Masimo Corporation (MASI)
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Investor Day 2022

Dec 13, 2022

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Good morning.

Speaker 13

Good morning.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

I'm Eli Kammerman, VP of Investor Relations here at Masimo. I'd like to welcome you all to our 2022 Investor Day today. We've got a really full action-packed and information-rich day planned for you. We think you'll get a lot out of it, and it will definitely have been worth your while to come out here to see things that people have not seen before and that they won't see on the webcast. Before we begin, let me cover a couple of important things. Firstly, the restrooms. The restrooms are through that exit door on the right and just follow the wall around to the right. Secondly, you probably saw that we have breakfast right outside these doors and coffee is in the back. Here's our agenda for today. As you can see, we're gonna have some presentations to start.

We've got a coffee break at nine o'clock. You'll come back for some more presentations as well as a physician panel, and then we'll break for a combination of lunch and rotations through demonstrations. We think you'll really get a lot out of that. You'll see many of the new products we've been talking about for a long time, and you'll be able to ask questions of our subject matter experts about the products. We'll come back for some more presentations and a wrap up with open floor Q&A. For today, we will be discussing forecasts and projections along the lines of what are described in our safe harbor statement. Please keep in mind that these forecasts and projections involve risks and uncertainties, and these are further described in our SEC filings. In addition, we will also be discussing non-GAAP financial figures.

The definitions for these non-GAAP figures are also contained in our filings with the SEC. I would like to introduce our Founder, Chairman, and CEO, Joe Kiani.

Joe Kiani
Founder, Chairman, and CEO, Masimo

Hi, Eli. Good morning.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Good morning.

Joe Kiani
Founder, Chairman, and CEO, Masimo

Thank you all for coming. Really appreciate you making the time to come here. We're excited to have this day with you. I know it's been a long time coming, especially since we announced the acquisition of Sound United. I hope you'll believe it was worthwhile. I have one thing we're doing differently here that I wanna tell you about. Today, we're gonna show you a little bit about some future stuff, things within the next year. We're not gonna go beyond that, but still, it's not our style. We'd rather just introduce the product than talk about it. I think, given that there was some nervousness about where we're going, we decided maybe it was the right thing to do to kinda change how we do things a bit.

You know, I started Masimo, gosh, February 1989, almost 34 years ago. Our mission, really from the almost the very beginning, was to improve patient outcome and reduce cost of care by taking non-invasive monitoring to new sites and applications. It's about to come to full circle. It's about to be totally envisioned. I know some of you are very clever. You saw some of our filings for trademarks like Stork, and you saw some of the videos we just showed you today, and you put some of it together, but there's a lot more. There's a lot more. You know, that mission we have accomplished to a great degree. We've saved numerous lives. We've improved numerous lives. I don't know, probably tens of thousands of babies no longer are blind because of SET pulse oximetry.

With hemoglobin, we've done so much already and so much more to go. The stuff we're about to do now, it's really gonna help us just take things to a new level. The degree of lives we'll touch, the amount of, hopefully, lives we'll save, it'll be tremendous. We couldn't have done it without a decade ago, putting into motion the products you're gonna be seeing today and in the next 12 months and beyond. We couldn't have done it, as you'll see, without bringing in the Sound United team to help us. We were engineers at the time when we started Masimo. We were good at math, we were good at the adaptive filters and signal processing. We've immersed ourselves now.

We're immersed engineers, and we understand the proble ms of our customers, whether it was overburdened clinicians, whether it was poor hand-off communication, whether it's recognizing that opioid-induced respiratory depression is just not something that happens in hospitals, it happens at homes. These are the things we began recognizing and we wanted to create solutions for. Today, we've got a lot to show you. Blair will come up here, and we'll talk about, first, about Masimo Consumer Health. With that, we'll show you some new products. Some you've already seen, like the W1 and Freedom that will be coming out. We're gonna show you Stork, which is a new baby monitor. That should be incredible. We're gonna show you our new Adaptive Acoustic Technology for creating earbuds that not only help people hear music better, but eventually hear their environment better.

We're gonna talk about the Masimo audio brand, this iconic set of products that have been around some for 50, some for over 100 years, that people keep going back to 'cause they are the audio company for high fidelity. We're gonna take some of the things they created, like HEOS, and we're gonna turn it on to turn them into health hubs. In the past couple of years, we've put about maybe 1,000, 2,000 health hubs out there as we rolled out Masimo SafetyNet for COVID. Today, 20,000 devices have been turned on to become health hubs, and in 2023, about 4 million devices will become home health hubs. Bilal Muhsin will come out and talk to you about our core technologies, SET, AAT, and we'll talk to you about what we're doing for hospitals, some of the new products we've developed.

In the last few days, we've announced some incredible products, technologies we've been working on for a decade, like Sepsis Index. More people die of sepsis than anything else. Early detection of sepsis can save lives. There's never been a good tool, a tool good enough to have the sensitivity and specificity you need to be able to react to the onset of sepsis. Hydration Index. We began showing athletes our pulse oximetry over a decade ago, and many of them told us they use it for training, knowing when to stop, do a massage day, as they would say, and when to push. Every one of them said, "If you could only let me know about my hydration." Well, we did a full market release of Hydration Index a few days ago. I am truly excited about that.

You know, I spent a lot of time in hospitals recently, and there's a lot I learned from that. I never had the patient's perspective. First of all, the one product that became my favorite product was the W1. It was easy to wear. It didn't tether me. It didn't pull on me. I had at the time, Hi, and it let me know about my hydration, and I used it to titrate myself. I'll tell you, I also learned there's so much more we need to do for hospitals, especially in the ICUs, especially in the neuro ICU. Not just getting the current products we have, like SedLine and O3 to become ubiquitous there, 'cause it did help me and it should help more people, but the tools they really need that they're using corollary adjacent products to try to get some insight with.

You know what else I got out of that experience? How I was able to complete my healthcare at home. The step-down unit became my bedroom. Why? I had the W1, I had the Radius Tº for my temperature, and importantly, I had a service team here that watched over me. One day at 4 in the morning, they rushed into my bedroom 'cause they had seen my deterioration. Fortunately, it was fine. They were a little overzealous. Look, hospitals are great. In fact, I used to say, "The last place I wanna be in the world is in a hospital." Well, at UCI , where I was, I was happy to be there. They gave me excellent care. Protocolized patient safety in their head. ICU doctors that collaborated together to give me the best care. Nurses that cared with empathy.

I'll tell you, going home was important. At the hospital, you have the risk of hospital-acquired conditions like infections, MRSA, and you've got that sinking feeling when you're in a hospital. At home, around your loved ones, around your environment with the right technologies, you can get better. I noticed my doctors worried about my pulse rate, my perfusion, 'cause they didn't know my baseline. Imagine when W1 becomes ubiquitous or Freedom, whichever. When someone walks into the hospital, their historical data will transfer to our devices, so people will know what my baseline is, and they'll know whether how I'm doing is good or bad. I mean, these are the things we don't have right now, and these are the circles we need to complete. After Bilal talks to you about that, we've got an amazing physician panel.

These are incredible doctors with great reputation that have transformed healthcare. They're gonna talk to you about telemonitoring and why Masimo is an essential piece of that. 'Cause if you can't rely on the technology remotely, why would you put it out there? When I started Masimo, monitors needed someone to monitor. Really, nurses and doctors were monitoring the monitor, not the patient. By solving the false alarm problems with patient motion, low perfusion, which by the way also solved the problem with pigmentation, which you've heard a lot about. By solving those, we made monitoring reliable. We did what people didn't think was possible, to make monitors work good enough to save lives.

Some of you invested in our company and told me that you don't invest in healthcare unless those products can save lives, and you were surprised that a monitoring company had saved lives, and you'd come to us for that reason. Yes, we did. You know what? By making it so good, clinicians revolutionized care. They invented things we did not dream of, like using it to reduce eye damage in the neonatal ICU, using it to monitor healthy newborns for congenital heart defect, which before they would miss, and sometimes babies would go home, and they would die because the parents would mistake their heart defect for a fever or a flu. Using it to save lives in the post-surgical ward from opioid-induced respiratory depression. I remember a call I got from one of the physicians here.

Two weeks into COVID, he calls me up and says, "We gotta take your devices into the field 'cause we have too many patients coming into ICUs. We can't handle them, but we can trust your product to let us know when to bring those patients back in." Literally, within a month, we stood up that technology, FDA cleared it, and you'll hear more about the statistics of that. You'll do the tour, which I hope you'll take the chance to really go through it all. I think some phenomenal takeaways from that. You'll come back for the, I guess, the punchline. Micah will walk you through the financials, and it's good. We have an amazing trajectory. You know, just Masimo Healthcare on its own has a path of growing small double digits with revenue and earnings faster than that.

Masimo Consumer Audio has a similar trajectory. Masimo Consumer Healthcare gives us a chance to grow an order of magnitude, if not more, our revenue and our earnings. It's not like it's gonna be easy. We're not saying it's a straight line. Look, we've overcome bigger obstacles when we started Masimo. Now we have this incredible team, the best team I've ever had. Nearly 10,000 amazing people, from people working down on the factory floor to people running the company day in and day out. We have a reputation that's been hard fought and hard won. You know, we've got some revolutionary products. We've announced some of them already. You're gonna see some more today. I'm confident we're gonna get there.

We accomplished more than I promised you all 20 years ago and 30 years ago. I hope once again, we'll accomplish more than what I'm telling you today we're gonna do. Now, at the end of Micah's presentation, he'll tell you why we acquired Sound United. We've talked about it before. We put it on a slide. You'll see why we acquired Sound United. Look, we told you about a 20,000 distribution channel. We told you about the engineers, nearly 400 engineers. They have about 500 sales and marketing professionals that would have taken us maybe 5 years to a decade to hire, even if we could. These people love what they do. We're gonna take what they've done and take it to a new level. Why?

They're all excited about saving lives and going beyond just improving lives, but saving lives. What we're about to do with the launch of W1 and B1 , we would have had to invest a lot in sales and marketing, but now it's part of what we own, and it has a positive EBITDA. We don't have to take a hit in our earnings to go and take a risk of what's about to come. Yes, it is risky. I will never tell you anything we do is not risky. I've learned when you take risk, you actually improve your chance of survival, if not the ability to thrive. These are calculated risks. We did not buy Sound United for 10x revenue or 20x revenue. We bought them for 1x revenue, 8x EBITDA, with practically our own cash.

We did not leverage this company. We looked at over 200 companies before we bought Sound United, many in the consumer side, but none of them had the iconic brands that they have. What we have in our hands right now is Rice Krispies and Corn Flakes. People keep buying them, and we just can't screw it up, and we don't intend to. We intend to actually take it to a new level. We couldn't have gotten that with some of the new companies that have emerged. They could be gone tomorrow. By buying Sound United, we now have another billion-dollar business that on its own will do well, despite, God forbid, what could ever happen to Masimo Healthcare. You know, we're in a regulated industry. I could say something here today and upset someone, and they could come shut down my company. That happens. I won't say anything. I gotta say, I have, I've never felt better. I am ready to commit another 5-10 years of my life to this because I just don't think because we should, because we could, because if we don't do it-I don't think some of the stuff we're gonna do will ever come out. Many people put out toys, put out things that don't really work. We won't do that. We don't do that. I'm gonna come back later. I'll have a chance to hear everything like you're hearing and respond to your questions. I just wanna tell you, we wouldn't have made it if years ago, people that shouldn't have believed in our vision didn't believe in it. When we went public, some of you helped us become a public company and supported us.

This relationship is critical. Your belief in what we're doing is critical. I'm one of the largest shareholders, if not the single largest shareholder in this company. The only difference between me and some of you is that I just don't look to what's gonna be best in one year, but what's gonna be best in 10 years. That 10-year window that I have, if you take it with me, like you did at the beginning when you invested in us, you're gonna be happy you did. You know, we had people that bailed on us, we had people that stayed with us. Those who stayed with us, they did well. They either became wealthier or they became wealthy.

What we're about to do, where we're about to go, will hopefully make an incredibly valuable company, not just to our investors, which without we wouldn't get the chance to do what we do, but to people. You know, you're gonna maybe tell me I'm crazy, but we wanna usher in 22nd healthcare. We wanna complete the circle from home to hospital to home, and we wanna give care to be more efficient, more effective, more precise, easier. Thank you all for coming. I'm so happy that you're here, and I hope the rest of the day you'll find worth your while. Thank you. Thank you.

Blair Tripodi
Chief Operating Officer, Masimo Consumer, Masimo

Good morning. My name is Blair Tripodi, and I'm the Chief Operating Officer for Masimo Consumer. Thrilled to be here in front of you all today. Thank you, Joe, for that great tee up. We are gonna go through a lot in the next hour, take you through a lot of our thinking in the early days since the acquisition, and bringing it full circle back to how we're going to continue to drive our messaging into the home, Joe's vision of bringing healthcare to the home, and of course, continue to dominate our own audio business as well within the home. Over the past decade, I've been fortunate enough to work with some of the greatest audio brands in the world, from Bowers & Wilkins, to Polk Audio, to Marantz and Denon.

These brands represent over 200 years of audio history and have been standing for something in consumers' lives with a differentiated market positioning, a premium and luxury market positioning, and have provided a point of excellence for our consumers for a long time, generations. Today, we're gonna talk about the connective lines from that story to our new story and our new challenge with Masimo Consumer Health. We're gonna build the bridge for you on how we're going to connect this brand from the hospital into the home. We're gonna talk about the muscles that we bring to this equation with the Sound United team integrating into the Masimo team and all of the resource that will be deployed against our strategy. We'll talk about our qualitative and quantitative research to date and the market segmentation and points of differentiation we feel we have the opportunity to win.

We'll dive into some great product launches. We'll share more detail, which will be supplemented later in your demonstrations in the vignettes out front in the lobby and in the back in the audio rooms to give you more insight into the operation that we are bringing to bear here today between Stork, Freedom, B1, W1, et cetera. Then we'll close with this is very important, as Joe mentioned, how we'll maintain our position in the home within the audio space, because we do believe that there are many green shoots there to come for our brand and our business overall. What does Masimo stand for in the consumer health space? Said differently, the answer is, I don't think consumers really know who we are yet.

This brand has been curated for decades in the hospital, it stands for innovation, unparalleled ethics and product excellence. Three amazing pillars to stand on as we begin our journey into the consumer space. That DNA is there for us to bring forward into our own Masimo consumer journey. What will Masimo stand for in the minds of consumers? Said another way, what will difference will we make in their lives? Answering this question is critical. We enter a crowded consumer health space with the likes of Samsung and Apple and Garmin, coming forward to the consumer with the messaging of what we represent, why we are built on a legacy of quality and unrivaled innovation, and most important, why these consumers can trust our brand is critical to our success.

Since Joe started the company over three decades ago, we have been known for improving lives and the outcomes for patients. This has made us quite formidable within the hospitals and clinicians around the world. Importantly, it has built that foundation of quality which we'll springboard off of within our consumer health messaging. This is an image from just after the pandemic began. This is a fella named Leonardo Frazier, and he appeared on CNN in April of 2020, stating to the world that, "This right here saved my life, and that's why I'm here today." He's talking about the Masimo SafetyNet and our technology. You have to admit, this is a priceless way to begin our consumer health journey. We improve lives for patients and their loved ones every day.

We empower athletes with the right information and data to optimize their training and to compete and complete their. I'm sorry. I think I might have skipped a slide. Excuse me. Yes. Sorry. Here. Sorry. The copy looks like it might be messed up. We improve lives for patients and their loved ones every day. We empower athletes with data and analytics to help optimize their training and performance every day. We make people feel safe. In a world where people are feeling more responsible than ever for their own healthcare, we can help them live healthier and happier lives. How do we take this heritage, our DNA, and create a differentiated position? We lean into what we're already known for. We lean into our story, we make it bigger, we make it more emotional, and we connect to consumers.

We have an opportunity to take our engineering prowess and combine it with our ability to make a huge impact on the health and happiness of people. Not patients, people. People like you, people like me, people all around us, our family and friends. This is what we do. Masimo is engineered for a beautiful life. This positioning draws directly from our heritage in technology and innovation, our ability to invent the uninventable, and our passion for improving lives. It connects the practical side of our company with the beauty that we are all looking for in life. There is no problem we cannot solve, and no person we cannot positively affect. Through our unique products, you can trust Masimo. This strategic foundation will guide everything that we do. It will help the Masimo consumer health brand in ways that no other competitor can.

I'd like to share with you a short positioning video that will demonstrate the type of content and messaging that this strategic North Star will guide us in starting to inspire our consumers.

Speaker 14

Life is everything. At Masimo, it's not enough to look at the way life is. We look at life the way it could be. To see the things in life that are truly meaningful. Embrace them. Protect them. Make them available to more of us. This is the future we envision for everyone, because for over 30 years, our passion for protecting the vulnerable and empowering the clinicians who care for them has inspired innovation and feats of engineering others thought were impossible. Now, more than ever, we're dedicated to developing an integrated suite of products that will bring our legacy of safety, trust, and unparalleled quality to people everywhere. This is our work, our passion.

Our hope to impact the world. Because life is everything.

Blair Tripodi
Chief Operating Officer, Masimo Consumer, Masimo

Through that positioning video, I hope you connect with a little bit more of the DNA of what we're trying and aspiring for from a storytelling aspect with our company. This sets up our brand architecture, which you can see here with Masimo Hospital and all of the products we build for our medical and practitioner based products. Our home side of the business, which includes our new Healthcare Business as well as our Audio Business. These worlds are already come together in amazing ways, which I'll be showing you in the following slides. Achieving this position will require some important perceptual shifts from where we are as a brand today to where we are heading in the future.

Our foundation of innovation, product excellence, and our caring ethos will not change, but it will become clear that we are a brand built to help people get the best out of life. Not just the medical brand for patients and care providers. People will see our vision come to life beyond the medical arena, showing life not as it is, but showing your life as it could be. Shifting into our next fundamental to building this brand, I wanna share with you a little bit about, as Joe alluded to, the Sound United overlay and input into the organization. We have four scaled platforms that we'll talk about here in a minute that we think add a lot of expertise and knowledge and know-how, especially as we go to attack a consumer marketplace. The first is our scaled engineering platform.

Together with Masimo, we now have an engineering team of over 800 staff members, skilled in building and developing the most innovative and consumer-friendly products imaginable. In addition, that group represents over 1,700 worldwide patents in both audio and healthcare. Operating through 7 dedicated factories, we are armed to develop the most innovative and creative products imaginable in this space. Our second pillar, connected software ecosystem. Complementing our hardware platform is our connected software ecosystem, which allows Masimo Health and 3.4 million devices in the field today to connect to the cloud and connect consumer healthcare information to the people that matter, enabling a worldwide connectivity of both entertainment and telecare services. Masimo and Sound United bring to the table a formidable software platform, which will be merged, will ultimately create the home software platform for the future.

As Joe mentioned, in 2020, Masimo launched the Masimo SafetyNet hub with a little less than 1,000 devices in the field. Today, as Joe also mentioned, we're proud to announce the activation and a significant integration milestone, 6 months post-merger, where we will turn on over 23,000 Denon HEOS units, which will behave as an extension to your Masimo Health Cloud and connect your data through your W1 device or other Masimo connected devices to the cloud. By the end of 2023, we will turn on a grand total of 4 million devices worldwide. Again, connecting all of your Masimo connected systems to the cloud, to your clinicians or your loved ones. An amazing feat by the end of next year. Our third pillar is our global marketing and brand framework.

Sound United was operated as a brand-led portfolio with independent teams of staffers dedicated to curating the product plans, the global marketing strategies, the go-to-market strategies, and the channel and distribution strategies for those brands. Those teams are dedicated at our global center to help us maintain a differentiated position to our consumers while taking advantage of our shared platforms and region. We are implementing the same strategy here with Masimo Consumer Health. We have stood up a Masimo Consumer Health organization. That team is working diligently between the two organizations to build the best products to create the go-to-market strategies and the consumer demographics to drive us with our product roadmap and our marketing strategies.

All of that will be handed over to our regional teams, who will localize that content, create local strategies globally for us to execute and make the most and biggest bang for our dollar. As Joe mentioned, we have over 500 individuals in region around the world dedicated to this portfolio approach, and it's a true weapon as we head forward in our consumer health plan. This is already paying off today. What you're seeing here is our first effort to integrate our creative services organization into the W1 program. These are advertisements, digital ads, trade marketing, which we have assisted the Masimo team in rolling out to already begin to overlay that specific consumer appeal to the W1 product launch. Very excited for this and very excited for the future within consumer health. Our last platform advantage, as also Joe alluded to, is our omni-channel go-to-market.

At Masimo Consumer, we operate in over 20,000 points of distribution worldwide. Over 60% of our global revenues in the audio space come from the international landscape. There is no consumer electronics channel partner we do not work with today. This also includes the world of custom installation, which I think will be very important as we consider the ramifications of home health rollout and integration into home automation platforms in the future. Our third area and third fundamental to building the consumer health strategy is understanding our market movements and segmentation. Since the acquisition, we've spent ton of time breaking down who this consumer is and who and where they want to shop, what's important to them, breaking down their demographics and psychographics to help build our personas as we go and try to attack this market.

Aspirational brands understand and embrace the fact that health and wellbeing have become the new luxury. Luxury is no longer about selfish, tangible possessions and actions. It's about the intangible values that define us as people like authenticity, transparency, and connectivity. People who live a sense of balance in their lives are healthier and happier and more fulfilled. As we studied this group through our qualitative and quantitative research, six key brand tenets became evident for our implementation. The first, consumers very view, excuse me, health and as an extension of their lifestyles and their values. The second piece is they believe knowledge is power, and they are not shy about stating it. Third, of course, they care about what a product does, but they also care about how it makes them feel.

They do their research, not just on what the product features are, but on the brand themselves and what they stand for. They're curious about that brand's story. Finally, quality and design go hand in hand. You'll see later in the audio vignettes we prepared for you how important design is, and you'll see in the wearables vignettes how important design is for healthcare as well. We believe we are positioned well to hit all of those points. Taking a step back, however, and looking at the landscape, the competition, some very interesting insights came from the study of what's in the market today. Our view is that many consumer tech brands today are offering information and guidance they are not qualified to offer.

Consumers told us that they will trust information provided to them continuously and accurately from a company born in a hospital before they will trust a company that makes their washing machine or their laptop. This void is the consumer health space that we feel our team can fill. We're gonna approach this market in four segments. These segments cover a very large cross-section of adults and children across the world who will be looking for products to address very specific needs around accurate and continuous healthcare monitoring. From daily life to athletics and sleep, we are focused on providing accurate and continuous monitoring that allows humans to live a more fulfilling and happy life in the category of vulnerability, recovery, health and wellness and sport. We're gonna attack this through three category segments.

In wearables, which includes hearables, sensors that will combine with consumer products to enable monitoring inflexibility through our connected life platform, products that follow us through life, enabling monitoring and seamless access, and telemonitoring, allowing the ability to share data with your professional caregivers or your loved ones. Let's get into some of the fun stuff and some of our product launches happening in 2023. As Joe mentioned, as many of you have already seen, I'd like to introduce you to Stork, hospital-quality baby monitoring at home. Parents just want to know that their baby is safe and sleeping well. The existence of SIDS or a variety of other newborn health conditions make the first year of life for any parent very troubling.

Given the need for a solution that helps provide peace of mind throughout the night, we feel that Stork can address well, what, many more than the $1.5 billion baby market-monitoring market today, and eventually attack the over 130 million babies a year born around the world. This is an opportunity for us to innovate in a category by providing unparalleled accuracy and insights from a trusted player. Leveraging our go-to-market expertise and capability to attack a category that is concentrated in a handful of retailers and a handful of channels worldwide. Let's take a look at how the scaled platforms I mentioned earlier can support our Stork launch going forward. From a scaled engineering perspective, the Stork product delivers best-in-class vitals monitoring while providing an alert system that parents can trust.

As you can see, we've focused all of our feature sets on true consumer insights and what parents actually want in a baby monitor. Through its continuous and accurate monitoring, Stork will give babies a voice by providing actionable data to family and parents and healthcare professionals alike. Alongside the Stork booty and the camera and the hub, which you'll see later in a vignette in the lobby, is a robust application experience which will work within our broader Masimo software healthcare solution. The Stork app will allow parents to have universal access to their baby's videos, sound, vitals. The Stork app is geared to not only serve as a health hub itself, but also to empower parents through positive reinforcement, a video, and a knowledge library. Through its connected software ecosystem, allow parents to share the greatest and cutest memories on social media.

We've created this positioning video for Stork to give you a little bit of insight on how we will bring the product to market. This is not a commercial. This is a positioning video. This is all about creating peace of mind and bringing hospital-quality monitoring to the home.

Speaker 14

Imagine if parents could sleep as soundly as their newborns. We did. Which is why we've been helping give parents peace of mind for over 30 years. Today, we're proud to introduce the only smart baby monitor that continuously and accurately tracks your baby's vitals using technology preferred by 9 out of 10 top U.S. hospitals, so everyone can rest easy. Well, almost everyone. Meet Stork, the only smart baby monitor developed by a leader in hospital pulse oximetry.

Blair Tripodi
Chief Operating Officer, Masimo Consumer, Masimo

I hope that gives you a little taste of where we're taking some of this messaging with the consumer, and I hope it gives you an idea of how we plan to win in that space and take the hospital into the home. Our fourth pillar is our omni-channel go-to-market. From telling that great compelling brand story, which we started to see some initial concepts on there now, to targeting the very specific channel base that these types of products represent. We have a very focused approach and opportunity to win in the baby monitor market. We will also make sure that we are using and leveraging one of our strongest muscles, which is our D2C business.

We have a robust D2C team within Masimo Consumer, we will do our utmost to drive consumers for education, but to also compel them to buy online through our own channels. Then there's winning on the shop floor. You know, we take Masimo to the shop floor for the first time in this case, and training, empowering, and educating through our team of global brand activation team members, and providing best-in-class merchandising solutions, winning at the baby registry are keys to our success as we roll out Masimo's first consumer healthcare product in the baby monitor market. Super exciting day for us today to be sharing this product with you all.

Pivoting to our next tranche of launches, we're gonna provide here a brief look into our wearables and hearables outlook, again, with many of these products launching in FY 2023. We recently entered the wearables category with our first health watch, the W1. In this segment, we will continue to leverage and our best-in-class sensing capabilities across a variety of form factors to provide incredible insights through continuous and accurate monitoring. This foray into wearables is an important step in our consumer health journey as the data we track from these wearables will be invaluable going forward in our connected software ecosystem at home. We are also excited to discuss the opportunity in hearables. $85 billion market combining the traditional over-ear, in-ear earbuds and headphones from today, along with our hearing enhancement products and opportunity.

Here we will leverage our heritage in providing great sound through our branded portfolio of premium and luxury products, together with our Masimo Adaptive Acoustic Technology, which we'll be talking about here in a minute. All this to create a world-class listening experience for our consumers. Our best-in-class health sensor for wearables currently being deployed in the W1 is launching in the premium consumer watch segment format with Freedom and B1. While the smartwatch market is crowded, we feel that the watch, with its health and wellness focus, will open doors to new consumers. Rather than health as an afterthought, the fidelity of the monitoring will allow us to generate new insights, alerts, and indexes the market has yet to see. Our wearables will set a new standard for accurate and continuous monitoring, as showcased in the W1.

While adding feature sets that modern-day consumers expect, such as LTE connectivity, premium design, form factors for sleep, and innovative features, as Joe alluded to with Hydration Index, which are made possible by the incredible technology in our sensing, in our sensors. Finally, although we are still too early to share marketing concepts, we've identified key consumer segments that rely on the utmost accuracy in their continued health data. As we think about the target audience for Freedom, it's important that we start close to our DNA by targeting the hospital ecosystem via the W1 and expanding our scope towards health and wellness gatekeepers, fitness coaches, influencers, partners like managed care facilities. With this approach, we can provide the right hardware and subscription solution to each of the key mass market demographics. These groups represent a large subset of the U.S. population.

It also represents a large subset of the global population, whose needs are not met by current offerings today. For these groups, accurate and continuous monitoring matters, when it comes to improving performance or just maintaining an accurate representation of their health any given day. Finally, a little bit on our audio trade. As we begin to launch these exciting products in consumer health, it is imperative that we maintain our leadership position in audio to maintain our strategic advantage and gateway into the home. Our audio brands have been relevant in consumers' lives for over 200 years. Our portfolio of brands are positioned from the mass premium with Polk Audio to the ultra-luxury in performance in Bowers & Wilkins and Denon.

Our business in audio is global, with over 60% of our turnover coming from outside the United States, providing us access to international markets for the healthcare. We are also constantly innovating our product offering, not standing still and not changing. We are leveraging our brand heritage to open up new gateways into categories and products that are the future. The value of our brands as strategic assets cannot be underestimated, and I hope you enjoy experiencing these later on in the demos this afternoon. Historically, our brands have been predominantly focused on the home. However, we have the right to play in this $85 billion hearable marketplace. Where we combine our brand legacy, our strength in building world-class audio with the likes of the new Masimo Adaptive Acoustic Technology, providing hearing solutions for every consumer.

To accelerate our approach into this category, we are launching at the conference today, our Masimo AAT. This technology allows us to map an individual's hearing by sending pulses into the ear, and upon receipt of the return signal, it allows us to profile a consumer's specific hearing. Which we then, in turn, optimize through the device with, to whatever content they're listening to. This will allow every consumer to enjoy their favorite music with the same rigor as the artist originally intended. In the future, it will allow us to build a suite of products to enable optimal hearing for all consumers worldwide, no matter what application. In addition to our growth in hearables, we will continue to focus on the over $6 billion premium and luxury segment of the home. This segment is our bread and butter.

We leverage our incredible network of engineers and innovators, of our factories, and our worldwide sales, marketing, and brand efforts to drive and develop this space. Our focus is to maintain each brand's unique position in the market. To create new distribution models where we can bring the most exciting global audio programs into the home. Finally, this omni-channel go-to-market capability allows us to sell and market our products across all relevant channels online, over 20,000 points of retail distribution, locations around the world, custom installation, third-party distributors, owned websites, and selective partnerships. Given the scale of our commercial operation, we're able to implement portfolio selling while offering our retail partners incredible efficiencies in the operating process. Thank you for the time this morning. Thrilled to be able to present and share some of these insights with you. Look forward to your questions later.

Speak to you soon. Thank you.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

All right, everybody. We're finishing that presentation a little bit earlier than expected, so consequently, we will take our coffee break a little bit earlier as well. Please take your time out there, enjoy our food selection, and please be back here at nine-

Blair Tripodi
Chief Operating Officer, Masimo Consumer, Masimo

Let's go a little faster.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Okay.

Blair Tripodi
Chief Operating Officer, Masimo Consumer, Masimo

Let's go back here by 8:45, if that's okay.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Okay.

Blair Tripodi
Chief Operating Officer, Masimo Consumer, Masimo

That way, I wanna make sure everyone gets to see everything before the.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

All right. 8:45 will be the resumption of our activities here. For those of you on the webcast, please note we are continuing at 8:45 Pacific. Thank you.

Speaker 14

Barry, press that button, buddy.

Thank you. Thanks for taking such good care of our family.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Absolutely. My pleasure and an honor, honestly.

Graded delivery systems have to be the backbone of American health care. I don't think it's going to be like this startup venture fund because they're not creating a network.

Bilal Muhsin
COO, Masimo

All right. Welcome back, everybody. If you can find your seats, please. Thank you.

Morning change at no cost. They have me on next flight in 30 or something. Could be the same flight Bilal's on. I'm not sure.

Good morning. Welco me to Masimo. My name is Bilal Muhsin. I'm the Chief Operating Officer. I'll be covering our professional healthcare segment today. Let's start by talking about our large and expanding install base. It's truly amazing what we've done. We would have shipped by the end of the year 2.5 million of our monitors and technology boards over the last 10 years. This is truly a huge accomplishment as it continues to grow year after year, even after the 2020 COVID year that took a big bump. We do this by providing technology in our own monitors that we distribute into hospitals directly or with one of our 124 partners that build devices and incorporate our technologies within their devices, whether they be monitors, ventilators, defibrillators that go across the continuum of care.

Let's start by talking about pulse oximetry, our biggest segment with Masimo SET, Signal Extraction Technology. This is a $2 billion market growing at 3%-4% annually, where at Masimo, we have a long-term annual growth of 6%-8%, 2x over category. Let's see why. Today, over 200 million patients are monitored by Masimo SET today in hospitals and at home. It's in 9 out of the top 10 hospitals reported by U.S. News & World Report, used house-wide. All 10 of them use Masimo in their hospitals today. We have over 100 independent published studies showing the power of Masimo SET technology versus any other competitor. It starts with the clinical evidence and its ability to read through motion and low perfusion. That is truly the most difficult condition for optical technology like pulse oximetry.

In a study by Journal of Clinical Anesthesia, it showed the power of Masimo SET not only to reduce false alarms, 5% against the Nellcor N six hundred, their latest technology at 28%, it also did not miss any true alarms, only 3% compared to 43%. It's actually picking up the alarms and not just masking it by increasing averaging time. In Anesthesia and Analgesia, it was compared against 20 other technologies and showed the power of its accuracy during motion conditions. The evidence continues with the latest studies coming out on skin pigmentation. We recently released our Journal of Clinical Monitoring and Computing, our own study showing that Masimo SET showed no significant clinical bias between Black patients and White patients.

That's dark pigmentation and light pigmentation. In an earlier study out of The Journal of Pediatrics, it showed that it only had a 0.8%. Remember, oximetry is shown at full digit on a monitor. This was at 0.8% on in terms of a bias between black and white patient versus the competitor of Nellcor at 3.9%. It is the only pulse oximetry technology out there that has been shown to show these positive outcomes. Joe and Blair alluded to what it was able to do with retinopathy of prematurity, ROP rates. This is in the NICU on these babies that are born prematurely in terms of how they titrate that oxygen to make sure they don't go blind at 80% reduction in ROP rates.

For critical congenital heart defect in the labor and delivery, screening these babies pre-ductal, post-ductal, measuring the different limbs, and making sure there's not a 3% delta in deoxygenation or below 93%, it's able to screen at 93%. We have over 6 published studies with CCHD screening, one of them over 200,000 patients showing this outcome. On the Med-Surg floor, this is a 10-year study now out of Dartmouth-Hitchcock, showing zero preventable death or brain damage over 10 years, 60% reduction in rapid response team activations, 50% reduction in ICU transfers, and saving over $7 million annually as they deployed this against all of their Med-Surg units. More recently, at home with Dr. Pronovost in UH, using our technology at home showed 77% fewer deaths, 87% fewer hospitalizations, and saved over $11,000 per patient cost.

The power of all of that technology we talked about has been improved with what we talked about last time with our RD sensor taking that accuracy from 2% and 3% down to 1.5%. Now with the Radius PPG being in a tetherless wearable format for patients, allowing them to be comfortable, untethered, helping clinicians and nurses reduce false alarms. A lot of the alarms that come in are due to technical alarms. Simply forgetting to plug in that patient cable is a big deal in hospitals. This helps with all of that and allowing patients to be mobile in hospitals, doing their 6-minute walks and everything else they need to do, which improves their health over time. This has been a very powerful tool during COVID at home and on the general care floor.

The addressable market we talked about was a $2 billion market. Post-COVID, all hospitals have realized that they need every bed to be monitored. This might not happen tomorrow, but over the next couple of years, this is for sure going to happen, where every bed will be monitored. That takes our market from a $2 billion market space to a $3 billion market by adding over 1 million beds on the general care floor. What gives Masimo SET the right to win and continue to win, not only by expanding with our installed base, but continuing to win customers from our competitors. It is those outcomes that we talked about clinically that give it the right to win, best-in-class accuracy, the introduction of the tetherless Radius PPG technology.

One of the most important things is our platform provides a pathway to not limit it to a 2 LED solution, which is where pulse oximetry is today, but allows them to expand into further non-invasive monitoring technologies on the Rainbow platform. That combined package solution makes Masimo SET technology a leader in hospitals today and will continue to be so looking forward. Moving to our Rainbow platform, you guys are all familiar with our SpHb, our continuous non-invasive hemoglobin, ORi for oxygenation, and now the addition of LiDCO. LiDCO is a minimally invasive technology that connects to the A-line, and that allows for continuous monitoring of cardiac output on the Root platform before the end of the year. This market is a $2 billion market opportunity with our long-term annual growth rate at 10% for Masimo. Let's look at some outcomes from SpHb.

41% reduction in RBC units transfused for high blood loss cases. That means when they're trying to transfuse, they could look at that real-time trend of hemoglobin, and clinicians can decide. Instead of sending something to the lab and waiting for 15, 20 minutes, during surgery, they can see the stabilization of hemoglobin and decide how much blood to actually give or how much does the patient actually need. In low blood loss cases, it had an 87% reduction in transfusion rate, meaning most of these patients did not require transfusion. By having that real-time information at their fingertips, it allowed clinicians to make the right decisions of not having to really put an organ, which is blood, into that body. Most importantly as well, out of Limoges, France, this is during ERAS protocols.

They used hemoglobin and PVi with their protocol, and they reduced 30-day mortality by 33% and 90-day mortality by 29%. What was unique about this Limoges study is that the administration decided not to deploy even after seeing these results. They removed the technology, the rates went right back up. Very smartly, they re-implemented and the rates came right back down, showing the power of what the technology was able to do with their protocol. SABM, which is the Society for the Advancement of Blood Management, in 2021 released a white paper. It's almost like a guideline telling clinicians the power of continuous hemoglobin, the power of that real-time trend in making timely decisions for their patients. How that it's not just a number, but how to improve outcomes using real-time information from hemoglobin.

This is a powerful tool when we walk into hospitals today talking about the importance of SpHb. You guys know at Masimo, innovation never stops. We've just announced our 12 lambda, 12 LED RD super sensor. This now allows all of the rainbow parameters to be on a single sensor. Everything from the SET parameters that you see up there in gray bubbles, the rainbow parameters including SpHb, SpCO, SpMet, all on a single patient use sensor, allowing this sensor now, a single sensor, to be used across the continuum for hospitals.

What our rainbow pulse oximetry has is unrivaled clinical outcomes, continuous innovations as we introduce new sensors. Now with the power of adding LiDCO, you have the continuous cardiac output of the patient plus the oxygenation information of the patient, giving clinicians, for the first time in real time, a view into the oxygenation state of the patient, of the oxygen delivery state of the patient. Moving to our brain monitoring with our SedLine and O3. This is a $300 million addressable market growing at 5%-7% annually, where at Masimo, our long-term growth rate is at 20%, 3x over category. What SedLine has brought to the table is an ability for clinicians to provide anesthesia to patients and monitor the depth of sedation, not to over-sedate or under-sedate the patient, hopefully with this technology.

Now, we have a unique way of displaying it. It provides the most complete view of the brain. A lot of the technologies out there can provide a number, as you can see with our PSI, but also provides the raw 4 EEGs on the front there and our DSA, our density spectral array at the bottom. You see with those black lines that you see vertically that are there, that immediately tells the clinician that patient is in burst suppression, meaning they've gone too deep. What it allows them to do is to pull back on the amount of anesthesia given, which lightens them up a bit, yet securely, hopefully, and safely has them exit. What this has been able to show is really great outcomes.

In Montreal, recently published a paper showing length of stay reduction, not only in the OR, but also in the ICU when they sedate these patients because they don't take them too deep, so they wake up earlier, they feel better, and they're able to exit to the home. We've recently received FDA clearance for now the pediatric population as well, which is really important for this platform. Looking at our regional oximetry with O3, this is the ability to monitor not only the oxygenation of the brain, but also now hemoglobin as well on the brain. It's delta hemoglobin. Really, if the brain is stable or I'm sorry, if the other situation is stable in the patient, it's indication of what's happening from a perfusion to the brain, which is really important for clinicians, not only during cardiac surgeries, but now applied to many more surgeries.

We've also now have absolute accuracy, not just in monitoring the brain, but we call it regional oximetry because now we can also monitor the gut or the kidneys or any tissue, calf on the patient as well. The combination of both of them on the Root platform with everything else we do, including the rainbow technology, makes the platform superior from a brain monitoring perspective by all means. The combination of the two sensors allowing them both to work on the patient forehead, it's the only platform that allows that, allowing them to not only monitor depth of the sedation, but also the oxygenation state. The clearance now that we have across the patient population gives us the right to win in this space.

Our NomoLine and capnography gas monitoring, this is a billion-dollar addressable market with a growth rate of 10% annually, where our long-term growth rate is at 20%, 2x over category. What makes our technology differentiated here is we have our NomoLine, which is our moisture-wicking capability, our patented moisture-wicking capability, that allows these cannulas to be used for longer periods of time and including in high moisture areas as well. It wicks away that moisture continuously, allowing them to use it for a longer period of time. We've also improved our patient comfort and completed the portfolio to launch next year. Now we also have our third-party compatible cannula. All the improvements we've done not only work on the Masimo technology, but also can work on other technologies in hospital, allowing hospitals to standardize on our cannula solutions.

Hospital automation and wearables. This is a $2.5 billion market opportunity. We're growing at greater than 20% for our long-term growth rate. What we've done in wearables that you'll see out there as well as in the discovery lab from the tour truly is differentiated in all aspects, starting with the core of the technologies and the way they measure. This is our Radius VSM, what's worn on the patient here. It has the Masimo SET technology. It has our own non-invasive blood pressure measurement that has a two-pump solution that measures very quietly and measures on the way up, allowing more comfort for patients when they wear it. That patch on the chest does a few things. It has a Masimo ECG, right, that does all the arrhythmia detections that a multi-parameter monitor can.

It also has continuous temperature and our positioning sensor, Centroid, built into it as well. Today, in hospitals, clinicians have to walk in on the general care floor every 4 to 6 hours. They drag in a monitor on wheels. They have to take apart the NIBP cuff, strap it around somebody's arm, pull out a thermometer, put it in somebody's mouth or ear, put on a probe on their finger, and wait to get those measurements. Probably write them down on a piece of paper, then go back to a nurse station and document it down to the electronic medical record. With a solution like this, it automates the entire thing. You set up the patient 1 time. Now, throughout time, it is continuously aggregating that data. The pump will go on on a periodicity that the clinician set.

The SpO2 and all of Masimo SET oximetry data will be flowing, as well as all the respiratory rate ECG data, temperature data, and that will all flow into the electronic medical record continuously now, truly automating clinician workflow. Next patch, we have Centroid. Centroid is a body positioning sensor that sits right there on the chest. It's a gyroscope accelerometer-based technology, but it's combined with a unique algorithm that we've built that tracks that patient position at every angle. Clinicians can set up zones for where they need patients to be and not be, how often they need to be turned and when.

The smart thing about it monitors all of that, and it triggers a notification to the right turn team or clinician to come in to do that so they can adhere to their protocols, hopefully preventing any beds or ulcers that can be produced from that. Our suite of hospital automation solution, we say that, and I'm gonna describe it to you today. We talk about aggregation of data. At Masimo, we don't just aggregate 1 Hertz parameter data every second. That's easy to take that to the electronic medical record. A few companies do that out there. What we're doing, we're actually collecting from all devices that are in the room.

Everything you have in the OR, in the ICU, on the general care floor, all devices that are there, you'll see this demoed in the discovery lab, we pull data from all of them. We don't just pull parameter data, we pull alarm data, we pull true waveform data, and we're able to do a lot with that. We're able to visualize that data for clinicians inside the room and out, and we'll talk more about that. We're able to notify on clinician platforms, be it an iOS or Android device. With our Replica solution, we will run analytics on that data, and we will provide decision support. This is UniView and UniView: 60.

All that information we're aggregating from what's happening in the room can be customized to be displayed in different ways, depending on the patient procedure, depending on what the clinician likes to see or what the surgeon likes to see most of the time. We're be able to customize this to be patient specific and be able to see all the things. That's the ventilator on the top left or anesthesia machine, that's the multi-parameter monitor, that's the pump, all synchronized on a single display. The UniView 60 takes that data and is able to display it also outside the room. Not only when they walk up to it, they'll be able to see, "Hey, do I need to be gowned before walking in?

Is this patient at fall risk? With a click of a button, they'll be able to take a peek about what's happening clinically with that patient. Not only in a live format, but also to review. It's called 60 because within 60 seconds, you can actually review patient data that's happened over time, helping tremendously with clinician handoff, which is a big problem in hospitals. You guys saw the launch of Sepsis Index. This is extremely exciting. This is the decision support tool that we were discussing earlier. Joe talked about some of the statistics. 1.7 million adults in the U.S. develop sepsis, 350 sepsis-related deaths in the U.S., and 1 in 3 patients who die in hospitals today have had sepsis.

There are solutions out there that tell you when a patient has sepsis, but most of them tell you that they've had sepsis, and clinicians already know the patient has sepsis, so it's not very helpful. What we're doing with this index today is we're showing you the capability of having an earlier detection of sepsis and warning clinicians before it fully develops. You can see there it gives a % of the likelihood of sepsis for clinicians and notifies them when a triggered event can occur. Let's see what this looks like for clinicians. You can see there it will present a percentage of likelihood, and as that starts to change for the patient condition, the likelihood of sepsis can change. This is happening not here, a little bit accelerated to show you the impact.

Hopefully, nobody's getting septic shock that fast. Then most importantly, clinician clicks. They can see the reason why the algorithm is getting there from a decision support perspective and guide them with their own clinical guidelines in hospitals on what they need to do next, making it a hopefully a very powerful tool for hospitals. I'm also very pleased to introduce our VCAM product, which you'll be able to see a demo of today as well, which is our Visual Clinical Activity Monitoring. This is video-powered AI. This watches clinicians as they walk in the room to make sure before they approach the patient that they've cleaned their hands either by a soap dispenser, alcohol dispenser, or washing their hands in a sink. It'll actually monitor the activity, mark a clinician clean after they've determined that they've completed the activity appropriately.

Once they start to approach the patient, it'll allow them to go through. If they miss any of those steps, the device will alarm, reminding them to go adhere to the hand hygiene protocol. We gave you guys a glimpse of some of the wearable technologies we're introducing, the largest third-party integration platform out there today with our Hospital Automation solution, and what we've done from a workflow enhancement in terms of improving care, everything from VCAM to Sepsis Index. The most exciting part of my talk is our telemonitoring and telehealth. This is something that we're really proud of at Masimo. Let's look at what the market opportunity is. It's a $20 billion-plus market opportunity, and we're growing at 20% plus from the Masimo standpoint. Let me tell you why.

Over the last few years, Masimo has built the largest continuous monitoring cloud in the world. It spans the globe, everything but South America today. I said continuous monitoring cloud. That means it's not about managing chronic care conditions where patients with these different conditions are stepping up on a scale or taking a once-a-day reading with their blood pressure cuff or oximeter. This allows for second-by-second data to be transmitted, monitored. Clinicians can view it, notify you based on it. We deployed this initially during COVID with our hospital to home. Now this is becoming the largest growing opportunity for us because hospitals today cannot manage the amount of patients they have. You'll hear clinicians come up and talk soon about their experience and impact the technology has had. Most importantly, think of what it can do for what we call hospital to home.

Think of pre-op, post-op, length of stay in hospitals. Do patients need to stay in hospitals for that long, or can they be safely monitored at home, like Joe's case that he talked about? Then all the way to Hospital at Home, managing those cases of long-term or episodic care where you need to be able to do that. This platform allows for all of that to happen on the cloud infrastructure that's already built or on the app that is provided with the largest amount of care pathways for patients. Once they get this app, it is white labeled with the hospital's name.

It has a welcoming message from the clinician, it walks them with all the activities they need to do day in and day out, including questionnaires, education and training material, but most importantly, monitoring all their vitals and even allowing for video visits to happen with their clinicians all on the same platform. This also provides a dashboard to clinicians that they can watch all of these patients remotely and communicate with them. We'll talk a lot more about the ecosystem with the services that we're providing here. It all starts with the technology. I wanna pause at this first one. That moved a little bit too fast. This is 1991. This is somebody by the name of, we're gonna go back one more time, Joe Kiani, envisioning our first wrist-worn pulse oximeter back in 1991.

We continue to innovate and try to develop. These are different engineering and clinical products that have been tested on our wearable device over time. Landing with our Radius PPG that you guys all saw earlier and now on to W1. This is a breakthrough product. This has the Masimo Health Module on the back that I'll discuss a lot more, but it provides clinical-grade technology with continuous accurate monitoring of pulse oximetry, your SpO2, your pulse rate, your respiratory rate. It comes in combination with an application that we talked about earlier. It has an entire ecosystem of services where clinicians can help support, provide triage or review of data on or offline, and even allows for video visits with your clinicians through the platform. This is extremely unique.

Today, we all use smartwatches, or most of us do, and we're used to the type of technology it provides from the healthcare standpoint, which is extremely limited, right? For us to take any of these measurements that we really need, we need to think about it, say, "Oh, I think I'm feeling something," or, "I don't feel well." I pause. I have to stop breathing, hold my hand very steady, try to get a measurement to see what's going on. It's you thinking that you need something in order to trigger. Imagine if that happened automatically while you're driving, while you're walking. Continuous accurate measurement of all of these parameters.

SpO2, pulse rate, pulse rate variability, pleth variability, perfusion index, ECG, we have a one lead ECG there that gives you the heart rate and also has arrhythmia detection capability, heart rate variability, continuous respiratory rate monitoring or respiration rate monitoring, and activity steps and fall. Now introducing Hydration Index. That's that Hi parameter on the bottom there, allowing people to monitor their hydration on a daily basis. This is a measure of the amount of fluid in the body. You wake up in the morning, you go for a run, you sweat it all out, this index will start to drop and tell you you need to rehydrate. Very powerful. We know how powerful it is for athletes. We know how powerful it is you can. We've talked to singers, we've talked to a lot of people that see tremendous value in index.

Also on the healthcare side, you guys saw the press release and saw with chronic care management conditions, depending on their medication, different things, this becomes a very powerful tool also for clinicians to be able to monitor that for their patients remotely. Truly a game changer in its ability. I talked about the W1 and that Masimo Health Module at the back and the importance of that accuracy and what does it really mean. Here's a comparative analysis for you. This is also available in a white paper on our website, so feel free to access that. I think we have a few copies in the back. I'm gonna walk through this slowly just to give you the impact of what this means. In the first setup here, we had seven subjects.

We had two watches, the Masimo watch always in continuous mode, and then the Apple sleep monitoring mode, right? The Apple Watch in sleep monitoring mode. There was generated 49 events. That's 49 desaturations where they crossed the threshold, meaning that there's a critical condition that the user should be notified on. The Masimo device caught 100% of them, 49 out of 49, while the Apple Watch caught 3 out of 49, only 6.1%. Let's look at it in the sleep position here. Masimo continuously triggering. Because the Apple Watch was in the sleep monitoring mode, here we tried to force it to get a reading, meaning we say, "Give me a reading." You have to click a button to say, "Give me a reading," at that time. That's all the X's that you see up here in this graph.

Even though we tried to force the Apple Watch to give readings, here we had 8 subjects, 60 events of desaturations where Masimo caught all 60 of them at 100%. The Apple Watch caught 4 of them, 6.7%. If you needed this for anything, for a loved one or for yourself, that you needed to monitor these conditions, you definitely wanna know where you're at on a continuous basis and an accurate basis. Here's what it looks like. We plot these graphs all the time to show clinicians and everybody kind of the accuracy. On the bottom is the reference, which is a blood draw that gets compared against the gold standard, which is a CO-oximeter or an ABL machine in the lab.

On the left-hand side is the Masimo W1, and on the Apple Watch is on the right-hand side here. You can see the accuracy in ARMS terms. That's the one on the left. Masimo is at 1.5%, while the Apple Watch is at 4.4% ARMS when it worked. When it was able to capture a measurement. Again, going back to the impact that our technology has in terms of outcomes and why, it's because of its capability to continuously, accurately monitor on these patients and people. This is the ecosystem that we were talking about. Everything from periodic and on-demand reports generated, the team will be able to show you those. If you've purchased a W1 more recently, you will see an upgrade come through on the app side that will enable all of these features.

If you have an Android, that's available today and very soon on the iOS platform. You have family and clinical sharing capability. This is the new app face that you'll see here with our Masimo Health app. Advanced detection of AFib. I'm here, standing here today introducing a new partnership that we've just concluded last night with iRhythm. iRhythm does the Zio patch, if you guys know that product very well. Now they have a FDA-cleared optical or from the PPG continuous ability to detect AFib. Instead of you having to push and hold from the ECG to see whether you have AFib or not, they have a FDA-approved algorithm to be able to continuously do that from the PPG signal, so from the optical signal the whole time. We're gonna be deploying this on the W1 and the Freedom platform.

Once that is detected, by the way, it will go back into the clinical services, providing additional clinical services back to these people and patients. All right. We also have the ability for virtual doctor visits. We'll show you that demonstration outside as well. Health coaches, alert triage. This is the ability to have a monitoring center look over these patients and people and trigger nurses to make health calls based on what they see, and then data review offline by clinicians as well, specifically for cardiac reasons. We talked about the cloud platform, we talked about our wireless sensors capability, and we also do this with some of the most advanced partners.

We've recently signed an agreement with the Cleveland Clinic, becoming our AI partner in analytics for cardiacFrom the device and analytics side, we have OMRON on our blood pressure and weight scale, VidiEM on the continuous ECG, and Essentia on our spot-check glucometry. Our cloud and telecom providers are we work in partnership with Samsung. Toda is our embedded video processing capability that we have on our own cloud, able to manage a much more advanced video conference capability, allowing about 50 people to come online and share images in real-time and communicate. Twilio is also our communication partner for texting and messaging. This platform that we've built on the telemonitoring and telehealth space really does not have a competitor out there today in everything it can do.

Starting with the largest monitoring cloud in the world, the broadest set of pathways and scalable pathways on our platform, industry-leading clinical partners, best-in-class medical-grade technology, and now most importantly, the most advanced continuous bio tracking wearable device in the W1. Here's what Masimo does best. We develop these core technologies, and then we're able to deploy them on different platforms. What you see today, you can only imagine what we can do more with. That's our Health Module that's in the back of the W1 today. That will go into different products. We talked about the B1, which is the band on the right-hand side, the Freedom device and the W1 you see today, and future products as well.

We took the technology that we've developed over two or three decades of our Masimo SET oximetry that we've learned so well on how to monitor on those neonates and newborn babies. Now you see that in the Stork product that you'll get to touch, feel outside today. Masimo's AAT technology, right, which is that ability to send a signal into the ear and measure that response to be able to create that customized profile for that individual, now deployed into the Denon product that you'll see out there, but that will expand further, not only in the in-ear products, but also in the over-ear products in the future, and the other brands as well.

That concept of having a hub, a medical hub at home, to be able to monitor your loved ones when they're sick or if they have chronic, care or for any type of data collection you need. Now expanding it from that small hub that we've accessed in the thousands in homes today to now being on the HEOS platform and allowing that to go from 23,000 devices as of this morning, going up to 4 million by in the next year and beyond. Truly attaching that. This is very important. This is taking a consumer cloud and giving it access to the medical cloud. Right?

What you get for in the package, you get a lot more for, and we'll be able to retarget these customers, tell them what they can have here from a medical-grade technology in their home. A few regulatory and reimbursement updates. In 2022, I'm sure you guys have heard the news, the FDA has created a pathway for OTC now, right? They bifurcated it into 2, depending if it's a self-fitting or not self-fitting, meaning if it needs 510(k) clearance or not. Now they have an off-the-shelf OTC indication for hearing aids, which is extremely exciting. We look forward for this to continue as we also develop products heading towards this area. Telehealth and telemonitoring. There's been a lot of changes. During COVID, the FDA, CMS, everybody rushed when they saw technologies, when they met clinicians. You'll hear Dr.

Pronovost come up a little bit later. When they saw the need for the ability to accurately monitor patients at home, they rushed to create these opportunities and to allow technology to really show its capability. CMS has pulled back on a few of their kind of what they've loosened up during COVID. From the FDA's perspective and from CMS's perspective, they see this as nobody's going backwards. They're gonna continue to allow companies and encourage companies to push this forward as they've seen the positive impact these technologies have had during COVID. I'll touch on a little bit what we have in the pipeline with the FDA today. Everything you see up here is with the FDA, starting with Masimo SafetyNet Alert. This is our ability to monitor opioid-induced respiratory depression at home.

We're seeking OTC indication for this. We would love this product to be deployed where it allows these people at home, once they do have an episode of opioid-induced respiratory depression, to either try to wake them up, notify a loved one or their emergency contacts to try to come provide Narcan. If not, auto-trigger a 911 call and a health call to save their lives. ORi, Oxygen Reserve Index. This is the ability to monitor oxygenation beyond what SpO2 can do. When they over-oxygenate patient or they provide supplemental oxygen to patients, it goes above 100%. This index is able to monitor that. Think of situations in the OR where they're trying to do a difficult intubation, they wanna make sure that they have sufficient oxygen, so they don't desat the patients, a safety mechanism, or in the ICU now.

In Europe, it's used heavily in the ICU, where they try not to over-oxygenate patients 'cause that is also shown to be extremely dangerous. Eve, which is an automated way of doing that congenital heart defect screening that we talked about. Today, it is a little bit of a cumbersome process where they're wrapping sensors and they're trying to do calculations in their head. This automates that entire process for nurses and clinicians. A newer generation of our softFlow with enhanced features of 60 liter at home and a smaller adapter as well. Rad-G, our handheld platform now with a temperature screening tool in the back. MightySat for over-the-counter. Masimo W1, Radius VSM that we talked about, that vital signs monitor, and now Stork. All of these products are with the FDA, and we hope to get clearance in a timely manner.

I'll remind you of the different healthcare segments we talked about and the growth rates that we've talked about from Masimo. Pulse oximetry now for us is a $3 billion addressable market after adding the general care floor. The segment is growing at 3%-4% annually, where at Masimo, we plan to grow 2x that at 6%-8%. We are the market leader in pulse oximetry today. On the rainbow pulse oximetry side, it's a $2 billion market opportunity. No competitor here. Our long-term growth rate is at 10%, and we are the market leader here. SedLine O3, our brain monitoring combination, is a $300 million addressable market. We are second here from a market standpoint. The market is growing at 5%-7%, and we are growing at 3x that, at 20%.

Nomo line or capnography is a billion-dollar addressable market, growing at 10% annually, where our long-term growth rate is at 20%. We are second here from that perspective. Our Masimo Hospital Automation platform is a $2.5 billion market opportunity. No real competitor here that we can look at just because of how our solution is put together across the continuum, and we have over a 20% long-term growth rate. Last but not least, our telehealth and telemonitoring capability, where it's a $20+ billion market opportunity with our growth rate at over 20%. When you look at how this segments in terms of revenue, our pulse oximetry makes up 79% of our revenue.

rainbow is now at 10% of our revenue, 11% comes from these small but very fast-growing opportunities that we have in front of us. Thank you. I spoke about telehealth and telemonitoring. We have a few clinicians that are going to come up here that are going to talk to you about their experiences and what they've done at their different facilities. I'd like to introduce Dr. Bill Wilson. Dr. Bill Wilson is our Chief Medical Officer at Masimo. His experience in this space has truly been his experience is tremendous here. He spent 10 years at UCI leading the telehealth and telemonitoring program there. He was also the leader for all the UC schools when it came to the eICU programs there. His experience here is vast, and he's partnered with Dan Cantillon and Dr. Peter Pronovost.

Please welcome Dr. Bill Wilson to the stage.

Dr. Bill Wilson
Chief Medical Officer, Masimo

Great. Thank you very much, Bilal. Thank you, everyone. It's my pleasure to moderate this section on telehealth and telemonitoring. Just a little bit more about myself. Thank you. Thank you. We'll use those in a moment. Just a little bit more about myself. Adult and pediatric cardiac anesthesiologist, 2 decades at UC San Diego doing that work and running intensive care units. Was re-recruited up to UC Irvine about 10 years ago to run all the intensive care units, then, yes, as Bilal mentioned, the telehealth champion for the University of California, Irvine, Some of that w ork was very important for us during the COVID pandemic.

One of the aspects that is very important with telehealth and telemonitoring is that you're gonna hear from myself and my colleagues. Let me introduce my colleagues first, I'm gonna give you a little bit of a update on the current state of the art of where we are with healthcare in general and then telehealth. In order of their appearance, I'll be introducing Dr. Dan Cantillon from the Cleveland Clinic and Peter Pronovost from University Hospitals Health System. Dr. Cantillon is the associate section head of Electrophysiology at the Cleveland Clinic, he also is the medical director of the CMU. It's the Cleveland Clinic's version of the central monitoring unit, monitoring 10 hospitals. You're hearing more about that. Dr.

Cantillon has a number of really impressive credentials under him. He's the first physician at the Cleveland Clinic to insert a totally lead-less implantable pacemaker, was also the first in the entire United States to put in a lead-less pacemaker in conjunction with an AICD. Those are really important distinctions. At the same time, he runs the central monitoring unit. Dr. Cantillon has published more than 50 scientific papers in really important peer review journals like JAMA, The New England Journal of Medicine, the Journal of Clinical Cardiology, and he was noted as the Health Information Technology Innovator of the Year for his work in the CMU. After we hear from Dr. Cantillon, we'll hear from Dr. Peter Pronovost.

Peter Pronovost is the Chief Quality and Clinical Transformation Officer at the University Hospitals , and he is a world-renowned leader in patient safety and quality. His outstanding achievements are really too numerous to count, but I would like to provide a little summary of some of them. The first is that he created the CLABSI Prevention Checklist. Now, CLABSI stands for Central Line-Associated Bloodstream Infection. Prior to others talking about checklists, Dr. Pronovost showed that if you do five things with fidelity, you can eliminate central line-associated bloodstream infections. He did that at Johns Hopkins, where he was at the time when he invented it, and he then brought it up to all the hospitals in Michigan on a special project, and then to hospitals in Texas, and pretty soon around the world, we were all using this.

This has markedly decreased. I can tell you in my work in the ICU at UC Irvine, in our neonatal intensive care unit, using his checklist, we were able to go three years without a central line-associated bloodstream infection. He's had over 1,000 peer-reviewed journal articles. He is an advisor to the World Health Organization's World Alliance for Patient Safety. He regularly addresses the U.S. Congress on matters of patient safety and quality. He's a member of the President's Council of Advisors on Science and Technology, PCAST, and in this role, he helped decrease the cost for Medicaid by 30% while improving outcomes.

He's now dedicated to expanding care delivery from hospital into the home. You'll hear more of this story from him when he comes up to help with his journey. Before inviting the first speaker to the stage, I would like to just set the story about where we really are in healthcare currently, and then where we will be going with telehealth. Currently, our healthcare, as you all know, is very expensive. It's fragmented, so that variability is problematic, wasteful, and it's not as safe as it needs to be. We have an aging population. The United States spends about 20% of GDP, upwards now of $4.6 trillion, on healthcare alone.

Of that, which is more than any other industrialized country, any country in the world, we don't get as much as we should for that money. If you look at our infant mortality rates, they are higher than they should be. In fact, they're nearly 3 times higher than what you what they experience in Japan and some of the Scandinavian countries. They pay half as much on a per capita basis for healthcare than we do. If you look at our healthcare spend over... you go year by year, it's about the same as the industrialized countries until you get to about 55 to 6 years of age, and then there's a divergence where we spend way more.

That elevation of money that we pay, increased burden in the elderly, is partly related to their disproportionate increase in chronic disease like congestive heart failure, but also due to waste. That is often care that is delivered in a hospital that could be delivered in the home. There's a 2012 JAMA article by Don Berwick that demonstrated that 50% of the healthcare spend was on waste at that time, and it was about $2.4 trillion, and now we're at $4.6 trillion. There's now a new paper by one of our speakers, and I think maybe Dr.

Pronovost may allude to this when he, when he speaks, that he now looked, and currently we still have 50% at least of healthcare wasted, and a lot of that is due to care provided in the hospital that could be provided in the home. The financial stresses and reduced workforce that was brought upon us with the COVID pandemic has exacerbated the problem, and the solution to all these problems is technology. Not just any technology. It has to be best-in-class sensing and monitoring to improve safety. Masimo is the one company that has demonstrated with Masimo SET actual, significant, tangible benefits, improvements, and outcomes.

You've heard already, and I'll enumerate again, a decrease in the retinopathy of prematurity in preemies, an increased ability to diagnose critical congenital heart disease, and a decrease in those patients that are unrecognized to have cardiac arrest in hospitals. If you're not a hospital with Masimo Patient SafetyNet with continuous monitoring on the care ward, which is still a problem for number of hospitals. We have the solution. If you're in a hospital on the floor, the chance that you could be found dead in bed is significant. It's a problem, and it happens in hospitals all around the country. We need to stop it. We have a solution.

It's remote patient monitoring in the hospital that we need to expand and remote patient monitoring in the home, but it cannot be just any remote patient monitoring. It has to have the sensing technology that is continuous and hospital-grade. That's what Masimo brings to the market. To help discuss this problem in greater detail, my colleagues will talk about some of these problems and solutions in greater detail. First up will be Dr. Dan Cantillon. What I would like to do without any further ado is invite him up to the stage. Remember, Dr. Cantillon is the director of the eCMU, amongst many accolades. Please join me in welcoming Dr. Dan Cantillon.

Dan Cantillon
Chief Medical Officer, Masimo

Thanks very much, Bill. Appreciate that. Thank you. Good morning. Thanks very much, Bill. It really is a privilege for me to be here with all of you and to kick off this session that we're going to be getting into. As Bill mentioned, I am a cardiologist at the Cleveland Clinic, and I am the medical director of our inpatient RPM program. I'm going to be speaking today about getting beyond the brick and mortar of the hospital and what we are doing at the Cleveland Clinic to get from the hospital into the home so that we can render the most effective care at a distance for our patients to improve their outcomes, but also to promote health within the community and wellbeing. I'll be getting into that as we go along.

I know this is a fairly sophisticated audience, and I can't imagine that anybody's been living under a rock for the last 6 months, but for those, just to be reminded of the extreme duress that the healthcare system is under right now. You've heard a lot about the tripledemic, which is this overlapping surge in cases related to influenza, RSV, and COVID. Certainly, that has placed a strain on the resources of our hospitals and our healthcare systems in terms of bed allocation and resources and things that matter. I'm gonna be describing a much bigger problem in the world of chronic disease and chronic disease management, particularly when you consider the fact that the Census Bureau indicates that by 2030, more than a fifth of the U.S. population is gonna be over the age of 65. That's Medicare age.

We are facing critical shortages for physicians and nurses. A McKinsey study has indicated that we are going to be down somewhere between 200,000 and 450,000 nurses by 2025. We have staffing shortages as a major problem. Length of stay, which is a little bit counterintuitive for non-healthcare people because we think, "Okay, well, if I'm in the hospital, the longer I'm in the hospital, the better the doctors and nurses can take care of me, and the better off I'm gonna be." Well, it actually goes the other way. The longer that we're in the hospital, the more apt we are to see hospital-related complications that can re-reduce the quality of care delivered to our patients, lower the outcomes across many different disease states, and also drive up the costs of care.

Thirdly, readmissions, which is a huge problem in my area of cardiology, where up to a quarter of patients that are admitted with congestive heart failure and treated can be readmitted within the first 30 days. That's bad for the patients, that's bad for the hospital systems, and it's bad for the payers. It's a lose-lose-lose. I wanna further expand upon the chronic disease issues that we are facing in the United States. Pre-pandemic, the top three causes of death in the United States were fairly consistent. Heart disease, number 1. Cancer, number 2. Accidents and unintentional injuries, number 3. In 2020, as we know, the world turned upside down, and we were confronted with the COVID pandemic.

Overnight, out of nowhere, this was vaulted to the third leading cause of death in the United States, with over 350,000 lives lost in the calendar year of 2020 due to this devastating disease. If you look at the data that I have up here on the screen, you can see that there was an even bigger problem than just that. If you look at cardiovascular disease, which was still the leading cause of death by quite a big margin. Between 2019 and 2020, the per capita mortality actually increased during the pandemic. If you look at the blue-shaded per capita mortality for 2019 and the gray for 2020, it actually increased. Why is that? You know, Bill alluded to, we've got all these great new innovations.

We've got these nano wireless pacemakers and all these really cool things that we're doing in cardiovascular disease. Why did the mortality go up? Well, as some of you know, hospital systems, including ours, were forced to restrict elective services, many of which provides care for conditions that feed into cardiovascular disease, such as hypertension and diabetes. As a practicing physician, I can tell you that my patients were scared out of their minds to come into the hospital during a time of the global pandemic. Where they were worried not only about their own health and well-being, but the possibility of transmitting the virus to a family member or loved one and putting them in harm's way. There was a lot of deferred care.

What it forced us to do at that time was to begin to imagine and begin to better refine our technology-enabled solutions to render care at a distance more effectively in the home and within the community. Bilal spoke at length about these technology-enabled solutions, and I couldn't have possibly covered the sensors and all of the magnificent engineering that goes into these products better than what Bilal has already said. I want to say, as somebody who's had the opportunity to collaborate with Masimo on the ECG platform, the VSM, which is shown here on your right of the screen, this is really phenomenal engineering. When I first began to work with Masimo in 2019, I really began to understand Joe Kiani's vision of building not just an ECG monitor, but building top-in-class cardiovascular solutions.

It's been extraordinary to work with Masimo on this product. Now to see this in the hands of my friends and my colleagues, my physician and nursing colleagues at the Cleveland Clinic as part of our IRB-approved studies, they're seeing all of this amazing technology for the first time. That's really rewarding for me. It's so rewarding, even more rewarding to see this on my patients and to imagine what kind of outcomes, changes we're going to see with these types of solutions. As we consider these types of platforms, we have to think not just about the devices and the sensors, but we have to think about how we are going to use these for our solutions. I want you to think about three ways. The first has been mentioned already, which is clinical decision support.

Giving our clinicians insight into what's happening with patients, which opens a lot of doors for hospital automation. The second is situational awareness. We'll dive a little bit deeper on that one. Telling us who are the sickest patients and who requires our attention first, second and third, and so on and so forth. Thirdly, precision analytics. What does that term even really mean? I would put forward to all of you that it's getting away from this idea, this doctrine of a heart rate or a vital sign value going out of range and just alarming.

That in a future state, we're going to provide clinicians like myself insight into what's happening with our patients so that we can get information, and we can very quickly deduce what's going on with the patient, and we can get towards those solutions and corral the resources that are necessary to get them better in a more efficient way. I wanna dig in a little bit and talk about the unmet needs and how we can identify those gaps and use the technology to better enable the solutions. Take something very simple, monitoring patients in the hospital. We detect cardiac arrhythmias, we notify nursing personnel, and then we corral the response that is necessary to care for the clinically deteriorating patient. What could possibly go wrong?

Well, it turns out that for patients admitted to the hospital with chest pains, nominal telemetry equipment generates 5 alarms per patient per hour, more than which 99% are inactionable. Does that sound familiar? Joe Kiani spoke this morning about the work that he has done over the last 3 decades in pulse oximetry to get away from those false alarms and to identify the true signal of those patients that require our attention. Well, here it is. This is what we're facing in the world of cardiac monitoring right now. Similarly, studies have shown that up to 44% of cardiac arrests are not detected appropriately. That is the true signal of the patient that requires our attention. What does it mean?

According to statistics from the American Heart Association, a little bit less than a quarter of patients survive a cardiac arrest in the hospital in a non-ICU environment. That's one in four. To contextualize that number, if anyone was to have a cardiac arrest on the sidewalk, your survival rate is about 10%. We don't consider a survival rate of 25% in the hospital acceptable. What have we done at the Cleveland Clinic as part of the solution? Let me introduce what has been discussed, which is our bunker, our command center, our central monitoring unit. That's my unit. It's about 20 minutes outside of downtown Cleveland, located in the suburbs, away from the noise and the distractions of all the normal hospital activities.

We provide continuous monitoring for the main campus plus 10 additional facilities that I show here, including our Florida facility in Weston. We are growing to expand to add more of our Florida hospitals. As you know, we are an international organization with facilities in Abu Dhabi and London. We have 24/7 coverage for over 2,000 monitored beds of non-ICU patients, both adults and children. We provide prompt bedside nursing notification, and we uniquely have the ability to be integrated with our rapid response teams. We can communicate directly with our rapid response teams, and we can selectively deploy those resources to the bedside. I'm gonna show you what those outcomes look like when we do that. This was our landmark paper, which we published back in 2016. We've had subsequent publications since that time.

In this study, we showed that this model works. This model improves the outcomes of our patients. We increased the notification of lethal arrhythmias. We numerically decreased the number of cardiac arrests, and we were able to, on a discretionary basis, deploy the rapid response teams directly to the bedside. When we did that, we saw that we had a 93% resuscitation rate, return of spontaneous circulation, which you can compare with that historical rate of 25% that I mentioned earlier. That is a game changer. Our solution has had fewer misses. It has used a team approach to monitoring patients. We have increased the efficiency. We have doubled the capacity of the number of patients that a human technician can monitor. Most importantly, we have improved the quality of care for our patients. As I mentioned, we're getting beyond the brick-and-mortar.

It doesn't stop with what we're doing inside the hospital. We need to get outside the hospital. You've heard a lot about the watch technologies. We showed in this study that the wearable ECG watch can be used effectively to detect atrial fibrillation, similar to a board-certified human cardiologist like me. Again, that's not just the end of the story. We're not just about detecting. What we need to do is we need to build these technology solutions, and we need to weave them into the fabric of our healthcare ecosystem so that we can translate that into actual improvement in outcomes for patients, 'cause that's really what matters. The patient is at the center of the wheel. This is what we did with our AFib Future clinic.

What we did is we took a pool of patients that underwent a procedural treatment for their atrial fibrillation, something called an ablation, which is what I and my colleagues perform. We monitored them with smartphone-based technologies. What we're able to do was we were able to integrate that into our electronic medical record system, and we were able to continually track who was in normal rhythm, which was the overwhelming majority of these patients. We're able to identify the true signal of those patients that were experiencing arrhythmia recurrences that required our attention, and we were able to corral the resources that they needed to keep them at home, to keep them out of the hospital, to prevent them from needing to be readmitted, and to improve the quality of care that they received.

For us, this is the benchmark of how we are gonna build into that future state with the collaborations that we have with Masimo. Excuse me. I'd like to conclude by talking about precision analytics and insight-oriented alarms as opposed to just flashing when things fall outside of a nominal range. I know that I'm the cardiologist in the room, but you're gonna have to take my word for it. That's a normal EKG that you're looking at. With the power of artificial intelligence, not talking about future state, just things that we can do today with AI. We can look at that EKG, and we can tell the patient's age, we can tell if that's a male or a female patient.

We can find camouflaged evidence hidden in that signal that that patient may be deteriorating from a heart failure perspective or may be vulnerable to certain metabolic arrangements. We can even make predictions about the concentration of certain drugs in the human body, all from that ECG tracing. There's a lot of power in the analytics, and that's why this is gonna be an important focus for the future. I just wanna say that it's been an honor for me to collaborate with Masimo. As Bilal mentioned, we have some exciting work planned for the future in the world of cardiac AI, and I'll conclude my remarks there and turn it over to my colleague, Dr. Pronovost.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Thanks for having me here, Joe, it's great to see you again. What I wanna do for a few minutes is just frame a little bit more of the national healthcare context, then share with you from my own experience why I think Masimo's culture and capabilities are designed to solve some of these problems that we face. Now, you heard others highlight that the U.S. healthcare system harms too often, it costs too much, and it learns and improves too slowly. The harms too often, medical errors or preventable death are easily the third leading cause of death. If you add failure to prevent those chronic diseases that you've just seen, it's probably up to number one and two. We spend $4.6 trillion, at least 40%, 50% is wasted.

What's wasted on what we would call defects in value, that things that we do that just don't get people well. We're struggling right now. Our healthcare costs have gone up 20%, about 18% for labor, 22% for supplies, and our revenues are up 2%. What does that mean? That means 60% of health systems have negative margins in this country. Just in the last quarter, I think it's 80 hospitals went bankrupt and those numbers are exploding. The bond ratings are all essentially uniformly downgrading health systems, and they provide a vital role. What does that mean? That means people like me and my job, I'm a critical care doc, but I run our health system, have essentially two major focuses.

One is to get our hospital cost structure down so we could be profitable on Medicare-level payments, because that's the only payer that is going down. We all lose money on Medicare. Second is reduce our per member per year spend so that we could win in value. Whoever provides that higher value of quality and cost is going to win. In that context, I like to say, well, why haven't we innovated to get good value in healthcare? Why have we had brilliant innovation in drugs and devices and pathetic in innovation in health delivery? Why do I say that? We have negative labor productivity. An average thousand-bed hospital 20 years was run with 2,000 people, is now run with 11,000.

Probably the best example of, I would say, failed innovation is the ridiculous amount of money we spent for the EMR. The only national signal of what got better is billing and burnout. I mean, there's literally no signal that safety or cost has any gotten better. Why is that? Well, I want to share with you a story of how Masimo innovates that I think will say why they're set up, because the innovation in health delivery failed because it's not focused on a clear defect in value. It's often a shiny object. Contrast to drug and devices, which has been brilliant. They often have horrible design and poor usability. If it doesn't fit into a clinician's workflow, it won't work. There's almost no independent evaluation if it works or not, unlike drugs and devices.

Some widget gets invented, say, "No, use me, I saved a ton of money." Okay, what's the control group? It's never published. There weren't great incentives for health system. Story. When March 2019, we're overrun in Northeast Ohio. We're talking about building these 1918 tents that have no technology. I called Joe, my friend, and said, "Joe, did you ever build that pulse ox that could be used at home to integrate with a phone? Because most people have a bed, and we have infinite capacity to expand hospitals if we can do that." Joe said, "No, we haven't. It's under review for drug overdose, but let's see if we can get a call set up with the FDA to get emergency approval." 2 days later, we're on a call. Just the case is so indisputable, we're gonna kill people.

What was happening was people were monitoring at home with non-medical grade devices, trusting that they were accurate. Many people were dying from unrecognized hypoxia. In other words, they weren't symptomatic, they just dropped dead, that those devices weren't good to approve. We got approval on the call. Next day, we started a literally every day, sometimes twice-a-day call, this is how you innovate with the engineers from Masimo, Joe and Bilal, we were leading it with myself and our clinical teams. We designed, okay, how do we use your technology to fit our workflow so we could hook people up in the ED or from physicians' offices or from discharge and get all the kinks out of how do you set it up? What's the display? What's the algorithms?

Literally, our clinicians would say, "This is a gap." Joe would say, "Engineering team, fix it." Next day, we'd come up. I mean, it's that kind of iteration so that five days later, we launched our first patient. 30 days later, we hosted a webinar with The WHO with 80 countries and 8,000 health systems, now we've monitored over, I think it's over 6,000 patients on there. What have we achieved? We published this in JAMA, 77% fewer deaths, 87% fewer hospitalizations, each of these cost $11,500 less than being admitted. That experience taught us a couple key lessons. The first lesson is how to innovate in health delivery, 'cause it doesn't happen with technology alone.

It really requires this trusted partnership with a provider that you do agile design and iterate 'cause it never comes out of the box fixing the workflow. Unless you have that culture of humility and collaboration, it won't work, which is why we have the EMRs the way they are, 'cause they were too rigid. The second, and perhaps more profound though, is what COVID taught us was the possibility of creating a web of well-being. What I mean is, prior to COVID, monitoring was dictated by geography. If you were in the ICU, you got certain monitoring. If you're on the floor, you got monitoring. If you're home, you generally got non-medical grade monitoring. What COVID did was say we could monitor based on risks. We'll monitor you anywhere.

You can get ICU-level monitoring at home if that's what your risks need, 'cause then we can couple those with therapies and treatments to allow us to care for many more people at home. That web of well-being has been a profound transformation that allowed us to go from care that was reactive and transactional to care that is proactive and relational. Where are we going with this? Well, what's happening now? Well, we believe that about 50% of medical admissions could be cared for at home. Health systems lose money on medical admissions for the most part, a lot of money, right? They can get better care if they're at home. It's not just doing it wantonly, it's they're getting better care.

It's safer because we've created this web that allows us to link risk prediction and monitoring with therapies and then real-time monitoring and insights to learn and improve so that we can now deploy blood at home. We could do tele visits. We have this web to essentially create a matching market where it says, what does patient need for their risks? We can match that to services and therapies that they need. Monitor how they do. Another example, the W1 is a transformative piece because it allows you to, with the Masimo platform, create that ecosystem. I mentioned 50% of medical patients, but as you probably know, 30% of Medicare patients get readmitted. We think they're mostly medicine, but even the surgical readmissions are the same read. Any guess what the number 1 reason for surgical readmissions are? Dehydration.

Really stupid, but you get a call that I'm dizzy, I have to come in. This watch could pretty easily be able to eliminate that and begin to create this transformation. How do we make this real or what does it take? Well, as Bilal will share with you, luckily, we had some payment models that were put in place for COVID, most of which are still here, that have allowed us to bill. In the past, you used to have to monitor patient for 18 or 20 days because our mindset was it's only for chronic disease. CMS, to their credit, waived it and made it for 2 days. We have some payment mechanisms. They pay a hospital rate DRG for the Hospital at Home, so we actually make more money on those. There's a huge...

The payment models, they've generally proved to be beneficial. You need a technology and a platform, I think Masimo has that in spades because what we've seen before is we had all these little one-off teams building on, I wanna monitor heart failure, and I have my own little gizmo, or I wanna monitor readmissions, I have my gizmo. As an executive, it's not sustainable. I can't stand up teams doing that. It's risky 'cause I didn't have the compliance or the oversight for it. What our clinicians used to say, "But Peter, if I'm monitoring heart failure, I don't want continuous monitoring 'cause there's too many false positives, and it's just not feasible for me.

I'm more bothered by it. What we are doing is we are making a false trade-off because we assume the technology wasn't valuable to give patients substandard care. What we saw in our COVID work was the exact same work Bilal showed you with the Apple Watch, is that if you do spot checks, you will understandably miss people. When we looked at our home continuous monitoring and said, "What would have happened if we just did twice a day spot check?" We would have had people dead because we would have missed those episodes of hypoxemia, it was a false choice. The W1 says, we don't need to make that trade-off. We have the technology to give you the continuous monitoring when you need it without having to compromise on those false positives, importantly, fit these into a clinical workflow.

I wanna conclude because technology's important, but the secret to high-quality care, and my friend Joe, who I've worked with for 20 years and respect immensely, you know, often I talk about the secret of great high-quality care is love. Love is an energy that uplifts and connects, and it's experienced in micro moments, right? What you've heard Joe and Bilal on the team describe is that energy that uplifts and connects. It's this technology platform. That alone won't do it. It needs to be partnered with health systems who could make sure that we make protocols, so you're not just predicting risks, you're prescribing actions. 'Cause AI alone without action hasn't really been... It isn't going to do much.

Health systems, given the financial patient, are gonna struggle to set up systems like you heard the Cleveland Clinic has because they say, "Does this sit in emergency medicine? Does it sit in hospitalist?" I think the vision of Masimo growing clinical services to outsource or partner with health systems that they're part of this web when we need to offset resources is really the future. I wanna end with a case example of this power of love. We have a project funded by Robert Wood Johnson Foundation to look at the really expensive patients, the 1%. In this case, we have some for commercial insurer. In this case, it's a Medicaid insurer.

You know, that they were spending somewhere around $3,000 per member per month in this cohort of patients, they had medical and social complexity and often behavioral health complexity. They don't trust us, and they have really low self-efficacy, so they're hard to engage with. We did a model where we put intensive case management into these populations. The case manager may have 30 patients, and they would meet them in the hospital if they got readmitted or at their home to understand what they do. We met this patient, Jim, who was in our emergency department literally every week for diuresis, every week. He would show up and didn't trust us. He saw his life as, like, destined to be overweight and have substance abuse.

That case manager got to know Jim and went with him to his clinic and said, "Well, hey, we have a clinic that you can go to that you don't need to go to the ED." The case manager is sitting there talking to Jim, and his girlfriend brings in a McDonald's Big Mac and oversized fries and saying, okay, that when they get sick, she is self-caring for both of them by giving them a treat at McDonald's, right? It was super well-intentioned, but disastrous for Jim because it led to him going over. We had some discussion with them about well care and what he should do and got him, you know, connected with primary care that focuses on wellness. Jim now hasn't been admitted for eight months.

In that pilot, we took the average per member per month spend down by $1,200. I can't scale it without this Masimo platform 'cause in our health system, we care for about 1.5 million people. About 650,000 are in our ACO, who we have some risk for. I probably have 50,000 people like Jim who need some kind of solution, right? I can't hire a ton of FTEs to do this manually. It's Organizations like Masimo that are humble and curious and compassionate enough to put their culture and their capabilities partner with health systems to drive value, that it's almost existential for us. If we don't get our costs down in healthcare and improve our value, there's gonna be many more hospitals going bankrupt, and it's not affordable for the country.

I think it's these private sector capabilities like you heard Joe and Bilal talk about that are the solution. Thank you. With that, I think we're ready to take questions.

Dr. Bill Wilson
Chief Medical Officer, Masimo

Excellent talk. Peter, thank you very much. What we'll do is we'll extend the question-and-answer period to 10:30 A.M. That'll give you a 30-minute addition to the time that was previously allotted. There's a lot to discover and explore outside, I wanna make sure that you get the opportunity for that. What we'll do is, do you wanna stand or do you wanna?

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

I can stay. Sure.

Dr. Bill Wilson
Chief Medical Officer, Masimo

That's good. Thanks. What we'll do is, please, start hammering away. What questions do you have? Go ahead.

Marie Thibault
Analyst, BTIG

Sure. I don't know if you can get a microphone. Marie Thibault.

Dr. Bill Wilson
Chief Medical Officer, Masimo

I'll repeat it.

Marie Thibault
Analyst, BTIG

Marie Thibault from BTIG. Thanks so much for doing this. I think just a general question for both of you. You're early adopters of this technology in remote care and hospital at home. What's keeping your peers from adopting all of this technology?

Dr. Bill Wilson
Chief Medical Officer, Masimo

Both are early adopters, both of our clinician experts. What's keeping some of our peers from adopting this? Do you wanna start with that?

Dan Cantillon
Chief Medical Officer, Masimo

Yeah, sure. I think we could talk about some of the barriers on implementation on the regulatory side, on the reimbursement side. I think Peter touched on some of those things. There's also a physician and nursing culture that exists. I think reimagining that care takes some time to really demonstrate the value for our colleagues. Once people see that and once people are alleviated from some of the burdens that are placed on them in their everyday jobs, they're able to move with the change and embrace this technology and even help us innovate and get better by providing feedback on what we need to do differently. As Peter mentioned in his remarks, we never get it right on the first time.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Right. Great comments, Dan. I would just add to that. Excuse me. You know, like many organizations, healthcare is really siloed, right? I mention, and these words are really carefully chosen, healthcare is largely reactive and transactional. If someone shows up in the ED, I do my job to get them. When they leave, I don't care about anything else. Like, my job is just... I'm a hospitalist, or I'm a cardiologist. To solve these problems, we need to be proactive and relational, right?

It requires leadership to say, "Yeah, I get you sitting there, but we're literally creating this web that's linking across the continuum of care, and we need to break those silos and pull, you know, people together." In my organization, I mean, it was a very intentional strategic transformation effort, where the model that we used was getting everyone to believe that we can get to zero defects and value, creating structures where people belong to a peer learning community. No reporting mechanisms, but just brought people together across the continuum to say, "What are we doing to drive value?" Then building good management systems because there's compelling evidence that good management matters, and good management is almost entirely absent in healthcare.

Dr. Bill Wilson
Chief Medical Officer, Masimo

Great. I'll just add to that, and before we take the next question, also that there's a lack of vision, and there's also.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Right

Dr. Bill Wilson
Chief Medical Officer, Masimo

information that people don't know that they don't know. When this first happened, you know, Peter knew enough to call his friend, and he knew that there was a device that might be ready. They iterated back and forth. About a month after it was adopted by Peter, I got a call from Joe and his team, from Bilal that, "Hey, we've got this up and running now. Would UC Irvine benefit?" At that time, we had built a military field hospital in our, in our parking lot, and Masimo helped us put devices out there, the SET technology. We also deployed 135 conference rooms and physicians offices that now became clinical areas that we deployed with devices as well. We heard that this Masimo SafetyNet was there.

We then deployed it in our emergency department to avoid admitting patients that had COVID, but they weren't sick enough, but we weren't sure, so we could monitor them at home. Then we could earlier discharge patients from the ward. It's a vision and knowing that information was super helpful. There's a question here, please.

Rick Wise
Analyst, Stifel

Rick Wise, Stifel. You're both speaking very eloquently and movingly about the challenge and, you know, your response to the challenges for taking care of patients. I won't speak for everybody. I'll speak for myself. I have the more mundane task of imagining how this translates into dollars and cents and adoption rates and sort of more concrete terms. I'm gonna ask this in the stupidest way I know how. Do I imagine now that every bed in Cleveland Clinic and every bed at University Health has Patient SafetyNet? Is every patient that comes into the hospital or is discharged or is coming to the emergency room now going to leave with a W1 watch because of the kind of capabilities? How do I think-

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Yeah.

Rick Wise
Analyst, Stifel

How do I translate the eloquent comments you're making into-

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Yes. I'll give you dollars and cents here 'cause I live it every day.

Rick Wise
Analyst, Stifel

Thank you.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Let me be very, very concrete. For my own health system. I mentioned we have to get our cost structure down to be profitable on Medicare patients, right? Our current cost structure is $17,000. This is public for, you know, $17,500. Medicare reimburses us about $15,000. I need $2,200 out per discharge. Very, very concrete. Where does that waste come from? Labor productivity, right? Nurses spend like 15% of their time documenting vital signs. If I could automate every bed, automate that documentation, saves them time, let alone with other people who walk around with machines taking vital signs, all to that. Complications. About 30% of patients suffer a complication. Any single complications doubles your cost of care or triple some of it. $15,000-$30,000 to $45,000.

We do it for clinically, but financially, those costs are really expensive. Finally getting length of stay down. You heard all the great work that Dan shared with you. You know, on average, every day in the hospital, on the floor bed, it's much more in the ICU, is about $6,000 we use in our cost, right? Not what they fee. ICU is probably more in the $4,000-$5,000. Everything I can do to manage that flow or throughput or keep people moving. Final piece, and this is less the logistics, but it's where their work fits in. If you look at like logistics or think of us as FedEx or UPS, a box moving along, and what happens if it falls off the conveyor belt.

In a hospitalized patient, we do work on them about 2 hours a day, maybe 4 hours. Everything else is waiting, right? The more we could get rid of that wait time and get people moving. This kinds of technology, which that's why I mentioned my opening points, if we don't get our cost structure down in hospitals, we will be all out of business. Dr. Majan and I were talking about this earlier. The value payments are growing exponentially. You know, it's right now, if CMS will say 80% of their patients have a value payment, the total dollar is still relatively small. We're mostly fee for service, that is growing hugely.

You don't just pivot a health system to say, "Okay, I've been feeding this fee-for-service beast for years, and now all of a sudden I'm gonna put systems in place to manage total cost of care." I mean, it takes many years to build those capabilities. This web of well-being or these monitoring is a huge capability that we have to keep patients like Jim from being out of our ED, you know, every week and costing $500,000. But I need technology to help do that, and scalable technology.

Dan Cantillon
Chief Medical Officer, Masimo

Yeah. I don't think I could have spoken better to the part of your question on the financial aspects. I'm grateful Peter took that. Let me take the second part of your question, which is sort of that spectrum of care going from the ICU to the non-ICU to the home, and why it's so important that we match the technology according to the patient's needs. That's really where the data aggregation and the risk stratification comes into play. It's not that every single patient is going to have an extremely high-end monitor system that will then be continued into the home. It's that we will know which patients do, and we will know how to use that information intelligently to keep them at home safely. I'll just build upon a comment that I made earlier.

There's a study that shows that, up to 40% of patients that are admitted to the hospital for treatment of congestive heart failure are not decongested by the time they go home. It shouldn't be any surprise to us that a quarter of them are gonna show back up again in the emergency room.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Right.

Dan Cantillon
Chief Medical Officer, Masimo

within 30 days, right? That's the opportunity there, where the technology really can give us those signals of the patients that are requiring our attention so that we corral the resources that they need to keep them well and along that arc of recovery. Really that's what it is. It's all part of the same continuum, ICU, non-ICU, and home. I just wanna say one last thing, because there was a thread of your question on the patient adoption side, and I can tell you, as a practicing cardiologist, my patients love their data. You know, almost whether I want to or not, they're gonna bring it into the office, and they expect me to comment on it.

Even though today's sessions have sort of segmented the consumer piece with the healthcare piece, you know, in my world, they're very much blended together because patients bring it into the office. They say, "Doctor, this is what I'm getting on my device. Can you tell me what this means?" It can't be a situation where it's garbage in, garbage out. We need medical-grade sensors and technology in the hands of our patients. That's gonna be a key differentiator in the future.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Bill, I just wanna go one other piece that I was remiss in my marks.

Dan Cantillon
Chief Medical Officer, Masimo

Yep.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Besides getting our cost structures down, one of the laser focuses that we in the clinic and others are building a well care system that is as robust as a sick care. As we take risk for total cost of care, as you all know, our health behaviors are 80% of our health spend, at least the modifiable behaviors. Environmental has a difference, and no doubt people of lesser means have difficult time practicing those behaviors. We know exactly what behaviors drive our spend. It's, you know, the dose of healthy food, the dose of exercise, the dose of sleep, the dose of social connection, dose of well care.

If we have to have a way to drive those healthy behaviors, 'cause in the long run, that's by far the most cost-effective way to drive down the total cost of care, many of these technologies help do that.

Dr. Bill Wilson
Chief Medical Officer, Masimo

There's a number of factors there. The, you know, the first is, if you can avoid being in a hospital because you don't need to be there, you're gonna avoid exposure to risks like infectious risks. You're gonna avoid problems like pressure ulcers that are going to be a problem in the hospital. You're gonna avoid central line-associated bloodstream infections, et cetera. The next is patient acceptance. If surveys have been done.

Would they prefer to have the care in their home or would they prefer it in the hospital? All aspects, with the exception of those who are homeless, prefer to be at home as long as they. The homeless sometimes will go to a hospital for refuge, but everyone else would prefer to have it at home. The next is the affordability cost. Bruce Leff at Johns Hopkins has demonstrated now for two decades that care can be provided at home with less complications, at less cost, and much greater patient satisfaction. Now we bring the Masimo solution, so we can look at other populations of patients that now can have real-time, accurate medical-grade, hospital-grade technology that is provided continuously to monitor those patients that are increasingly sent home.

Dan Cantillon
Chief Medical Officer, Masimo

It didn't used to be that we would send somebody with a total hip home the same day. That's happening now, and they're gonna have some discomfort. They may be on opioids. We need to watch them, and continuous pulse oximetry is the technique for that. Next question, please.

Mike Polark
Director and Senior Equity Research Analyst, Medical Devices, Wolfe Research

Thank you. Mike Polark, Wolfe Research. A similar thread focused on Hospital at Home. I mean, the discussion here, the economic discussion was very much about cost avoidance, keep that patient well at home, prevent them from coming back. I guess kind of what is the state of revenue generation for this model today? Is there reimbursement to provide these services in the home? What does that look like? What might it look like in 5-10 years, and what's the pathway?

Dan Cantillon
Chief Medical Officer, Masimo

I'm gonna let Peter start with that one-

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Yeah.

Dan Cantillon
Chief Medical Officer, Masimo

There is reimbursement he referenced, but.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Sure. There's a number of different models. CMS has a program called Hospital at Home. These are literally people who are admitted or would qualify for an admission, and we either refer them there from the ED or, more likely, when they're already on the floor and get them out early. We get paid the same DRG we would get in the hospital. There's a number of requirements, like you have to provide food, yet we'd use paramedics because they're much less, like, more cost-effective. To give you an example, just the economics. In the hospital, we have, you know, a nurse might care for five or six patients, and there's data if they care for more, mortality's a lot higher.

In these innovative models where we can deploy paramedics, we have 1 nurse who can care for 10 or 12 because we can scale paramedics. We're now piloting those models in the hospital to say do we get our costs out, but we can do it because they're all monitored with the Masimo technology. That has a very accretive margin. You know, maybe like 35%, 40% of, on the Medicare DRG payment, and our efficiency is growing monthly because we're learning how to deploy them more effectively. The remote monitoring, which they're not in a DRG, we could bill for that, so they cover the monitoring fee. We largely get the benefit of that from our ACO when we have risk or now when we do a televisit, we can cover the physician fees.

It's a combination of putting a program of covering the physician time, like if Dan's overseeing it, covering the nurses or staff time for doing the monitoring, and then getting the upside on the downstream.

Dan Cantillon
Chief Medical Officer, Masimo

Add one other thing. We are still very much trying to figure a lot of this out, with that AFib future clinic that I alluded to in my presentation, we have figured out some creative ways for the patients to share some of that cost with us as well. For example, for that particular program, what we did was, patients who had participated in it were offered a discount on the device, and they paid a subscription service at a nominal cost, which covered the period of time of 3 months, where we had performed the procedure in the hospital, got them home the same day, leveraged the technology to make sure that they did well up until that standard 3-month follow-up.

There are a lot of creative models there where, in an affordable way, the patients are contributing to the cost of these programs.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

You know, Dan, just great point. We're also working with payers and employers because, you know, and every commercial employer, they have the 2% of patients that are 40% or 50% of those costs, like Jim, and they do a horrible job. The same thing for the commercial insurers. The interventions vary by a Medicaid population versus commercial, but several innovative things where we're then taking a per member per month spend to say, "Could you manage these 1,000 patients for us, like Jim, that we would deploy technologies?

Micah Young
Executive Vice President and Chief Financial Officer, Masimo

Hey, thanks. Matt Taylor with Jefferies. I just wanted to ask, you know, you seem like you're piloting a lot of really interesting programs. There's a lot of opportunity here to scale these over time. Help us understand just exactly where you are with current state and what the future state could look like in 3 or 5 years, and how many patients could you go from monitoring now to at scale, and which of the Masimo technologies would you be employing? Would you be using some of these new consumer things like the watches, the hearables? How do you envision some of those playing into these telemonitoring programs?

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Do you wanna start with that one, Dan?

Dan Cantillon
Chief Medical Officer, Masimo

Sure. All of it. All the above. No, we... You know, these technologies are carefully crafted, designed, and engineered, as I said, to be woven into the fabric of what we're doing. The use cases, which I, you know, I don't wanna say too much about all the things that we're doing for the future, but we have imagined a large number of use cases of a way of using things like the Hydration Index, you know, which we spoke a lot about, athletes remaining hydrated. Well, patients with congestive heart failure are overhydrated. They need to be diuresed. They need to have that extra fluid weight taken off of them.

You can imagine the way that we can put together these pieces and the data aggregation and the predictive analytics and use this intelligently to manage, as I showed you in my presentation, a very large and growing number of aging individuals with chronic diseases that require our care.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

I would say super insightful question because there's a lot to that and, you know, some reflections. Right now in the Hospital at Home, we have capabilities about to do 20-25 patients a day at any time. Those are hospitalized admissions. The reason, though, is because we did it as a pilot. Because you probably have seen hospitals across the country are now exploding with influenza-like illnesses, so we're rationing that up significantly. That transition has been from funding it with, like, an ad hoc team of, you know, like, Hey, I support some of the hospitalists.

I have some nurses who are in our system operations center to now literally working on a business plan the last couple of weeks to say we're deploying hospitalists, we're deploying nurses, or ideally, partnering with someone like Masimo who may have those staff to, you know, so you can do it at scale. The remote monitoring at home, we, on average, might have between 20 to 40 patients a day. We had previously separated before the W1, the acute monitoring that needed a continuous from the chronic disease like heart failure and COPD, who people thought they were happy with just doing once a day spot check. Now, with the W1, we'll have 1 platform. As you can imagine, you can't scale like 5 different pilots.

I mean, you have to have one core technology that is a platform that you can plug in whatever devices that they need, but having three or four platforms is just nonexistent. Where I would say we and other health systems is because these largely grew out of COVID, there wasn't an enduring organizational structure that housed them. You know, they. We've created that. Now, literally, we have a vice president of this approach who reports up and to me that now coordinates these work. There'll still be plenty of innovation, but I think the capabilities of having a platform that could meet all your needs, that has peripherals that you could, you know, plug and play from the ICU to the home, whatever the patient's risks are, has been a great accelerator.

Dan Cantillon
Chief Medical Officer, Masimo

Modularity as well. You know, if you look at the VSM platform, the modularity there, that if you want just the ECG, you can have just the ECG. If you wanna add in the blood pressure cuff, if you wanna add in the pulse oximetry, those other capabilities, that the idea that we have the opportunity as clinicians to exercise our judgment to decide which patient needs the different components of that platform.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Right.

Dr. Bill Wilson
Chief Medical Officer, Masimo

Great. I might just add to that some of the barriers really are waiting for regulatory oversight approval.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

Right.

Dr. Bill Wilson
Chief Medical Officer, Masimo

We have a number of devices that are ready. You saw the VSM. Once that is deployed, we can use that universally. We have Radius PPG now, it allows tetherless, continuous, real-time monitoring of patients in the hospital. We would like to advance so that, you know, clearly, we have a number of devices, some of which we haven't even shown to you yet that are ready to come out there. Once we get those deployed, not only will we be able to use them in the hospital, but also in the home.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

You know, Bill, let me just add on 1 second because you heard a similar thing to kind of old state to present. Most hospitals right now have tele on the floor and maybe intermittent pulse ox, like 1 a day if the nurse is worried about someone. Though Dan's an EP physiologist, you know, this is his expertise, most of the people we put on tele don't need tele, they need pulse ox, like by far. We don't have it, so we put them on tele as a surrogate that hopefully will pick up something bad happens, right?

Dan Cantillon
Chief Medical Officer, Masimo

Absolutely.

Dr. Peter Pronovost
Chief Quality and Clinical Transformation Officer, University Hospitals Cleveland Medical Center

What we're seeing now is that when you monitor every patient on the with pulse ox, not only do you automate the vital signs and get those labor savings, you get safety. When VSM come, I wanna have to move a person to a different unit to be tele. I can just convert any ICU, any floor bed to also be tele because it's just another box that I plug in, and it would help productivity and efficiency so much by integrating these, as you say, in a modular way.

Dan Cantillon
Chief Medical Officer, Masimo

I really hate to linger on this question too much, but it really was a very insightful question. You know, just, you talk about humbling learning experiences. When I took over the telemetry program, I learned that a lot of our gastroenterologists were putting patients on cardiac telemetry because they were concerned about people that had been admitted to the hospital with GI bleeding. One of the most sensitive indicators of rebleeding was when their heart rate went up again. If you think about that, you know, to your point, Peter, there was a lot of misutilization of telemetry because we just didn't have the sophistication with our tools and with our sensors and with that data aggregation to really get the patients the level of monitoring and support that they truly need for their condition.

Dr. Bill Wilson
Chief Medical Officer, Masimo

Okay. Well, great. I'm sure there's probably additional questions, but our time is up now. We'll be happy to take questions along the side. We really do appreciate everybody's attention. We had some really interesting, insightful comments from both of these leaders. Thank you very much.

Dan Cantillon
Chief Medical Officer, Masimo

There are those we count on to support us no matter what.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

Is everything okay, doctor?

Dan Cantillon
Chief Medical Officer, Masimo

Whether we see them or not, we need to know that they're always there.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

Can't go home.

Dan Cantillon
Chief Medical Officer, Masimo

For the past 25 years, Masimo has been monitoring patients in hospitals around the world.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

I just had to come back one last time.

Dan Cantillon
Chief Medical Officer, Masimo

So that doctors and nurses can make sure you feel safe.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

All right. We'll get started.

Dan Cantillon
Chief Medical Officer, Masimo

As new challenges have arisen, we've grown.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

Won't take nothing but a memory.

Dan Cantillon
Chief Medical Officer, Masimo

To bring that same safety and support to the place that you want to be most.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

Figure it out then.

Speaker 14

If we've learned nothing else, it's that when challenges arise, there's only one way to rise above: together. Masimo. Together in hospital, together at home.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

All right, everybody. We are now ready to take an extended break which will involve our group rotations. We're going to reconvene in here at 1:00 P.M., not 1:30 P.M., because we are running ahead of time. We'll take a look at the rotations, and you'll see a colored sticker on your name badge that will correspond to this checkerboard on the screen here. We've got lunch as one of the rotations, and then we've got three product-related stations that you'll rotate through to learn more about our technologies. When you go outside this room through the wooden doors, you'll see a person standing there with a colored flag that matches the dot on your badge. Please follow those people around.

They will take you on schedule through each of the stations, and hopefully, you'll learn a lot of useful information that will help you appreciate the great potential we have ahead. Thank you. All right, everybody. Can you all hear me okay? Testing. Hello?

Micah Young
Executive Vice President and Chief Financial Officer, Masimo

I can.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Microphone number nine. Hello? Hello? Hello? Hello?

Micah Young
Executive Vice President and Chief Financial Officer, Masimo

I can.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

Can you hear me? Testing, testing. Microphone number 9. Now number 10. All right, testing. Are we on? Everyone, please take your seats. We're about to reconvene.

Micah Young
Executive Vice President and Chief Financial Officer, Masimo

Yellow.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

All right. Third time's the charm, right?

Micah Young
Executive Vice President and Chief Financial Officer, Masimo

Yeah.

Eli Kammerman
VP of Business Development and Investor Relations, Masimo

All right. Here we go. All right. There we go. There we go. All right. Okay, welcome back, everybody. We hope you enjoyed the product demonstrations as well as a nice hearty lunch. Now we're ready to go through the afternoon sessions. We'd like to start out with our president of Europe, Southeast Asia, and Africa. This is Stacey Orsat. She'll come up and talk to you about sustainability and responsibility.

Stacey Orsat
President, Europe, Africa, S/SE Asia, ANZ, Masimo

Thank you, Eli. I got my mic, I think. I think I might. Oh, great. You guys had a very nice lunch and visits around the building. I hope you guys enjoyed yourselves. It was great to see all the interaction, and we really enjoyed speaking with you. Thank you very much for coming back in. I know there's a lot you want to still see out in the lobby. I'm Stacey Orsat. I work with our teams overseas in Europe, Southeast Asia, Australia, New Zealand, and I'm really pleased to be here to speak to you about our sustainability and responsibility goals. I love talking about this subject. This area of Masimo is a great example of the fabric of Masimo.

The sustainability and responsibility objectives we have are not because we have to or because the industry pushes us to, but it's part of who we are to always do better, to lead by example, and to find ways to improve life in everything that we do. Today, I'm gonna talk about two areas of where we're working to make an impact with our products beyond patient care. With our products and our packaging initiatives, as well as in our facilities, which you've had a chance to see some of today. Now, when we look at our products, I'm gonna talk about our sensors and our cables. I'm gonna talk about our instruments and the packaging that goes along with our products. Let's start in the middle here first with the instruments. Bilal on his presentation, as well as Dr.

Cantillon always talked about as well our instruments. Having our pulse oximeters, moving through to having even wearable devices. In the medical electronics world, just like in our electronics world, you guys have your phones, your iPads, your computers, so many things are obsolete from the day you have them. They end up in electronic waste around our world. From the very beginning of Masimo, Joe's first product invented was the Radical. The Radical device was a pulse oximeter, but it also allowed for it to be a portable pulse oximeter. It was a tabletop pulse oximeter. It had connections to share data. It could be reused, it could be repurposed for different uses. The Root platform is an incredible example of looking in a sustainable way to have a device that is not a fixed architecture, but can be repurposed, can be reused in so many different ways.

It can be a basic pulse oximeter. With the open connectivity ports, you can add in other medical technologies that are invented today or in the future. By changing the Radical on the front to Radius VSM, it becomes a fully wearable wireless monitor. It can even be upgraded to parameters to become a full hemodynamics platform, as Bilal talked about with LiDCO, with Hemoglobin monitoring and a brain monitoring platform. It's an incredible, flexible device. It reduces environmental impact of electronic waste, it improves efficiency in the hospitals, and as we saw during COVID, it allowed for devices to be repurposed really quickly as opposed to buying new devices that then again become obsolete. It's had a phenomenal impact on transforming healthcare and leading by example, that medical devices can be flexible, can be innovative, and do not belong in the landfill.

Let's look at sensors and cables. I brought a couple with me. These sensors are used on millions of people every day. Millions. When we look at sustainability, we think about reuse, recycle. Those are our common phrases we look at. What about refuse? Refuse the status quo. This has been the status quo forever with pulse oximetry sensors. This long sensor goes in the garbage when a patient is done their healthcare. Joe and Bilal challenged our engineers to look at our product to do better for the patient first. Can we improve the accuracy of this product? Can we improve the light weight or the weight on the patient? Can we improve the profile of the sensor, so it doesn't impact on pressure wounds?

The engineering team did an amazing job of making the RD sensor line, launched in 2016, that allowed for a low profile, highest accuracy sensor for patient care. The other impact was an 84% reduction in materials. You think about this in the garbage and this. Now, the healthcare world can say, "We've always used this. This is what we need. This is what we must have." The decision to refuse status quo, to push the limits to improve quality, improve care, and reduce dramatically the amount of plastics and copper has had a phenomenal impact on eliminating the use of materials. Now, that elimination also has led to be able to reduce the box size. When looking at the boxes of this product versus this product, the 44% reduction in the carton that has to be used.

11, 1.1 million square meters of box surface reduction. It's like covering half a city in boxes, reduced in the last five years of having the RD sensors shipping. A massive reduction in paper. That also pushed us to all of our sensor lines to eliminate the electronic instructions for use that go in the box. That paper was in every box that shipped out. We were able to reduce 11.5 million electronic instructions for use shipping around the world. It's not just the paper, it's the weight. Every bit of weight you ship around is fuel that has to be used to get it on a plane, on a train, on a truck, and it impacts our environment at every stage.

These types of initiatives are changing the healthcare landscape to not accept status quo and to recognize that we can avoid using materials and we can avoid waste. Our team never settles there. The next step was there's still waste, right? We went from this to this. Now what? Up to 2021, the end of 2021, over 400 customers agreed to participate in recycling program. The RD sensors started being collected by hospitals. They put them in collection bins. Our team looked at how can we aid landfill waste. We partnered with a company who salvages the product. The RD sensors come in, they're brought to the salvage company, and the question was: what can we do? How can we salvage this? The end answer was 100% of this can be salvaged.

This is put into a shredder. It is shredded down to the plastics and copper components that are then separated and able to be used for other, making other products in the world. Reduce the need for materials from this to this, but bring this back in and have zero impact on the landfill with this sensor. We now have more customers around the world moving to our RD sensor. We anticipate that we'll have 25% more users of RD sensors at the end of 2022 versus 2021, and the impact on our waste is profound. That activity, the RD sensor activity and the avoidance of this to this, has resulted in 1,100 metric tons of material use avoidance. Complete avoidance of material use.

With the recycling, I talked about the salvage and other initiatives we have, 100 metric tons of waste diverted from landfill in the time we've had the RD sensor line. What does that mean more practically as well when we look at some of these initiatives? When you look at the electronic instructions for use, reducing those or eliminating those from our sensor boxes, 13,000 trees are saved. The production of paper, of course, is not just the paper, it's the water. Most things we produce in the world use a lot of water. 35,000 cubic meters of water saved. When you think about a person, we use about 3 liters of water a day, and we use 5 or 10 trees a year for our oxygen.

That is a profound impact on thousands of people, saving that water and saving those trees. Now, if we go beyond our products to our facilities and where you are today, we're really excited to have you here, and up until not long ago, I think it was the only sunny place in North America here today. We're able to enjoy and experience some of the important features of our facilities as well that contribute to the environment. 24 electric vehicle charging stations are here at our offices, and our other offices around the world have like electric charging stations as well that you may have experienced. Our roof is part of our environmental footprint, so some of you may have seen pictures of our roof. When we acquired this building, it had solar panels on the roof. We have upgraded those.

There are 2,500 solar panels on the roof, 325 kilowatt panels that produce over 1 million kilowatts of energy that allow us to have 35% of our headquarters energy production coming from our roof. Our roof also can have a negative impact on the environment. Roofs are hot. On our roof, we have a cool roof technology to reduce the heat impact on our neighborhood, ensuring that we're having a positive impact on our community around in the neighborhood as well. Also, water. There's recuperation of water, salvaging of water for irrigation, for our pond, for our gardens, to allow for water to be reused in our building. We have low water use toilets and other aspects in engineering that allow for lower water use as well. That has allowed us to have the Water Star certified program here.

It's not about having the certificate, it's about showing that this is possible, that it's easy to do if every company puts their minds to looking to initiatives to save water. As well, on the paper side, a huge amount of effort to avoid paper. Even today, you've received very little paper. Where we have paper, we continue to recycle that paper and reduce that impact as well. There are over 40 initiatives for sustainability around the world, and that list is growing all the time. These are only a few examples. They're in our sustainability report from 2021, and we look forward to sharing the results of our efforts at the end of 2022 as well. These efforts, like I said, they don't come from corporate mandates, they come from our team.

I wanna talk to you about our team. We're really excited about the team we have around the world who bring forward these initiatives. We're very lucky at Masimo that our average retention is five and a half years. In fact, we have over 20% of our employees who've been with the company for over 10 years. In our employees, 34% of our employees are women, and 26% of our leaders at Masimo are women leaders. We also have 47% of our team and 34% of our team members who have racially and culturally diverse backgrounds who make up our Masimo team.

We're incredibly proud of this team and all they bring to us to challenge us to do better every single day, to make sure that our goals that come from our consumer business, the vision that you saw from Blair, from Bilal, from the doctors who share the application, that we take that one step further every day to improve lives in everything that we do. I want to thank you all for being here. If you have ideas for us on how we can improve the environment, we welcome those. I wanna thank our leaders for challenging us to improve life. At this time, I want to invite Micah Young, our Chief Financial Officer, to come up and present the next part of our agenda. Thank you very much.

Micah Young
Executive Vice President and Chief Financial Officer, Masimo

All right. All right, can you guys hear me? It's great to be here with you guys today. Appreciate you guys coming all the way out here. I know the last investor, I think it was back in 2019, it was a rainy day. Today it's a bit cold, but glad you made the trip out. I also wanna take a minute too to say thank you to the whole Masimo team, the production team. There's a lot of workers behind this, so just a round of applause for the entire team. All right. If, if you can't get excited about some of the things you're seeing today, then I don't know what you can get excited about.

The product demonstrations, the presentations earlier, I hope you enjoyed all of those, and you're starting to see how everything's coming together, how it's weaving together and seeing the vision that we have here at Masimo. I'm gonna jump into our financial overview and outlook, but before I get started, I wanna just remind everyone that all the financial measures I'll discuss today are gonna be on a non-GAAP basis, as well as they will include pro forma financial information that includes financial data from prior to the acquisition of Sound United. Just remind everybody to go look at our GAAP to non-GAAP reconciliations. They'll be in the back of the presentation that we just posted with an 8-K this afternoon. Jumping right into it.

One thing we like to do is, even before we get into our long-range outlook, I wanna look at how we performed against the commitments we made 5 years ago. You look back at even the Investor Day, back in 2017, we set out goals, to grow revenue by 8%-10% on an annual basis. You can see here, we actually exceeded those goals. We delivered 14% average growth over that period from 2017 to 2011. Looking at really comparing the actual performance to the commitments we put out there. A lot of that growth was achieved through robust growth in the installed base. We saw a really rapidly growing installed base.

COVID, we saw strength where a lot of customers really turned to us during a time of need. If you look at that, we had record levels of contracting. You've heard us talk about that here more recently in the past couple years. We've seen a record number of customers convert over to Masimo. That really demonstrates the power of our innovation. The innovation in this business, the ability to continually innovate in markets that, you know, there's no devices today that can serve those markets even, to drive that kind of innovation and be able to really invest in the R&D to drive growth in this business, you're seeing that play through in the last four years. Turning to our earnings growth.

We committed to or provided targets of about 12%-15% earnings growth. Over the last, if you look from 2017 to 2021, we saw earnings growth of 12%-15%, and we saw very strong leverage in the business. I'll show you that on a couple more slides, but we delivered 23% growth over that timeframe. There's some other things that we laid out. We laid out some growth targets by revenue category. If you look here, you can see Set, Rainbow, Hospital Automation, and other advanced parameters. You can see the total revenue targets that we laid out. In the green are our growth targets. If you look at Set, 6%-8%. We also had an upside case there, and we exceeded that for our Set pulse oximetry.

Rainbow, we had a 10% growth target. We exceeded that growth as well, but fell short of the upside case. You know, as you know, we try to push ourselves internally, and these were some of the upside cases that we were putting out there for those products. Hospital Automation, other parameters, we had a 20% or better growth rate for those products, and we delivered, as you can see here, well above 30% for those over that period of time, almost nearly 40%. Total revenue, as I mentioned before, we actually came in line with that upside case, and delivered significantly higher than the 8%-10% growth that we set out for.

If you look at the next slide, turning to margins, we had a margin target of improving our gross margins by about 50 basis points per year. Over that period, from the 4-year period there, you can see that target was about 200 basis points, we fell a bit short of that. We delivered about 160 basis points of improvement. As you know, during the last few years, we've seen supply chain challenges and also some of our product mixes has even shifted more towards some of our equipment and that's driven some pressures on our gross margins. Still very strong performance, but we fell a bit short there.

Through balanced reinvestment, but also just very disciplined, management of expenses, we were able to still deliver on our goal for operating margins. Operating margins improved 520 basis points over that period, and we committed about 100 basis points per year. If you look at, one of the most, important things is we've really been able to drive some improvements here. Like, if you look at our SG&A spend as a percentage of revenue, we've taken that down from 36.8% to 30.9%, so about nearly 600 basis points of improvement in our SG&A. That's allowed us to really reinvest that back into R&D and drive further innovation.

That's why I think you're seeing the results in the top-line growth of this business, because of the investments work we've been making. You're seeing the fruits of that labor come out in all the products that we're showing you today. I think that's important to see that innovation live and go through some of these demos. We've been able to increase R&D from 8.8% to just over 11%, increase of about 230 basis points, and still deliver on our OpEx targets, which would've been about 50 basis points improvement per year, 200 total basis points, and we've dropped that by about 370 basis points. Now, turning to what you've all been waiting for.

Our consolidated revenue guidance range for 2023, we're looking at $2.33 billion to $2.4 billion for next year. I'll break down more of the of those categories underneath it by segment. It includes, now that we've worked through the planning process, we're estimating about $64 million of currency headwinds. That represents, on a constant currency growth basis, about 6%-8% growth organically. Turning to our Healthcare revenue. Our Healthcare revenue guidance range is $1.42 billion-$1.45 billion. That includes about $22 million of currency headwinds. We're guiding to about 9%-10% constant currency growth. All right. Looking at the next...

Turning to our non-healthcare revenue, $910 million-$950 million is the guidance. That guidance includes or incorporates about $42 million of currency headwinds, and that represents growth of about 2%-5% next year. We're, you know... As you know, we're being very thoughtful about the macro environment right now, and we feel like we're putting forth a more conservative view of the guidance as we look into next year. All right, 2023 operating profit guidance, $360 million-$375 million. That concludes about $32 million of foreign exchange headwinds for the year. 2023 EPS guidance, $4.25-$4.45 per share, with about $0.44 of foreign exchange headwinds, about 10% currency headwinds that we've got incorporated. All right.

Now turning to our financial outlook as we look beyond 2023. Consolidated revenue growth, high single digits, 7%-9%. I'm gonna go through the segments here in a bit. Operating profit dollar growth, 10%-12%. EPS growth of 10%-12% for net, for beyond 2023. All right. Looking at how we're gonna drive the leverage earning growth. If you look at the revenue growth, 7%-9%, 10%-12% earnings growth, we're gonna drive through several initiatives. A lot of these initiatives are ongoing, but there are some new initiatives that we have in place as well.

If you look during the last several years with some of the supply chain challenges that many companies have faced, where we face them is really being able to get a consistent flow of raw materials from vendors and also other supply chain bottlenecks throughout the process. If you think about it, getting that consistent flow allows us to really avoid, you know, expediting freight. We've seen a lot of higher freight costs as a result of get the products inbound, go through our manufacturing processes, which has created a lot of inefficiencies for us because it creates a bottleneck in the process as we're trying to work through that and get it to the customer. Then on the back end, we're having to expedite that to the customer.

There's a lot of different things that are impacting our margins today. We plan to continue to streamline and get after some of those supply chain inefficiencies. We also want to tie in and go after manufacturing scale productivity and drive more efficiency throughout our manufacturing and supply chain. The team is continually focused on driving product cost reductions. This has been an ongoing initiative for the company. We design for manufacturability and trying to make things as streamlined as possible and reduce costs. Stacey showed you some of the product earlier that with the RD sensors, where we've taken a lot of the excess waste out of those sensors and been able to reduce some cost of those products over time.

We also have procurement initiatives, continuing to go direct in key markets with customers, and that helps us to drive additional margin improvement by getting that end customer pricing. Next one is Salesforce productivity. This is an ongoing initiative. Our team has done very well. You've seen that through the leverage we've had in our SG&A spend over time, is really, as we put out more and more product and more and more innovation, we've got sales reps who have a lot more things to sell that are more in the portfolio. That enables us to really drive more revenue per rep, and they've done a great job of really being efficient there. We're continuing to do that. Then, of course, leveraging our back office and G&A spend.

If you look at the next slide, as you think about the growth in the business, you can see here in the, in the black boxes, you can see our Healthcare business going from $1.4 billion, $1.42 billion to $1.45 billion is where our estimated range is next year. That's growing 9% to 11% per year. You can see our non-healthcare business growing mid-single digits there out into over the next 5 years. Our consolidated revenue, you can see the critical mass we're starting to get into our revenue and our earnings. Growing consolidated growth rate of 7% to 9% per year. This next slide shows the cash-generating power of the business.

If you look at our adjusted EBITDA, we're around $500 million is where we're estimating for next year, that will be growing 10%-12%. You can start to see the power of our ability to generate cash as we move forward. This is on a very large scale, if you think about how big this business is and that kind of growth. You can see the mix of our healthcare business here. This is a revenue mix, you can see we're set just over 75% as we're estimating into next year. rainbow over 10%. You can see the breakout of some of those other categories. If we look at the revenue growth contribution, we start to break down the 9%-11%.

The first category, of course, being SET. With that being two-thirds of the business growing 6%-8%, that contributes about 4.5%-6.5% to our growth rate over the long term. We also have, rainbow, which is growing at 10% in our long-range plan, and that will contribute about just over 1 percentage point to the overall growth rate of 9%-11%. You add in NomoLine capnography, SedLine O3 brain function monitoring, and Hospital Automation. Each of those are contributing nearly 1 percentage point each to our growth rate. The last piece is some of the new products. As we start to size up, you've seen the market sizing of some of these new products and where we're going.

Telemonitoring, a very big market, over a $20 billion market that Bilal mentioned earlier. You also have wearables. Wearables is over a $50 billion market that Blair mentioned earlier in his presentation. Then hearing enhancement. This is where we put the hearing enhancement category. That's over a $30 billion market within the $85 billion hearables market. We're entering into some massive new markets where we can take and really drive a lot of these new consumer health products, it's pretty exciting to see the opportunity we have ahead, and that we believe is gonna contribute at least 1 percentage point to our growth rate.

That contribution is coming from mainly right now we've got incorporated W1 and Stork. As we launch new products, we'll start to bring those into our long-range forecast. Total revenue growth, 9%-11%. The size of those markets when you combine those, over $110 billion when you start to bring in telemonitoring, wearables, and hearing enhancement. Now I wanna break down our non-healthcare segment. If you look at that, you start to look at the revenue mix on the left side here. 95% roughly is home audio, you can see there. About 5% of the business is headphones, which is in a very rapidly growing side of the market. You see the breakdown of different components of home audio, and you've seen a lot of those things in the demonstrations today.

You got to experience some of the home audio and those, that type of equipment. If you look at home audio, Blair mentioned that being over a $6 billion market for premium and luxury home audio. That's growing 3%-4%, with it being a majority of the business that contributes 3%-4% to the growth rate. Headphones. Headphones are part of that $85 billion hearables market that's growing rapidly. That represents about $55 billion-plus in terms of total market opportunity. That's growing. We have that growing at over 25%. This will become a big growth driver for this business moving forward. That gets us to 4%-6% growth, this growth we believe represents market-leading growth in these categories.

We're excited to bring the team on. You can see the power that it's gonna bring to the consumer channel, and that's what I'm gonna talk about here shortly. If you look at the new product launches, we've talked a lot about those new products. You've seen the demos. We've got a lot in store for wearables, which is a massive market growing, it's a $50 billion market growing double digits. We're gonna be launching Stork baby monitoring, the B1 bands, as well as the Masimo W1 and Freedom in that category. We're also going to be launching more and more in the hearables. As I mentioned before, Sound United, with that acquisition, they brought forth a lot of experience in the hearables market with the headphones.

Now we're gonna take and combine the signal processing capabilities of both organizations and really leverage that engineering power and also leverage the Adaptive Acoustic Technology for hearing enhancement devices as well. The last one is telemonitoring. If you look at telemonitoring, as I mentioned before, over $20 billion total addressable market. Bilal mentioned some of the things that we're launching there with, of course, we're in the process with W1. We have Radius PPG as another option as a wearable, and then we have our home health kits. Then there's all the things that we're doing from a software and data management capability as we move into the home.

If you look at all these markets coming together, I mean, we have a tremendous opportunity here as we are expanding our total addressable markets by nearly 20 times what they are in the traditional hospital space. You can see there with home audio, premium luxury, hearables being an $85 billion combined market there, wearables and then telemonitoring. Now I just wanna kinda recap through, you know, talking more about the acquisition. The power of this acquisition is it provides immediate critical mass for what we're doing today and all the things that we're showing you today with new products, all the things we're coming out with consumer health and also it plays a key role with our future of telemonitoring. I'll talk to you about that in a minute.

If you look at the consumer channel and infrastructure, Masimo is a standalone business. We had a limited consumer channel and infrastructure. It would have taken us multiple years and significant investment to be able to build out the capabilities that we have through this acquisition. If you look at the combination of the companies and bringing on the Sound United team, we've now have immediate access to over 20,000 points of retail distribution. We have a team of over 450 consumer sales and marketing members globally that have not only retail distribution experience, but also a direct-to-consumer marketing expertise. That is a powerful thing. That would have taken us a long time to build out.

We also, as you think about Masimo's brand, we're a trusted brand in the hospital, but we have limited consumer brand recognition today. This gives us immediate access to over 200 years of consumer brand heritage, and it also gives us the ability to leverage those premium audio brands. Think about, where we showed earlier the Denon earbuds with the Masimo AAT technology. Being able to bring that brand name to great technology is gonna give us a head start in these channels and really optimize the opportunity we have to win in this space. It's a massive hearables market. It's over a $85 billion market, and we had no products in hearables today. We had a lot of development in the works. We were developing technologies, we had our signal processing and of course, bringing along Masimo Adaptive Acoustic Technology.

Sound United's been in the space for a while. They've been a rapidly growing business for them. They've got the expertise in that market to be successful. That gives us the ability to leverage our Masimo AAT technology. The next one is we also gain immediate access to a large network. If you think about it today, even during COVID, if you look at the home health hubs we have with Masimo's SafetyNet and being able to connect to clinicians, connect through the cloud back into the clinician's office, that's less than 1,000 home health hubs today. With Sound United, as Blair mentioned, we have the ability now to connect, you know, that platform through HEOS.

We have over 3.4 million connected devices growing about 500,000, 600,000 a year. Those will soon be capable of acting as health hubs by the end of this year. That gives us that rapid start for what we're wanting to do with creating telehealth systems in the home, being able to access through the cloud in a bigger way, connecting data and connecting patients back to their clinicians. The next one is engineering power. I think you probably saw a slide from Blair earlier that showed Masimo engineers today, over 450. Now we're adding 375 engineers from Sound United. We have an engineering powerhouse with over 825 engineers combined.

That gives us the ability to leverage that engineering power, for more products that we can roll out and continue to innovate both in the hospital, as well as going after those, large consumer health and telemonitoring markets. Last but not least is really the financial impact. We evaluated a lot of things through the process, a lot of companies, looked at partnerships, we looked at all these different things. You can see where this company, this acquisition, checked the box on a lot of areas that were important for us. We absolutely needed to have immediate access to a large channel. We've been investing in all this innovation for years.

Bilal showed earlier where the wearables, and Joe mentioned it, that technology goes back a long time, and we've been developing that for many, many years. To see that evolve, and now we're ready. We have a product immediately today to go to market within the next year. We needed that channel to really successfully launch these products that we think are gonna be impactful to many out there as far as consumers and patients around the world. If you look at that would have taken a heavy multiyear investment for us to establish the infrastructure we needed to be successful. That would have diluted our earnings for multiple years.

What we found was a company that had all the majority of the things we were looking for, and it was a reasonable valuation, 1x revenue, 8x EBITDA, and it gave us immediately accretive earnings. The biggest thing here for us too is it provides significant upside optionality. We've made the investment in R&D. A lot of that's in our run rate today as far as all the things that we're doing. We've made the investment in the acquisition that gives us the channel, gives us the breadth, and it also gives us access to those telehealth opportunities. Now we have huge opportunities, upside optionality to promote new products that we're rolling out, all the things you've seen today. That upside optionality is something we couldn't capture if we wouldn't have done this acquisition.

I'm gonna turn to the next slide here and show you, what you've probably all been waiting for is some of the timelines. If you look at this acquisition too, it accelerates our time to market by giving us that channel. We would've probably had to trickle out products over multiple years without being able to drive the success in those launches. If you look at Stork, and you can see here some of these timetables, that really represents how we're finalizing the launch of those products. Within that range of time is when we expect to launch these products. If you think about Stork by middle of next year, MightySat VS1, this is our next generation MightySat, that'll be middle of the year next year, as well as Radius Tº disposable.

Then we got hearables with AAT. That'll be a second half of the year launch. W1 and Freedom will be second half to late next year. That will be also combined, and we are going to ultimately launch W1 into that channel. That'll give us a multi-tier strategy as you think about pricing, with Freedom being more the luxury type, premium luxury type pricing. You've got double W1, and then you've got all the bands for sleep and fitness that would be more of a mass consumer... It'll reach more consumers in terms of price. We're excited about all these product launches that are coming, and it's gonna give us tremendous opportunity to drive upside.

These are not all the products we're launching, keep in mind, but we wanted to highlight some of the key products that are gonna that really are consumer health products that we'll be launching within the next 12 months. This next slide shows how we build up, how you think about the buildup of the 7% to 9% growth. You can see here where we've got the professional healthcare, we've got consumer non-healthcare, and then consumer health. That gets us to a buildup of 7% to 9% growth, high single-digit growth. All these things we're doing, we have tremendous upside optionality to deliver significantly higher growth. This could change the trajectory of this business. Again, I'm not committing there, but the upside is tremendous.

If you start to look at what this could do for the business, it could take us to a new growth trajectory, if a lot of these things are successful. That's pretty significant when you think about the size of the revenues in the business, and we talked about the size of the earnings together. The last piece, I just wanna recap. Our goal is to deliver sustainable revenue growth. If you look at our plan, high single-digit growth, 7% to 9% combined. We're gonna do that through market-leading performance of our core businesses. You think about the consumer audio, the traditional healthcare business. We have a lot of upside optionality to capture.

We plan to make the right investments as we move forward and balance reinvestment within what the guidance we've provided to really capture that upside optionality and hopefully drive significantly better results than what we're even targeting today. Of course, leverage earnings growth. If you look at our long-term outlook, we're providing 10%-12% earnings growth. We're gonna do that through driving gross margin improvements, continue to leverage operating expenses, and balancing reinvestment to support those new product initiatives. That will help us capture the upside as well as continue to deliver sustainable revenue and earnings growth as we move forward. That's it. I'm gonna wrap up there, I'm gonna have Joe come back on stage.

Welcome back, Joe, our Chief Visionary Officer, our Founder, our Chairman, CEO.

Joe Kiani
Founder, Chairman, and CEO, Masimo

Thank you. Thank you, Micah. I hope you guys like the punchline. As I put it, Micah had the fun stuff to report. Hope you guys enjoyed the product demonstrations. Got a chance to stretch your legs. I appreciate you being here. It's 7 in the morning. Some show of hands, who enjoyed seeing the wearables the most? W1, Freedom. All right. Who enjoyed seeing the baby monitor, Stork, the most? Wow. Okay. A baby's coming. Who enjoyed Sepsis Index, Hydration Index side of the business the most? All right. All right. Who's gonna watch The Greatest Showman when they get home? Great song, huh? All right. I really, really wanna just emphasize a few things. When we were developing W1, we got some signals that told us to go faster, go harder, take more risk.

One of them was the market. The market used to be for electrocardiography at home. It changed to photoplethysmography at home. It changed to pulse oximetry. Pulse ox became a home name, a household name because of COVID. You saw how we're about to do continuous arrhythmia analysis with this partnership with iRhythm, 'cause nobody else has continuous PPG like we do that can really bring out continuous arrhythmias instead of, you know, thinking you may have something, you press a button to try to detect something. We also got the signal from everybody who's trying to help during COVID, from major companies like, I don't know, Verizon, AT&T. They were calling us saying, "We wanna work with you because you're the only real thing." Everything else was vaporware. To date, they still are vaporware.

We got to see some of those things come out in haste. You know, when I got a chance to get a demonstration of W1, this is one of the other important signals. You saw the difference between Nellcor and Masimo. You saw the difference between Apple and Masimo. It is greater than I expected. I knew we're gonna work well because of our core technology and our incredible team, but I didn't expect it to work so well. I've seen it help detect problems with loved ones in my life. That told us something. That, by the way, that extra improvement in accuracy and performance, the continuous accurate measurements matter. Think about how until Masimo SET came to market, despite pulse oximetry being ubiquitous, there was not one outcome study that showed pulse ox made a clinical difference. Not one.

Post the delivery of Masimo SET. There are now four or five areas where pulse ox made a clinical difference. Reduction of retinopathy prematurity, detection of CCHD in newborns, helping save lives from people suffering from opioid-induced respiratory depression, helping save lives for people at home with COVID. I really believe this extra accuracy, this continuous capability will matter. If we didn't introduce it, a lot of stuff that's out there would look like, "Well, what does it do? It's not doing anything for me." I'm really excited. I have to tell you, the future looks fantastic. We have this incredibly talented team, nearly 10,000 people now. We have this incredible revolutionary technologies from W1, E1, Sepsis Index, Hydration Index, SET, of course, rainbow. We have Masimo Radius VSM. We have hemoglobin on Root.

We've got an incredibly great hand, and we intend to do our best to make the most of it. We intend to usher in 22nd century healthcare. We have the critical mass already, there's a lot more. We showed you some stuff until the end of next year. There's more. More that we believe will complete this picture from hospital to home, back to hospital, back to home. That circle is critical. I mean, you've heard Dr. Pronovost, Dr. Kenton Zehr , which I'm grateful for. These guys are iconic clinicians in the U.S., if not worldwide, come to you to tell you how important these are, and what it will mean to not only survival of hospitals, but to survival of people, and getting that care at the best place they could get the care for, at home.

You stuck with us for so m any years. Please stay with us longer. We've got a great future ahead of us, and we're gonna see this through. Thank you so much. I hope you have a safe journey back home. Thanks for being with us. Thank you.

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