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43rd Annual J.P. Morgan Healthcare Conference 2025

Jan 15, 2025

Mark Stolper
EVP and CFO, RadNet

Thank you, Matt, and thanks, everyone, for coming this afternoon and deciding to spend part of your JP Morgan conference listening to the RadNet story. In this presentation, I'll give you a brief introduction about who we are, what we do, talk a little bit more about the industry, which is setting a stage for the continued growth and success of our business. I'll do a deeper dive into RadNet's core imaging center business, and Dr. Sorensen will give you an overview of what we're doing on the digital health side, and then we'll end the presentation talking more about the recent financial performance and the future outlook of the business, so with that, for those of you who are less familiar with the RadNet story, RadNet is the largest owner-operator of fixed-site diagnostic imaging centers in the United States.

We own and operate 399 locations focused both on the East Coast and the West Coast. We're not exactly an overnight success. We started the business in the early 1980s as a one-center operator in Los Angeles, and over the years have built it into today what is close to a $2 billion revenue business. We have a lot of unique aspects of the business, which we'll get into later on in the presentation, including having over a third of our centers, 38% of our centers, held within joint ventures with some of the largest health systems in the United States. And I'll talk about the logic behind the joint venture strategy. We take risk in certain of our markets, particularly California, in a capitated business. And more recently, we've grown a Digital Health platform, which Dr.

Sorensen is going to give you more details about later on in the presentation, which is creating tremendous growth opportunities and opportunities for profitability for the company going forward. We have been a fast grower. We've quadrupled the size of the business since 2006. In 2024, the year that we just finished, when we report our numbers, later on in February of this year, we'll have gained $1.8 billion of revenue, north of $1.8 billion, about $280 million of EBITDA. And our operations are focused, as I mentioned, East Coast, West Coast, where we have a highly concentrated model in eight states: New York, New Jersey, Maryland, Delaware, and Florida on the East Coast. And then our West Coast operations include California and Arizona. This is by intention, this density and concentration, and I'll talk later on in the presentation about the benefits it provides to our business.

We have a multimodality strategy, so the vast majority of the centers we operate have the full breadth of imaging equipment in them from the more routine studies, X-ray, ultrasound, mammography, all the way through the more advanced studies. This has been a competitive advantage vis-à-vis the rest of the marketplace who don't have large multimodality centers like we do. And I'll talk about the benefits of that later on. And this digital health business has been growing very substantially. We expect it to grow over 30% next year. It includes a radiology software suite that we've used and enjoyed for our own business over the last 15 years. We have 200-plus customers on the outpatient side of the imaging business that are outside of RadNet, so third-party customers.

More recently, we have been developing that software package into a new product, which we launched in December of this year called DeepHealth OS, which is a full cloud-based native solution, full end-to-end solution that we're going to be implementing inside of RadNet, where we will be able to enjoy automation tools that will allow us to operate more efficiently, rely less on human capital, human labor, which is a constraining resource in all of healthcare in our business as well. More recently, we have been leading our industry down the road towards AI, both on the clinical side as well as the business processes side. I'll let Dr. Sorensen get more into that later on in the presentation. With that, I'd like to talk a little bit about the industry. It's a large and growing industry, if you believe the research out there.

It's believed to be north of $100 billion of annual imaging services revenue each year in the United States. It grows every year. We can say with great certainty that next year there will be more imaging done in this country than this year, and it will continue to grow. The growth is being driven by a number of factors. Obviously, we're enjoying some of the same positive trends that all healthcare services are enjoying in the country regarding a growing population and aging population. As the population ages, we all utilize imaging more frequently. In fact, Medicare lives utilize imaging three times more frequently than commercial lives. So the demographic trends are with us. But what is unique about diagnostic imaging is that we're being driven by technology.

Technology advances each year in equipment, in post-processing software, radioactive pharmaceuticals, contrast materials are driving new clinical indications for ordering these types of diagnostic tests. It's been shown and proven that the earlier and the more accurate you can detect disease, the better patient outcomes are on the back end and the lower cost it is to treat these patients. This industry will continue to grow, and we'll continue to enjoy the growth. It's highly fragmented. RadNet is very unusual for the diagnostic imaging industry. Most of the players with whom we compete are small mom-and-pop radiologist-owned facilities, small groups of radiologist-owned facilities, and the outpatient departments at hospitals. On the digital health side, this is also a large industry. Today, it's north of a $4.4 billion worldwide industry.

The products we have currently, meaning our eRAD software products, are being sold in almost every continents across the globe. And we are focused, and our products are focused today on the outpatient industry, which is the industry that RadNet's core business is in. And we're bringing these solutions also to hospitals and more enterprise solutions for health systems. And I'll let Dr. Sorensen talk about that later on. So just in terms of our business, I mentioned we're an East Coast, West Coast business, and we're highly geographically concentrated, intentionally so. In the eight states we operate, that comprises over 30% of the United States population. So we're where the people are, we're where the density is. There's a lot of growth. As large as we are in these markets, there continues to be a lot of growth. And there are two main reasons why we are geographically concentrated.

The first being we're able to operate much more efficiently the denser we are. And what I mean by that is we've been able to centralize very effectively many of the services and the functions that we perform on behalf of our centers, such as call centers, pre-authorization departments, marketing. We have employees that roam amongst our centers. And this allows us to be a low-cost provider in those markets. And secondly, what this does, and perhaps even more importantly, it gives us a seat at the table with respect to negotiations with the commercial insurance companies. So they recognize that we are the leading alternative to hospital-based imaging and that our costs are much lower. In fact, in our markets, typically the hospitals charge between 200 and 500% of our costs for performing the same services.

So in recent years, the commercial insurance companies have recognized that we really are their partner in trying to drive this business out of the much more expensive hospitals into the freestanding locations. And the insurance companies have been doing this through plan design by having much lower copays and co-insurance to induce patients to come to the outpatient centers. And they're also doing it by instituting pre-authorization and utilization review, where when an advanced imaging exam is authorized, they're then directing the patient into a lower-cost network, which is comprised of ambulatory outpatient centers. And the fact that we are the largest player and the largest provider in their provider base gives us a seat at the table to have long-term stable and even increasing pricing.

So with respect to where we get our revenue, if you look at the left side of this page, you'll see that only about 25%, 26% of our procedure volume is from the more advanced imaging exams. This is the CTs, the MRIs, and the PET CTs. However, that 26% or so of our procedure volume is driving the lion's share of our revenue. It drives over 60% of the revenue that we have on an annual basis. But there's huge benefits for us to be a one-stop shop.

There's value to be able to go to the thousands of referring physicians that we have in our markets and provide one prescription pad and say, "Whatever your imaging needs are, you can send them to the RadNet facility down the street." Very often, someone will be sent into one of our centers for a routine study like an X-ray or an ultrasound, and based upon the results of that study, be sent back to us for more advanced imaging. From a payer standpoint, we have a pretty diverse payer mix. About 58% of our revenue comes from negotiations that we have with commercial insurance. This is HMO, PPO work, indemnity insurance. Medicare represents 22% of our business. Capitation is a unique aspect of our business.

We're the only imaging center company that we know of across the country that takes full risk on about 1.7 million lives, predominantly in California, where we get a per- member- per- month fee from the various HMOs and the medical groups with whom we capitate for providing imaging to those lives on an exclusive basis. It's a great book of business. It's predictable cash flow, predictable revenue, and it's an alignment between the provider being us as well as those physician groups that are taking the various risks from the HMOs. And this has been a nice book of business for us to grow. Then we also have some smaller books of business like personal injury and workers' comp. As I mentioned in my opening remarks, hospital joint ventures is becoming a bigger part of what we do.

These same hospitals with whom we've competed for many years for outpatient business have recognized that they are on the losing side of the trend and that more and more of this business is going to move to ambulatory lower-cost sites of care. Many of them have approached us over the last decade in order to establish joint ventures with them where we allow them to either buy into existing RadNet centers or we both open up centers in conjunction with each other where we're now servicing the ambulatory outpatient market. And this gives them an ability instead of fighting a losing trend, it gives them the ability to actually benefit from this trend.

So we partner with some of the largest health systems in the United States and in our markets, including RWJBarnabas Health in New Jersey, Dignity Health, Adventist Health on the West Coast, the University of Maryland Medical System, and a bunch of others. It's been great for us as well because the quid pro quo with allowing the hospital to own an equity piece in our imaging centers is that we expect them to use their relationships and their influence with referring physicians in the community to then drive those referrals into our jointly owned centers as opposed to into their hospital outpatient departments. It also increases our seat at the table with the commercial payers where we can establish long-term fair outpatient pricing. I'm going to turn the presentation over to Dr.

Sorensen, and he's going to tell you a little bit more about our Digital Health business.

Gregory Sorensen
Chief Science Officer, RadNet

Thanks, Mark. It's a pleasure to be here with you this afternoon, and I'll try to quickly give you an overview of the digital health part of RadNet. It's part of how RadNet is becoming a tech-enabled services provider. Over the past year and a half, we've been investing substantially in building new technology that really helps us do our job better and helps radiology groups around the world do their jobs better. And I thought the best way to explain this to you might be to just think a little bit about the patient journey and what happens when a patient needs to get an imaging exam, especially in the outpatient world. And this diagram highlights on this figure of eight a number of the steps.

Today, each of these components has a best-of-class point solution of some kind. There's really good scheduling software. There's very good image acquisition software. There's really nice viewers. There's pretty good revenue cycle solutions, etc. The problem for most providers is they need to integrate all that themselves. And even worse, there are many different people who touch each of these different solutions, and so they each have different needs. And one can spend an enormous amount of time focusing on the interoperability of these pieces to the detriment of having them work together and having this seamless and productive experience. Our goal is to build that exact unified experience. And so we have, over the last year and a half, put together all of the components we need to have this full integrated operating system, we call it, or set of suites of applications.

There's really a set of applications for each of these people or personas, we call them, and they have their own needs. However, we have moved this all to the cloud and all in a unified data source so that the information can flow seamlessly as the patient moves through their journey for all these different tasks, and so each of these different people gets a different, essentially, pane of glass for them to look at, but it consists of the applications they need to do their part of the experience but without creating the silos on the data or the other kind of interoperability that makes for an efficient and cost-effective practice, and it also allows us to do some new things that you might not be able to do well otherwise, and I'll just quickly walk you through what some of these things are.

So specifically, we're very interested in boosting the efficiency of the work that we're doing. And so in the old days, one might have had a RIS or a radiology information system, but now we can bring new capabilities to the old-style RIS that are listed here, things like much more intelligent scheduling that leverages generative AI, much more intuitive ways for the technologist to access lots of different things. For example, I'll show you one of the tools that we're building that links to this radiology information system is the ability to scan remotely. And in fact, let me just move to that slide just in the interest of time. We are leveraging existing tools and building new versions of our own tool that let an MRI technologist literally sit in Arizona and scan patients that walk into an MRI scanner in New York.

In the New York MRI scanner, there's a safety tech, I call it, somebody who's trained to take the patient in and out of the scanner. And then using remote technology over the internet, the MRI tech can be sitting in her home or in an office and remote control the MRI scanner, see the patient through a camera, watch the power injector and through another camera, see the radiology information system information to know what's going on. And most importantly, can do this for two or three or more MRI scanners all simultaneously. This is a big plus for so many reasons. The simplest reason that we're doing this now thousands of times a month is because it's hard to find labor in the markets where we see demand.

We have tremendous demand for our centers in New York, in California, but it's hard to hire MRI techs in a cost-effective way in New York, but we can hire them in Arizona or in Florida. And then with the Tech Live Suite that I'm showing you here, we can enable that technologist not only to operate remotely but to operate two or three systems remotely if they need to. We've actually announced a partnership in last December with Siemens Healthineers to introduce this onto their ultrasound machines so that we can provide expertise remotely. It's much better care for the patient, much more cost-effective for the operations. It lets us extend the hours when we or anybody else could scan patients. And it's an example of how this enabling technology that's seamlessly integrated allows us to do more than we could do without such technology. Here's another example.

This is the Diagnostic Workspace , we call it. This has a series of tools that let the radiologist quickly go through their work list. They can actually see all the images they want to see remotely. It has all of the functionality of other existing so-called PACS products but leverages that integrated workstream and data set, but also importantly is remote. Being fully cloud-enabled, we can not only deploy it anywhere, but as cloud-enabled packages become more freely available, such as, for example, in generative AI, where the AI enablement can allow me as a radiologist to create a dictated report, but then instead of me having to dictate the summary, the Gemini or ChatGPT plugin can quickly generate that for me, making me 15%-20% more efficient. These are the kinds of things that we radiologists really love. It makes us more productive.

It helps deal with the shortage of radiologists. It's just another example of the kind of technology. This is live. We actually showed this at RSNA, and we're deploying it across RadNet now. We've been able, given this whole suite of tools, to now bring new products to market. For example, using the AI that we started building back when I started DeepHealth separate from RadNet back seven or eight years ago. This is AI technology that does a better job of detecting cancer than the human can. It aids us radiologists. And now we can bundle that with all of the scheduling and other software and reporting tools into a single turnkey package that we call SmartMammo. And we've entered into a partnership with GE to sell that for non-traditional as well as traditional providers.

If you're an OB-GYN office and you want to be able to offer mammography to your patients, but you don't know anything about X-ray, we can deliver everything remotely or locally for you and enable you to essentially bring the care to where the patients want it. This is what's enabled RadNet to open Walmart locations where we can do mammography right after the checkout stand in Walmarts. This kind of bundled workflow solution where you get the whole thing, this is really what makes a difference and makes us really a tech-enabled area. Now, we've also had very powerful point solutions for bringing AI to the radiology world. And I won't spend a lot of time because this is not that kind of audience, but just to highlight a couple of the other things in addition to mammography where these point solutions have shown tremendous clinical benefit.

For example, in Mammo, we just published some data last month showing that with the EBCD workflow solution where there's a second radiologist that comes in to look at the most dangerous cases on top of the first radiologist and the AI, we've shown in hundreds of thousands of women a 21% higher cancer detection rate. So it's great for mammography. I would highly recommend it to my wife. In addition to breast cancer AI, we've built and have deployed a very powerful prostate cancer AI tool. This makes the radiologist much more efficient. Again, helps them find the prostate cancer, which, as you know, kills as many men as breast cancer kills women every year. So it's a very powerful and compelling tool. We've also built and deployed very powerful lung nodule AI for lung cancer screening.

This is actually widely used in the U.K., as I'll mention in a moment, in their targeted lung health check program. Very powerful, very fast. The doctors love it. It helps them find lung cancer earlier, which has been shown to be a marked improvement in survival. We also have a brain MRI product that helps identify brain lesions, and we have other products in the pipeline. Let me just finish about talking about this Digital Health business by talking about its real-world impact. We actually have deployed this not only at RadNet but external to RadNet. We have multiple customers in many countries. Here, I've just given you a few of the statistics. As I mentioned, our breast cancer screening product shows really world-class improvements in screening mammography. We've partnered with RadNet as part of the DeepHealth team to start offering prostate cancer screening with MRI.

There are fairly compelling data that show that about 16% of prostate cancers are missed by PSA testing but can be found on MR. So we think there's going to eventually be a role for prostate MR in screening for prostate cancer. And as I mentioned, we are the leading provider of lung cancer AI solutions in Europe. And just to give you a couple of examples, again, I wanted to highlight this boost in the performance of the radiologist when they have access to our AI. And to put that in context, when mammography went from 2D- 3D, the boost in cancer detection, as you can see in this slide, was about 9%. We think this really is going to change the way breast cancer screening is done.

Just to finish about the impact in lung cancer screening, now our AI is in use at about 90% of the centers in the U.K. that are in England that are doing the lung cancer screening program they've rolled out. We've seen what every oncologist really wants to see, which is what we call stage shift. That is to say, we're not only finding more early-stage cancers, we're actually finding fewer late-stage cancers. This is what we all want to see. We want to drive the process where we pull those late-stage cancers forward, find them earlier because the survival is so much better. The actual, if you model out the impact on survival, this early detection is much bigger than all of the advances we've had in lung chemotherapy and surgery and radiation over the last 20 years combined. It's really very compelling.

So I would just finish by saying I think we're in a very interesting and compelling situation where we have a very powerful technology team that you've seen. We've got a few hundred engineers and scientists building state-of-the-art technology, but we're doing that inside and fully vertically integrated into a large-scale, very nimble provider organization that's highly focused. This vertical integration story of delivering services with a very cutting-edge technology team together, I think, makes for a super compelling way to create value for patients and ultimately for our investors. And with that, I'll turn the podium back over to Mark to finish on the financial performance.

Mark Stolper
EVP and CFO, RadNet

Thanks, Greg. This wouldn't be a proper JP Morgan presentation if we didn't talk about the financial performance of the company. The company's been doing well. We've been growing double digits for the last several years. On the top line, EBITDA performance has been even better. The third quarter, which is the last quarter that we reported, was no different. Our revenues were up almost 15% from last year's third quarter. EBITDA up over 27%. We continue to grow both aggregate and same-center volumes, and we expect that to continue. So if you just look back at the last 15 years of the company's history, we've grown the top line at almost 9% compound annual growth. EBITDA has grown nicely along the way, and that's driven primarily by increasing procedure volumes.

We think that not only is this sustainable for the future, we think we can actually accelerate this because of the positive trends that are going on in our industry and our business, which I talked about previously. We've actually been growing double digits over the last couple of years, and we think that that will continue. There's also a bunch of acquisition opportunities and consolidation opportunities, hospital joint ventures, and then, as Greg mentioned, a lot of growth ahead of us on the Digital Health platform, which both will, as we implement this new DeepHealth OS software and some of these AI tools, there's a tremendous amount of cost savings available to RadNet as well as we sell it to the rest of the industry that has the promise for not only increasing revenue but increasing our margins. I'll end on this slide.

It just shows you we're about a $5 billion market cap company currently. Our guidance this year, or I should say in 2024, was about $280 million. We're well capitalized. We have currently about $750 million of cash on the balance sheet. We're very unlevered for a capital-intensive business. We've got less than a one-time net leverage ratio at this point. Our capital structure is solid and in place through 2031 with a fairly low cost of capital. And we actually have a net operating loss carry forward where we don't believe we're going to be a taxpayer for the next few years. So with that, I'd love to open up the floor to any questions of Greg or me. Thank you.

Moderator

Yeah, we have a few from the iPad, but defer to the audience first if there's any. Cool. So I did see a hand. There was a hand that went up over there.

Leo Hei
Analyst, Millennium

Hi, Leo. Hei, from Millennium. Could you just talk about what was the price-mix benefit in 2024 and what you guys think that could be in 2025? Thank you very much.

Mark Stolper
EVP and CFO, RadNet

Sure. So typically, when we talk about our growth algorithm, historically, we've told investors that we feel like we can grow same-center volumes at 2%-4% over the long term. However, over the last several years, that growth algorithm on the same-center basis has accelerated. And we've been averaging, if you track our numbers over the last couple of years, we've been averaging mid-single-digit same-center performance, which was indicative of our last year's same-center performance. That's part of that growth algorithm that's been contributing to that double-digit growth over the last several years. On top of that, we've got hospital joint ventures. We've got better driving procedure volumes. We've got initiatives such as Digital Health. All of that's contributing.

On the pricing side, although there has been some minor price deterioration on the Medicare fee schedule, which has not been directed towards radiology per se, as you're probably aware if you track healthcare services in general, the conversion factor in the Medicare fee schedule has been declining slightly over the last several years, which was a budget-neutral issue that went back about four years ago when Medicare increased the reimbursement for these E&M codes under budget neutrality, the evaluation and management codes that primary care physicians bill under. So we've had some price deterioration on Medicare. However, that commercial book, which you saw in the presentation representing about 58% of our revenue, we've actually been driving pricing increases in that book as well as the capitation book to the tune of 2%-3% over the last several years.

And we think that that will continue in the future as the commercial payers are recognizing our importance in trying to help bring these patients out of the much more expensive hospitals into the lower-cost sites of care, i.e., the ambulatory centers. So we think, on average, going forward, we should have some modest price increases in the coming years. You combine that with the certainty of procedure volumes going up, and that will continue to drive our growth.

Leo Hei
Analyst, Millennium

Cool. We can go to the iPad. So a few questions. So start with capital allocation. Can you walk us through your capital allocation strategy and how much will be allocated towards these tech initiatives? And with that, how much do you plan to expand your facility footprint, and what are you allocating towards this?

Mark Stolper
EVP and CFO, RadNet

Sure. So we're obviously throwing off a fair bit of free cash flow every year, and that's contributing to this already large position that we have in terms of the cash balance. We have been spending aggressively in reinvesting into the core business through growing de novo centers. We're facing very high demand in most of our local markets. Many of our markets have backlogs, and so we have been aggressively opening up centers. In 2024, we opened up eight centers. This year, we have 15 de novo projects in the works. And so we've been expending some of our capital extraordinarily on growth CapEx that's driving this same-center and aggregate performance. We also, in the normal course of our business, acquire smaller operators. So tuck-in transactions, mostly in our markets, is something that we do. We can generally buy these operators at four to seven times EBITDA.

And because they're in market, we are able to enjoy some synergies by consolidating them into our operations or what we kind of jokingly call RadNetize those operations. There are some larger acquisitions and mid-size acquisitions that we think will be available to the company in coming years. So we're looking to do that as well. And then in 2025, we're going to be investing substantially in our Digital Health platform, particularly in the areas of infrastructure around implementation teams to roll out this new software platform within RadNet, as well as with external customers, as well as sales and marketing. Do you want to say something?

Gregory Sorensen
Chief Science Officer, RadNet

Yeah, I was just going to add this past year, when I was here a year ago and we talked, we didn't have almost any of these products other than the early versions of the AI. And we've really been working hard, and most of the team has been focusing on building them. Now they're built, and so this year is deployment and rollout and scale-up. And so that will take some capital. And we think, though, that it will pay off in the long, not in the long run, but in 2026 by having expanded capacity. Similarly, with the commercial teams on the digital health side, we've kept those in check until we actually do this initial implementation and have the kind of proof points that customers want to see.

We're confident that the tools are going to deliver meaningful improvements in care and meaningful improvements in the financial operations of RadNet, and then we'll share that with customers, and we think that will really drive adoption.

Leo Hei
Analyst, Millennium

Awesome. And then a little bit deeper on the capital allocation point, what is your comfort level with leverage, and would you look to flex leverage to fulfill these capital allocation strategies? And how would you characterize leverage of your competitors in the space?

Mark Stolper
EVP and CFO, RadNet

Sure. So I mean, obviously, at under one-time net leverage, we're comfortable. We sleep well at night. Our debt cost of capital is at SOFR plus 225. So we've got a—we're throwing off a lot of cash. The types of investments that Greg and I have talked about today, either in the Core business, in de novo centers, in the investments that we're making in Digital Health, we're doing all out of free cash flow. So that's not eating into this small war chest of money that we have on the balance sheet. So I think the only way we would lever up materially from here is if there were a very, very compelling, very value-creating larger-scale acquisition. And even with that, we would be hesitant to go—we'd want to keep our leverage below three times on a net leverage basis.

So if we were to do something of scale, we would either raise that capital through a combination of debt or equity or use our stock as partial tender in some sort of a scale transaction. So I think, as we saw interest rates increasing over the last, let's call it, 36 months, we felt it prudent, especially as a public company, to make sure that we kept our leverage in check.

Leo Hei
Analyst, Millennium

You asked about competitors. What's your?

Mark Stolper
EVP and CFO, RadNet

We're highly unlevered for our industry. Our industry is a capital-intensive one. There's a requirement each year to reinvest in your capital equipment and your facilities. And so most of our competitors, at least other scale competitors in our industry, tend to run with much higher leverage. And many of them are private equity-backed, and a lot of them took out a substantial amount of leverage three, four, five years ago when they got into these investments. Some of them didn't hedge or buy interest rate caps, and so they got caught up in the rising interest rate environment. And so I think what that has allowed us to do is, as new acquisitions have popped up, I think it gives us a better ability to—or a more competitive advantage to look at those acquisitions.

Leo Hei
Analyst, Millennium

A little bit deeper on DeepHealth, I guess, what are your funding needs to accelerate what you're doing at DeepHealth, and how have you sanity-checked the cost buildout there?

Mark Stolper
EVP and CFO, RadNet

How have we sanity-checked the what?

Leo Hei
Analyst, Millennium

The cost buildout.

Mark Stolper
EVP and CFO, RadNet

The cost buildout, yeah. So great questions. That's one of the benefits that I see and that our customers see is that we're part of a substantial growing profitable parent organization. So access to capital for us is not a problem at all. We make it transparent. You can see now that we do this segment reporting how we get at what that capital does to our balance sheet and our performance. But we have the capital that we need. We have said, and I do expect that this coming year, that we will grow substantially, probably revenues over 30%, we expect. And we will probably not grow EBITDA by that same 30% because we'll save some of that revenue growth and those profits that we will generate and reinvest them back into the business so that the EBITDA growth won't be as much.

But essentially, we can be self-funding because of the strength of the business and the relatively modest capital expenditure needs, which is quite different than a parent company that has extensive CapEx needs. Our CapEx needs are quite small. I think the growth challenge for everybody in the software industry is talent. The good news is, especially as we've designed this to be cloud-enabled, the number of people we need to service both RadNet and external customers is much smaller than it might have been in the old days. And so I don't think it's actually pretty straightforward to rationalize the capital expenditures that we need to make and show productivity and, within a few quarters, a really positive ROI on that investment.

Leo Hei
Analyst, Millennium

Great. And then one last one, I guess, is DeepHealth, are you planning to keep it just RadNet, or do you plan on setting it outside?

Mark Stolper
EVP and CFO, RadNet

No. No, in fact, I should have made that clear if it wasn't already that we already have 350 external customers for DeepHealth. That's outside of all the RadNet 399 centers. Another 350 customers around the world are using our solutions and paying us money today. And in fact, of the $60 million or so that we estimate will generate in 2024, the majority of that actually comes from outside of RadNet. So we already have a very solid, independent Software business that is fully embedded and in the service of the parent company, but strong and growing on a standalone basis with clear external validation in the marketplace.

Leo Hei
Analyst, Millennium

Great. Thanks.

Moderator

That's all the time we have. Thank you, everybody.

Mark Stolper
EVP and CFO, RadNet

Thanks for your attention, everyone.

Moderator

Thank you.

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