Recording in progress.
So we're really excited to have you all here today, and most importantly, to talk about the progress we've made and to talk about the course of the future. Oh, I was remiss. I need to remind everyone that we will be making certain forward-looking statements. Make sure you look at our website in the event changes. So Ted, I'm not seeing the prompts here, but I'm gonna keep going anyway. There we go. All right, little technical difficulty to start. Thank you. Again, welcome everyone. Really excited to have you guys here, both in person and virtual. We have a lot to cover today, and I think most importantly, you'll hear from our team about the excitement, about the progress that we've made and the future that we've laid before us.
It's important for investors and everyone to understand that we're a really mission-driven organization here. Our folks get up every morning thinking about the patients that we serve, the providers that we enable to provide care, and the role that we think genomics and precision medicine can play in our healthcare delivery system. We'll be talking a little bit more about that opportunity, but I'm awfully proud, and you'll see throughout the presentation, that over the last three years of the transformation journey that we've been under, that we've made great progress in the things that really matter to patients.
High quality tests, quick turnaround times, and ease of use for our providers, who are caring for 30 or 40 patients a day, and really depend on us to get actionable results, and help explain those results in, in ways that are meaningful and for patients. For those of you new to Myriad Genetics, we, we have a long history, and the science and the foundation of that history is the dedication we're making here to the Walter Gilbert Innovation Center. We're really proud of, of the science that Dr. Gilbert helped found, and upon which much of our mission is, is based.
What I think gets lost sometimes in the investment community is how powerful those capabilities are, and how, as you'll hear from others today, we continue to build on that, and the reputation we have in the markets that we serve for quality, reliability, and trust. Those are measured in lots of different ways. First thing I start looking at, and Nicole will talk about, is the progress we've made with teammates. Turnover is down to 9.6%, and as Mark will say, "You can't sell if you're turning over sales force, and you certainly can't produce great lab results or innovate in advanced technology or science without dedicated teams." So I'm really proud of the progress we've made in terms of our teammate engagement, and how that's translated to really high Net Promoter Scores , above 72% across most of our products.
So we'll get into the financials later, but just to, to level set there. Last quarter, we produced what I would say is a foundational quarter. So I'll just go through those results to level set everybody. 10% revenue growth for the third quarter in a row. As you'll hear today, that is where we are building from, and, and we plan and hope to accelerate growth from there. That's been driven by 17% volume growth across the portfolio, and you'll see that in terms of all our product channels. That growth at 10% is despite some headwinds and some administrative issues we were dealing with, with payers in the first half of the year.
Most of those transitory issues are largely behind us, but I think what we discovered is that we have more opportunity when it comes to reducing no-pays, and it really kind of put a spotlight on it. And so you'll hear a little bit about our emerging strategy to really improve our payment, reduce no-pay, and the significant leverage that that can create in our P&L. So Bryan will talk a little bit more about the continued progress on gross margins, but we stood up here at our last Investor Day, and we talked about 10% growth, we talked about 70% gross margins and getting our OpEx in a stable place, and that's exactly what we've been delivering here. So that's the base upon which financially that I wanna level set you on.
More fun and more interesting, quite frankly, for today, are the things that we've been investing in for the last three years, what we think are foundational to the future of innovation and improving access for patients, which is one of our huge goals here and opportunities. And they're really built on four different things: science, innovation, enabling a customer experience. And I'll tell you, the biggest change that we've done here over the last three years is putting patients and providers at the center of everything we do. And we've created, and Mark Layton will talk about from a product management standpoint, but everything from lab ops, to customer service, to commercial, with the idea of putting patients and the providers that serve them in the center of everything we do.
It sounds like an obvious thing, but it really creates a lot of value, a lot of stickiness with our relationships, and it's a big part of why we're seeing the growth that we have seen. That is made possible, and you'll hear a lot today about the investments we've made in technology, over $50 million of technology investments, across things like EMR and other platforms to enable the customer experience and enable our commercial teams. That is also, as those of you that saw today on our tours, the ability to build scalable Labs of the Future . And as you'll hear, Lab of the Future is a broad concept. It's not just a real estate play, it's about process, systems, and innovation around the technology to make us better at everything we do.
All of that with the mind of scale. You know, the industry has done a great job over the last decade in terms of advancing science, but right now, the real opportunity, and in the context of some of the dislocation in the sector, is to prove out the value proposition at scale, to be able to reach more patients, more cost effectively, and make this science available to everyone. That, again, these four pillars underpin a lot of what you'll hear us talk about today. Okay, that enables—we'll sort of lay out the broad business goals here. What we'll talk about is: we have, as we've committed to and demonstrated last three quarters, a baseline of revenue growth of 10%.
We believe we can accelerate that going into 2024, and as others will talk about, that our new products will really not start kicking in until 2025 and 2026, so... and mostly in the back end of that. So we'll talk about the excitement around launching First Gene and MRD, but we believe we can get to above the 10% growth just with the core opportunities that I'll speak to in a second, and Mark will talk about in our core products. And that goes to our right to win, and, you know, those four pillars go essentially to: what is our right to win and compete in the markets that we're in?
I'll go through a little bit of a teaser in terms of that, to size the opportunity, and the team will take you through the how we expect to do that. Really exciting pipeline of innovation in our existing products. Every day in product management, we talk about how we're gonna elevate our current product portfolio and make sure that they are staying competitive and improving the clinical utility of those products. And Katie will talk about the re-energized clinical validation work that she and others are doing. And as I mentioned before, all of this ultimately leads to accomplishing the mission, but also driving growth and profitability at scale. The ability to grow our gross margins above 70%, and to do that on an OpEx that is growing moderately at around 5% or 6%.
Capital deployment, I think we've been pretty good stewards. And again, thank you to our investors that are here and those online. Over the last three years of divesting assets that we felt were not strategic, and while we continue to work on improving the balance sheet, I think we've been pretty good stewards of deploying capital, and making sure that we have an eye towards good returns on invested capital for those shareholders that have entrusted their capital with us. So again, I'm just gonna lay out the opportunity for you, and the rest of the team will do a much better job of talking about how we're getting out at it and why we have a right to win.
But for those that continue to believe that this sector is mature and that these products are commoditized, it's really not consistent with the data. And Mark will talk about all of the energy around genomic testing and precision medicine that, that is coming out of the pandemic. We see adoption rates of less than 40% across our portfolio, so we see a huge underpenetrated market in many of the things that we do. We see that even among the top players, that business is only concentrated about 20%. And importantly, and sadly, you know, a lot of the smaller players are struggling. So we see this very fragmented market as an opportunity for us, and quite frankly, many of our competitors, to grow in terms of adoption rates and, and to consolidate market share.
As you look across our products, and Mark will take you through, you'll see that not only do we think we have a right to win in traditional markets like hereditary cancer, but given the investments we've made and the deep nature of the relationships we have, that we have multiple levers to grow and to innovate across the portfolio and across these channels. I'm excited to have the team share that with you today. Mark?
Thank you, Paul. Good morning. Bear with us. Yep. We plan every day to differentiate. No, to back up and loudly, so hopefully the folks on the phone could hear as well. It's been so important for us and. Thank you, Maggie. Okay, thank you. Our approach is holistic, multidisciplinary. Holistic, as Paul mentioned, it's not just about the test anymore, it's about how we show up in our customer's ecosystem, and the different bets that we make, and how we diversify the roadmap. Multidisciplinary, we really believe it's a team sport. Product management is a team sport. It's very intentional, our design. And a couple of things I wanna highlight that are core tenets for my team and product management as a whole. Really, at the top, we're evolving our culture, and we're there to be more data-driven.
Not just in the bets we make and the hurdle rates and the commercial impact. That's very important, but it's more about - it's also about user research, market research, competitive intel. Putting all of those elements and data points together, that helps inform our product strategy, helps inform our roadmaps. Paul mentioned that ease of use is critical, so we are relentless. We've invested heavily in just great experience. Our digital product teams, our design teams, they wake up every day figuring out: How can we show up better and fold ourselves into the workflows of our providers? How can we meet them where we work? How can we be easier to do business with?
We put ease of use and the experience; we put that on par with the science, and that's how important it is to us, because we know it's no longer about the test in this industry.... My job and my team's job, with a lot of my partners in crime, Julia Wells, who's our SVP of Program Management, Kevin, who runs our technology organization. Once we set the vision of the products and the roadmaps, we have to align the stakeholder groups. This has been a big unlock for us. Once we've unified under these strategies, whether it's a particular portfolio overall or individual products, it's been an amazing unlock for us. We're all rowing in the same direction towards a unified strategy. That's just mobilized all the teams. And you're seeing that show up.
You're seeing that show up in the diversity of projects that we're able to ship and get out the door, and the value that we're able to create. I won't steal the thunder. You know, one of the things when you're making investments in running product management, it's a real balance between let's just build, let's grow, grow more products, let's build new features, stuff that's externally facing that you can touch and feel. That's exciting. We're not short of ideas here, but we've also balanced that and have the discipline to balance that with, you know, making our engines go faster, and that, that work around technical architecture, that work around sustainability. You're going to hear a lot of that in Nicole's section about how we're able to bear the fruits of that. Just a couple of takeaways.
It's a team sport, and we're really intentional with the design of how we've evolved this and built this capability. This is our business, this is our portfolio. We're incredibly proud of our current portfolio. We're in the women's health space, oncology, pharmacogenomics. These are large markets. You can see just from the sheer dollar signs. What makes them also attractive, and we'll talk a little bit about this, when you click in to the segments in these markets, you'll find them relatively underpenetrated. So we're competing and winning in large areas, and we still feel that there's more to do and there's more go get for us. One thing I wanted to highlight, you'll notice along the, one of the ribbons, the target customers.
Tying this all back to experience, we have to show all of these different provider groups that you can't take a cookie-cutter approach to how you show up for them. So that's why user research, getting close to the customer, letting them know we get their workflow, and the workflow is different in the women's health space, as it is in oncology, as it is in the mental health and pharmacogenomics space. So we got to show, we show our customers that we get that, and it's honestly a, it's a privilege for us to serve these stakeholders and work with them every day. Okay, now the fun stuff. Let's jump into the products. We got to start with MyRisk, right? This is a flagship product for us. We sell it into our women's health channel, oncology channel, urology channel.
It's, it's a differentiated option, offering, not only in the sense of the test, but it's what we surround it with. MyRisk with RiskScore, MyRisk with the Medical Management Tool . It's not only the test itself, but it's what we complement it with that's a differentiator. So we're just immensely proud of this product. It's a flagship of ours, and the versatility to sell it in those multiple channels is a real opportunity for us. I want to step back and just briefly talk about how we view the hereditary cancer market. We split into two channels: unaffected versus affected. On the unaffected side, you can see we're all in, in this space. Tremendous opportunity. We have very strong market share, and we're just scratching the surface from a penetration standpoint. It's a little bit of an eye chart.
The number that I want to grab and talk about is the 25 million. That's 25 million women in the United States that qualify for hereditary cancer testing. 25 million women. That's 25 million women who can have a MyRisk test to empower them, give them the insights to take care of their care and be proactive. What a humbling, humbling opportunity and challenge for us. And then on the business side, my goodness, that's a huge pie where we have the right to win and we're positioned to win. On the affected side, it is a more mature market, but we're really committed to stealing share, and we're committed to getting back to a position of leadership. I'm going to talk a little bit about the roadmap for MyRisk and do a little bit about how we're performing.
Dale Muzzey, he's going to talk more about the pipeline and get you excited about all the flexibility and the things that we're going to be able to do with the assay down the road. But we're investing today. That's the key part. Our current portfolio is very strong. We invest in depth, and we take care of our products and innovate as they are today. Some examples of that, I talked about RiskScore. We're constantly updating RiskScore and making that more innovative. The Medical Management Tool . Why are those so important? Well, you get the insight from the test, but we also partner and equip our providers and with our patients of, okay, what do we do next? How does that guide what needs to happen next? And that's a really sacred workflow where MyRisk shows up and delivers tremendous amount of value.
Mark's going to talk about our breast cancer risk assessment program. That's just another way, anchored to MyRisk, how we're able to open new value creation levers for our customers. I won't steal his thunder, but a lot of exciting things. On the volume, it speaks for itself. We know this is sustainable volume. We're really proud of it today, but in a way, we do feel... We feel like we've scratched the surface about all the investments that we're making around commercial activation, et cetera, et cetera. Again, the takeaway here is we're extremely bullish about the unaffected hereditary cancer market, but we're not, we're not letting go of the affected space either... Let's switch gears to GeneSight, our pharmacogenomic offering. We know there's a mental health crisis in this country, and being a market leader in this space, we wanna do our part.
We're the tip of the spear. We wanna do our part. And what we see with GeneSight is, it's a very effective tool to help guide the medication management of patients. It's a vicious cycle of this trial and error, trial and error, trial and error, and we play a part in helping reduce those cycles and matching the medication to the patient. And so we're really proud of their offering in the pharmacogenomic space, and again, the role we're playing to do our part at the mental health crisis in this country. I won't steal. You're gonna hear from Katie. She runs our clinical product. She's gonna talk a little bit of the great work we're doing in the study space. But, you know, the way I think about it is, hey, how can this test work to help more indications, to help more people?
That's a little bit-- that's sort of my layman's example of, or how I'd categorize our clinical strategy. The growth speaks for itself. You know, we are a market leader here, a clear market leader, but we still feel this is an unpenetrated market. So the opportunity there is really exciting. We know the volume's sustainable. And again, we're doing our part to continue to get through and change the hearts and minds of payers to keep unlocking that volume to revenue conversion. Okay, Prolaris, switching gears. I think of Prolaris. I know as a product manager, I have to love all my kids the same, but Prolaris is-- it really is the darling of the portfolio.
And you know, when I think about this product, and you do a dive in and thinking about prostate cancer, that urologist is the front door for that patient's journey. And the time of biopsy, that's where we lean in, and that's where we dominate this market. But it's an important moment. It's an important moment to use Prolaris to simplify and guide the treatment path for that patient. And we know with prostate cancer, some of those options for treatment, if there isn't a profitability for a great outcome, what that puts the patient through, what that puts the patient's loved ones through, is immense. And so we owe it to the provider, we owe it to the patient to put themselves in the best position for their treatment path.
That's why there's the Prolaris and where we play in the biopsy space at the time of diagnosis. We're always gonna be investing heavily there. Why else do I love it? But if to keep the clunky analogy, you know, making your bed, doing your homework, cleaning up after yourself, great reimbursement rates, really, really strong payer mix, and very healthy margins. And so that opens the door for us to have opportunities to invest. And on the left side, when I think about our clinical strategy here, it all just boils down to we're equipping the provider and the patient to have the conversation about treatment. That's our focus, that's our intention with all the programs that Katie's team's running, all the clinical utility and effectiveness that we're going after in studies.
We know that's an important moment in the journey of that patient, and that's what we're focused on. From a volume standpoint, this volume trajectory and trend is real. And again, it's—we have a strong, admirable competitor in this space, but we have a right to win. It's still largely underpenetrated, not as much as in the pharmacogenomic space, but there's still a lot of go get here, and we're really proud with our offering. I mentioned we own the biopsy space. You will see in the Prolaris post RP launch, we're working on that now, where we are gonna lean in to—towards more of the rad oncs. That's a place that our main competitor plays, but we feel we have a right to be there and a right to win and the credibility to do that. Okay, we talked about MyRisk for women's health.
This is the other part of our women's health business, our prenatal space, with Prequel and Foresight. Prequel is absolutely, the best test in the marketplace, unequivocally. And I wanna talk about Foresight. We have a lot of exciting things on the roadmap. Dale is gonna walk you through the excitement, but the takeaway here is we're a pioneer in this space, we belong in this space, and we're just so proud of the... what the products do today, and we're really excited about our roadmap down the road. From a market standpoint, you know, it's somewhere between mature and underpenetrated. Our market share is strong, but the things that we're doing in and around this space to show just how committed we are, Dale's gonna talk about launch of First Gene. I'll briefly mention our Foresight panel expansion. We're creating a new Universal Plus Panel.
So just everybody's seeing how much we're investing in this space, and that's starting to resonate. When you see our volume trend, we know some of the competitive landscape is softening a little bit, but we don't attribute it to that. We know this is sustainable, and as we expand the panel at Foresight, as we launch FirstGene, we've gotten Prequel and Foresight on new technologies. We're so positioned to just keep a really strong growing footprint in this space. Last product I wanna highlight is kinda sort of a Trojan horse for us. It's from MyChoice, and, you know, it's the only FDA-approved test for HRD. It's extremely strong and differentiated in ovarian. One of the things that's attractive about this is-... We're looking into the indication expansion into breast and prostate. That's a space that we do well in, in our portfolio.
We have a right to be there, and it's aligned with our strategic direction. It also is gonna make us. We have strong partnerships with pharma. When we expand those indications into breast and prostate, we're gonna be that much more attractive to our biopharma partners. So I just wanted to share and give a little snippet of the strong but mighty MyChoice. I wanna close out. Again, extremely proud of the current portfolio. I couldn't help myself putting some MRD and FirstGene on here. The takeaway here is we're investing in depth. We're not just chasing new things. We're making each of these products that compete and win in our different channels. We're continuing to listen to our customers, watch where the market's going, and make them better. That's the takeaway of this.
Doing all of this, as well as we're making the engine stronger, investing in technology, investing in sustainability projects. That wouldn't be possible if we didn't partner together as an organization, go through the transformation from programmatic management to product management. So really proud of what the team's been able to accomplish. And with that, I'm gonna hand it over to Mark to talk about how we're winning and how we're gonna keep winning.
Thank you, Mark. Oh, look at that, we got the mics working. Before I start, I just wanted to bring this to life and show one of our more recent patient stories. So please enjoy this two-minute clip.
Losing my mom at such a young age to breast cancer was very, very difficult. She was my best friend. We were a very, very close family. With my family history, they started having me do annual mammograms. When I first heard about the genetic testing, the MyRisk test, I was so excited. Lisa was a good candidate for MyRisk because of her family history, and she also had dense breast tissue, which in a lot of cases, with mammogram screening alone, can be missed, especially with very small breast cancers. It showed me I was very high risk. It even said that I had a 1 in 4 chance of having breast cancer. It scared me to death. 1 in 4 chance is not a 1 in a million chance. Lisa's MyRisk result was negative for a known gene mutation, but her MyRisk Risk Score was elevated and does indicate a change in medical management.
The doctor moved forward and ordered the breast MRI. They called me at work. The doctor told me her name, and she said, "I was calling to let you know you have invasive, aggressive carcinoma." I just froze for a minute. I was in shock. All that fear that I'd had all those years, it was just hit me. Now I'm in my mom's shoes. Started thinking of my kids, my grandkids, my husband. We were able to catch it at such an early stage that she was able to have just the bilateral mastectomy.
I believe the MyRisk RiskScore did save Lisa's life. It allowed us to catch her breast cancer at a very early stage, and without it, we don't know what the outcome would have been. If Dr. Franz had never recommended the MyRisk genetic testing, the cancer wouldn't have been found. I don't know if I'd be sitting here today. The MyRisk test is absolutely priceless to me.
My colleagues wanted me to just do a mic drop there, but instead, you're stuck with me for the next hour and a half. Just kidding. I've got about 10 minutes. But, you know, when you see that, that just brings to life what every employee at Myriad, why we wake up every day, why we do what we do. You know, this has been a 30-year journey that Wally started, and MyRisk is celebrating its 10-year anniversary, and we've tested over 2 million patients. But the reality is, Lisa falls into that 25 million bucket that Mark spoke about. So we have a lot, lot more work to do. You know, at Myriad, because we're the pioneers, because we're the market leaders, the piece that we can bring to light, sure, we can sell our test, but it's more about awareness. But you heard Lisa.
Lisa didn't know that a test like MyRisk existed. So here, just in the last two weeks, here's some of the muscle that we've built on how we get our awareness out. In the last two weeks alone, millions of people have got to hear about Myriad test, NBC, Today Show. You may have seen the article that was in the Washington Post. This is still a journey. This is still a fight, and Myriad plays a role in it. This is a muscle that, you know, we didn't always have this capability of reaching millions of people every other week with our, with our test. And we've talked about the transformation that the commercial team has been on. We started with resetting the base. Those were some difficult times back in 2020, 2021.
As a matter of fact, during that time period, we reduced the overall sales headcount by 18%. Those were not easy decisions. During the last three years, though, that team has produced volume growth of 62%. So on an 18% reduction, we're now growing volumes at over 62% over the last three years. That's through things like you see on this screen that I'm gonna share with you today about optimizing our marketing capabilities, building our enterprise team. Mark is part of that. Our market intelligence team, I'm gonna talk about in a little bit. So we're now transitioning to, we're able to use data, we're able to use insights, to continue that sustainable growth and also very profitable growth moving into the future. So this is a team that makes it all happen.
This is why I have one of the best jobs in the world, because I get to be a part of this team and helping someone like Lisa on the front lines... When you think about what's in our business units, we've expanded. You know, historically, it was just outside sales, which is clearly the front of the spear. They're the folks that are out there every day. They're now bolstered by inside sales, marketing, medical, and they're supported by the 59 people that are at the enterprise, as I mentioned. The folks that are doing the data, the folks that are doing the insights, the customer work. Everything that you see in the middle is what's allowing us to be able to be profitable and to be able to be more efficient. Just some stats around that.
It is one thing to put sales enablement tools in place, it's another thing to get folks to use them. And so here, as you can see, we're proud by the fact that 96% of our teams are waking up every morning, looking at a live dashboard, deciding: Where do I go? Who do I see? What is the message I need to deliver? How do I balance between what the inside team is doing, what the outside team is doing? For the 4% that are not using it, I'll be following up with them later, but in general, a 96% number of folks that are really enabled every day to do their work smarter, more efficiently. The landscape has changed from the days, especially coming out of the pandemic, just having a team that is out knocking on doors, right?
Those days are over, and teams need to be thinking a lot more holistically about how we're enabling patients, and we're bringing them into the Myriad world. Some more stats, and Paul mentioned it before. We can't sell if we have turnover. What we've seen is our turnover below 9%. We've got a team that is achieving their goals. You can see 110% in the, in the first half of the year. That means the team is happy, that means the team is staying. More importantly, when you have a team that is 77% of our team has more than two years experience, that investment that an organization places in bringing someone into the organization is measured in thousands of dollars during the first six to nine months.
And so the fact that we're able to maintain folks and just continue to build a mature team, gives me lots of excitement moving into the future. So let's talk about the future. Why do I feel bullish about what we can do moving forward? Well, clearly, we're gonna leverage the diversified portfolio and the momentum that we have today. That is one of Myriad's strengths, that's clearly one of our, one of our differentiators. I mentioned the idea of bringing data and, and insights. I'm gonna talk a little bit more about that. I'm gonna talk about how we have sustainability in the areas that we haven't touched. How do we reach the underpenetrated market? Everyone talks about an underpenetrated market, but it's underpenetrated for a reason. So how do we think we can tap into that and do that in a slightly different way?
Those are the strategies that are on the right that I'll share with you moving forward, which is number one: how do we think about accelerating integrations? I talked about when you partner with customers, they have their own workflows. The last they want you to do is to bring more, more work to them when they're already busy doing the things that they have. Second, large account focus. We've talked before about how we win in the community. We are winning in the large account, but there's more work for us to do there. Next is driving depth. We've talked about driving depth, which is getting our current customers using our products more. The piece that we're starting to unlock is not only using the singular product, but using the multiple products.
When you think about OB-GYNs, when you think about primary care, they can use multiple Myriad products, and we're in those channels today. And then last is channel expansion. So you think about the fact that we think we're doing everything we need to be doing. The reality is this, there's patients and providers that we need to reach, but we need to reach a different way than what we're currently doing. So I'll shed some light on that. So let's talk about integrations. So this is something that all of us have either heard about or we've experienced personally. Most of us have experienced Epic. What you may not realize is that across all of our portfolio, there are many of integrations. There's Epic, there's Flatiron, there's Greenway, and this is an area for Myriad where we were behind.
I mean, as you can see, when you think about all of our providers and all of our customer bases, back in 2023, you can see only 500 providers were using true EMR-integrated abilities to be able to order Myriad test and also get a result back through those integrations. We've realized that when we integrate with those providers and those health systems, we see a 20% lift in our, in our volumes, specifically when you think about prenatal and also MyRisk. But that's not the full piece of the story that I'll talk about in a second. So as you can see, this is an area that we are doubling down in, and for Myriad, this is a lever for us moving forward into 2024 and into 2025.
When we think about those integrations, sure, the 20% volume growth is the commercial leader. That's fantastic, but the better pieces are when we talk to our providers about integration, right? Their goals are not just to use more Myriad tests. Their goals are speed and also reducing the friction. Anytime that their office staff has to take time to get out of the system that they're in and move to a portal or move to a, to a paper TRF, that slows them down. So we know when we integrate, we increase speed, we increase our ability to get paid, 'cause now you have the bidirectional information, so it's easier to be able to get the information necessary to reach medical necessity. And last but not least, and probably the most important piece is the overall comprehensive patient care. That all goes up.
All of us have experienced when our providers and all of our data is in one place, and we're able to know what that data is and our providers have it, that's the best-case scenario. When we think about, just as an example of how we see those two, these integrations impacting our different businesses, Epic, when you think of OB-GYNs and primary care, specifically with GeneSight, we see that as a very key driver, whereas the oncology space lives in a different platform. Many of you have heard about Flatiron. So the good news is, within our internal teams, our tech team under Kevin, has built those capabilities across all of those platforms, and as I mentioned, it's gonna be a huge unlock for us moving forward. Those are the existing integrations that we've all heard about.
Let me pivot a little bit to how we're impacting large accounts. What we've seen when we go into large accounts, they have their own workflows, and they have their own challenges. We mentioned the unlock about how do we reach the underpenetrated... How do we penetrate that market where, as we mentioned, Lisa, that falls into the $25 million piece without putting more burden on the provider? And so partnering with, with SimonMed, and I'll share with some more details in it in a second. We realized that SimonMed and our providers have the same challenge, which is: how do they get patients to show up to their appointments?
How do they make sure they're collecting everything at intake, and they're not doing it by way of showing up, as many of us have, and some providers, where they hand you a clipboard and a number 2 pencil, and you have to fill out 10 pages. Clearly, that is not the way, right? But guess what? Many of our providers, I'm sure many of you have been to a provider, where that's what your, you know, that's what they hand you, and it's clearly sort of a signal that it's not the best way to treat patients. So we've partnered with, with SimonMed, and we've built an end-to-end frictionless experience. It doesn't start... It starts with intake, but it doesn't end there.
It can move from intake to identifying whether a patient is at risk and whether they qualify for guidelines, automatically flag the patient, to alert our genetic counselor team that if they need education to understand what it is, it can alert them. Within the system, they can easily press a button and order one of our tests. They can get the results back, and ultimately, an end-to-end experience that doesn't negatively impact the current workflow within our providers. And I'll talk about the results that we've seen so far with SimonMed. The best piece about this is this is an uplift that we can take to other large providers. We can either take pieces of it or we can take all of it. So we're in early innings here, but what have the pilot sites shown us?
So SimonMed is, as a large customer, they have over 100 imaging centers across the country. They do over 300,000 mammograms a year. What we've seen in the pilot is, through our digital experience, over 32% of the patients end up meeting guidelines. And when they're made aware that they meet guidelines, 30% of them opt in to getting a MyRisk test. This happens automatically, digitally. And the best piece about it is those 30% who are raising their hands, as we saw with Lisa, 50% of them end up getting a medical management differentiation. In most cases, it's not just getting a mammogram, but it's adding an MRI to be able to catch cancers. So an unbelievable experience.
Early innings here, but just with the SimonMed opportunity alone, as I mentioned, 300,000 mammograms, that large account alone will be a big driver for us in 2024, and we plan on adding others like Onsite, LifePoint, and others as we partner. Okay, let's talk about the last channel expansion. We've talked about the GeneSight success and how we're meeting patients where they are through all of our digital marketing efforts. I've talked about the funnel of bringing millions of people to our website. Here's another channel where we can meet people where we are. Specifically, SneakPeek has partnered up with Walgreens. We're in over 3,000 stores, which is phenomenal for our SneakPeek product, right?
They're going to Walgreens to get their pregnancy tests, then they're moving to their fetal sex tests. 60% of those patients tell us that they go on to get a prenatal test. So for our prenatal market, unbelievable opportunity. The bigger opportunity, though, is 10 million patients today that are—or 10 million people that are walking into a Walgreens are hearing about Myriad Genetics for the first time. So when you think about how we penetrate the underpenetrated market, folks who don't even know that genetic tests exist, we think about what happened in the COVID space, about how many millions of people got educated about what a COVID test is, what a genetic test is, how they get it, going through the Walgreens channel.
Now they're going to be able to see Myriad Genetics for the first time, and we'll be able to bring them into our franchise, our digital team, and our enabled team. We'll be able to educate them on the benefit of all of our product lines, and so there'll be more to come on that. Those are just a few reasons why I'm excited for the future. On that note, I will turn it over to my partner in crime, Nicole, to walk us through operations.
Thank you, Mark. We are well into our transformation, and it's my pleasure to talk a little bit about the results. When we started this transformation journey, we had a couple of challenges. We were not very good at gathering customer feedback regularly and really understanding what all of their pain points were with us. But when we did talk to them, they were pretty loud about the ones that they didn't like. And I think we've done a really good job of addressing those things, addressing those things first, really focusing on what mattered to our customers most. A couple of things I would point out, especially in the genetic counselor community, the sharing of data. That was big for them.
They felt like we weren't sharing enough data for scientific advancement, and so that was important to them, that we were willing to share more of our data. And then we always had feedback from, you know, OB-GYNs and surgeons about turnaround times, right? As they're dealing with patients that are waiting to schedule surgeries, waiting to understand which surgery to do, waiting with... to understand which treatment would work for their cancer, pregnant patients. These patients have a real sense of urgency, and so ensuring that we were always on top of turnaround times was really, really critical, to our customers. And then, you know, really listening to their feedback and understanding, how we could make the process easier for them. We got a lot of feedback that it's just more difficult to deal with Myriad.
There were some antiquated processes that we had that were not tech-enabled or places where we were worried about payer requirements and places where it was easier to understand what the payer wanted and how better we could get that data without stopping the test, being able to get that data from an EMR or from a provider directly to enable a faster result to a patient. And it's great to see that coming through in the data, where we now have mechanisms set up to gather regular feedback from our customers and to actually see that a positive opinion of Myriad growing and moving up and up and up over time. And as we've gotten better and better at understanding their real-time feedback, we're able to address it faster, and we're able to see this opinion accelerate....
So I want to talk a little bit about some of the key things that we measure internally as well. We've done a good job of unifying, all the different acquisitions that we did over time and all of our different laboratories, so that we're all looking at one dashboard. We're all looking at the same key performance indicators, and we're all understanding together, how are we functioning? How are we delivering on our promise to customers? I always start with the left, with employee engagement and our people, because really, that drives everything else about our business. Every other performance metric that we look at is because there is an employee behind that, that really saw the patient need and why that was so important to do that job well. So we've done a really good job in reengaging our workforce.
It's a challenge, I think, for every company coming through the pandemic to get everybody together and engaged and aligned on what we're all trying to accomplish. But we've seen our employee turnover cut in half over the past year or so, throughout the pandemic and coming out of the pandemic. So we're seeing now people are engaged, they want to be here, they understand why they're here. They're, they're having closer connections and collaborations with their teammates as we come back into the office, and that's driving everything else on this slide. So our market perception, we've talked a lot about that. Mark's talked a lot about that. Customers are starting to see that come through as well.
As our sales forces have come together, as we've given them more tools with respect to market research and what the customers are looking for, they're able to engage their customers more than they used to. That goes all the way through to our customer service teams and laboratory operations. Turnaround time is something that we're very, very proud of. We think we're one of the best in the industry when it comes to delivering those results quickly, and that's really, really critical for patients that are going through our testing process. You never want to get in between a pregnant patient and their test results. They really want those right away.
So being able to deliver those quickly and not having our customers have, you know, a nurse on the phone explaining, "I don't know what happened to this," or, "Let me check on it for you," is really, really critical for them. And then lastly, rev cycle. This is another place where I think we are one of the best in the industry on collecting for the tests that we run.
This is something we've put a lot of investment into automating throughout the years and ensuring that the teams are aligned and our systems are aligned to understand what does the payer need to see on the front end to approve of the running of a test or the payment for a test, and how can we ensure that goes all the way through the process to the back end, where we get paid for the test that we run, but also that patients are not surprised with any sort of surprise bill or owing more than they expected to. So all of these really look great throughout the transformation, and I love to see us, as employees, come together as a team, especially as we move into these new buildings, to look at this dashboard and all see together where we're winning and where we can still improve.
A lot of this is enabled by investments that we made into tech, into every single aspect of this process. We've put in about $50 million, to, as I said, enhance every single step on this slide, starting all the way from when a patient first is up at night googling, you know, "Why do I need this test? Could I benefit from prenatal testing? Which antidepressant is right for me?" From the time they start to engage with those topics, we're able to pull them all the way through the process to help them understand, "Is this test right for me? What would this mean for me and my treatment plan? How much is insurance going to pay, or how much am I going to have to pay for this test? How fast can I get the test result back?
And then how fast can I have that discussion with my physician about what we do next?" And so really, we've put a lot of investment into making sure that this entire process runs very, very smoothly. We've also put a lot of investment into upgrading our facilities, and I'm glad that so many of you have chosen to join us here today and to look at one of the newest facilities, and we'll talk about real estate next. But, we also put an $80 million investment into upgrading our labs and our Lab of the Future program that we've talked about in some of our investor calls. And I'm pleased to report that this project is on track, on target, and on budget. We'll go into a little bit more of the details of how this is advancing, but it's not just about the real estate.
It's also about making sure that our tests are run on the most advanced platforms available, and so we've completed the transition of our MyChoice, Foresight test over to the NovaSeq platform. And we are starting the process of transitioning MyRisk over to whole exome. That's important not just for the efficiency of the clinical tests that we run, but also for innovation, for being able to discover what's the next new test, what are the next future enhancements that we can offer to these patients, as we go forward through their care and as new genes and new drugs are discovered. Automation as well. So this is very, very important as we think about volume and being able to handle the growth that the commercial team is delivering. We have to have laboratories that are able to run things, you know, 24/7.
They're able to run through holidays, and they're able to handle the volume that is coming in the door. So we're working on the first phase of automation right now for our DNA tests, for MyRisk and Foresight, and looking to move automation into the new spaces as well. So let's talk a little bit about the spaces. Again, welcome here to South San Francisco. I hope you all enjoyed the tour this morning of our research and development hub. We really do view San Francisco as a place where our science teams, our R&D teams, our tech teams, can come together and collaborate on what the next new tests will be.
This facility is just recently opened, but it's already, as you can see, the team starting to work in this space, and we're starting to go through the process of regulatory approvals, to be able to start to run some of our prenatal tests in this space as well. Our Salt Lake City facility, and I hope you all have the opportunity, to come visit our Salt Lake City facility, is built for that scale. It's a very large space. It's a very well-designed laboratory. It runs in a linear pattern so that, samples can go straight through the entire lab with speed and automation.
This really is the backbone for most of the testing volume that we do today and also provides a lot of opportunity for expansion, whether that is, you know, new products, future opportunities that we choose to put into this building, consolidation of our spaces. This really is built to be a first-class production facility and a little bit of the roadmap of how we're moving into these facilities. So we have a lot going on. In addition to the new facilities, we're shifting to automation, we are introducing technology into our process, we are transitioning sequencing platforms. So there's a lot going on, and in the face of all of these different projects and transitions, we also have to deliver results to patients every single day.
And so that's been the biggest challenge, is how do we get into these new facilities, on these new technologies, and not drop the ball at all on turnaround time? We need to ensure that we're still providing great clinical care throughout all of these major projects here. So far, as I said, the team's done an incredible job with this. The, all of these moves and transitions are on track, on budget, and really, we're excited to see people coming into the new spaces. We have gotten certificates of occupancy, and so you can see people actively working, not only in this space, but also, we started running our first clinical samples out at the Salt Lake City facility as well. And lastly, I just want to bring together our customer service teams.
These are teams that we get great feedback on as we have measured, you know, our NPS score and our feedback from customers. Our billing team and our customer service teams get rave reviews. They really take care of our patients very, very well. But right now, they're spending a lot of their time doing monotonous, you know, tasks that really could be automated and should be automated. So we're putting extra effort into unified order management system that will allow those teams to sort of practice at the top of their license, to spend time where it matters with patients, and also to collaborate across those teams so that our pre-authorization team, our customer service team, our billing team, can all see across that entire patient journey and places where they can insert themselves to help the patient most. It's all coming together beautifully, and I'm very proud of the team. With that, I will hand it over to Dale to talk about our pipeline. I'm very excited about some of the things to come and for you all to hear it directly from Dale.
Great. Thank you, Nicole. All right, yeah, I'm excited to talk about a lot of the cool things going on in R&D here. So, orient myself here. I want to just start with an overview of the R&D strategy here at Myriad. So I want to read what's actually on the screen here. Just, we aim to increase access via innovation, product development, and evidence generation to life-changing diagnostics that align with our core business goals. Just want to dwell for a minute on this, on the access part. So a test has to be built before it can be accessed. That's one of the things that we do. We also need to generate clinical evidence for that test before it is actually available through providers, covered by insurance, for instance. Another part of access is the equity of the test.
So whether it's our Amplify technology in Prequel, that increases fetal fraction for all individuals, including those with high BMI, or the RiskS core test that we have, which is available, the only polygenic RiskS core in breast cancer available for women of all ancestries. We really do stress equity in care. The other part I want to pull out here is the alignment with our core business goals. This is not Myriad University. We are not an academic department. We have many people from academic departments, but here we really focus on coordinating with our partners in product management and operations and technology, and our commercial organization. So we want to make sure that, yes, we're building cool new things for the future, but we're sort of directed in a way that is consistent with the aims of the company.
So I'm going to read every single word here on this slide. No, I'm kidding. I'm just going to give you a quick glance at some of the products that we're going to talk about. So, FirstGene is our multiple prenatal screen. It integrates multiple different types of offerings into one. I'll go into more depth on that in a minute. Foresight is our expanded carrier screen that tests for risk for recessive diseases. In the oncology space, our Precise Tumor and Precise Liquid offerings are complete, excuse me, comprehensive genomic profiling tests on solid tumor and liquid biopsy, respectively. And then Precise MRD is our whole-genome-based MRD that I'll be talking about as well in more depth. But with these things, I just wanted to orient them as well on the timeline. So we will be expanding the Foresight panel, as Mark mentioned.
That will be in Q1 of next year. I'll have a couple of slides on that. Precise Liquid will be live later in the first half of next year. Our FirstGene test has, you know, a somewhat nuanced path here, where it is actually currently being validated in our laboratory down the road here in South San Francisco. It will be relocated to and launched in this facility. We'll soft launch into a clinical study, make sure it gets off the ground successfully, and then be available for a commercial launch later next summer. Precise MRD is currently already launched in a research-use-only mode in concert with academic partners of ours. We are currently running that in Salt Lake City. That will be relocated from the old Salt Lake campus to the new Salt Lake campus.
We're aiming for pharma availability next summer, and then as the clinical studies that I will talk about in some depth here come to be published and then incorporated into regulatory submissions, that will position us well for an LDT launch, a commercial availability early in 25. Before moving on from this, I do want to stress that the 10% growth or more that Paul has already talked about, like, does not require the contribution from these elements that are shipping in 24. So it's independent of those. These will be additive to that and really position us well for the future.... Okay, so now let's start with a platform development. We have, as you can see here at the bottom of the slide, five different products that are run really in their own kind of little silos.
So we have a separate workflow for MyRisk, which has 50 genes, a separate workflow for MyChoice that has between 50 and 100 genes. Foresight has a little south of 200, and then our Precise products have a little bit north of 500 genes. These are all run separately. What we aim to do is to integrate these into a single platform. So we are running all of them on a whole exome platform. Not only does this provide efficiencies of porting it into our Lab of the Future, taking advantage of the automation that we have there, but it also gets us out of the sort of incrementalism of individual panel updates, where we want to take MyRisk from 50 to 75, and that's its entire separate project. And then you want to make Foresight bigger, and that's another project.
By just going all the way to the exome, we don't have to do that type of incrementalism anymore. Similarly, that's really like it is economically viable by putting all of these types of tests onto the X Plus instruments, the fleet that we purchased there. This is viable, something that we're working to develop and should really increase the sort of plasticity of our tests and their-- while maintaining their economic attractiveness. Moving on from platform, I want to focus on Foresight, one of the products that was on the previous slide. We have recently completed a pretty massive overhaul to the Foresight test. It's now running on a new sequencer, has new chemistry, new hardware. It's running in our lab down the road that will be moving here as well, and that is being powered by new software.
So a lot of new things in Foresight, and what that really unlocks for us is lower cost of goods for the test. We achieve lower operational costs by ultimately being able to package that into our Lab of the Future, running it along the other tests. And really, the ability to do that is because it's just more harmonized in general. Like all of these types of chemistries and software end up being kind of the same for these products, and so there's better harmonization there. By doing this overhaul, we also have enabled the ability to add content more easily. And this is important. Even though I just told you, we're going to move away from these incremental advances, there's one more. This is the last one, where it's really important that we upgrade the actual size of the Foresight panel.
So it currently has 176 genes. Early next year, we will launch a version, Foresight Universal Plus, that has 274 genes and critically is inclusive of the recommended content from ACMG, and we anticipate guidelines from ACOG to be soon, and that should as well be included in the new Foresight panel. So we are really excited to make that available early next year. So while we will forever remain excited about our Foresight and Prequel prenatal products, we are also super stoked about the FirstGene product that we are going to be launching very, very soon. So to set the stage for that a little bit, I want to talk about some of the current problems with genetic screening and how FirstGene addresses them. So in brief, providers do not have enough time to talk about genetics.
Like an OB-GYN might see 30 people in a day. Like, they might have 10 minutes to talk about the totality of care. They don't have 8 minutes to spend talking about genetics and Mendelian inheritance and how you have to screen the partner, and then there's a 25% chance... They don't have time for that. Because they don't have time for it, quite often it doesn't happen. In fact, 50% of women in this country do not get carrier screening at all. Next, for those who do, the whole point of carrier screening is that if you screen positive, if then you go screen the partner, and if they're positive, then you go from there. 30% of the time, literally only 30% of the time, does the father get screened after a mother has been found to be a carrier. That is crazy.
That's a massive deficit in the administration of prenatal care, and we don't want to blame the system. We'd rather make a product that actually solves the problem. Lastly here, though very important still, is that there's low gross margin on these tests individually. So the answer to this is the FirstGene multiple prenatal screen. It integrates into a single offering, NIPS, carrier screening, and it goes even further than that. The point of carrier screening is to identify recessive risk in the fetus. FirstGene actually just does that, and it does that without even needing to screen the father at all. I'll show you some of the performance data on that. It's excellent, but critically, NIPS, carrier screening, fetal recessive status, blood compatibility, and further, this is a platform onto which we can add multiple further tests as well in the future.
It's extremely flexible in that way. Final bullet's an important one. We estimate a 30%-40% higher gross margin on this test compared to Foresight or Prequel alone. We have spent the time and engineered this such that it basically costs the same amount for us to run as a Foresight or a Prequel, yet the compensation we expect to be from NIPS and carrier screening together. I want to show you just how it performs. It's really, really good. This makes me happy. This is data from our completed verification study. This is the study that you do before validation. I'm going to say this again, validation is happening as we speak.
So this is not just like a theoretical test where we're going to talk about this every investor day, you know, for the next five years, and it's like some person who's just walking up to the bench, and very talented person. We've got great people walking up to our benches, but this is not just like a hack, okay? This is now been built. It is running in, like, on robotic equipment, powered by software in our operational labs. That's where we are with FirstGene. We're really close, and this is data from that, that verification study. I want to draw your attention to the performance on NIPS and carrier screening. That's basically what your performance would be at-... for, for Prequel and Foresight respectively. So there's not like a step back in terms of taking FirstGene, it's just as good as those for those elements.
The orange box is drawing your attention to the fetal recessive status performance. Honestly, I didn't think it would be this good. I am really happy about it. What this means is that even though there is only, only a minority of the cell-free DNA is from the fetus, most of it's from the mother, we can basically go through the maternal DNA, look at the fetal DNA, and identify carrier status and affected status of the fetus, almost, I mean, basically as well as we can in the mother. That is remarkable. And then finally, as well, and we have this, we're looking at RHD compatibility between the mother and the fetus. The performance there is really good. That's actually just about the easiest part of the test in some ways, and we'll have more samples there, powered in the validation study.
Validation is happening right now. There will be a publication forthcoming from that study, but then we're really excited to bring it here, launch it, develop it further. So that's FirstGene. We really can't wait. It is still a screen. So yeah, the question, in case weren't able to hear it, is whether this removes the need for amniocentesis. It does not remove the need for it. It is still a screening test that should be followed up with diagnostic care. The thing that really is different, though, is you can even think about being a carrier couple on carrier screening effectively gives you, you know, a 25% chance on that amnio that there's a, an affected fetus and a 75% chance that it isn't.
With FirstGene, we should really be able to not even call positive the 75% that aren't, and then really focus it on that 25% that are. And so effectively, the positive predictive value of the holistic test and the reason for taking the amnio is higher and better motivated. Thanks, Lee. Okay, great. I want to pivot now to oncology, just for one minute for our Precise offerings. So we've had the solid tumor Precise available for a while now. This is a test that has more than 500 genes, looks at DNA and RNA. Feedback that we've gotten from our providers is that they also want a liquid biopsy offering, and so we are adding the Precise Liquid sort of counterpart to the solid test to have that available as well. It looks at the same genes.
It has also the similar type of extensive clinical validation that exists. So this is a very a test based on a really extensive amount of evidence, and we're excited to bring that to market. So I want to pivot now to MRD. So the Precise MRD that we are building is a high-definition MRD test. I want to start by saying that like, even though we have done a lot of work on this in R&D, we kind of had a head start here at Myriad because we could build upon capabilities that we already have. With our MyChoice CDx test, we already have built and gone through the growing pains of making a tissue lab that then runs a genomic test. We're really good at that. We don't have to send this out like other MRD labs are still doing today.
After we've done the tumor processing part to inform our tumor-informed MRD, the liquid biopsy part is actually very similar in like, chemistry and construction and analysis to the FirstGene product that I just talked about. So this really allowed us—let us kind of—even though we may have started a little later than some, I think we have moved faster than many, and so that's because we're building upon core competencies that we have. Now, I said earlier, I'm going to say again, we're going to take a little minute here on like... This is a whole-genome sequencing-based MRD. I want to contrast that with most MRDs in the field are whole exome-based. Exome and genome aren't top of mind. The genome is all of your DNA. The exome is the part of the genome that encodes proteins.
It is only 1% of the genome, so exome, 1% of genome. By looking at the genome, we are looking at 100 times more sequence. We will identify more tumor-specific variants and have those available to us to create a more sensitive and specific offering. I want to provide a little bit of intuition for how this works. So all of us have had this experience. You're walking down the sidewalk, you feel a drop on your head or your hand or something like that, you're like, "Gosh, is it, is it raining?" You're asking yourself, "Is it raining?" What's the first thing you do? You look down on the sidewalk, and you basically scan to see, do I see drops anywhere? In this analogy, the drops are circulating tumor DNA. The question we're asking, like, is there cancer?
Is there circulating ctDNA in the blood? That's basically like, is it raining outside? And what I want to stress is that, you know, we've got this grid here. You can either have a grid that's 16 sites, that's sort of the typical size of an MRD test now, so maybe 16 units of sidewalk versus 500 units of sidewalk. The question is, which would you rather have? Like, this is not just, we're not just doing whole genome sequencing because we think you guys will find it fancy. Like, we're doing it because it is a better way to run the test. In this example, you can notice that there's, it, it's clearly raining. None of the drops fell into the 16 grid.
So the 16-site test would say, it's not raining, it's negative, and it would be wrong because it is raining, and the 500-site test would see that and see that with confidence, because you didn't just get one drop, you got multiple. Okay, so this is the power of looking at the genome, finding a lot of variants and tracking them collectively. And I just want you to think about, again, like, what type of test would you want for a loved one? What type of test would you want for yourself? I know that I would take the 500-site test in a second. I would be grateful that it was offered, and that's what we're building. All right, just to show a little bit more technically, some of the performance, not going to dwell here too long. What's being plotted is the tumor fraction.
So that's effectively like, yeah, how much circulating tumor DNA is in the blood, and then percent of targets that—the percent of sites that we look at that had evidence of circulating tumor DNA. Main thing I want you to see is that we will call positive, we will say there is tumor present anywhere that there's a dot above the sort of gray line. You can sort of see the threshold of between positive and negative. And the really important part is that even at 0.001% tumor fraction, we've got nice confidence with more than 1% of our sites lighting up. And just do a little bit of mental math for a second. 1% of 500, 5. I've got 5 sites lighting up on my assay. That's actually pretty good. What is 1% of 16?
That's going to be zero a lot of the time. So that is why you'll see that the competitor limit of detection is about 10 times higher than ours, even though this is investor talk, and nearly every plot you're going to see is going to be up and to the right, because we're doing good things. This is a plot where being to the left is better, and being sensitive to the left is good, and that is where we are with this test. Now, the other thing I want to stress before moving on from this is that, and this is actually really important, that second to last bullet there, because we're doing a whole genome test and not an exome test, we can use less tissue input. That matters.
Like, there's not a lot of tissue to go around when an oncologist has to send sample to multiple different types of testing, and by having two times less, that makes us easier to work with. All right, so it's one thing for me to talk about why I think this is a great test, but we are not alone in this thought. I'm excited to talk about just two studies at collaborations with leading cancer centers in like across the country. So this is one with MD Anderson, and we announced this is now, I think, a couple of months ago. It is underway in our laboratory currently in Salt Lake City. We've had some really cool preliminary results, but what I want to stress here is that it's in renal cell carcinoma . That is one of the top ten most common cancers.
It is also a cancer that tends not to have too many tumor-specific variants. If you just look at the exome, you literally may not even have 16 to work with. You may only find 100 or 200 in the entire genome. It's a good thing we're looking that far. What we're doing is that typically, renal cell carcinoma—metastatic renal cell carcinoma is treated with systemic, pretty intense chemotherapy. People who have more indolent, slow-growing disease may be able to have a combination of radiotherapy plus MRD to monitor if it's going well. Having a sensitive and specific MRD is important. Coupling the Myriad Precise MRD with radiotherapy may be able to diminish the treatment that people with metastatic renal cell carcinoma have. The second study I want to highlight is one that we announced yesterday.
This is with Memorial Sloan Kettering. This is a breast cancer study, and this has its two phases, has 100 patients. These are patients with metastatic breast cancer, sort of similar to the renal cell carcinoma one. You are basically introducing MRD in the care of these metastatic patients so that you can identify when have they acquired resistance to disease? Are they responding to the current treatment? You can adapt the treatment path in concert with the data from the MRD, but again, it's important that that MRD be really sensitive and specific, so you can find changes early enough to make pivots in the treatment course. I think our collaborator, Dr.
Pedram Razavi stated it well, and I do want to read this aloud: "So we anticipate the MRD test for Myriad will be more sensitive and specific than many other ctDNA offerings for monitoring the response, and therefore may accurately identify the patients who will or will not benefit from certain therapies. Importantly, some of these patients may go undetected on a less sensitive MRD test." So closing these out, both of these tests have about... This one has 100 patients, the previous one has 120 patients. Those study sizes are commensurate with those that have secured reimbursement from MolDX and CMS in other indications, so we are eager to process these samples. Other thing I want to note, sorry, before going on, these are already completed prospective observational trials, okay? So we do not need to wait 5 years for this to close out.
The study has run. They have these samples in the freezer, and I think something that's super cool, that I think we are honored by it, they could have pulled these samples out of the freezer and tested them a while ago, elected not to, based on tests that were available to them, saw our data, our approach, and are working together with us. So we are excited about that. All right, and I'm just going to finish now, summarizing in a little bit of timeline. So in 2023, we hit some of our major milestones. We launched the Research Use Only test, have partnered, as I just described, on several clinical validation studies, and as Katie will talk about in a minute, we've begun our prospective clinical validity study. In 2024, our focus is going to be on advancing the test, making, and scaling it up, making it available for biopharma partners, ultimately leading in 2025 to the launch of a lab-developed test. With that, I'll hand it over to Katie.
Thanks, Dale. Well, I'm excited to be here today to talk with you all about the clinical studies and real-world evidence initiatives that we have underway to demonstrate the clinical validity and clinical utility of our products. This is an area in which we have historically underinvested, but we are committed to and focused on understanding the evidence gaps that are cited by payers and evidence, sorry, payers and guidelines makers. We sometimes are working directly with these entities to understand exactly what kinds of evidence they're looking for to support the clinical information that is coming from our tests. Let me start with just a quick overview of what we've been doing this year. We are really busy. We have more than 30 studies underway that we are either conducting ourselves or supporting others in conducting....
We are on track to publish about 20 papers in this year and another 20 planned for 2024. We have already presented at 30 different conferences, and that doesn't even count the fall conference season, which is going to be quite busy for us. You'll see that number get higher as well. Let me just talk about a few of the highlights that we're really excited about that are listed here on the right side of the slide. The FirstGene analytical validation study that Dale mentioned is going to be ready to submit for publication by the end of this year. Look for a manuscript that will be published early in 2024.
On the hereditary cancer front, we are really proud that our study validating RiskS core across several different ancestries was selected for a podium presentation at ASCO earlier this summer. As a reminder, the RiskS core , polygenic RiskS core , is the only breast polygenic RiskS core that is valid and accurate for a woman of any ancestry. We think that's extremely important because we care about equity of care. Turning to Prolaris, you may have noticed on one of Mark's slides that we recently launched the absolute risk reduction feature for Prolaris, and the manuscript that describes the validation of that feature is maybe being submitted just as we speak. It's going to be submitted sometime this week, so we're really excited about that as well.
And then just two weeks ago, we presented results from a meta-analysis showing that patients that had access to GeneSight had improved response and remission rates for major depressive disorder, even after they failed one treatment. So I'm going to go on now and tell you about three peer-reviewed studies in particular that we are really excited about. Sticking with GeneSight, we know that GeneSight helps patients with major depressive disorder. It's a really important tool to help patients that are suffering from this very debilitating disorder, and it's been shown in several studies to improve outcomes among those patients. But we're not stopping there. We're continuing to build the evidence base for this study, for this product. So we partnered with Optum Genomics to analyze the healthcare utilization and medication use among patients that are receiving GeneSight.
We used the Optum Labs' data warehouse to compare de-identified healthcare claims among more than 20,000 GeneSight patients, and then we assessed the changes in their healthcare utilization before and after GeneSight. So I want to, I want to make sure that you all know this is preliminary data, but we're really excited about it, and that's why we're sharing it today. What we saw is that in the 180 days after patients received GeneSight, there was a 25% decrease in total hospitalizations and a more than 35% decrease in psychiatric-related hospitalizations. Now, critically, there was no change in hospitalizations in non-psychiatric-related hospitalizations. So that tells us that this decrease that we're seeing in hospitalizations really is driven by the psychiatric-related hospitalizations. So again, this is preliminary.
We're doing additional data analysis that will be included in an upcoming manuscript. We've also started the next phase of this study that's going to include additional control groups and some economic analyses. We know that hospitalizations are expensive. We know that mental health care is expensive, and we're really interested to see what the cost savings are that could be realized by these decreases in healthcare utilization that are being driven by GeneSight. On the prenatal front, we have a study on our performance for 22q detection. Prequel includes screening for the 22q microdeletion. 22q deletion syndrome is a severe disorder that is characterized by cardiac defects, renal abnormalities, cleft palate, developmental delay.
It's very serious, and it's almost as prevalent as trisomy 18 and cystic fibrosis, and those are two conditions that are routinely screened prenatally. But what we have found is that by using Amplify, we can detect this very small microdeletion that is very technically difficult to detect. Using Amplify, we can detect it, and we are very excited to share that our positive predictive value for 22q is 100%. So I've shared a little sneak peek at the data here in the table. We're going to be publishing this manuscript here very shortly. But what you'll see here is some of the data from that study compared to a study that details the competitor offering.
Our study had almost 400,000 patients, compared to only 18,000 in the competitor. Our average fetal fraction among the screen positive patients was more than 22%. That's more than twice as high as the competitor, and that is the power of Amplify. That is why we can detect these small microdeletions. Among the screen positive patients that underwent diagnostic testing, every single one of them had a confirmation of that result. That's where that 100% positive predictive value comes from, compared to the 52% positive predictive value that the competitor is seeing, is showing. Patients deserve better than 52% positive predictive value. ACMG already recommends that patients be offered screening for 22q deletion syndrome.
We believe that because of the robust evidence base that has been building, that 22q is the next condition that ACOG could support in its guidelines updates. So Prequel, which is already the already has the industry-leading failure rate in, in, among NIPS, the lowest failure rate among NIPS out there, is going to be very well-positioned for 22q as well. Okay, let's turn to MRD. Now, Dale mentioned our partnerships with MD Anderson and Memorial Sloan Kettering, which we are really looking forward to. But I want to note that those are not the only studies that we have underway for MRD. We have more than a dozen studies across several different cancer types, across 3,200 patients, more than 20,000 time points, and more than six cancer indications.
Critically, all of these sample sizes are big enough to be well-powered, publishable, and eligible for submission to CMS for coverage determination. So we believe that we are well on our way toward building the evidence base that we are going to need to be paid for our eventual commercialized MRD product. Let me talk about one particular study that Dale mentioned, our prospective study. This is called MONITOR Breast , and this is our study. This is Myriad's study that we are conducting. It's a multi-site prospective study that is enrolling 650 patients across all three breast cancer subtypes. We are collecting samples across the entire patient journey, from diagnosis to neoadjuvant treatment, to surgery, to adjuvant treatment, and to surveillance.
Now, this is going to enable us to answer some really important clinical questions, such as: What is the power of the breast MRD product to predict the progression of the disease, to enable prognosis, to enable treatment decisions, to understand surgical decisions? And it's a complex study. This is going to. It requires a lot of coordination with our clinical sites. It's going to include several thousand samples that have to be processed and interpreted. But we are not shying away from this study because breast cancer is our specialty. There is no other company that has the suite of products that we have to enable providers to take care of their breast cancer patients. And so we believe that it is our responsibility to be generating this evidence and supporting our own MRD product.
So we're doing really well with this study. The progress is great. We have three sites that are already actively enrolling for this study. We have 7-10 more that are in contracting, and we'll be looking forward to giving you updates on the progress of this study as the coming quarters are coming around the bend. So I will stop there and turn it over to Bryan. Thank you.
Thanks, Katie. I want to start with talking about our volume trajectory. I mean, to me, this is really where the rubber hits the road in terms of, you know, patients and providers choosing to work with Myriad Genetics. And so this shows you what we've seen over the course, really, of the last two years, 16%, LTM volume growth, as we look at that through the June quarter. I think one call-out I would have here is that hereditary cancer number at +16%. If I go back to the latter part of last year, it was up 4%, and before that, it was not up at all.
So I think returning that business to growth, a business that has been foundational to Myriad, I think has been one of our, one of our focus areas, and it's nice to see that business, returning to a nice growth trajectory. Why is this? Mark talked about it some earlier in his presentation in terms of commercial execution, improving the provider experience with Myriad, focusing on things like turnaround times, you know, the blocking and tackling that you have to do in order to run a quality operation. Those things are really important. And then what does this allow us to do? It allows us to, when there's the opportunity in the market through dislocation and, and other competitive dynamics, to be in a position where we're, we're there to take advantage of it.
And again, that's what I think we see in terms of the volume growth that we're seeing. But generating volume is only half the equation. The other half is getting paid for the testing that we do, which is really something that we've focused a lot of attention on in this market. A few areas that I'll highlight here, really at maybe more of a strategic level, and then we'll talk about some of the more tactical things that we've been focused on. First and foremost is there's a growing awareness of genetic testing within the market. I think you see this in things like states passing biomarker bills. There's 13 that I believe that have been passed so far.
Those would not only impact payment for tests like our oncology products, but 10 of those we believe would apply to GeneSight as well. So really significant opportunity, as we go forward there to drive more payment for the tests that we do and ultimately reduce our zero pay rates. Expanding payer coverage, this is where we think about expanding things like medical policy coverage. This would be expanded carrier screening, moving into guidelines from ACOG. We've seen a number of Medicaid, state Medicaid plans, that now cover GeneSight and have priced our PLA codes. We've started to see cash flowing in there as we submit and get paid for claims. And then...
You know, at the bottom there where we target, it may seem like a little thing at the end, but we've invested a tremendous amount of capital in our rev cycle process over the last few years. Again, that's what allows us to be in a position to really execute and take advantage of the opportunity that we have. I wanna talk a little bit about the spectrum of zero pays, as we talk about, and we have a team internally that is focused on this all the time, and we talk about it relentlessly. But there's really a spectrum here. There's things that are a little harder to solve on the left-hand side of the page. These would be things like medical policy, coverage for our test.
This is where initiatives like Katie spoke about really come into play as we look to drive the body of clinical evidence that ultimately supports payment for our claim. There's things in the middle there as we talk about authorization, gathering the information that's necessary in order to support payment for the claim. This would be where you look at things like our Epic integration and gathering the information needed to get paid for the test at the time of service, being very important. And then finally, on the far right-hand side of the page, there's things like documentation requests and other requirements that payers have put in place, where we introduce things like robotic process automation and other things that allow us to gather that information and reduce the number of zero pays.
It's really, it's really focused in a few areas. First of all, we talk about our ground game on the left-hand side of the page here. This is where we're talking about. We've reallocated resources that can really help us to focus on the states where we have opportunities under these state biomarker laws. So, that's an important element of the process. Again, I highlighted the Epic integration, EMR integrations in general, in the center box, center column there, as we look at ways to not only increase the level of payment that we get for our services on an average basis, but also make for a better experience for our patients and our providers, something that has less friction in the process.
On the right-hand side of the page, there are just gonna be areas where we reallocate resources and make sure that we allocate capital to high return opportunities. This will be things like investing in 13 new pre-auth, you know, people that can help us to, you know, gather the information necessary at the time of service in order to ultimately get paid. There's a tremendous return on that investment, and we'll also be doing things like that. Where does this take us as we look at the combination of volume and, and, and ASP over time? Again, we're focused on that 10%+ opportunity. Over time, this is where we get to, in 2026, $1 billion+ in terms of revenue.
When we think about 10%, you know, Paul mentioned it earlier, three quarters in a row now of 10%, top line growth. So we believe the foundation has been laid, and we're in a great, great position to do that. We've talked about before, hereditary cancer testing as a foundational and solid foundation. I just wanna make a call out there. I think we view that as a growth business now, and I think you've seen that, the last couple of quarters and the volume growth will start to deliver supportive of that top line growth. And then again, we have a small amount of MRD and FirstGene in the plan.
Really, as we think about 2025 and 2026, this is where we start to see those as the commercial launch of those products as upside, you know, relative to a 10% number. So that's where we get to the plus. As we look at gross margins, we continue to believe we, we have great opportunity here. You heard from Nicole about our Lab of the Future investments, the automation, all the initiatives that we have there. We believe we have the opportunity to expand gross margin by 100-200 basis points over the three-year period. You know, some of the pieces that we'll look at, their product mix, this is where we think about products like hereditary cancer testing and the, and the margin profile of that product, really being supportive of that gross margin expansion.
Then you get into things like the lab transition and the rev cycle opportunities that we have. Those are supporters of gross margin expansion over time. From an OpEx standpoint, Mark talked about this earlier in terms of our sales force team and some of the reduction, yet more effective, you know, sales force that we've had over the last few years. We believe that we have a sales team that is fully built out today, maybe minor investments over time, but this is a team that's ready to go to market. We don't need to invest a lot more here. We're unique in that way, I think, in the market.
As a result, as we control our operating expense, with that growing in the 5%-6% range over time, we get a tremendous amount of operating leverage, and we would expect to see a decline in the SG&A as a percentage of revenue over time of about 1,000 basis points. And then what's the net of all that? Well, if you're growing the top line at 10%+, you're expanding gross margins and you're controlling OpEx, it's a business that goes from, you know, being on the cusp of profitability in Q4 of this year, to one that's gonna generate at least $100 million of operating-adjusted operating margin in 2026. This sort of brings it all together. Again, we're reaffirming our 2023 guidance that we had left you with back in August.
And then the right-hand side of the page really lays out, you know, what our profile looks like over the course of the next several years. 10%+ top line growth, 70%+ gross margins, 5%-6% CAGR on our operating expense, and, and adjusted operating cash flow growing in line with that operating margin number. So we would expect that as we grow operating margin, that, that we would see a, a trend that would, would align nicely with that from a cash flow perspective. And with that, I'll make just one last, have just one last slide here as it relates to our capital structure. We at the top there, we highlighted, we expect to be positive from an adjusted operating cash flow basis in Q4 of this year.
Importantly, I think the bottom graph there shows you that we expect a pretty significant decline in the level of CapEx required for the business. We would expect it to be more in the $5 million-$6 million a quarter range, versus where we've been the last couple of years as we've invested heavily in our Labs of the Future . And then finally, we talked about this on the call back in August, but we are working to expand our credit facility. We said we have the option to do that, to take it from $90 million to $115 million.
That will add about an additional $10 million of availability by our math, and that would put the liquidity number that we had provided previously about $10 million higher than what we showed you in August. So instead of $101.3 million, I think was the number, it would be more like $111 million of liquidity at the end of the year. And with that, I'll turn it back over to Paul for closing thoughts.
Great. Thanks, Bryan. Well, appreciate everyone's attendance today and participation. You've been very generous with your time. We do have a little bit of time for Q&A, but I just wanna make some closing remarks, you know, before we do that. I think what you've heard today, and what's interesting, at the Morgan Stanley conference with Bryan last week, and one investor said: "Well, what are you gonna talk about at Investor Day? Do you have anything to talk about?" So I think we've answered that question. There was plenty to talk about, in terms of the progress we've made. I can't emphasize enough the foundation that's been built here to succeed in terms of our mission and growth and innovation.
We are really excited about the trajectory of the business, the trajectory of our R&D and pipeline, and the ability to operationalize that in a very differentiated way than I think most of the industry. I think a lot of folks are doing great things. As I said before, I think that the market is large, fragmented, and still fairly underpenetrated. I think we have absolutely the right to win and to be real successful for our patients and for our shareholders. With that, let's open it up for some questions. We'll take mainly from the audience today, since you guys have made the trek, and we will have some time for some questions from our virtual partners, and we'll be able to do some more at the lunch time as well.
Hi, this is Rachel Vatnsdal from JP Morgan. Thanks for putting this on today. First up, just on that long-term growth algorithm of the 10%+ revenue growth from 2024 to 2026, can you break down that contribution for us between mental health, women's health, and oncology? I believe last Analyst Day, you noted that mental health was expected to contribute 4%-5%, women's health was 3%-4%, and then 2%-3% from oncology. How have those assumptions changed at all with the new growth algorithm?
Yeah. I think fundamentally, the piece that we see accelerating growth, you know, above 10% going into next year, is coming from hereditary cancer and ASP growth at GeneSight. I mean, those are two things. The other contributor that we don't call out a lot is our emerging biopharma business. It's $20 million, high margin. We think that can grow to $50 million over this time period, so that's a grower as well. I just bring you back to, we've got very mature products, commercial engines across the different channels, and the ability to gain more share. And so the contribution margin, you know, so for example, Precise Tumor and Liquid, we don't have to win the market there.
You know, if an oncologist wants to get MyChoice and send one tumor sample to us, we can provide them a Precise Tumor. And often they are ordering hereditary cancer, MyRisk as well. So the efficiency around that process, the ability to solve to what that oncologist needs in a timely basis and give them one report, the contribution margin we think is significant there. So I think the big drivers that are underappreciated are the momentum we have in hereditary cancer. Mark spoke about affected and unaffected. On the affected side, we're just winning back the share we lost over the last decade. We are winning that back, and you're seeing that in the momentum in the business now. On the unaffected side, that's truly the patient opportunity here.
Our breast cancer risk assessment program that we're rolling out, the opportunity to, to get to women, to empower them, that is a 15% penetrative market. Again, GeneSight ASP, hereditary cancer, and- but Prolaris is another big contributor. Again, there's a lot of products. Add them up together, we think the plus sign is gonna get much bigger over the course of the next couple of years.
Yeah. So maybe just a follow-up to that then. On the pipeline product contribution, Dale mentioned that some of the upcoming product launches were not included to hit that 10%. Really, it's that upside, that plus. So how should we think about the potential contribution there from things like Precise Liquid, FirstGene, and MRD? Really, how much upside could it drive for each of those?
Well, I think the goal around here is to set expectations that we can exceed. We're gonna be rolling these things out in 2024, as Dale said. We're being really careful and thoughtful about our product management and our commercial rollouts to make sure that FirstGene, for example, isn't commercially launched until we can run it through the lab on an automated platform. So, A, can we have turnaround times out the door that are market leading, do it efficiently and profitably at first day. We don't want to launch things and be losing money for a year.
So what I think one should expect is that FirstGene, MRD, I mean, MRD should contribute from the pharma side in 2023 and 2024, but the real ramp up here is in 2025 and 2026 as we get through the launches and market adoption accelerates. And that's where I think you're gonna see us grow beyond the 10% in 2023 and 2024, and then going into 2025 is where we think we really kind of start taking off. Matt?
Hi, thanks for hosting us today. Matt Sykes from Goldman Sachs. Maybe just following up on Rachel's first question on, on hereditary cancer. I noticed that you've had obviously a reacceleration of growth in that category. The 2026 assumption, though, looks like mid-single digits. So I'm assuming there's an expectation that share gains in affected will carry you through in the near term. Is it the unaffected opportunity that kind of will help sustain that growth? I'm just trying to marry the recent growth with sort of the, the mid-
Yeah, You know, some have asked about the recent growth in women's health at 12%, for example, and certainly there's dislocation there, and there's some dislocation in hereditary cancer as well. I think adoption rates are the bigger issue here, and we're just seeing increased adoption coming out of the pandemic and increased market awareness as Mark talked about. We're absolutely winning customers and getting more wallet share of existing customers, but it's about a third each, right? So we just see adoption rates really starting to take off, getting more wallet share, and the new customers that we acquire, that's a more recent phenomenon. Which again, is why we think that the growth will accelerate going into next year.
I want to underscore again that overall, in terms of the portfolio, only about 40% penetration, and that is highly concentrated only in the top three providers, about 20%. And most of the dislocation that unfortunately we think is gonna happen is gonna be with the smaller providers. We're seeing and hearing a lot of that, of people just throwing in the towel on genomic testing, that they haven't turned the corner on making it profitable, and this includes nonprofit institutions and others, so.
Got it. And just for my follow-up, just two quick ones. One on GeneSight. You had mentioned that Medicare is picking up some of these PLA codes and paying for it, but you also just mentioned that ASP, increase in ASP. So what is your expectation for potential commercial coverage for GeneSight, and what else do you need to show? And then just my last question would be on the Precise MRD using whole genome. How does that look from a cost profile standpoint? The data is clearly compelling. I'm just wondering from a cost profile standpoint, how that looks.
Yeah. So, so on the first thing, we're continuing to make progress on, on, on the GeneSight coverage. It's slow. I mean, it, it has absolutely been sort of trench warfare there to try to, to try to move that along. But we are absolutely making progress. And as Brian said, we're starting to get paid from some of these Medicaid plans. 10 states, within 10 of the 13 states that have adopted biomarker laws, we're gonna just get much more assertive in our advocacy, and GeneSight should be covered in those states. We're building the clinical evidence, the Optum Genomics study, so we are having pretty good discussions with some of the big payers. But the large payers right now, whether it's on the Medicare Advantage side or otherwise, are kind of retrenching.
They're raising the bar, whether it's on prior auth or, you know, Blue Shield announcements of retrenching on some coverage, the role of these laboratory benefit managers. So it's a tough environment. Nonetheless, as we said, we've identified this, the friction and administrative challenges we had in the first half of the year have opened our eyes, that we have more work to do and more opportunity to advance a revenue cycle payer market strategy. And we think there's, you know, $40 million of annual revenue that we just need to get after. So that's part of it, Matt. And as Mark said, you know, we got to maintain the growth rate and volumes, so we've got to be really disciplined to get, you know, to continue to get paid for everything we do across the portfolio.
In terms of MRD, you know, the Lab of the Future strategy, the investments that we are making here are to stand up things in our labs in a really efficient way. We're running things at a 70% gross margin now, and we have a path to being not only the best in MRD, fine, we're a, you know, fast follower, but we're gonna be the best in terms of accuracy, and we're gonna be the most profitable in terms of margins because of the capabilities that we're building in our labs, putting this on our X Plus and everything else we're doing to scale our lab operations. We've got our great lab ops team here that's been working on it right behind you, so they can talk to you about it after the one-on-one.
Hi, Paul.
Zach?
Jack Meehan, Nephron Research. First is on the 10%+ sales target. I think the prior targets talked about 3%-5% price reductions. Are you still assuming that, or what do you see across the different products?
Yeah, I think with the mitigation efforts. Again, I think it's gotten tougher here the first half of the year. So we've achieved the 10% last three quarters, despite the fact that payers have raised the bar on prior auth requirements and medical necessity reviews. And on the Medicare Advantage side, Matt, that you talked about, some of the Medicare Advantage plans are violating CMS regulations about putting up additional requirements above the LCD. So we're just gonna get much more aggressive in terms of our advocacy there. It's just not right. They're not following the program requirements. So, you know, the opportunity on ASP, we still think it's in that 3%-5% range. We absolutely believe, as we are continuing to advance contract negotiations and other things.
But as Bryan pointed out, the components of ASP are coverage, yes, prior auth, a much bigger role than people think, and then getting the medical necessity documentation as well. And this is where our portals and EMRs matter a lot. Our ability to, to pull a prior auth out of, out of an EMR is significant. We left $10 million on the table in the first half of the year because we did not get prior auths in a time, and that was a discovery over the last couple of months that we're getting after. I mean, it's just that kind of blocking and tackling stuff.
Great. And as a follow-up on GeneSight, so the Optum data, you know, most of the GeneSight data we've seen has been compared relative to the treatment as usual. So the 35% decrease in psychiatric hospitalizations, can you or Katie frame for us, like, what do you think the control arm will show, and when do you think that data will be available versus treatment as usual? Thanks.
Yeah, that's in the next phase, Jack. So we just wanted to share the preliminary data, which consistent with, quite frankly, our real world data and what clinicians are telling us about the power of GeneSight as a tool to help them manage, you know, the mental health crisis. That the nurse practitioners are just bombarded in primary care offices with having to—with trying to deal with not necessarily the primary condition, but as a secondary condition of, you know, the depression and anxiety. And so we are—we're collecting our own data, and we'll have more to talk about that, so I don't have a real good time frame. But the fact that we're engaged with Optum Genomics on this is—and Dr.
Conway and I have talked a lot about this. It's really important stuff because we want to demonstrate, and I've talked about this more, across all of our products, the clinical utility for the provider, but also for the payer, and that includes MRD and the study that Katie was talking about. We're going to try to pull in some of our provider partners into that, so we really understand what does that mean in treatment? What does that mean in terms of the total cost of care to a payer?
Hey, Paul. Dan Brennan over here from TD Cowen.
Yeah.
Maybe the first one, just on 22q, since there's a lot of investor attention about that. Just, you know, the data you put up on the slide, that was a prospective study on 1,000. Can you give a little color on what exactly that data was? And then any color you can provide today about, you know, what kind of revenue contribution are you getting from 22q and/or microdeletions today, and are you expecting... You know, just kind of how do we think about-
I'll make sure I don't mess up the study and let Katie talk about that.
Yeah, I'll say a couple words about the study, and then, of course, Paul is your person to talk about the revenue. But yes, this was a retrospective study. This was patients that had received GeneSight from the time that we launched Amplify up until present. And so, there were, you know, we presented some of this data at previous conferences. We have a manuscript that we're just about ready to submit, so you'll see that coming out soon. Much more detail about the data, about the prevalence that we saw, about our screen positive rate, et cetera, detailed in that manuscript.
I had to hold Katie back on this study, quite frankly. Because it is quite powerful. What I would say to you is that Prequel with Amplify is absolutely a differentiated test, and that's part of the reason we've been winning. We haven't been winning market share back in women's health because of other people's problems. We've been winning it because we've solved the ease of use, and Melissa and her team have gotten in front of our customers, and we're starting to win back customers there. On 22q specifically, we're excited about the ability to serve that from a mission perspective. I'm less excited about what I think will happen from a reimbursement standpoint and guidelines. Generally, what I would say to you, Dan, we are just getting ourselves together in women's health. We just see a huge opportunity there.
You know, our margins there are 30%-45%, depending on the test and the quarter, quite frankly, because of some of the volatility. But as we grow, as we move into this Lab of the Future, and we bring down cost, as we continue to grow and get more wallet share, we're just very excited about our position in women's health, and that includes continued growth of Amplify, whether it's 22q or Foresight panel expansion, you know, in terms of guidelines that we think will, you know, will happen in the next 12 months. So...
Great. And then, maybe just a follow-up on MRD. So you indicated, I think, from the slides, that you've got six indications, and you're planning to file in 2024 for renal cell and breast. Can you just give a little color on-
We haven't made a decision yet, because, again, our product management means that we're trying to be thoughtful about thinking about what the data's telling us and where we have a right to play before we file. So, definitely breast, we feel that the studies that we're doing there is absolutely, as Katie and Dale both said, a significant area for us. In terms of the exact indications, I think that's still under review, and based on all the discussions that we're having. So we're trying to look at all the places where our MRD tests can be clinically significant, and that will inform our product management strategy in terms of commercialization.
Great. Okay, thanks.
Thanks, Dan.
Why don't we take a question from the virtual audience? So, Foster.
Yeah, so we have one question here from Prashant Kulkarni with Goldman Sachs. Prashant asks: Given the upcoming launch of FirstGene, what is your rationale for continuing to work on product advancements in Foresight and Prequel?
Well, there's a role. I mean, part of the product management work we've gone out in advance of any launch is to hear what our customers are saying and how they would think a product like FirstGene would be used in clinic. So Dale did some extensive work over the last year, along with Melissa, visiting customers and talking about the products and asking questions about: How would you use this? And how do you view this as compared to Prequel or Foresight? And what came back is that there's a role for all three, that there are places where clinicians will continue to use Prequel and continue to use Foresight. What we would underscore, and going back to Dan's question about women's health, FirstGene will open up a new market. Might it cannibalize a little bit of Foresight and Prequel?
Possible, but the data isn't showing that to us in terms of where we're working. It's more about FirstGene opens up, as Dale described, a whole new market and a whole new possibility to reach, improve access, and solve to a patient need. And that's what we're the most excited about. And gross margins are 30%-40% higher than Prequel and Foresight, so forgot about that one, so.
It looks like it wraps up the Q&A session for now, and I'll turn it over to you, Paul.
Great. Well, again, thank you all. You've been very generous with your time. Those participating online, thank you for your support. A shout-out to the team that made this day possible and all the hard work of everybody and the team for today. Again, thank you to our investors who have remained supportive and have given us great feedback along the way, our board of directors, and to our founder, Wally. So, great to have you here, and we'll look forward to lunch and having some more Q&A over lunch. Thanks again.