy tests, so that we can both help with therapy selection as well as all other aspects of recurrence monitoring and, and even eventually screening and detection of cancers, ahead of time. We've long been a leader in the area of women's health. It is, it is now more and more including the use of next-generation sequencing, whether it be for family planning, reproductive genetics, but we're also making terrific advances in underdiagnosed and underserved areas such as preeclampsia and endometriosis in the future.
Dr. Franklin talked about the amazing work that we are very proud of in the area of cell and gene therapy, our early development research labs, as well as our central laboratory work, working hand-in-hand with very specific biopharma clients that are betting the farm, if you will, on cell and gene therapy products that are treating rare diseases that to date have often had no therapy whatsoever. Nothing to offer to parents whose child was expected not to live to the second birthday. So we're very proud of the work that we're doing in that regard. Almost every one of us in the room has been impacted by a family member or a loved one, either with oncology or a neurological condition.
As the world ages, here and around the world, there is an increasing incidence and prevalence of cognitive impairments, not just Alzheimer's disease, but others. Only about two-thirds of cognitive decline or dementia cases are from Alzheimer's disease. Doctors need a way of helping identify the difference between an Alzheimer's patient and somebody that has another type of dementia, whether it be vascular or otherwise.
We have launched a variety of different, both cerebrospinal fluid as well as blood, blood-based biomarkers over the last year, with several more in the pipeline, to very specifically help identify patients that are ripe for a clinical trial, or to help a neurologist, a memory clinic, or another type of specialist identify patients that need further diagnostic workup that might either be prepared for an Alzheimer's disease therapy, one of the new ones that's come on the market, or appropriate, again, for one of the many clinical trials that we're helping with for other types of therapies in the pipeline. We've also launched a variety of other neurology-specific assays over the last year, including those for paraneoplastic syndrome, very difficult cases for neurologists and others to diagnose sometimes, autoimmune neuropathy cases, encephalopathy, myasthenia gravis, and a variety of others in the area of neurology.
There's so much opportunity there, there's so much unmet need, and we know that we are, we're gonna be able to really advance it. In the Alzheimer's disease framework that I mentioned, there's a new framework called ATN, looking at a variety of different etiologies or causes of Alzheimer's, because in spite of the importance of it, we still don't exactly know what causes Alzheimer's disease. So we have to look at a variety of different changes in a person's body to see what might be causing the mental impairment or cognitive decline that we sometimes see. There's a framework called ATN, looking for amyloid, phosphorylated tau, and other neurodegeneration markers, and we now have blood-based biomarkers and CSF markers in all of those categories to help specialists differentiate and make those decisions down the line.
One of the areas of medicine that we frankly know the least about is the human immune system. It can be impacted by exposure to almost anything that we see in the environment. There are many, many different autoimmune diseases, which often result in your own body making antibodies to one component of itself because it's confusing it with an environmental insult. We've launched a host of new assays and done a couple of acquisitions over the past year in this space. We've now launched a comprehensive lupus portfolio, which is a very complex autoimmune disease. We have one of the broadest rheumatology portfolios that exist, including a variety of assays specifically for rheumatoid arthritis, to both identify it upfront, make the definitive diagnosis, as well as evaluate the risk of radiographic progression of the disease down the line.
It also requires precise matching with the right monoclonal antibody or other therapy for a lot of these autoimmune diseases. We have the broadest therapeutic drug monitoring portfolio, as well as other markers to measure the immune system response, so that the doctor can keep the patient on the right medication, which is certainly going to deliver better outcomes, but also, frankly, in the interest of government and commercial payers as well, to make sure that patients get the right medication that are going to be effective over time. We're going to continue to invest heavily in the science. We know that these five areas are ripe for the work that Labcorp can do across its early development, central labs, and clinical diagnostics business, and we intend to continue pushing the envelope and delivering great science over time.
Now, I'm going to ask Lance to talk about some of the technology and IT work that we're doing in this space. I've left the clicker here.
Thank you, Brian. My name is Lance Berberian, and I'm the Chief Information and Technology Officer for Labcorp. Labcorp applies technology to all aspects of our business, including our internal operations, but maybe even more importantly, to our customer interactions. Today, I will focus on three key areas: the digital experience for patients and providers, proprietary robotics at scale in our laboratories, and artificial intelligence infused throughout our business. Labcorp has digitized many aspects of our patient journey, including locating and scheduling appointments at our patient service centers. The automated check-in process, including the ability to receive a text message when it's time for your specimen to be collected. Convenient and modern bill pay methods, including Apple Pay, Google Pay, PayPal, credit cards, and even a payment plan to spread your payments over time.
Also, as you'll see on the slide, we have enhanced test report formats that bring health insights to patients. Notice the color coding that emphasizes key data elements, and as well, the trending of current and historical values to easily see the trajectory of key analytes. We also offer tools to physicians and health systems that differentiate our laboratory services. Labcorp Diagnostic Assistant offers clinical and operational support capabilities in the physician workflow. We leverage a technology called FHIR that enables the software to reside within the electronic health record system that physicians use on a day-to-day basis, including Epic, Cerner, Athena, and many of the other standard systems that physicians use. We offer Labcorp Link, which is a companion app to the electronic health record, that allows physicians and their staff to perform self-service capabilities for Labcorp services that are not naturally embedded natively in the EHR.
We also offer population health and laboratory stewardship dashboards. As you heard Bryan Vaughn mention earlier when he was talking about Ascension, we have a product called Visiun, which is a laboratory key performance indicator system. This system can be layered across numerous disparate laboratory systems, but pull together all of the data and present to that health system single set of KPIs that let them manage their networks across the entire health system. If you think about health systems, as in many times being brought together through mergers and acquisitions, they frequently do have disparate lab systems, and this gives them the capability to have a single view, a single dashboard, into the laboratory, their laboratory network. Mark and Mary discussed the existing robotics we have in our lab and the efficiency and quality that it brings to our laboratories.
They talked about the Propel serum pipetting robot and sample preparation robot. They also talked about the pre-analytical sample processing robot for molecular diagnostics. All of these have been designed and built by Labcorp employees, our electronic and electrical engineers, our mechanical engineers, our software engineers. We believe, as a company, that there are many more opportunities to deploy proprietary robotics in our lab, and I'm going to share something new with you now. If you go into an at-scale laboratory, you're going to find a lot of employees that are routing samples to the correct laboratory and the correct department within that laboratory. The way they typically do that is they'll take that test tube, they'll scan the barcode, that'll pop up information on the Laboratory Information Management System.
They'll determine where that test tube is destined for, and they will put it in the correct container for shipment. We have developed a new proprietary robot called the Labcorp Matrix, and what you will see is the Labcorp Matrix separate, scan, and deposit the specimen in the correct container at a rate of 6,000 test tubes per hour. Then you will see on the video that I'm going to share, the AI-driven matrix transportation robot that literally will bring those specimens to the correct department in the lab. It is not on any tracks or guidance. It's using artificial intelligence to make its way through the lab to the correct department for to drop it off at the correct area.
As you can imagine, by using these robotics, it adds a level of precision that eliminates the adverse effect of human errors on specimen routing, and that can improve the turnaround time of getting the result back to the patient and physician. And even in the case where a specimen is misrouted, it can affect the specimen integrity, which may require that patient to have to have a specimen redrawn. However, the robot's precision addresses that. Now, I'd like to actually introduce the video of this new robotic capability at Labcorp. So here you'll see the Matrix robot is actually doing the separation of those actual samples. It's now taking it to the point where it's going to be able to read those barcodes. And now you'll see the robotic arms on the track, dropping those samples into the correct containers, all of them with RFID capability.
Those could be destined to a particular department in that laboratory or in a completely different location at one of our laboratories. I mentioned the software engineers. You can see this is a software-driven system along with the physical robotics. Now you'll see the Matrix transportation robot is going to pick up those specimens and actually make its way through the laboratory to drop it off at the correct department. Again, you'll see there's no track involved. It literally will call the elevator and go to a different floor if it needs to, in order to get those specimens to the correct place. Finally, I'd like to share some information about our AI focus and make sure that I bring to you some real-world examples that are already bringing value to our patients and to our physicians.
Our AI company focus is on generating profitable growth, launching new revenue, generating products in precision medicine, and shifting our employees from repetitive tasks to value-added activities. As an example of generating profitable growth, we built a reinforced learning contextual bandit AI model. This model takes large numbers of demographic and transactional data elements into the model, and then drives customized content, the communication method, whether it's text messaging or email, and then the transmission days and times. So some people might be receiving it on Tuesday at 8:00 A.M. before work, and other people might be getting it on a Saturday afternoon. And all of this, this AI model is reaching out to our 90 million contactable patients, improving our collections for balances due by patients. And I can tell you, this has had a significant impact on our liquidation rates.
As an example of launching new revenue-generating products in precision medicine, we recently collaborated on a public health event focused on NASH, which is a liver disease. When comparing the traditional methods of building a cohort of patients that may have NASH with a cohort of patients selected by Labcorp Predict, which is a neural network AI model, Labcorp Predict was substantially better at identifying patients with NASH. As an example of shifting employees from repetitive tasks to value-added activities, we built a cloud-based convolutional neural network that is a reinforced learning model that eliminates the keying of insurance information from patients' insurance cards. This is part of our patient check-in process in our patient service centers.
It can recognize the thousands of cards across many insurance companies and many of their plans, to identify where the relevant information is, harvest that information off the card, and auto enter it into our system, eliminating the manual keying for both our patients and for our employees, which is both time-consuming as well as error-prone. This process has contributed to our world-class NPS score for our patient service check-in process. These are just some of the ways that we are leveraging technology and innovation at Labcorp. I'm extremely proud of the advancements we're making at Labcorp on a daily basis, and please don't hesitate to reach out to Christin if you have any further questions or would like to discuss the topics further. Now, I would like to introduce Glenn Eisenberg, our Chief Financial Officer.
Thank you, Lance, and good afternoon, everybody. We're gonna wrap up our formal presentations by giving an overview of our financial outlook. We'll start a little bit by talking about kind of the financial model that we have, our playbook, if you will, on how we're looking to drive shareholder value. You've heard a lot of good stories today from the leadership team on the focus of the company, organic growth, all the different areas that we're capable of continuing to drive science and innovation, which helps drive our top line organically, and we do what you've heard with operational excellence. That also helps drive our margins. The end result is we're able to drive strong earnings growth and then the corresponding strong cash flow that goes with that.
Frankly, one of the strengths of the company from a financial standpoint is the consistency and strength of the cash that we generate. We then use that cash flow, in part, to reinvest back in the business. All the things that you've seen talked about today, and lots of areas for innovation and growth that we reinvest back in our business, as well as support through capital investments, the growth that we're looking at. As well as from an operational excellence, including our LaunchPad business process improvement initiative, also our ability to drive our margins going forward as well. After we've used our cash for internal needs, we then look for strategic acquisition opportunities.
You've heard a lot of the presentations today talking about the opportunities we have to supplement our organic growth through an acquisition program from the health and hospital systems, the independent labs, the specialty testing. There's a significant opportunity for us to continue to grow through M&A, to supplement our organic growth. And then finally, cash back to our shareholders. We generate substantial cash flow. We've initiated a dividend last year, for the first time, a quarterly cash dividend that we're continuing now to pay. In addition to that, still cash flow generation that enables us to be back in the market, repurchasing our shares. So with that as the overview, let's talk about our track record of performance, and then we'll talk a little bit about our outlook.
So first, from a revenue standpoint, you'll see that we're looking at a period from 2019 through 2023, and we're using the midpoint of the guidance that we have for 2023. What you'll see is that from a company standpoint, we've grown our top line at 7.5% compound annual growth rate over that period of time. All the financials on this slide, you'll see, are call it pro forma for our spin of Fortrea. They're all from continuing operations, even going back to 2019 period, so the business as we are today. You'll see that organically, in constant currency, we've grown our top line at a 6% compound annual growth rate over that period of time. Again, we tend to think of ourselves as a mid-single digit organic growth fairly consistently.
Including in that, you'll see, includes our in-hospital lab management agreements that have been a big focus of the company. You've heard Bryan Vaughn talk about Ascension and the other ones that we've done. We treat that as organic growth. We're not acquiring that business; we're entering into long-term partnerships with the health and hospital systems that enable us to grow organically. Given the size of Ascension, when you look at the growth rate, Ascension alone added around 1% to our organic growth, or call it around 5%, excluding that. So still solid, mid-single-digit organic growth, with still opportunities to grow in excess of that as we continue to hopefully consolidate and do more within the health and hospital system area.
When you look at the two segments, you saw the business leaders talk about their different areas, but in diagnostics, which represents around 75% of our revenues, you'll see that our organic growth rate over this period of time was around 6%. So again, we tend to think of our diagnostics lab business as a low- to mid-single-digit organic growth business. This, obviously, a little bit higher, but reflective of the big Ascension transaction, which on diagnostics, added around 2% to that growth rate. So still a solid 4% organic growth, and then additive to that with the hospital systems. On the Biopharma Laboratory Services side, we look at more of a mid- to high-single-digit growth rate business for the 25% of our revenues right now comprised within that area.
And you'll see here we did around a 7% compound annual growth rate over that period of time. Here, part of the benefit of the top line growth has come with the inflationary environment and how it applied to our NHPs that we use within our early development research lab, part of our business. A lot of that, especially the hyperinflationary part of that pricing, is more of a pass-through, but still adding to the revenue growth, but still, again, mid to high single digit growth historical. When you also look at the slide, you'll see the year-by-year comparison of how we've grown our revenues. And worth noting is if you look at 2020, kind of the peak of the pandemic, you'll see that the base business of Labcorp was down probably around 4%, while obviously we grew significantly because of COVID testing.
But it really also speaks to the underlying base business that we have, and as you would have looked at it, even over longer periods of time and through financial cycles, our ability to withstand those cycles are very good. What we do matters. What we do is needed. You heard Mark talk about the low cost of what we do relative to the overall cost of healthcare that is needed for people. When you look at 2023, our growth rate, you'll see actually we expect to be up 2% this year, despite the level of COVID testing that's down fairly dramatically from the prior year, which means that our base business, excluding COVID testing, is up around 12% this year. Greater than, call it, that mid-single-digit growth rate because we're coming off of not a fully recovered year.
But we actually believe that 2023 is pretty indicative of now some more normalcy, as we go forward. So now when you translate revenues to profitable growth, you look at our earnings per share, and first of all, you'll see the growth rate. A 9.5% compound annual growth rate from our adjusted earnings per share from 2019 to the midpoint of our guidance for 2023. So higher than the revenue growth as we continue to benefit from capital allocation as well. And again, when you look at the year-by-year, bars, you'll see again, 2020, the negative impact on the base business of the economy slowing down, physician practices that were closed during that time, still a profitable business. And then on top of that, all the revenue, all the earnings that were associated with the COVID testing we were doing.
Again, such that for 2023, the midpoint of our guidance at roughly $13.5 a share, would represent around a 19% decline year-on-year because of all the decline that we were experiencing with COVID testing. But the underlying base business is going to be up around 20%. So a good, good growth within our base business revenues, good growth from margin improvement, good growth from capital allocation, helping drive very strong earnings performance. Then finally, translating that to cash flow. And you'll see here the kind of similar profile as you would expect with how our earnings went, so goes our cash flows.
You will see that the growth rate within our cash flows over this period of time was around 3%, so lower than the growth rate in earnings, and that's due to some timing-related issues in 2023. Principally due to the timing of working capital, and a very big component of that was our prepayment of NHPs that was used to lock up supply for early development business. As the industry was constrained, we entered into new supply agreements with new vendors to shore up that capacity that now enables us to see and expect strong growth in the second half of the year, as now we have that capacity to address the current levels of demand.
So as we normally think, and we'll talk about that cash normally growing in line with earnings, as we look to 2024, we'll actually see our cash flow even growing greater than earnings because of the timing issue that we had this year. So let's switch gears a little bit. We talked about the track record that we have. How does that translate into what our expectations are going forward? You've heard from the team and from Adam at a high level, that over the next three years, we expect, again, our organic growth rate to be in the mid-single digits. We'll supplement that with acquisitions. We'll drive margin improvement, capital allocation, to drive double-digit earnings per share growth, around 10% at the midpoint of the outlook range that we're going to provide.
So a very attractive outlook we feel for the company, again, using 2023 midpoint of our guidance as the base. So first, you'll see the organic revenue of the company at an enterprise level, 3.5%-5.5%. So again, as we talk about mid-single digit enterprise growth, again, to think about that growth rate, two things still constraining it. In the base year, we have still COVID testing, around $150 million that we'll generate in revenues from COVID this year, that most of which we expect will be gone going forward. That, as well as we've modeled, that PAMA will be back, that price reductions affecting our diagnostics business will be in. The combination of those two headwinds for 2024 would be around $200 million in revenue.
Again, even despite that headwind, looking at solid mid-single-digit growth for the company. Then you see the breakdown between the two segments with diagnostics that we talked about. Again, the low- to mid-single-digit growth year, 2.5%-4.5%, so 3.5% at the midpoint. Again, both of those headwinds of COVID testing and PAMA affect the diagnostics business, so those growth rates are growing consistently with historical, even despite those headwinds. Then on the Biopharma Laboratory Services side, you see the higher growth, the mid- to high-single-digit growth, here, 4.5%-7.5%, or around 6% at the midpoint. Again, a consistent track record going forward with what we've experienced historically. On top of the organic growth, we talked about acquisitions.
Strong cash that we'll deploy to M&A, good pipeline of transactions we expect over the next few years to be able to supplement that organic growth with around 1.5%-2.5% additional through M&A. And again, the prospects look very good, a lot of very strategic opportunities. From a margin standpoint, we're looking at around 100-150 basis points of margin improvement beyond our margins in 2023. And again, still constrained with the headwinds we have, we still feel very strongly in our ability to drive our margins through the top line growth of the businesses, through the operational excellence that you've seen, through the LaunchPad initiatives that we have, will continue to drive margins.
What that means for 2024 is that margins will be flat to slightly up because of those headwinds that we've modeled, and even including that, still over the three-year period, expect the overall margins to be up 100-150 basis points. From an EPS, that translates again to double-digit EPS at the midpoint of our guidance range, 8.5%-11.5% over the next three years, again, with 2024 being a little bit below the range, given the headwinds only to come out of it, still on average, over that three-year period at a double-digit level. And we've talked about cash flow growing commensurate with earnings.
We talked about a little bit of the timing in 2023 that caused it to be a little bit lower, so we would actually expect to see our cash flow grow at a little bit higher rate than our earnings, but still in line. Then finally, from a philosophy standpoint, we continue to be committed to being investment grade. We target 2.5x-3 x our gross debt to trailing 12 months EBITDA.
We're currently operating at the low end of our range, which means that over the next three years, we still have financial flexibility, not only to utilize the free cash flow that we generate, but also use some of the balance sheet as well, to still be within our targeted range, but gives us additional capital, should we find the right opportunities between M&A as well as share repurchases. With that, we'll just drill down just on a couple of issues. One, you've heard a lot about our LaunchPad throughout the discussions and the operational excellence that we look for. LaunchPad has been around for the company, part of our culture since 2015.
The current LaunchPad initiatives that help drive, again, that margin improvement, our current plan is a three-year plan that would take us through 2024 to take out $350 million of savings, and we're on track to doing that. When you look at what's embedded in the model for the three years, that new three-year outlook, we've assumed $100 million to $125 million per year of cost savings through the initiatives that you've heard earlier today. Some of them, just business process improvements as we look about being a global leader in laboratory services, the commonality across all of our labs that you've seen, not only across diagnostics, but across the segments.
You've heard our talk about standardization of our equipment, standardization, obviously, of our supplies, the procurement of having the size and scale to continue to drive savings. You've heard from Lance and others on the automation that we have, the technology that we utilize, whether it be from AI, whether it be from robotics that continues to improve the efficiencies within our lab which improves our quality, which reduces our turnaround times, which reduces our cost structure. We have a global footprint that we continue to leverage and take opportunities from. From the lab standpoint, we're still in an opportunity to consolidate facilities that we have, and given, again, the focus on the lab business, we're able to centralize a lot of the support functions now and have developed centers of excellence that we have spread in strategic areas throughout the world.
An area in Bangalore, India, to cover the Asian areas. We are in Sofia, Bulgaria, for within Europe and in Raleigh, North Carolina, in the U.S., where we have those centers of excellence for the support functions, which again, drive the support for our business at reduced costs. And then finally, with LaunchPad being part of the, you know, culture, the fabric of what we do from an operational excellence standpoint, all acquisitions that we do go under that banner as well. Every transaction we do, upfront, we identify where the opportunities, where the synergies are, where the cost savings are, such that we continue to generate strong returns from all the acquisitions that we do as well. Talk just a little bit now, too, about our cash flow and then how we allocate that cash.
So here you'll see from the years 2019 to 2022, so four years of actual results, and this includes discontinued operations. So we wanted to show actually how did we allocate the capital. So when you look at the numbers here, and call it 2020 in particular, you see the impact of the pandemic. So over the four years, we've generated around $8.5 billion of operating cash flow. You can see in 2020, we utilized the least amount of that cash flow, given all the uncertainty was going on at that period of time. The one thing we didn't change was the amount of capital investments we made. We continued to invest even with that uncertainty because we invest for the long term.
What we scaled back on was our share repurchases, was our M&A activity, and actually used some of our capital to pay down maturing debt at that time. Obviously, coming out of the pandemic or the strength of the COVID testing in 2021 and 2022, generating substantially more cash flow, bringing up again the M&A program, the acquisitions, and then you'll see substantial capital that was returned back to our shareholders. So on the right side of the slide, the pie graph, you see kind of how we allocated that capital. Around 20% of the operating cash flow that we generated went back into the company through internal capital investments. Around a third of it was used for M&A opportunities. A little over 40% was returned back to our shareholders, again, with a little bit that we used to pay down debt.
As you think about the operating model over the next three years included in our outlook, that's probably a reasonable profile as well, with around 20% for internal capital needs, the other 80% split between M&A and returning capital to our shareholders, and again, fluctuate close to each other depending upon the level of M&A activity that we have will dictate that overall match. Then we've talked to the commitment of being investment grade throughout that process, with additional financial flexibility to pursue the right opportunities. And then finally, from an M&A standpoint, you've heard a lot of the opportunities that we have, how that's gonna continue to supplement our growth, that it's part of our strategy. So we're a pretty acquisitive company, and we're very disciplined, and it's one of the core competencies as well.
You've heard about all the science and innovation that drives what we do, but we also do acquisitions and integrate them effectively as well. On average, we do around 10 acquisitions, tuck-in acquisitions for the most part, with an average of around $700 million spent per year, at least over the last few years. You see the names of the various acquisitions that we've recently done with the focus, again, on the health and hospital systems, the independent labs, the specialty testing. You'll see that we've done that meet the strategic criteria of what we're trying to identify, as well as our financial criteria when we do acquisitions.
On the strategic side, other than focusing obviously on the businesses that are common to what we do, that leverage our core competencies, we look for businesses that are also market leaders in what they do or would add to our existing market leadership position. We look for companies that have strong management teams or our way of saying we're not looking for turnaround situations. We're looking for good companies with good products and services that we can utilize. From a financial standpoint, we look for our acquisitions to be accretive to our earnings and cash flow in year one and earn our cost of capital by year three. There have been a couple of exceptions to the financial criteria.
When you look at our PGDx and OmniSeq, where we were focused on growing within the oncology space, and you heard Jon talk more about a focus in liquid biopsy. Those transactions we knew would be dilutive initially, but still then earn a very attractive return as the business would grow. And even in the years that we acquired those businesses, when you put all the acquisitions that we would have done within that year, it still would have been additive to the earnings of the company, overall. Again, the pipeline for M&A that we see in front of us is still very strong, and we would expect to continue to deploy a fair amount of capital to pursue those strategic acquisitions. Again, in summary, the company is focused obviously on improving health, improving lives.
You hear about all the innovation that we're doing, what we do matters, but it also translates to a very attractive financial profile for the company and for our shareholders. Our ability to consistently deliver strong top-line growth organically, as well as through our acquisitions, our ability to drive margin improvement, as we leverage that top-line growth, and we instill that operational excellence in LaunchPad, and that the strength of that earnings is our cash flow that we'll redeploy back into our business, investing for the long term, as well as we continue to look to consolidate and acquire companies within a fairly fragmented industry that we have. So with that, I will now ask Adam to come back up to provide some closing remarks, and then we'll be happy to take questions.
All right. Thanks, Glenn. All right. Thank you, Glenn. So I first want to thank all of you that joined us here today in New York. I want to thank those of you that joined us by the webcast. We appreciate you spending time with us today, and we appreciate your interest in Labcorp. It obviously takes a lot of work to prepare for a day like today, so I want to thank everybody, and where's Chas and Christin and their teams? But I want to thank everybody that helped us get everything done so we could be here with you all today. But as importantly, I want to thank our 60,000 employees that we represented here today.
Hopefully, you get a sense of what our mission is all about and how important the 60,000 employees we have around the world are to that mission. The mission is the really driving force behind what we do each and every day. So I want to reiterate how excited we are about the near and long-term opportunities. We believe the future is bright for patients, for shareholders, for Labcorp, and we're excited to be on this journey. So we're going to answer questions now. I'm going to ask Christin to come up here and my colleagues to join me on the stage. Thank you.
Yeah, I liked the shout-out. All right, great. So I'm going to open it up for questions. We'll have about 30 minutes. We'll start with Jack.
Thanks. Jack Meehan at Nephron Research. I wanted to ask about some of the specialty areas of the portfolio. You talked about some of the recent deals that have been an exception to the rule in terms of the financial framework. How do you think about MRD as a strategic area, and what's your tolerance for dilution? Is there some magnitude you would consider, just if something were really important?
No, thanks for the question, Jack, it's nice to see you. I'll ask Brian to jump in a little bit as well, if he wants to add at the end. But at the end of the day, it's about having the broadest menu that we can possibly have. Minimal residual disease, or MRD, could become very important in the future, and we have our scientists working on various things in, in MRD ourselves. Not to say that we won't partner or that we won't acquire, but at the end of the day, we really do hold to those kind of three things that Glenn talked about. We've got to be able to return our cost of capital quickly. We have to be able to be accretive quickly, and we want to make sure we can integrate these types of deals fast.
It is a rare exception that we're willing to be dilutive. We do not want to make that routine. It has to be something very special that accelerates our strategy significantly faster than if we can build it ourselves. I don't know, Brian, if you want to talk about some of the things we're working on in MRD.
That was great. Jack, you're exactly right. We think about the entire continuum of care for everything from screening all the way to, you know, recurrence monitoring, et cetera. We work with global industry partners everywhere. We are aware of a lot of the research that's being done right now. Our own R&D team is working on a variety of different things itself. One of the things that we like to think about deeply is the pace of clinical adoption and standard of care, how it's being used by the clinicians and oncologists that are using it, and then, of course, very importantly, what are the requirements necessary to demonstrate clinical utility to get adequate reimbursement and coverage policy? So we're thinking about all of those different aspects, and we have not yet pulled any triggers, but we're very well aware of everything in this space.
Great. And one follow-up on PAMA. Just, Adam, how do you handicap the likelihood of another delay? Given your comments on 2024 EPS being just below the range? If we did get another delay, would that shove you to the top end? How do you think about that?
Yeah. No, it's a, it's a great question, and every year, towards the end of the year, I spend most of my time on the phone with congressmen and women and senators and trying to say: If you're not gonna pass SALSA, which you should pass, can you at least give us a delay? We have bipartisan support for SALSA. It just is not negative in terms of when the CBO scores it, and anything positive, where it costs money, is very difficult to get through these days. ACLA continues to have very strong network, and we have a lot of support for SALSA.
But at the end of the day, I'm building an $80 million downside next year because I don't think that our strategy should be, "We're gonna be okay if PAMA doesn't come." What I wanna show you is a good profile, assuming that we have an $80 million downside, and if PAMA does not come, there'll be an $80 million more that we will add to our numbers next year. I'm hopeful about SALSA, but if SALSA does not look like it's gonna be passed, we'll again try to do a delay. A delay actually is positive from a CBO score. There's many reasons why. So, SALSA is the right long-term fix. That's what we're focused on.
That's where ACLA is focused on, but if we have to pivot at the end, although we wouldn't like to, we'll, of course, have to consider that. Yeah.
Hi, it's AJ Rice from Credit Suisse. Two questions. One, comment about the managed care pricing being sort of flat to up. There's a lot of components of managed care pricing. It'd be absolute price, it can be incentive payments, it can be, other things. Can you just comment on what's underneath that flat to up? And then, on the comments about the hospital opportunity, you guys are signing systems that have multiple hospitals. I think today, for the first time, you told us you have got over 200. Your competitors, your nearest peers out there, what is the addressable market of the potentials for partnerships, and how much of that is penetrated, and how much of the opportunity is still in front of you?
Yeah. No, that's a great question. I'm gonna ask Bryan and Mark to add on that. The only thing I would say first is that, you know, the 1.5%-2.5% that we put in for additional revenue, that's assuming that we get a lot of these hospital deals in the future. It's hard to predict whether there's gonna be another big one that's gonna move or it's gonna be multiple smaller hospital systems, but the pipeline looks terrific, and it's as big as it's been before. So Bryan, why don't you talk a little bit about hospitals and then, Mark, jump in about payers?
Sure. To add on the hospitals, there is still a lot of opportunity in front of us. It's billions. I mean, Mark showed the slide with $85 billion, and most of that is in the hospitals. Most of it's in front of us, but it's in smaller chunks at the end of the day, and it takes a lot to execute. So we're focused on growing and hitting our revenue targets while being able to execute on the ones that we do do.
Just to maybe clarify one thing on that. I know that about 40% of hospitals in the U.S. are categorized as sort of small community or, or rural. Are those off the table, and you're just focused on the large, and therefore we can sort of size it a little bit from that, or not really?
I would say we're focused on the largest ones because they give us the opportunity to bring that whole balanced value proposition in a much bigger way. Not to say we wouldn't look at a smaller opportunity if it fits the criteria and is a good one, but the focus and the emphasis is on the bigger ones.
On the payer side, neutral to slightly accretive is basically on a CPT code level. It's like for like. We are constantly engaged with the payers on coverage policies, which is a different bucket, particularly with the emerging technologies and their willingness to pay.
Okay.
Lisa Gill, JPMorgan. Thanks very much. Adam, I told you I was gonna look back at 2018 and hold you accountable for what you said you were going to do. I would just say a couple things from my perspective. One, when I look at the market share in 2018, and I look at it today, it's still 9%. A s I think about the rest of the market, what are the opportunities to continue to gain market share there? W hy do you think that you and your largest peer haven't gained incremental market share, as we sit today, would be my first question. T hen secondly, much focus around acquisitions, w e talked about hospitals, we've talked about the biopharma services side. Do you have more of a focus in one area versus another when we think about the next few years of acquisitions?
F irst question, you know, 9% market share, it, it's interesting because if you talk to most people, and you say: "What would the share be for Labcorp?" They would think it'd be much higher. And it's a lot to do with the prior question, which is there's a lot of small hospitals and lots of different businesses. So I do believe these hospital deals are going to give us more market share over time. It's funny, if you go back and you say, "What's one of the biggest surprises since you started in 2019?" It used to be, I would say in 2020, 2021, how hard it is to get these hospital deals done. The pipeline looked good back in 2019, and how many times did I call you, Bryan, and say, "Bryan, I mean, how long can this possibly take?"
I was able to buy a $40 billion company in a prior life faster than this, and it just took time. We're seeing that different now, and we're moving faster, and the pipeline is better, and the hospitals are moving quicker with us. I think partially they need to, but partially because we have such success, and we've shown our ability to integrate, that that's gonna give us more and more of these opportunities, and that's gonna help us with market share over time.
The way I look at health systems is, the more we do, the better we get, and the better we get, the more we do.
Then in terms of capital allocation, first and foremost, I wanna do as many of these hospital deals as I can. That's, that's - I mean, they're accretive immediately, they return our cost of capital quickly, and we've shown we can integrate them, and it gives us, you know, additional strength in the marketplace. So I, first and foremost, would do as many of those as I could do. Separate and distinct from that, we outlined some strategic areas, like cell and gene therapy. We might need to do some work to enhance our capabilities there. I'm not talking about a major acquisition or a third leg of a stool, if by any means, but if there was something that would accelerate our ability to be successful there, I would, of course, look at that.
We've done some expansion in China and Japan in our central laboratories, and we're gonna continue to see, do we need a broader footprint and presence in order to turn around these trials for our pharma partners faster? But by and large, when I look at that 1.5%-2.5%, I would like the majority of it to come from the hospital health systems and local laboratory, regional laboratory deals. You've seen a couple of those up there, too. Those deals are great deals for us as well. I mean, those are really good deals for us.
Andrea.
Thanks so much. Hi, it's Andrea Alfonso from UBS. Glenn, thank you so much for providing the 2023-2026 outlook. I guess, when we think about just the phasing of 2024, absent formal guidance there, how are you thinking about that? I think one of the footnotes had sort of an 800 basis points impact from PAMA on COVID. Is that netted against that 8.5%-11.5%? How should we think about that?
So the guidance that we have, obviously, for the three-year period includes all of that. So to your point, in 2024, it's gonna have the biggest impact of a headwind from us, from when we talk about lower COVID testing, and if PAMA comes in which we've modeled. We said it would be around a $200 million revenue impact, for 2024, a little bit more than that in the outer years, because PAMA unchanged would still be additive in future years, but just not at that, at that high of a level. So then you look at, from a profitability standpoint, that PAMA pricing is all to the bottom line, where obviously COVID is at margin, that would be call it at our diagnostics average.
W e would still said that even with those headwinds, from a margin standpoint, in 2024 relative to 2023, margins should be flat to slightly up, even though we expect 100-150 basis points of improvement over the three years. But the first year will be constrained unless PAMA is deferred. And similarly, from an earnings per share standpoint, we still expect to see good earnings per share growth, but not at the range that we had because of the constraint with, with PAMA in particular. But that's factored into that midpoint of, call it, 10% growth over the three years, but the first year would be below, 2024 would be below that.
We'll give our guidance for 2024, more specifically when we normally would, in February, but at least I think it gives you a good indication of where, what our expectations would be. And another way, frankly, of thinking of it, too, is that if you took those two headwinds that we've talked about, and we've given the impact, you could put it in and it would, you know, 2024 would then kind of get you back to that midpoint of our range, were it not have been for those headwinds.
Hello? A gain, just for the assumption underlying the margins being flat to slightly up, does that also contemplate the cost base being sort of more exacerbated that year, and then it kind of eases in the subsequent years?
Well, what we try to do there is attack the coverage policies. So the neutral to slightly accretive is on a like for like basis. It doesn't in take into account the inflation rates. We try to do that through what I call the wraparound services for our payers, the largest being, we've got new technology, we'd like you to start to reimburse it.
Great. Thank you.
In terms of the overall margin, it does include, you know, because of the COVID testing being less next year and the impact of PAMA, which is direct to the bottom line, that's why it's not as great as if you just took third, third, third.
Brian.
Hi, good afternoon, Brian Tanquilut from Jefferies. Glenn, I'll start kind of like qualitative turning to quantitative. So you give that 100-150 basis points of guidance improvement, right? What I'm hearing is that the hospital side will be a big driver of growth going forward. In the past, you've said that hospitals generally come with lower margins. Obviously, you've got cost inflation that's pretty consistent, even in a normalized basis. So maybe if you can bridge us to these qualitative parts, bringing it up to 100-150 basis points of improvement over the next three years.
Bryan, it'd be helpful maybe if you talked about the margins in the hospital business a little bit, 'cause one hospital is one hospital.
Sure. I mean, so I talked about those three main business lines within the health system deals, the lab management component, the outreach component, the reference component. The lab management component can have a lower margin, right? I think when you look historically at the deals we've done, as well as what we have in our pipeline now, there's a pretty good balance between the lab management component at a lower margin and the other business at, call it, more traditional fold-in type margins. I think all in all, if you blend it out, it's pretty neutral to margins, unless the mix of that business were to shift dramatically, or we did another Ascension-sized deal, in which we would call it out. So that's sort of how I see it from a margin balancing standpoint. Yeah.
The only thing I'd just add to it, because Ascension was so large, it was not only large in the size of what we were doing, but it had a much higher percentage of the part of the business that was the in-hospital lab, which was at a lower, number. And even for diagnostics this year, we expect our margins to be up year-over-year for 2023, even with the dilutive nature of that in-hospital lab management agreement in the first year, which then in subsequent years, we expect to drive that margin up as we integrate it better into the company as well.
I t really just does depend a bit on the type of hospital deal, how dilutive it may or may not be to the margin. And that's where we look at those closely, but it has to meet our financial criteria under any circumstance.
W hen you look again, the expectation for the margin improvement, it's really the impact of lower COVID testing in 2024 and the pickup of PAMA. You know, those two would have around a 70 basis point headwind to our margins in the first year. So if you say, "Okay, well, we're flat to slightly up," well, we've given up 70 from those two, then it means we have to do 100-150 in second and third year, where we won't have those headwinds like it would have happened in 2020. Again, if PAMA gets deferred, expect that margins would be up even greater in 2024 and would take our overall outlook higher as well.
Pito Chickering, Deutsche Bank. Looking at the competitive landscape for early development, how do you believe that you're positioned versus your larger, larger competitors? And when you win and lose deals, you know, what are the key drivers in both cases?
If you look at early development, we're certainly a leader. We have a very strong presence with the large pharma companies from our central lab. But in early development, a lot of the competition is in the smaller biopharma area. So, you know, the average trials are much, much smaller in those areas than are in the big areas. I think part of our advantage is the fact that we have both early development and central laboratory, and we can actually, especially in things like cell and gene therapy, oncology, where you go from phase 0 or phase I to phase III, much faster than other therapeutic areas. If we can show people work with us in early development, and then we can do your central laboratory work, and then we can do your go-to-market for the testing afterwards, that's our competitive advantage, frankly.
I don't know, Jon, if you would want to add anything to that .
That's a good point. I think, you know, there are areas where speed is everything, and cell and gene therapy is probably the most exaggerated. We're really at, while we're working in early development, we're already thinking about the clinical trial because it's a relatively small clinical trial number of patients. And that's where clients come to us to be able to say, "Okay, we need to get this off the ground," and think about the clinical piece, even though it's still in the pre-clinical phase, and that's a big advantage for us.
Maryland, I think it might be helpful to explain our manufacturing of cell and gene therapy strategy, because I do think it's differentiating versus some of the competition.
T hanks for that, Adam. We've taken an approach to look at manufacturing more from a collaborative standpoint than bring it in-house, because, you know, I showed two just examples, but there are so many different approaches that the industry is taking in this space that, you know, what one customer needs may be very different from another customer, from another customer, from another customer. And there's still a lot of changes in the regulatory landscape. We don't know, you know, what it looks like today may not look the same five years or ten years from now, probably won't look the same.
So being able to partner with, manufacturing organizations specific to cell and gene therapies gives us more flexibility in order to bring the right expertise together from, the Biopharma Laboratory Services side and the expertise needed for manufacturing, so that we can help reduce risk and increase timelines, in that early development phase and then into clinical, delivery development.
Then a question on free cash flow. F or the next few years, how should we think about the split in the buckets between dividends, M&A, and repo? Is it like 20% dividends, 20% repo, 60% M&A? And, you know, can you talk about the deal multiples you're seeing for outreach programs at this point?
W e've talked a little bit about that internally. We expect roughly around 20% for internal capital needs. We tend to use around a 3.5% of revenue target for our capital investments. Dividends, we have a policy of around 15%-20% of our payout of our earnings. We're at the upper end of that range right now, given that we've just completed the spin, and obviously, the associated earnings that went with that spin. So for right now, we're at the high end, if you will, on that. But we're at the low end of our targeted leverage, so we have the ability to use additional debt, if you will, to fund, but the dividends are strong. Then it's really a function of the opportunities we have in M&A versus share repurchases.
T his part of the strategy of the company is to continue to grow through M&A as long as the pipeline of deals are there, where we feel we can get very attractive financial returns on it, we're going to do M&A. We've talked about historically, the balance has been more towards returning capital to shareholders than M&A. It was a little over a third, but for modeling purposes, you know, we're assuming it's going to be 40%-50%, call it M&A, 40%-50% of share repurchases inclusion, including the dividends after we've done our internal CapEx. So assume weighted to M&A if the right opportunities are there.
Hey, great. Thanks, Patrick Donnelly from Citi. Glenn, one for you, just on the LaunchPad side. You continue to mention technology advancements, rationalizing footprint, headcount. You know, you guys showed some pretty good advancements already, obviously, with Matrix and some of the automation you guys have. You know, what inning do you think you're in there? I mean, automation has been talked about as an opportunity for a long time for you guys. It seems like you're pretty far along, just judging by some of the robots you showed there. So how do you think about that piece as a lever and where we are?
Yeah, it's hard to put an inning into something that's part of the fabric of what we do for continuous improvement all the time. We're always looking for opportunities to expand as we grow. As we acquire companies, there's still gonna be more opportunities. We've talked about the global footprint that we have and how we can leverage that more. Talked about more as a pure, call it, laboratory services company, the ability to centralize support functions and reduce costs there as well. So, you know, we've made a lot of progress. Again, we've been doing this now as a holiday banner under LaunchPad since 2015, and we expect to take $100 million-$125 million per year of costs.
We tend to think about it more of a cost savings initiative, but there's also opportunities to improve productivity, add to capacity that could fuel top-line growth. That will help margins as well. But there's no end to the game, let's just put it that way. We're trying to offset the inflationary environment that we're in, and LaunchPad, as an overall program, helps us, you know, offset at least more traditional inflationary cost pressures that we have. Obviously, the last couple of years, we've seen even a higher level, but it seems like those are at least normalizing.
Yeah, go ahead. Go ahead, Lance.
That there are a number of different categories of technology that we're working on that can contribute to what you're asking about. When I look at the robotics aspect and the pipeline of ideas that we could employ, the pipeline is long. And when I think about software engineering of improving our efficiency and quality through software, that as well has a pipeline that's impressive. And then when you talk about AI, I can tell you that there's numerous opportunities. We talked about three that are in production, real-life, operating and supporting providers and patients, but that list is also quite long. So it's not like we're nearing a point of diminishing return yet.
No, that's helpful. I appreciate it. And then, Adam, maybe on the cell and gene therapy, yeah, have you seen any change in customer behavior? You know, whether it's life science suppliers or CDMOs. I mean, they're seeing some softening in that market. So just curious what you guys are seeing there. It sounds like you're pretty, pretty bulled up on it. And then I was gonna ask about just the capabilities. Do you feel like you need to add more? It sounds like maybe that's an opportunity. What parts of the portfolio do you see in cell and gene therapy that, that maybe is worth expanding into?
I think it's an exciting opportunity right now. And when you look at pharma, and I talk to my colleagues in pharma, I mean, they're still investing significantly in their pipelines in cell and gene therapy. So, and particularly in, you know, areas like oncology, areas like the high specialty area. So, so I think it's very robust, and it's gonna continue to be robust as we look out further. You know, we've added some capacity in some of our laboratories because you need specialized equipment to do early development trials with cell and gene therapy. You need some specialized, you know, types of rooms and so forth. So we've expanded those areas so that we have more capacity.
I remember, I think it was two years ago, Maryland, I said: "Why aren't we doing more cell and gene therapy?" We said, "Well, we're using everything we have every day." And I said, "Well, let's just, let's expand," and we've been able to successfully do that. I can tell you that we've got a long list of things that Maryland would like to do, and we kind of look at those versus the other things. We are gonna support it, but it's gonna be more kind of internally building and getting more capacity versus any large-scale acquisitions and so forth.
Right. I think one opportunity we have, which is, many of the hospital systems we work with are interested in participating in cell and gene therapy as well. So now with those relationships, with our presence at those sites, we can actually kind of bring those into the drug development pipeline and kind of connect, whether it's a small biotech that has a program or a large pharma, and connect those hospitals with the drug development team, clients we have.
Great. Thank you, Tim Daley, Wells Fargo. Mark, you listed off three growth factors or vectors for diagnostics, price, volume, mix, laid out why price on apples-to-apples basis is probably flat, slightly up. So if we think about that 2.5-4.5, what of that is volume? What's mix? And then of those factors as well, what gets you to the high ends, and what kind of brings you down to the low ends, if you were really o ne factor, I know there's a lot .
So, Glenn, keep me honest here, but we think the specialty testing market is gonna grow somewhere between 8% and 9%. And that's one of the reasons why we're getting behind it, and pushing that forward, and that's gonna outgrow the normal organic-based business.
That gives you part of the range as to what could be at the higher end, how fast we penetrate it. If you look at our average market share in oncology, for example, it's not where it should be. It's actually slightly below what the average is, because you have some of these specialized oncology companies that do well. We think with our broad portfolio and with the new capabilities that Mark and his team are bringing with Lance and so forth, that we'll be able to get some share there, that would give us some kind of, you know, upside in the specialty area. I would be disappointed if we grew our specialty business at the market rate of 9%. I expect us to grow faster than the market rate of 9% for that group of specialty products. You know that, right, Mark?
I do now.
Frankly, as part of the growth, when we think historically, we've probably done around 2, 2% of our growth from volume and then 1% from price mix, which would have been mostly mix related. You know, our growing of our esoteric business is greater than our routine and, you know, more tests per accession that we do. Right now, we're seeing stronger levels of volume, and as Mark said, we're for the first time, instead of seeing price - unit price down, even though price mix is up, we're now starting to see unit price leveling off, which bodes well for part of that reason for the slightly higher growth rate.
All right. No, that's, that's really helpful. And then, you know, moving over to biopharma. So if we think about the $900 million or so, I think, in the ED business, how much of that is discovery versus safety? And then, you know, taking a step back, similar question to my other one, you know, the 4.5-7.5 for BLS overall, you know, what is that growth assumption for lab versus, versus ED? So breaking out ED, then kind of the two bigger segments in terms of growth.
Yeah. So I don't think we've broken out within ED the different parts of it, and that fluctuates depending on the client flow. And like I said, there's a lot of small clients that you have, and it could differ from, you know, I wouldn't say quarter-over-quarter, but certainly every six months or so. In terms of growth rates, you know, we expect the early development to grow faster than the central laboratory business, and we'll give guidance on revenue, you know, when we come to February. But we would expect to see the early development growth rate a higher percent growth than the central laboratory business. What has it been historically, Glenn, do you recall?
We will give the outlook for the segment. But to Adam's point, historically, they've been pretty much in line, call it central lab, more in the mid-single digits, early development, a little bit higher than that, to get to the mid-to-high single digits. As we think about 2024, you're gonna see a much higher growth rate within early development because of the constraints that we had with the NHPs in the first half of this year. That will help fuel it, but over time, you would expect, as Adam said, a slightly higher growth rate within our early development research lab part of the business.
All right, great. Thank you.
Adam?
Thank you for joining us today. Hopefully, you leave with feeling the excitement that we have for our future growth opportunities, and we'll look forward to continuing to update you as we go through the quarters and see you at conferences. We look forward to that. Thanks for your time today, everybody.