All right. Good afternoon or good morning, about to be good afternoon, and welcome to the 2024 Wells Fargo Healthcare Conference. Thank you for helping make this our largest healthcare conference yet. I'm Larry Biegelsen, the medical device analyst at Wells Fargo, and I'm thrilled to host this keynote session with Geoff Martha, the CEO of Medtronic. Geoff's an ideal keynote speaker because he leads the world's largest medical device company, so he has a unique perspective on device trends around the world, as well as healthcare trends.
Medtronic's also at an interesting inflection point, as new growth drivers start to contribute to the company's revenue, and Geoff has made leverage more of a focus as well, so we should start to see high single-digit earnings growth later this year. The format will be moderated Q&A. If anyone has a question, just raise your hand and someone will come around with a mic. We'll spend about half the time talking about industry trends, and the other half on Medtronic-specific topics. So Geoff, thanks so much for taking the time to be here today.
Yeah, thanks, Larry. Good to be here, and congratulations on the conference, the attendance, and the impact that it's having. It's good to see.
Thank you. Appreciate that. So Geoff, let's jump into the questions. From your perspective, what's the state of the med tech industry today?
Look, we've come through, I think, a couple of tough years with COVID and everything, but it's in a very good spot right now, namely because of innovation, I believe. Innovation is really strong, and it's innovation in areas that where there's a big patient need and a lot of patients, you know, areas like diabetes or AFib, and you know, we're counting on hypertension. But you know, from an industry perspective, I think it's a lot of innovation. That innovation is getting rewarded with growth and pricing. And then we have, I think, healthy end markets. So all that, it's a good time to be here.
There's the other piece that I'm excited about for the industry is just the digital piece coming in. And I think of digital, whether it be data and AI, but also computing, you know, supercomputing, edge computing, cloud computing, everything's connected, and then finally, robotics. All of that coming into the industry, these big tech areas coming into to med tech is exciting.
That's good to hear. So, Geoff, obviously, this is an investor conference, and year-to-date, large cap med tech has underperformed the S&P 500 and most other sectors, subsectors within healthcare. Why is this a good time to invest in med tech and Medtronic?
From a Medtronic perspective, I'd say we're in the early innings, if you will, of launching, as you mentioned in the opening comments, new and novel technologies into high-growth areas. And we're starting to, you know, show consistency, seven quarters in a row, mid-single digit growth. I still think that's early innings, though, of these launches, and we believe that's durable.
As you mentioned, a number of changes we put in place to drive the bottom line as well, and you know, we're starting to see that, and we anticipate the back half of our year at high single-digit growth. You know, we think it's durable between investments and innovation to drive the top line and the discipline and the rigor we're showing to drive the bottom line as well. We think it's durable.
That's helpful. And Geoff, can you talk about what you're seeing with regard to procedure volumes around the world?
Like I said just a second ago, I believe they're healthy. It's like procedure volumes. I think the noise has worked its way out. There's a lot of conversations that you and I have had on different investor calls and stages like this. Is there - when coming out of COVID, is this as big bullish? You know, what's going on? I think all that's worked out, and we're at a new normal, a healthy growth rate of procedures, and I expect that to continue.
I think some places that the GLP-1s have had an impact on certain areas of med tech. For us, it's well, I'd say GLP-1s have an impact on sentiment in certain areas, and actual procedures, the one area we're seeing is bariatric. That's a relatively small part of Medtronic, low single digits, and we expect that to actually get back to growth in calendar year 2025. So we think that's, you know, kind of bottoming out, and we'll start to grow again.
That's good to hear. You talked about innovation. That was in your opening comment. You know, what are some of the areas you're most excited about?
The areas I'm most excited about, it's what's driving the excitement is a couple things: the patient impact, the size of the patient pool, the relative near-term nature, and the financial impact. When I have those kind of criteria, things that jump off the page for me would be PFA for ablation, for AFib ablation, and hypertension, so the RD and technology for hypertension. Those two, why they jump off the page is because in AFib, you know, we've been, like, sub-billion dollar, relatively niche player in this growing market.
Growth has accelerated, I think, due to the innovation, and we feel like on the PFA side, we have a very comprehensive portfolio of technology, both in the single shot and in the point to point. It's very comprehensive offering, and it's gonna get us to market growth in the near term, and then, you know, exceed that.
Well, we're definitely gonna dive deeper into PFA in a minute when we talk about, you know, Medtronic-specific topics. I'm curious, innovation has been strong within the industry. I agree with you. There's a change going on at the FDA. The head of the Medical Device Division, Jeff Shuren, is retiring. What, you know, how might his retirement impact the regulatory environment at FDA?
Well, first, I think Jeff, we owe Jeff a debt of gratitude. You know, I got the chance to work with him at Medtronic, but also in my role at AdvaMed, on the leadership team or the board of AdvaMed. And I think he's done. And not just him, but the FDA in general has done a good job at protecting safety, but first and foremost, but being advocate, advocates for innovation, and making the U.S. market competitive. You know, behind the scenes, I see them actively balancing that. It's not a balance. Patient safety is number one, but still driving innovation, and they've created new pathways, and they've been constructive with industry, and so that's all under Jeff's leadership. So we'll miss him.
But I do think. Look, Michelle Tarver's stepping in, Dr. Michelle Tarver, on an interim basis, and they've, they're conducting a search. I think there are a number of good candidates out there, and, you know, it was under Jeff's leadership, but there's a broader leadership team, and of course, Dr. Califf, the head of the FDA. I would expect that approach to continue, where patient safety is number one, but advocates for innovation, to make the U.S. market the best place to get your care.
That's helpful. You talked about digital commitment to growth. Everyone talks about, you know, AI, but the question investors are asking is: How do you monetize it?
That is a good question. First of all, I don't think it's hype, but I think we've launched a number of FDA-approved AI-based innovation, whether it be in colonoscopies or surgery or AFib detection, diabetes or algorithm. It's really having an impact, and that's one of the things that I've challenged our team, and we've had some success here, is making sure the business model is there so you can get paid. Like in, you know, and it, it's doable. Like, for example, in our spine business, the surgical planning, we talk about robotics and navigation and this whole AiBLE, what we call this AiBLE ecosystem of enabling technology.
One of the key things that has accelerated our spine business growth is the surgical planning software, and that's an AI-based software that really guides the surgeon through the procedure and how tracks the follow-up, et cetera. We're just getting better outcomes, and for that, we're charging. You know, we've created a subscription model there. Same thing we're doing in GI Genius, you know. So we are. You can get paid. Right now, it's been, you know, something that hospitals got to come out of pocket for. I think the next step for us is getting actual, you know, specific reimbursement for this, and that's something we're working on. It's something you just have to focus on, but the opportunity's there to get paid for this.
Is it? Can you envision a time or a way where you could quantify that for investors, or is it just the AI is embedded in the products? It's difficult to kind of... You know, in other words, AI or digital-
Yeah.
is contributing $500 million. You know, is there any way, do you think there's ever gonna be a way where you can quantify?
I think for some products, the answer is yes. I mean, like I said, sometimes the AI is embedded, and it's just helping you win more market share or grow that market or win more market share, but it's embedded. In other cases, like I said, the two examples I gave, we're calling it out and saying there's a specific, you know, a business model where you get paid for the AI, specifically separate from the rest of the technology, and I think that that's obviously quantifiable.
So I'm pushing for more of that versus just the embedded. But in some cases, it's embedded and kind of the cost of being competitive. But more and more, we're starting to charge for it, and that we'll be able to quantify. We're not prepared to do that right now, but we've got these six AI-approved products, and about half of them are specifically charged for versus just buried in the price.
Is this an area where Medtronic's scale is an advantage? Do you have, like, a centralized AI/digital, you know, function or research or, you know, leader, or is it, you know, segment by segment that you address?
The answer is yes. We hired Dr. Ken Washington. We hired him from outside of healthcare. He was a big tech in Amazon, and before that, he was in the automotive industry in Ford, driving their Ford F-150 program. You know, AI played a big role in all of that. And so we've brought him in. The impetus, because we hadn't had a chief technology officer before at Medtronic, so why now? It was really AI and a bit of robotics as well, so we can. You know, it's centralized a bit, but it's also in the businesses. We started in individual businesses. We did like a shark tank, said, "Here's..." We held back some R&D.
After the budgeting process was over, we had held back some R&D, and we said to the business, the shark tank, this is like four years ago: "Give us your best AI ideas, and then we'll fund it from the center just to get it going." And that was in the businesses. But we definitely see an opportunity, and we've acted on it, to centralize part of it. There's certain aspects of your AI strategy, I think, are better at a company like ours to be centralized, so each business doesn't have to build the platform by themselves. So now we've got a platform and, or, or platforms, if you will, at the enterprise level the businesses can leverage.
That's helpful. Let's switch gears and talk about China, which has been very volatile in recent years in the medical device industry.
Yeah.
What, what's Medtronic doing to, A, you know, minimize the geopolitical risks there? And, and, B, what are you seeing on the ground there today?
First, let's start by, yeah, it's been with the volume-based pricing, that's gone through quite a bit of the med tech industry in China. The pricing has come down quite a bit over the last couple of years, and we've had to eat that in our financials. That's largely behind us. What hasn't changed is the procedure growth there is very high, right? It's just high procedure growth, but now at a lower pricing level. And for Medtronic, you know, that's largely behind us. We still have a little bit left to go in volume-based pricing, but what you have now is a very high growth business from a procedure perspective, just at a lower pricing. But we've maintained good profitability there.
We've really able to take out some costs, and maintain very good profitability there. So that's where we are right now, and it's a contributor to our emerging market growth, which is a strong contributor to our emerging market growth. Now, what we're doing to de-risk it for, you know, for a variety of reasons, you mentioned, geopolitics and, you know, what. We don't rely on China as a big, for our supply chain. There's a little bit there, but not a lot of exposure, and we continue to manage that down. But in terms of the end market, again, like I said, largely, a lot of this VBP is behind us.
Still a little bit left to go, which, you know, in a given quarter, could be a little choppy, but we're still talking growth. What we're doing over time is... Oh, and by the way, when the next round of VBP comes back, we're seeing price increases. So I think we've kinda hit. I think the government realizes it hit kind of a bottom, if you will, and they don't wanna see us pulling out.
So what we're doing now for the long term is localizing more, so in China, for China. Design, manufacture, sell in China for China, and we could export those products to other, you know, emerging markets, but that's gonna take us some time to shift our portfolio from largely imported into China to more in China, for China. We've been on this journey now for a decade, but we got to speed it up a little bit.
Any idea what percent is local today, still made in-
Yeah, we haven't disclosed that, but it's the majority is still imported into China. And as you look at other industries, and we look at all the industries inside the healthcare and outside, I'm on the US-China Business Council, the Asia Society. I'm gonna spend a lot of time on this. You see patterns, and so we just know we're gonna have to accelerate localization. Now, to participate in the growth, but that's not happening overnight. You know, I mean, it's local companies in our space, they you know, China still relies heavily on the US for its advanced medical technology.
Got it. Geoff, pricing has gotten better over the past few years for the industry. It sounds like pricing maybe even turned positive for Medtronic in fiscal Q1 that you just reported. Is that accurate, and how are you thinking about pricing going forward?
Yeah, it's historically, it's been like a low single digit bad guy, like, every year, and we've been creeping it up, and it's crossed over to being net, accounting for everything, including China, VBP, and other government pricing actions. Net, it's been a slight positive for us, and we attribute that to two things: one, focusing on pricing, having maybe a little more backbone on this and driving this and incenting people on this, more than we had in the past, but two, innovation.
So we're really measuring how much of our revenue comes from products we've launched in the last three years, and we measure that Vitality Index, we call it. And we, you know, we're at a little over 20% right now of our current revenue comes from products in the last three years, and we wanna keep growing that Vitality Index because we, when you drive innovation, you know, it, it helps your pricing.
Right.
And so that's how we're doing it.
But the pricing that was positive in fiscal Q1, that's pure price?
Yes.
Yeah, got it. Geoff, before we transition to a Medtronic-specific question, what about industry risks? We talked about a lot of opportunities. I mean, China-
China, you brought up.
Yeah.
I mean, I think, look, there's a lot of growth in China, okay? So the Chinese government, make no mistake, is investing in healthcare. They, they're serious. So when you talk to the Chinese government and the Chinese health policy leaders, they're very sophisticated, and they really do want to drive better healthcare for their population. And but economically, they want that money that they're investing in healthcare to stay in the country, and so they are pushing for local. So, it's a risk, geopolitically, but I think if you take the you know, that's something you got to watch out for, but the healthcare policy is pretty clear. Localize over time, and it's a choice you can make or not make, to participate in that market. So that's one risk.
But look, let's just start with the positive. I mean, we started, it's healthy procedure volumes, you know, that we're seeing out there in the industry, and you're seeing innovation combined with the healthy procedure volumes. So I think there's more opportunity there than there are risks. You know, I think China is one risk, but you know, I don't know that there's another that rises to that.
I think one opportunity that I've got out there is AI. I think a risk would be if the FDA somehow loses control of the regulation of that. Like, I argue with U.S. government officials that we're already regulated in med tech on AI. Don't come over the top with some other regulation. That's a risk that we wanna to mitigate. And I think, look, the hospitals that we sell into, the healthcare system we sell into isn't at the, you know, it, you know, we've got to make sure that continues to be healthy.
That's helpful. Let's switch gears and focus on Medtronic. Geoff, big picture question: How are you thinking about creating shareholder value at Medtronic?
Well, I mean, it starts with the top line, innovation-driven growth. The top line consistency at that mid-single digits or over time, even more, but let's start with mid-single digit, and it's durable. So it's coming from markets that are large and growing, and you know, we've gotten a lot better at that, seven quarters in a row. Like I said earlier, our growth is starting to come from these big, high-growth markets like diabetes, PFA, robotics will be coming, you know, that'll be more meaningful in the years to come, structural heart. So, you know, that, but then also the driving leverage down the P&L and delivering that high single digit actual EPS growth.
The good news there, we've taken a lot of action there, driven a lot of rigor into the system, digitized a lot of things, and we're seeing the leading indicators of that. With, like, last quarter, we were 8% EPS growth on a constant currency basis, but investors want to see actual. But it is a leading indicator, and that will flip in the back half of the year, where we'll see the, you know, high single digit actual EPS growth, and our, you know, our goal is to make that durable. And I think we do that, you know, what I'm told from investors is that that will make the stock work.
Understood. And Geoff, in recent years, growth names have seen greater share price appreciation. Would you consider getting smaller or breaking into three or four smaller companies to grow faster?
We're constantly looking at what we're not shareholder value creation, and so we're not stuck mentally on being as big as we are. We're really focused on creating the shareholder value. The last couple of years, it's been improving the fundamentals of the company, the operating rigor, the quality of the operations, we have all these supply chain issues, and getting those products out there. We're gonna maintain that, and I'd like to see a scale benefits from the size in three areas going forward. Operations, global operations, supply chain, so resiliency there, but also efficiency, driving costs down, and that's showing up in our numbers. Innovation, like you talked about, there are areas of innovation that cut across the company. AI is one, implantable electronics is another, robotics is a third.
More of those tangible results of... You know, like, for example, you asked me about, like, tibial nerve stim. You know, we're taking a product from, you know, our cardiovascular business and making a few alterations to it, and that's our tibial nerve stim. And so it-- that's an example. We need more of that. And then finally, at the customer. So, like, scale, contracting scale across, we talk about PFA, but that's a big part of our PFA strategy, is contracting across the cardiac service line to make it easier for them to acquire our PFA generators, and so there's no switching costs. So these three areas, and if we don't get that, then, you know, I-- maybe we relook at the thesis.
But we're. It's a constant conversation with our board, not out of defensive, but out of, like, proactiveness. What's the best way to create shareholder value? So one thing I would say, there's openness to... It's all about creating shareholder value. We're not stuck on a model, and there's humility in our thinking here. We're not just, you know. Hope that makes sense.
That makes sense. And Geoff, you've talked about leverage. You know, your margins are still down pretty significantly, versus pre-COVID levels. What's the plan and the timeline to get margins back up?
Yeah, so you talk about the gross margins, and, you know, it has some impact on the operating margins. We've started, and we've got the top line, like we talked about. We spent a lot of time on how do you grow that top line without growing your SG&A at the same rate? We feel like we've got that, like I said, between digitization, process changing, changes, creating global capability centers. Like, we've got a lot of our R&D now in India, for example, that's a global capability center. These things are helping us on the bottom line, so grow the top line without growing the SG&A.
The gross margin is the one that's tougher to move, and that's a combination of the pricing, the cost of goods sold, productivity, a part of which - a lot of which has been masked by inflation and the strong dollar. Both are improving, so you should see the benefit of that cost of goods sold productivity, near term as inflation comes down, as the impact of the strong dollar turns around. The last one is mix. Certain things of mix we control. We're funding and prioritizing high-margin areas, like hypertension is a very high margin for us. It will be like, you know, things like in cardiovascular, like PFA. These things are high margin, neuromodulation, our spine business, we call it Cranial and Spinal Technologies. These are all cardiac rhythm.
These are all areas that are very important to us. But we do have some, you know, mix is almost like a mixed bag, because those things. But, but we do have some high-growth businesses that are lower, lower margin, like right now, diabetes. That growth, that does create a mix issue for us, the gross margin line. But net, net, we, we believe we've stabilized it, and it'll improve from here. We haven't given a time frame on, on getting back, but, but you'll see it, you know, it's stabilized in the back half of the year when that currency flips a bit. That's when you'll start to see it grow from here.
That's helpful. And how are you thinking about the EPS power of Medtronic beyond fiscal 2025?
The EPS, you said?
EPS and sales. I mean, is it basically mid-single digit, the algorithm mid-single digit, organic growth and high single digit EPS?
Yeah, that's the algorithm that we're managing to.
Yeah. And capital allocation, Geoff, you've been relatively quiet with regard to M&A recently, but based on your comments on the Q1 call, sounds like you're preparing to do more. Is that fair? And-
Yeah, I think it's fair. I mean, we haven't changed our capital allocation strategy. I mean, the dividend is a priority for us, and then after that, it's tuck-in M&A. I'd say we raised the bar on tuck-in M&A in the last 18 months. If there was something we felt we really needed to have, we would go get it, but we had a lot of things going on inside the company. On all the changes on the operations front, we were integrating Affera, and other acquisitions. I wanna make sure we focus on a few critical initiatives, a bunch of digitization initiatives as well, and get the fundamentals right. But we're in a much better spot now, and so I think, you know, get it, and the increased cadence on tuck-in M&A is where that's a priority.
Dilution? How are you thinking about dilution? Are you... You know, because right now you're on the cusp of this high single digit EPS growth.
We're, we have to-- you know, we would have to make sure that this all works, and that we're still committed to the high, the leverage-
Offsetting dilution.
Yeah, we-
If there is any.
Yeah, we'd have to offset it. So again, part of the focus would be on these deals, make them less dilutive, so closer to commercialization, and if that means increased price, I think it's worth it because you're de-risking it as well. The further away you are from commercialization, the more risk you take. So closer to commercialization, you de-risk it, and it helps us on the dilution front.
All right. Let's talk about some of the new growth drivers. I think I've lost count of how many times you mentioned PFA so far during our conversation, so why don't we start there? EP has been obviously electrophysiology.
Right
... atrial fibrillation has been a strong market in general, and PFA is accelerating that growth. How is Medtronic positioned, and what's the outlook for Medtronic?
So we're excited about it. First of all, the market's a great market. I mean, it's and it's growing. Like, even before PFA, you saw a pretty big market continue to grow really well, and I think it's a combination of, you know, just an aging population and the world, you know, getting a little bit more wealthy, and so people living the lifestyle that developed countries live, and you're getting more AFib. And now with PFA, you know, you're creating more capacity. Doctors like the safety profile, so I think it's and you're lowering the threshold to do ablation on patients, so the market's gonna grow even more. And so I really feel good about the market, and we're in a leadership role.
We've got, you know, we may not be the first, but we've got, we believe, the most comprehensive offering here between our PulseSelect technology, which is in the single shot space. That's a smaller market, fast growing. And then, that's our PulseSelect, and then in the focal or the point to point, we've got Affera, and that's the large market. So we've got a cut across. Everything I've talked to docs about and I've seen from analysts, and a lot of good feedback on Affera, that that's like the, the crème de la crème, if you will, the premier product in the space today. It's, it, you know... And we're pairing the two together, you know, in contracting.
And you know, we have to wait to actually execute on some of those things until Affera gets approved in the U.S. And we're also. So, so we feel good about it. And then you have the mapping, which is very differentiated, too. The Affera, what's so exciting about it, is that it's an all-in-one catheter, so you do the, as you know, you do the PFA, but you're also gonna do the RF, so you don't need two catheters. Because hospitals are sensitive to the price, because all this is a price uplift. So if you can sell them on value, that's a big piece, and then the mapping. It's a next-gen mapping system that everyone's excited about. So it's comprehensive. We're linking the two together. We're gonna use our cardiovascular service line, heft, to do contracting, to ease switching.
And I don't think this isn't like some other segments of healthcare where you've got... or medtech, where the first player has some big training advantage or some big evidence advantage. I think switching really comes down to, can the hospital acquire the generators or not? And the best offering wins, and we like our offering. We think we're gonna be growing at the market here soon, and then growing ahead of the market. So that's why I'm bullish about it.
What's the assumption for the U.S. approval of the Affera?
We haven't. You know, it's not that far off, and I don't want to get ahead of the FDA. We just talked, you know, the partnership we have with them. I don't wanna get ahead of them on that, but it's not far off.
Talk about when you do have approval, how you're feeling about the three kind of pieces, the supply, being able to manufacture it, the mapping, getting the mapping systems out there- and having the personnel, the mappers-
Yeah
... the clinical support.
Yeah, I think, you know, first of all, a lot's been written on the positive about the efficacy of Affera in particular, but. And that's coming from physicians, and our competitors have also pushed the narrative on the complexity to make the catheters, and they are hard to make. And the organic solution for us has been it's scaling now. That's PulseSelect. It's so the supply is scaling, and the revenue will start to scale. We grew 6.5% last quarter net. That's inclusive of Cryo going down.
So that's a lot of PFA, that's all PulseSelect, and that's gonna continue to accelerate from here. And then Affera, we've had some breakthroughs on the manufacturing capabilities over the last couple of months, even weeks. And we've got lines up around the world, factories up around the world, and we feel like we've got our supply base in a good spot, and we're validating all that now. But for us, revenue for our FY 2025 will be largely PulseSelect, and then FY 2026 is where you'll start to feel the impact of Affera revenue ramp.
But supply, you feel-
That's what I'm saying.
Good.
Yeah, that's the, that's the timing. That's inclusive of supply. We feel yeah, we've got work to do, but we feel good about it based on what we've seen and the breakthroughs we've had, and we're validating it all now. So we feel good about it. And we're hiring mappers. Mappers are coming over from the established players and mapping. They see the future in the Affera mapping system and where we're going with where Medtronic's taking PFA.
Your guidance for fiscal 2025, which you're in right now, assumed limited contribution from the U.S., from Affera in the U.S. Is that correct?
Yeah, I'd say limited. So, like I said, we said we grew 6.5% last quarter. We said it was gonna meaningfully accelerate from here. I don't wanna change that. So that's accurate. I don't wanna go any further detail. And what the only maybe incremental detail that I'm dropping is that that's mainly gonna come from PulseSelect. But the aura of Affera is already having an impact.
You have it in Europe, obviously.
Yeah, we have it in Europe, but even that's limited supply. The aura of what's to come is having an impact on contracting and what, you know-
Sure, that's helpful. What's it gonna take to make renal denervation Symplicity Spyral a billion-dollar product from Medtronic? And are you still bullish on the opportunity?
Yeah, very bullish. I mean, like, we're the, you know, the clinical study, I mean, you had to read through it a little bit to get to the bottom line, but we're seeing incredible patient outcomes here and a pristine safety profile. It's the number one contributor to death in the world. Three out of four people in the United States don't have - do not have their blood pressure under control. This is a solution that is patient-friendly, like I said, pristine safety profile, and it works. We're getting, you know, double-digit drop in blood pressure, and it sustains. So it's that's pretty exciting. And so what we need to do is two things. Everyone in the investment community is focused on the coverage decision.
You know, we are in very constructive conversations with CMS, and I can't say the exact timing, but it doesn't seem like it's that far off, that they'll give some sort of decision here. And the smoke signals are positive, the dialogue's positive. So we think a national coverage decision from CMS would be very helpful for this. Again, I can't get ahead of CMS, but the dialogue's been good. And then once you get through that, it's not totally sequential, but this will accelerate after working with health systems, particularly, you know, all over the world, 'cause the rest of the world's waiting for the U.S. to move, too, on establishing patient pathways. These are patients that the health system really isn't used to managing from a specialist perspective.
They're managed out on the edge with GPs and maybe even general cardiologists with medicine. But that's not working. So how do you funnel those patients into an appropriate funnel that the appropriate patients get Symplicity? So that, we have to work with health systems on that. But this is gonna be a big one for us.
That's helpful. Diabetes has been a nice turnaround for Medtronic. Why was this the right time to do the partnership with Abbott?
I think, well, first of all, this is one of those situations, like I was telling you offline, it's a win, win, win. I think Abbott said this publicly, they've talked to me about it personally, but it's a win for them, it's a win for us, and it's a win for patients. They have more choice. I think this now is the right time because I think Abbott, we were able to get the deal that we wanted. I mean, Abbott sees the direction we're going in the automated insulin delivery space and sees the strength that we have. They see the pipeline that we have, and they wanted to make this investment. It's an investment on their part, too, to do the integration, and they thought we were the right partner.
Because of that strength, we were able to get terms that were acceptable to us. It's a fully integrated system. It's their latest technology, fully integrated, which I'm not sure, you know, and the terms that, you know, financial terms that make sense. We said on the call, it's definitely revenue accretive and profit neutral for us. So, we're launching, this may be counterintuitive, we're launching our latest sensor now. So, we do think we're committed to that. We do think, yeah, having the ability to control our own destiny and provide patient choice on the sensor is important.
Got it. Any integration timeline?
It's not gonna be FY 2025, so, but it's, you know, I don't think it, you know... So it's sometime after that.
Got it. And the other, you know, area you talked about earlier is robotics. Just remind us of the timeline and, you know, do you believe you could be, you know, the number two player after Intuitive Surgical?
Yeah. No, first of all, we realize we're up against a strong competitor here, so you know, I get that. We're not. Our heads aren't in the sand on that. But we do feel we got a great platform here. We've got to make it you know, meaningful from a financial perspective on scaling it. We've got to get our leading instruments on there, so energy, stapling, and others. And we need to get that U.S. approval. And that you know, we submitted or in the process of submitting. We wrapped up the urology trial and are gathering, pulling out, packaging all that data and are submitting that to the FDA, and that went well.
And this De Novo 510(k) clock is like 180 days. So, you know, so we don't know exactly how long it'll take, but that's the clock, and we're close to submitting it all. And we believe the trial went well, and, so we've got, that's the U.S. approval timeframe. And then we've got, we've got to continue the. It's not invention, but engineering to get our instruments on. You get all that, and we have a, we think we have a competitive solution. And we, yeah, we, it's right now, it's a, surgery is the biggest market that there is, I think. You know, I mean, it's everywhere. It's gonna go more minimally invasive. It's gonna go more robotic, everywhere. And, it's a three kind of company. Market at this point, you know, for most of it, and I like where we sit in among those three.
Hugo's been available outside the U.S. for a couple years now. What's the timeline to integrate the instruments outside the U.S.?
It's the same in the U.S. I mean, it'll happen likely after the U.S. approval, in that timeframe.
Got it, and it sounds like, Jeff, as we were talking offline, you see, you know, robotics coming into, you know, developed markets, developing markets, lower, you know, more cost-sensitive markets. How do you see different types of robots in different market segments? I'm talking about surgical.
Yeah.
Or do you see Hugo, you know, being kind of a robot that, you know, is, you know, useful in all different types of procedures?
Yeah, the thing, one of the things we liked about Hugo is the design. The modularity leads to versatility. So you can. The arms are modular, the open console is physician-friendly. So we think you don't have to have all four arms in every case. We think we can innovate on what's on the end of those robotic arms to make it versatile beyond, you know, you know, just what the cases that you're seeing da Vinci do today. So we do think it has versatility beyond that. Think of, you know, I was just in India not too long ago, and they're really pushing to take, okay, take two arms and focus it on certain procedures and optimize those procedures.
So I do think the versatility of Hugo will be advantage in price-sensitive markets where we can still get the value for the robot and it's affordable to these countries. I just don't see this going as sequential as you see open to lap. I think it you know you're gonna see a pretty fast adoption even in some of the poor countries because they don't have the trained physicians. This will over time robotics will be good enough to augment you know physicians.
Got it. Geoff, a minute left here. There's a lot of other things going on at Medtronic. I wanted to give you the last word. Other areas you're excited about, spine, neuromodulation, and any other-
You're hitting a couple of them. I mean, you know, we talked about, look, cardiac rhythms, really excited about what we've been able to do with cardiac rhythm and take it. Cardiac rhythm, spine, and surgery are our big three businesses. We've got a lot of innovation going on in surgery just with robotics, but there's a lot going on in our spine business. We call it Cranial and Spinal Technologies, as well as it's this whole AiBLE ecosystem, so it's even more advanced than robotics. We're excited about that. And like I said, it's taking the spine industry and going from four hundred competitors down to four, and we're taking a lot of share there. And it's really shored up.
And then cardiac rhythm, also doing well, whether it be leadless or conduction system pacing or the Aurora EV-ICD. These things are taking over half of our revenue, about half of our revenue and more when it comes to profit and cash flow. It feels very secure, very secure, and that allows us to fund other things. One of those things, we talked about a lot of those things that we need to fund, but one is neuromod.
This new technology, this sensing technology in DBS and spinal cord stimulation, I think is foundational, and it's gonna open the door to a whole decades of neuromodulation growth. So I'm excited about that as well. And, oh, by the way, it's immediate financial benefit. I mean, we grew double digits last quarter, and I would expect that to continue in our neuromodulation business, which is a meaningful business, $2.5 billion for the company.
All right. Perfect. Geoff, thanks so much for being here.
Thank you, Larry. Appreciate it.
Covering a lot of ground.
All right, thanks.