Good afternoon, ladies and gentlemen, and welcome to the Progyny, Inc. 2nd Quarter 2021 Earnings Call. It is now my pleasure to turn the floor over to your host, James Hart. Participants, sir, the floor is yours.
Thank you, Catherine, and good afternoon, everyone. Welcome to our Q2 conference call. With me today are David Schlanger, CEO of Progyny Petronevsky, President and COO and Mark Livingston, CFO. We will begin with some prepared remarks Before we begin, I'd like to remind you that today's call contains forward looking statements, including but not limited to about our financial outlook for both the Q3 and full year of 2021, the impact of COVID-nineteen, including variance on our business, are participating in the call to our
clients, member activity and industry operations our
ability to acquire new clients and retain existing clients our market opportunity, size and expectation of long term growth Our corporate governance plans, business performance, industry outlook, financial outlook, strategy, future investments, plans and objectives and other non historical statements further described in our press release that was issued this afternoon. These forward looking statements are subject to certain risks, uncertainties and assumptions, including those related to Progyny's growth, market are available for events and financial trends that we believe may affect our business, financial condition and results of operations. Although we believe these expectations are reasonable. We undertake no obligation to revise any statement to reflect changes that occur after this call. Descriptions of these and Reconciliations with the most comparable GAAP measures are also available in the press release, which is available at investors.
Progyny.com. I would now like to turn the call over to David.
Thank you, Jamie, and thank you, everyone, for joining us today. We are pleased to report that we had a solid second quarter reflecting not only our continued strong revenue growth are in
the range of $1,000,000,000 margin expansion, but
more importantly, our further success in scaling the business, growing our presence in the fertility industry and building long term value in our business. We believe 2021 will be another year where we not only achieve exceptional client retention, but also deepen many of those relationships through And while client retention is critically important to the growth of our business, so too is sales activity and our selling season is off to are in the range of $1,000,000,000 in the quarter as it relates to both new sales and upsell commitments. Additionally, we have built a strong pipeline of active opportunities that are continuing to pursue over the remainder of this year's selling season. We believe this positive momentum across many facets of our business demonstrates how Progyny remains in its strongest ever competitive position, that our market opportunity remains very robust And that all of the macro factors that have been contributing to our growth remain fully intact. You have likely seen from our press release that we have slightly revised our outlook for the second half of the year to reflect a lower level of expected utilization for Q3 that began are in the range of approximately $1,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000,000 or $1,000,000 or $1,000,000,000,000 are clear that we don't believe that this is indicative of any macro change in behavior.
In fact, 90 plus percent of our members have been going through treatment as we would normally expect. For a small percentage of members, the uncertain and changing external environment appears to have caused a slight pause in their pursuit of treatment. It's difficult to gauge whether this is associated with the summer vacation season after 16 months in the pandemic or the impact of the Delta variant or both. Fortunately, we're already starting to see indications in the most recent week that the pacing of appointment scheduling is returning to more typical levels. And while we believe this is an anomaly that will be short term in nature, we expect it to have a modest will be impacted by the near term results and we've adjusted our guidance accordingly.
While Mark will take you through the results in more detail, here are a few of the highlights in the second quarter. Revenue in the quarter nearly doubled over the Q2 of last year to $128,700,000 Adjusted EBITDA of $18,500,000 in the quarter reflected a nearly fivefold increase in the Q2 a year ago and and our margins continue to expand at a healthy rate. Art Cycles more than doubled from the year ago period to a record 7,340. Average members for the quarter grew more than 30% from the year ago period to 2,800,000, showing the resilience of both our business and our clients during participating in the first of the pandemic. Another highlight during the Q2 was the CDC and the Society For Assisted Reproductive Technology releasing their latest fertility data, And second, our outcomes have continued to improve each year, while the national averages have stayed largely the same over those 5 years.
The lack of improvement in the national averages really underscores not only how differentiated the Progyny approach to managing fertility is as compared to the rest of the industry, but also how difficult it is for a competitor to replicate our approach. Otherwise, we would see their improvements reflected in better outcomes. Are unable to either impact or measure the outcomes for their members due to their benefit design, member support and network models. We are exceptionally proud that Progyny is the only company with a 5 year history of achieving proven documented outcomes over thousands of patients have far exceeded the national averages with over 60,000 completed ART cycles since the launch of our benefit in 2016. And we believe that outcomes are the best measure of the value of a fertility solution.
From the employer's perspective, better outcomes result in better financial value, are happier employees and higher retention. To illustrate this, Progyny's live birth rate is now 25% better than the national average, reflect our success in not only getting people pregnant more quickly, but also in a healthier way that resulted in significantly fewer miscarriages. Consequently, the typical Progyny client will have to fund significantly fewer rounds of treatment across their member population than they would under a competitive solution. When you add in the value of the medical cost avoidance from fewer multiple births, the Progyny benefit provides meaningful financial savings are participating in the call, both in terms of medical and pharmacy costs as well as improved employee productivity. And we do so while also creating an experience where each member are educated, supported and cared for throughout their journey.
The combination of our superior algorithms and the exceptional experience we deliver have also allowed us to consistently achieve an industry leading NPS score from our members, which now stands at its highest level ever. This high level of member satisfaction as well as our leading clinical outcomes provide the foundation upon which we have continued to build the company's scale and industry presence.
To talk about the progress we made in the Q2 from a sales and client perspective, I'll now turn the call over to Pete. Thanks, David. Good afternoon, everyone. Each selling season, we focus on 3 areas. 1st, expanding our market share through the acquisition of new clients second, retaining the clients we already have With an emphasis on whatever clients are coming up for renewal that year and third, expanding our relationships with our existing clients through upsells.
Will walk you through what we've seen in each of these areas over the past quarter starting with new client acquisition. As a reminder, we began the year hearing that consultants benefit buyers were looking for 2021 to be a more normal year for them than 2020 was in terms of their ability to evaluate new benefits and make changes to their health plans. And while that early sentiment was encouraging, ultimately the best barometer to measure the progress of the season of sales commitments On that measure, we've seen that demand among prospective accounts has returned to pre COVID levels. The second and third quarter are the heart of any selling season for us with and potential clients understand in detail how the Progyny benefit works and how our superior outcomes translate into not only are in the range of significant financial savings for the company, but also higher workforce productivity and employee satisfaction. As a result, we have historically seen that the majority of client decisions are made at the tail end of the summer or early fall.
And while a certain number of commitments have always come in in the second quarter, the commitments we've received to date are the most we've ever received as of this point in the season and well beyond what we expected to see at this point in the year. It's impossible to know whether some of this is because of certain benefit managers simply choosing to commit to us earlier than they normally would, particularly Many of those early commitments have come from the Not Now accounts that had deferred the decision from the prior season and they were well primed to make a decision somewhat earlier this season. Nevertheless, we believe the record level of commitments that we've received to date is a strong indication that prospects are in a much better position to make decisions this year are compared to 2020 that the demand for fertility and family building benefits continues to grow. In every sales season, are going to grow the absolute number of new clients and covered lives from what we achieved in the prior season. Given how COVID affected company's decision making last year, We're looking to 2019 as the baseline for which we want to meet our growth goals this year.
And with the early results we've achieved thus far, we believe that we're on track to return to have a strong trajectory of sequential growth in new clients and new covered lives that we had been on prior to COVID. Turning now to renewal activity. In addition to the excellent start we've had to our selling season, our client retention continues to be exceptional. In fact, a number of clients whose agreements were up for renewal this year, including some of our largest and longest tenured accounts agreed to contract renewals during the quarter. One of our guiding principles is that we have to earn our renewals every day and this influences every interaction that we have with clients and members.
We recognize that signing a new client can often be based on the promise of what you say you can do, but the renewal is going to be based on the reality of what you've been able to achieve for them. We believe the high retention rate we've historically achieved and the renewal activity we've seen amongst our largest clients continues to affirm that we're helping our clients achieve their goals. Participants are in the range of $1,000,000,000
in the quarter.
In addition to the renewal activity, another important indication of the value we provide to our clients can be measured through their appetite to expand their project relationship either by enhancing their coverage with additional Smart Cycles, by adding additional services such as Progyny Rx or by including employee populations that may have had access to Progyny in the past. As one final data point and the momentum we're seeing in the market, we're pleased to report that we've seen healthy upsell demand and have have already achieved our sales target for upsells this year. Although there are still upsell opportunities in our pipeline for 2022, the majority of upsell commitments do generally occur are early in the sales year, the new sales activity. Turning now to utilization. Although we can't control utilization, We're able to look at each client and consider a number of factors to model a range of expected utilization that in the aggregate has proven to be highly accurate over a prolonged period of time.
Our utilization in the Q2 was within the range of what we expected. As the Q3 began, we saw a sudden change in member behavior that resulted in lower scheduled for initial consults and treatment cycles. We've spoken to some of our largest network partners who confirm that they're also seeing softer with the non Progyny patients as well. While we can't know for certain what drove this change, given that we're not able to speak to people who don't pursue treatment, We believe it's not a coincidence that this change in behavior began around the end of June, which is when many states across the country reopened and relaxed restrictions put in place because of COVID. With so many people across the country having been unable or uncomfortable traveling or visiting their families over the past 16 months, we believe that there was a pent up demand among a portion of our members to resume these activities such that this became an immediate priority in the short term and consequently chose to defer their pursuit in treatment.
There may also be some impact due to the delta variant surge in some areas of the country. However, as David discussed, we don't see this as being a new macro trend Because we're already seeing indications that the pacing of appointment volumes is returning to normal. And while this recent activity may have a short term impact to our results, review this largely as an anomaly that should correct itself in relatively short order. Let me now turn the call over to Mark to talk about the results for this quarter. Mark?
Thank you, Pete, and good afternoon, everyone. I'll start by walking you through the Q2 results and then provide our expectations for the Q3 and the full year. Revenue grew 99% over the Q2 last year to $128,700,000 Our growth was primarily due to higher number of clients covered lives as compared to a year ago. Though as previously reported, revenue in the prior year period was negatively impacted by the lower utilization are in line with the Q2 of last year with medical revenue growing to $92,300,000 And pharmacy increasing to $36,400,000 We had 182 clients as of June 30, representing an average of 2,800,000 covered lives during the quarter. This compared to 134 clients at an average of 2,100,000 covered lives in the quarter last year, reflecting growth of approximately 31% in lives over the past year.
Turning now to our utilization metrics. There were 7,340 art cycles performed during the Q2. This is more than double the number of cycles from the Q2 last year and reflects our highest ever quarterly total. The female utilization rate this quarter, which as a reminder, is a component of utilization that corresponds most closely to our financial results was 0.47%. This compared to 0.32% a year ago, Though the utilization rate at that time was negatively impacted by the temporary disruption in fertility care related to the pandemic.
Although utilization rates will vary from quarter to quarter due to a number of factors, our 2nd quarter utilization was equal to with what we saw are
in the Q1 of this year.
Turning now to our margins and operating expenses. In addition to the factors I'll highlight in a moment, I'll remind you that our margins and operating expenses as a percentage of revenue in the Q2 of 2020 were negatively impacted by our decision to keep all of the Progyny workforce are intact even with the pause in treatments at that time due to the onset of the pandemic. Gross profit more than doubled from the second recorded last year to $29,600,000 reflecting a 23% gross margin and an increase of 4.50 basis points from the year ago period. This increase is due to the favorable impact of the previously disclosed new terms with our pharmacy program partners, the ongoing regular contract renewals with our providers and the efficiencies that we continue to realize across our care Sales and marketing expense was 3.1% of revenue in the 2nd quarter, reflecting a 2 50 basis point The leverage we are achieving in sales and marketing reflects not only our improving scale, but also the benefits of our high client retention rate, Given that our acquisition costs are largely borne in the 1st year or so after a new client launches with Progyny.
G and A costs were 10 are in the range of $1,000,000 with the across the board improvements in our cost structure, adjusted EBITDA increased nearly fivefold are in the 2nd quarter from $3,800,000 a year ago to $18,500,000 this quarter. Our adjusted EBITDA margin of 14.4 reflected a modest increase from the Q1 of this year and an 850 basis point improvement from the year ago period. Adjusted EBITDA margin on incremental revenue in the quarter was 22.9%. We continue to believe that margin on incremental revenue is useful as a forward indicator for where the business is capable of moving and it highlights our expanding rate of margin capture on new revenue. Net income was $18,700,000 in the 2nd quarter or $0.19 per share.
This compared to a net loss of 1,100,000 are in the range of $0.01 per share in the year ago period. The higher income in EPS as compared to a year ago primarily reflects deductions associated with equity compensation activity. Turning now to our cash flow and balance sheet. Operating cash during the quarter used during the quarter was $7,500,000 This compares to cash provided of $2,200,000 in the year ago period. The year over year difference is primarily attributable to the short term use of working capital we described to you last quarter and which relates to a change in the timing of payments we receive under the new pharmacy partner arrangements.
The payments owed to us are reflected in the balance sheet as accounts receivable and are also the primary contributor to the increase in AR as compared to the Q1. We continue to expect that our operating cash flows will normalize by the Q3. As of June 30, we had total working capital of nearly are $140,000,000 reflecting $94,000,000 in cash, cash equivalents and marketable securities and no debt. Now turning to our expectations for the Q3 and the full year 2021. To reflect the slight reduction in utilization that we've seen as of the start of the quarter, we are projecting 3rd quarter revenue of between $121,000,000 to $130,000,000 representing growth are between 22% 31% over the prior year period.
For adjusted EBITDA, we expect between $14,000,000 are participating in the call to $16,500,000 along with net income between $3,100,000 to $6,700,000 or between $0.03 $0.07 earnings per share on the basis of approximately 101,000,000 fully diluted shares. For the full year, we now expect revenue of $510,000,000 to $530,000,000 reflecting growth of between 48% 54% over the prior year period. On this basis, we now expect adjusted EBITDA of between $67,500,000 are subject to $72,500,000 and net income of between $43,200,000 to $50,400,000 or between $0.43 $0.50 expense earnings per share based on approximately 101,000,000 fully diluted shares. As a reminder, our net income ranges for both the quarter and the year do not reflect estimates for discrete income tax items, including the income tax impact related to equity compensation activity. At the midpoint of this guidance, we expect to see continued expansion of our margins in 2021 with adjusted are in the range of $1,000,000,000 of $1,000,000,000 of $1,000,000,000 Let me now turn the call back over to David for some closing remarks.
Thanks, Mark. To conclude, we are pleased with both our results this quarter as well as the progress that we have made in the execution of our strategic initiatives, are in the range of $1,000,000,000 in the quarter. At this point in the season, we are ahead of where we thought we would be for sales commitments for launch dates in 2022, which includes a strong are in the 1st quarter of the not now deferred accounts from previous seasons. We are also having good upsell success within the existing base and a continued high level of renewal activity, including from our largest clients. In addition, we have a strong pipeline of active opportunities that we continue to pursue.
With the sales commitments we have received to date for new client launches and upsell starting in January 2020 as well as our expectations of what we believe we should be able to close from the active sales pipeline over the remainder of the season using historic close rates, As we look into 2022, we are comfortable that we can continue to achieve a comparable rate of revenue growth as to what we expect to achieve in 2021. With that, we'd like to open the call up for your questions. Operator, can you please provide the instructions?
Certainly. Your first question is coming from Ann Samuel with JPMorgan. Your line is live.
Hi, guys. Thanks so much for taking the question. I was hoping maybe you could provide a little bit more color on utilization. Is it You said it rebound, is it kind of back to where it was pre June drop? And is your thought that maybe some of those if those new appointments were deferred while people go on vacation.
Do you think that those are able to recover in the back half of the year? Thanks.
Yes. So it's rebounding. It's not rebounded yet. So just to give you some clarity, As we were entering the quarter or exiting Q2, we were basically on pace to what we would have expected and We dropped scheduling pacing dropped significantly relative to what we would have expected, and that's been recovering. It's not recovered yet.
And because we do believe it is related to the activity that we talked about in terms of pent up demand for people to just basically get out of the house, get on vacation, get to see their family, etcetera. And because it's already rebounding, including the early scheduling that's happening for September, we do believe it's going to rebound. We're not are going to fully rebound, which is why our guidance doesn't reflect why we adjusted the overall guidance down for the year down to 5.30, but we do believe it's going to rebound some are
welcome. That's really helpful. And then maybe just a question around the selling season. In your conversations, are you finding that You're speaking to more clients that don't have fertility benefits or maybe starting to look to add more fertility benefits? Or is it still a similar mix as you've seen in prior years and your conversations are taking away from those with existing benefits.
We've historically about 2 thirds of our New clients have had some level of benefit in the past, although as we've spoken about in the past, Andy, that the level of benefit varies pretty dramatically. So And about a third have had really no coverage at all. Those trends are largely intact this year also, where There's a large group of accounts that we're bringing on that had coverage before, but it's certainly not insignificant minority that had had no coverage before. So that continues. So takeaways from the carriers are really important source of business, but companies that have not provided coverage before continue to be a strong source of business also.
And that's consistent with many of the industry trends we've all been seeing that the percentage of employers that are offering coverage continues to grow every year.
The other thing that's also happening, which has happened in the past is when existing companies that have fertility benefit today take on On the Progyny Benefit, usually they're expanding what they're offering to their employees versus what they've been doing under a dollar max plan and that's also been consistent, current sales activity in those companies that are purchasing that do have the benefit that's are happening this year as well.
Great. Very helpful. Thank you.
Your next question is coming from Michael Cherny. Your line is live.
Good afternoon. Thanks for taking the question. Just diving a little bit on the revenue side, and I know there's probably some randomness to this, but it looked like revenue per Art Cycle fell pretty meaningfully. It was, if I'm doing my math correctly, up 1.2% last quarter, down 8% in 4Q, are down 7 this Q, up 1.6 in 3Q last year. Is there anything any rhyme or reason to that?
Does any of that tie into The dynamics you saw around utilization and maybe how utilization was used in terms of how broad or how deep each of the art cycles that was recorded was?
Yes, there is. It is always mix primarily and the mix, the medical revenue in total Isn't only from the art cycle, this is a simple example. And so to the extent that you have a different level of mix in dollars, and those show up in utilization for those starting out treatment and doing initial consults, that's going to drive a Different level of revenue per art cycle versus periods where you don't. So if you look at the change year over year, for are in revenue per art cycle, you see a drop this year in Q2 versus last year. That drop isn't any fundamental change pricing or anything like that is really just a function of the fact that a year ago, if you remember during COVID, there were a lot more folks just doing initial consults in Q2 and not going on treatment as a mix.
And so the overall medical revenue divided by our cycles looked higher versus this year, you're back to more normal activity in terms of mix. So and that does fluctuate in each quarter. Q1 is generally every year, even normal are seeing the highest percent of initial consults, which again would sort of drive that number appearing to be higher and then it's going to drop sequentially.
Got it. Just another question. You had a pretty nice sequential improvement in new members in the quarter despite not adding MyChex Main to customers, obviously the fill there is Same store growth from your existing customers. Obviously, you have a number of customers that are still very much heavily in hiring sprees. As you think ahead to those growth rates for next year, how are you expecting a normalized level more or less of same store member growth versus what you had previously?
From everything that we're seeing, we do expect normal levels. So last year, I think we grew on the base over the year around 200,000 lives off of the beginning of the year around 2,100,000 lives in round Numbers, right? So something in that range, plus or minus some percentage point is a normal activity in terms of growth and We'll see that. What happens is, unfortunately, the reporting that we get from clients isn't always perfect each quarter And we do our best to sort of make sure we get the most perfect reporting, but the reality is that there's sometimes a lag in reporting. So there is sometimes within a quarter versus a prior are in the Q2, a bit of a catch up just in sort of true it up numbers with our clients.
So the sequential growth isn't perfect over just the quarter, but over the year, I think is much are indicative of what's happened.
Got it. And if I could just squeeze one more in, when you think about the new revenue guidance range for this year and completely understand The variability that COVID either for a number of reasons likely to be causing, can you just give us a sense on where you see utilization or activity versus normalized levels participants would fall based on the low end and high end of the range?
Yes. So I'll do Q3 and then full year. Q3 at the low and high of the range has us at are either down 5% of what we expected or said a different way, 95% of what we expected is happening And at the low 11.5 percent, to put that in perspective, we're currently at roughly 10% are down, but have been improving. We were down further as we had talked about in our comments earlier in the month, and it's turning around. And so the expectation is that we believe because of the reason that we said it's going to keep turning around, but nonetheless those are our assumptions.
For the full year, we're On the high, down roughly 2% and on the low, roughly 5.5% for the full year in terms of our revised guidance. Again, We don't know exactly what's going to happen and whether or not all of it could come back, but that's our view right now based on where we're at in terms of scheduled appointments for
Q3. Perfect. Thanks.
Your next question is coming from Stephanie Davis with SVB Leerink. Your line is live.
Hi, guys. Thank you for taking my questions. I was hoping you guys could give us some color on the key selling season, maybe frame it in the context of are in the prior year selling season. Traditionally, you've always had kind of a typical $20,000,000 step up from 4Q to 1Q. Given this 2022 ramp in client cohorts, should we think of that as far too low as we get into the out year?
The easiest way probably to think about well, are we talking about 2022 or are we talking about we're not talking about we're not giving any commentary for years beyond that. So we talk about out years. We did make a comment relative to our expectations for 2022 growth versus full year guidance 2021 growth As compared to 2020. And based on our view right now in terms of early commitments that we've already gotten in new sales activity as well as the upsell activity that I talked about, that's been favorable. Our view is that 2022 could see comparable revenue growth Off of 2021 full year guidance, as 2021 full year guidance implies growth off of 2020 axles.
And when I think about that kind of that Similar growth, is that assuming that utilization is flat? Or is there any assumption that your I mean your hot girl summer disruption becomes
a baby boom as we get to
a more normalized environment? Assumes a baby boom as we get to our normalized environment.
It assumes normal utilization assumptions, not Hot Cross Summer Utilization assumption, as you call it. Just to use your words. Participants It assumes normal levels, doesn't assume any catch up in any other sort of pent up demand or anything. And so, that's what it assumes. And so what it does, if you remember the way we do it, is it takes into account client by client, industry by industry, our expectations for those clients, obviously, those that are booked so far and those that are and again, the upsell activity and And all of that is sort of factored in to the comment that we're making around expectations as we sit are here right now for 2022 revenue growth.
And last one just to think about the out year. If we didn't have all this utilization disruption in the year, how should we think about the revenue range or the missed opportunity that could be coming back in a bolus?
The thing that we think about, which is positive around sort of this activity, put aside for a second, this little bit of bumpiness in utilization activity is all participants The return to normal level sales activity, both on the upsell side as well as on the new sales acquisition for new clients. And I think that's sort of the most favorable trend that we're seeing, and continue to see, and then continue to be Excited about in terms of remaining pipeline as we continue to get through this sales year, but the early activity and early commitments certainly is positive relative to where we're at, which is why we're able to comfortable making the comments that we are around potential 2022 growth.
That's helpful. Thank you, guys. Your next question is coming from Ralph Giacobbe with Citibank. Your line is live.
Great, thanks. I guess first one, just anything you can tell from a geographic perspective on markets any more or less impacted from the lower scheduling? Yes. The specific market data is actually confusing. So in markets, for example, that are having
They're getting hit harder by the Delta variant, right? There's some of those markets, although smaller for our book of business, but nonetheless, they're actually up a little bit, participants Right. However, other markets that are also getting hit are down and they're the ones that are sort of dragging down the overall results. They're some of our bigger markets. So, as we look at market by market, throughout the country, including our largest markets, it's not consistent.
And that's what sort of makes the whole thing difficult. But the one thing that is consistent is that generally across the book of business, scheduling pacing is down. And as a result, because the drop sort of occurred pretty much across the board, across markets, it continues to be What we believe, which is just sort of short term activity related to literally people getting out of the house and deferring For a short period of time, any treatment decisions they're going to make and that's what's impacting our visibility into what we're seeing currently. And unfortunately, as we've talked about in the past, that That visibility is limited. We have decent visibility, pretty good visibility into a current month and a lot less visibility into Next month, but it's generally about a 4 week or so visibility.
So as a result, we can only look at what we see and patterns of what we see and we look And then make our best educated guess.
Okay. All right. Fair enough. And then I guess historically, How often do you see abrupt changes in scheduling? Is this really sort of a one off time, obviously, outside of the COVID Period.
And if I heard you right, it sounded like it started in end of June or early July and so it's been are a month now and it still hasn't recovered. And if you could, what's the magnitude of the change? I guess I'm just struggling with just trying to size or think about how much lower scheduling is. Yes. I think the
Let me answer the first question first. It started the literally so this is new in terms of this level of drop this quickly across the book of business. And like you said, aside from put aside COVID, and it happened literally the last week of June into the 1st week of July. It leveled off for like 3 weeks and is now improving. So the level of it is roughly we're down now roughly 10 Percent from what we would have expected, right, but it's gotten better.
And so the recent activity as you might imagine because of just math, the recent activity has been real strong in terms of starting to covered, but hasn't recovered fully yet because people again only generally schedule out about a month or so out, right? And so That's the activity that we're looking at and the turn of that activity. First, the flattening and sort of not worsening of that activity and then the positive activity in terms of scheduling pacing that we're seeing now in the most recent week or so. And so that's what's giving us Optimism that it's a very short term anomaly for the reasons that we said, both the fact that it dropped dramatically and we generally don't see that, as well as the The fact that it seems to be already recovering combined with our conversations with our largest clinics in terms of what they're seeing in their book And so it's sort of the collective view that gives us the view that says we think it's an anomaly. And just to remind you, And our expectations, as I commented on the prior question, for the quarter at the midpoint for Q3 is 8% down.
And if the improvement continues, hopefully, all participants We'll be either at or above the high end, but who knows. Right now, it's too short term in terms of the improvement and when it started is the date of this call. Okay.
All right. Fair enough. And one more if I could squeeze it in. I just want to I think the math is straightforward, but just figured I'd ask. The 2022 revenue growth in line with 2021, I think that's about a 50% increase at the mid point just want to sort of confirm that we're looking at the right numbers and the midpoint off of the current guide would suggest about $780,000,000 of revenue for next year.
Participants Yes. You're right that it's off the midpoint around 50% and comparable would be around that. That's right.
Okay. All right, great.
Thanks very much.
Thank you. This concludes the Q and A portion of today's call. I would now like to turn the floor back to James Harte for closing remarks.
Thank you, Catherine, and thank you everyone for joining us today. Obviously, feel free to will reach out for any follow ups. Otherwise, we look forward to speaking with you next quarter. Thanks again.