This is amazing. So glad to have you guys here. Good afternoon to everyone in the room. Good morning, good evening to those of us joining us online. We're so excited to have you here. I'm thrilled to welcome you to ResMed's 2024 Investor Day. This is our first Investor Day in three years, but I think it's been several more than that since we last saw a group of you in person like this. We've got a packed schedule for you, and I know you all wanna get to the heart of today's session, hearing from our leaders. But before I turn it over to Mick, let's quickly review today's schedule and go over a few legal and logistical details. First, the webcast is being recorded, and we'll post a replay online, along with the slides, on the investor relations portion of our website.
I've got to do the standard forward-looking statements. Just a reminder, everything we say today is subject to risks and uncertainties. The associated presentations may include forward-looking statements. They, the actual results could differ, and we do encourage you to review our SEC filings for a full list of the risk factors that could impact our actual results. All right, let's get to the agenda. Like I said, we've got a full schedule for you. We will try to break things up. We've got a break about halfway through. What I'm really excited is that you're gonna get a chance to hear from leaders that you don't get to often hear from. You often hear from Mick, you get to talk to Brett. Many of you get to talk to me, probably more than you like.
But you're gonna hear from a whole suite of others, and they all look forward to sharing with you our 2030 strategy that we've just launched today, starting with the kickoff of our new N AirFit - or sorry, AirTouch N30i mask, which I saw many of you trying on earlier, which is fantastic. For those of you joining the online webcast, I know you might not be able to stay tuned in for the entire day. We've got a number of different things happening, but I wanted to point out two Q&A sessions for you.
If you do have to hop in and out, the first one at approximately 2:20 P.M. Eastern, followed by a short break, and then the second Q&A session will be about 3:45 P.M., and we intend to wrap up today by about 4:45 P.M., and you're all invited to join us back in the showcase and for cocktails and a brief reception. So before I kick things off and welcome Mick to the stage, I'd like to share a video with all of you that provides just a brief glimpse and a teaser into what you're gonna learn more about during today's event. So with that, thank you again for being here, and let's roll the video.
At ResMed, we're celebrating thirty-five years of delivering better experience, better results, better outcomes, and we're just getting started. Please welcome Chairman and CEO, Mick Farrell.
Good afternoon, everybody. Thank you for coming here to the New York Stock Exchange to celebrate our 35th birthday as a company, 25 years on the big board. I don't know if you know, but we first IPO'd on Nasdaq in 1995 and then went to New York Stock Exchange in 1999, and the idea was to lower the volatility. That didn't work, but we've had 25 great years, a hundred amazing quarters, and, as Amy said, you hear from me, and you hear from Brett Sandercock every quarter. But about every two, three, maybe longer years during COVID, we do an Investor Day.
So we're very happy to be here in New York for our Investor Day, and thank you for joining us here live, and thank you for those who are watching on the live stream as well.
So there are three takeaways that hopefully you are able to get from Brett and me and the whole amazing team of ResMedians you'll hear from. Number one, that ResMed has a clear market-leading value proposition with strong growth drivers and an incredible market opportunity. You saw that in the numbers of patients that are in our disease states, but that's point one, clear, incredible market opportunity. Point two, ResMed has probably the most sustainable competitive advantage in the field of respiratory medical, sleep health, breathing health, medtech. We have a digital health ecosystem that is unmatched.
We have strong, deep, and talented management team that you'll get to see today in the breakouts, the Q&A, and you heard from our many of our commercial team on the brand new AirFit N30i, AirTouch N30i, which has brand new fabric-type capabilities. But number two, sustainable competitive advantage. Number three, an exciting 2030 strategy. Five years of growth ahead of us. Talked about the hundred quarters behind, what about the twenty in front? We have an innovation machine. We have hardware, we have software, we have solutions. We're bringing business development to pathways, not just products. We think products... You're gonna hear from our Chief Product Officer. Products are hardware, software, business solutions, and pathways, and that's the way ResMed thinks about it. And another one is, you know, we're students of Clayton Christensen.
We changed the basis of competition in our industry, and we've done it two or three times during our history, most recently in 2014. We're doing it again, and you're gonna hear about that. So yes, past predictors are not always predictors of future performance, like all the disclosure that you saw from Amy earlier. However, I think it is important to look back at 35 years of growth, 25 years of growth here on NYSE, and this on the screen right now, the last 5 years, the last 20 quarters of success, 12% compound annual growth rate on the top line, + 400 basis points from that to operating income and EPS, and then + 1,100 basis points from that to free cash flow. So pretty strong, pretty strong performance from the team.
We don't just sit back and accept market growth. I think at our last Investor Day, it was online, where we're in San Diego, we're all sort of clustered around. We talked about mid- to high single-digit growth, and we clearly beat that. You're gonna hear some guidance from Brett, some long-term guidance from Brett around revenue and where we're to get with our profitability. I hope that you understand that ResMed does not accept market growth. We talked a lot about mid-single-digit growth in the devices, high single-digit growth in the masks, high single-digit growth in our software businesses. That's if you don't have a team like you're gonna hear from today. If you have a team like you're gonna hear from today, we drive market growth.
We drive 50, 75, 100, 125 basis points or more above what the market would be if we weren't there. And we're gonna show you how we do that with demand generation, demand capture. How we're gonna leverage, frankly, what is a once in a lifetime, I think, opportunity with pharmaceuticals and consumer tech, investing in sleep health and breathing health like never before. So what's our, what's our vision? Well, we envision a world where every person can achieve their full potential through better sleep and better breathing, with healthcare delivered right where they live, preferably in their own home. So worldwide, there are billions of people with sleep apnea. As you saw in the video, there's a whole lot more with insomnia, 800+ million, 480 million with COPD, but then there's all other types of neuromuscular diseases that lead to respiratory insufficiency.
And you add it together, it's 2.3 billion people, one in four people on the planet. So we're not just envisioning this better world, we're gonna create it. So this word might not be often shown in the New York Stock Exchange, the last one on the slide here, but when I wear the ResMed brand, I go through TSA or I'm in an airport, I run into somebody, and I have the ResMed brand on, I don't know, CEOs rarely get hugs. I get random hugs from people. The guy who was running the camera on the New York Stock Exchange, who did the NYSE TV after the bell: "Oh, I'm a user of your product." Literally, the dude that just walked me over here, "I'm a user of your product.
I love your product." And we've never embraced that, but now we are, and we're saying we create life-changing healthcare technologies, which is true, that people love. And we're trying to bring more emotion to the brand. ResMed's innovation is personal. People fall in love with our products. Patient one, I don't know if you've heard this story, but ResMed exists because Peter Farrell walked into Colin Sullivan's lab while he's working at Baxter and met patient one, which was Eddie Merck. His name was Eddie Merck, and he had this huge contraption, Rube Goldberg-type device, really noisy machine, like run a swimming pool pump off it.
And he said, "Why do you keep using this?" And he said, "Because it saved my job, it saved my marriage, and it saved my life." And I was just talking to Professor Pelayo, you're gonna hear from a Stanford professor later today, and he was telling me, after calling us the Apple of the sleep apnea business, which I thought was nice, he was saying that divorce rates among snorers are statistically significantly above those others. And female snorers have even higher level of divorce rate, and people joke about this sleep divorce, separate bedrooms. Sleep apnea will literally bring love back to many, but Eddie Merck is the reason for that. We're gonna be using the word love here. So beyond the emotions, what's our strategy for acceleration of market growth? How do we get that demand generation or demand capture from big tech and big pharma?
And how are we gonna convert it into patients coming through our funnel? So we're going to combine demand generation, demand capture, but particularly demand conversion. I think when you look at technologies to expand the pathway and to try to capture all these patients who, from their watch or wearable or from a new pharmaceutical med, are showing up to a primary care physician, you're going to need more and more technologies and tools to do that. We're also going to have to partner with, not just folks at, you know, key opinion leaders from Stanford. We're going to have to partner with the whole world of sleep medicine to expand screening pathways with home sleep apnea tests that you can wear on your finger that are sensitive and specific.
We need diagnostic tools that are easier to use for patients, and we need, frankly, scalable setups that we can scale much faster than we have in the years gone by. So it's that whole pathway. I talked a little bit about our past, present, and future. I don't want to take too much of the time here when I hand off to the team, but yeah, 1989, ResMed was founded on a core of innovation. When Dad started this up, we were going to be the world's leader in taking care of sleep health. But really, for the first decade, we were known as the world's best CPAP mask company. We had the Bubble mask and then the whole Mirage range of masks, but we were in that hole that we were just the CPAP mask company.
There was this other company from Pittsburgh that did the devices, and we did the masks, and then around 2005, we changed the game and said, "You know what? We're going to make small, comfortable, lifestyle-oriented devices," so the S8 and the S9 changed the basis of competition to say, this isn't a medical device anymore. This is fitting in your bedroom like a Pottery Barn set, that they're now designing CPAP-capable bedroom sets. We were thinking of that in 2005, 2006, 2007, 2008, 2009, and we launched the S8 and S9, and we changed the basis of competition, then we built. We're the world leader in CPAP masks and flow generators. Then in 2014, yes, we were making the smallest, the quietest, the most comfortable devices. We changed the game again, and we said, "We're going to do the Internet of medical things.
We're going to have 100% connectivity into every single device that we sell," and Brett, my amazing CFO, you'll hear from later, said, "Mick, you know we make a million a year. You know the COGS of that. It's a guaranteed whack to the bottom line. How are we going to get the value?" We had created seven different pathways of how we're going to extract value. We actually had many more and different ones than we thought of, but that reverse Amazon play, if you like, Amazon, a software company, took hardware, the Kindle, to unlock books and digital books and then logistics. We were a hardware company, the world's leader in CPAP masks and CPAP devices, that said 100% connectivity to become the world's leading digital health player, and so as we look today, what's the new basis of competition?
Everyone in this room has studied it. AI and ML have been around since the '50s. ML, for sure. We've been applying ML, basic ML, in our systems for a while, but generative AI with a new programming language is English. Even with an Australian accent, Siri can understand me. Dawn, which is our generative AI, actually started in Australia and New Zealand and has now just launched into the US. The new basis of competition, ResMed's not going to be the world's best at AI, right? That's going to be Amazon and Microsoft and Google, but we are going to be the world's best at applying generative AI to the world's biggest data lake. I actually call it a data well of sleep health and breathing health information on the planet, so you've seen all these numbers before from me.
I won't go through them all, but what you probably aren't as aware of is some of the overlaps here. The overlap between a person who suffocates every night with sleep apnea and who also has a psychological reason that they cannot sleep, insomnia, that is called COMISA. The term was coined by a professor at the University of Adelaide, but comorbid insomnia and OSA. It's incredibly difficult to treat insomnia, period. If you suffocate as well, it becomes a double-wheeled problem. We don't know how many of our patients are not adherent to CPAP because they have insomnia, and we don't know how many insomnia patients with OSA aren't being treated, but that overlap is significant, and ResMed's investing in digital health on both sides of that. The other overlap there is what's called overlap syndrome, which is chronic obstructive pulmonary disease and sleep apnea.
So you actually have difficulty breathing 'cause of the geometry of your upper airway, but then in addition to that, you have lung disease. These are some of the most difficult patients to treat, and ResMed has the technologies, the bilevels, the ventilators, but also the digital health technology that can help physicians take care of these patients. So who is ResMed? Well, look, ResMed is absolutely the clear number one leader in a hundred and forty countries for providing sleep apnea care. We make the smallest, the quietest, the most comfortable, but now also the most connected medical devices on the planet.
I would actually go as far as to say we make the most intelligent therapies that are available, not just because of the smarts within that new AirSense 11, AirCurve 11, but the smarts that are in the cloud, the smarts that are on the phone of 8.3 million people with a myAir app looking at their Fitbit for sleep as they track their numbers every day. Yeah, we just launched that it can now go onto your Apple Watch, so the data can get there, be part of your Apple Health ecosystem. We did APIs into Samsung's system as well. Samsung actually led on this. They got FDA De Novo clearance for their new Galaxy Watch in the field of sleep apnea. ResMed is the clear leader in sleep apnea. But the best hardware and the best software alone won't get you there.
You do need the best pathways, and so what I hope you'll get out of today is hearing from our Chief Product Officer, our Chief Marketing Officer, our Chief Revenue Officer, about how they're thinking commercially about breaking down the barriers and finding ways for patients to more seamlessly, efficiently, and in a consumer-friendly manner, get from suffocating to treat it for life, and that's what ResMed does. We don't cure, we treat for life. We put 7% of our revenues into R&D, right? So we've got $5 billion in revenue, so that's $350 million, and that's growing, right? It's growing, and Brett will tell you how fast it's growing on the revenue line for the next five years. You know we're gonna grow our R&D budget as well and continue to lead the world.
So I talked about this, the world's biggest data lake or data well. It's the deepest and most profound location of medical data on the planet. Nineteen billion nights of breathing and sleeping, de-identified, unlocked value. What have we done with that? We've lowered costs. We lowered the cost of setting a patient up on positive airway pressure by 50% through the digital pathways. We've increased adherence up to north of 87% from patients who are using a myAir app on top of the doctor using AirView and the full connectivity. What real world data is gonna come forward over the next five years? What are we gonna do with the exponential technology that is generative AI, and how are we gonna take it to the next level? 'Cause all that we've done has been with basic tech.
As we go to this next phase, I think adherence rates are gonna go up. I think outcomes are gonna be there. I think what we're gonna do is see a combination. Consumers will drive it. They'll combine their sleep health data with their cardiovascular health data, their diabetes health data, and they'll be doing it themselves. But hopefully, if we can work well with the health systems, we can actually help with whole person health and find pathways to empower patients with their own information, but also empower their physicians for treatment of the whole person, not just your lungs or your heart or other parts of your body. So, yeah, this image, and you'll hear more about this from Hemanth as he drills down and Bobby as he talks about our residential care software business, but we see the person in the center.
This says patient, patient-centric. To be a patient, you have to be diagnosed by a physician and go through the system. I see it as person-centric 'cause there's 2.3 billion people that need our help. But the ecosystem that combines Brightree and Somnoware and AirView, so, so, you know, software for HMEs, software for sleep physicians, software to run whole payer-provider systems. And then you look at myAir, where you say, "Actually, does a doctor have to treat everything, or should a patient be empowered with their own information?" So 8.3 million people have downloaded myAir, and they get those data every day. Dawn, the digital health concierge, now who knows where she is gonna take the world? Because the ability to then have a 24/7 doctor, you can ask any question to.
I'm not embarrassed to ask tech, right, a question I may not bring to my doctor. And how many people get access to care that can't afford to go to see that doctor? That's an interesting part. And then, obviously, you know what we've done with the cloud-connected devices and a wearable home sleep apnea test like NightOwl. I think that the combination of this is gonna, as we add more and more AI, is gonna increase the rate of innovation in our field like never before. The timer jumped up to 14 minutes, so I don't know if I've got 14 minutes left, but I'm just gonna continue at the pace that I was going because I was going fast. Okay. Look, there's a lot of mega trends out there.
I think the three mega trends that hopefully you hear from us on today are these three, and we'll go through them, and we'll talk about how we see them and how we're gonna embrace them. Number one, I was just talking about it there with myAir. Consumers are focused on their health. They don't consider it their doctor's job to take care of them anymore. It's their health, and I think that sort of tracking, improving, digitized self, quantified self, I'm gonna go and check what I wanna do with my body is a trend that has been sort of growing for the last five to seven years, but is now really accelerating. Number two mega trend is the tech industry and what they've done. I mentioned Samsung, I mentioned Apple, but we all know Gen AI is gonna revolutionize healthcare.
We all know it's gonna revolutionize every industry, but healthcare is probably the least efficient industry on the planet, and I've worked in a couple, right? I mean, in chemicals and steel and biotech, we were down to this, like Six Sigma plus, plus, plus. In healthcare, it's not that way. People go to this doctor. I mean, they are still using faxes for half of our outside hospital care software. I mean, it's nuts what's happening. What we can bring with that global trend of consumers embracing is incredible. But the tech industry and what we can bring by us applying these tools faster than ever before and capturing the wave of patients from their wearables, I think is the second big mega trend. And the third is obviously the pharmaceutical industry.
We have a brand-new class of medicines that are gonna be like high blood pressure meds. They're gonna be like high cholesterol meds. These GLP-1 class of medicines are going to bring a whole new group of patients into the funnel that we've never seen before. And, you know, I'll drill down a little bit on the data that we're seeing from the first 811,000 subjects that we're tracking through GLP-1 prescriptions, but I think that mega trend is one worth noting as well. So let's do a little bit of a double click on pharma and consumer tech, and then I'll hand off to Hemanth. So this slide you've seen. What may be different about it is the 10.7% higher of GLP-1 patients coming in.
You know, I was asked by someone, "Can you slice and dice this, dice this by BMI, by AHI, by age group, by gender?" And yes, we're working on all of that. I was with two physicians at the table over lunch talking about, let's get that peer review published. Let's have it evidenced down to the nth level of detail. I'm just a simple engineer.... I look at something comes in, something happens in the box, and something comes out. This new class of medicine is bringing people into the primary care physician community like never before, and it's bringing people that wouldn't go in there. They were embarrassed or didn't want to. It has what I would call a Botox effect, that there is an actual improvement in physical appearance that is drawing people in, but also this idea of this dream medicine.
I love it. I think it's early days to see, you know, what levels of penetration it truly gets to, but right now we're seeing 10.7% higher start rates for people who are on a GLP-1 med to start their CPAP. We're seeing 3.1% higher resupply rates at 12 months and 5.3% higher resupply rates at two years. We're gonna keep updating it. We'll keep analyzing it, and yes, we will peer review and publish by every slice and dice you like, but these numbers are not going away, and every time we update them, they get bigger. So the other double click quickly. Yeah, I talked about Samsung. FDA De Novo clearance, that's a lot of work. It's like 8-10 months work, and Samsung didn't have to do it.
I think they wanted to be ahead of Apple, but I love that they did it 'cause others can now 5-10K off that De Novo. But the fact that a pulse oximeter on a wearable in just three nights can be agreed by the FDA to get FDA De Novo clearance for moderate to severe sleep apnea detection, I think is a landmark for consumer tech investing in sleep health and recognizing this is a major problem. Apple are using actigraphy, so they couldn't use the pulse ox for reasons I won't go into, but they are doing a 20-day actigraphy assessment to detect for sleep apnea.
So it's actually almost like two technical experiments going out there, and tens of millions of people, maybe hundreds of millions globally, are gonna find out, "I have possible sleep apnea," and what are they gonna do about it? You're gonna hear today on what ResMed wants to do about it. I actually think this could be the biggest demand gen operating opportunity in a generation for us. Okay, now they've moved the clock to zero, so I'm gonna speed up. ResMed has the world's leading franchise, and it's a sustainable franchise in sleep apnea. We have the right to win in adjacencies. We have the right to win in insomnia because we interact with every sleep physician on the planet, and we bought a technology through Mementor of Somnio that has CBTI, that can scale.
We're gonna test it in Germany, but if that works, we can scale globally, and we'll be watching for more technologies. I think there's a lot more to come in the field of insomnia. You think about light, temperature, environment in the bedroom, and in the field of respiratory insufficiency, COPD, ResMed is already a clear leader, and I think we can take it further with high-flow therapies and beyond. In terms of health technology at home, we're the only strategic investor, that's involved with Brightree and MEDIFOX at a global scale, looking at how to take care of people, not like Cerner and Epic, with just digital health in the hospital, sick care system. We take care of people where we think healthcare should happen, which is in the home.
So look, at the end of last year, we put in a new operating model, which, you know, you're gonna see the people that were promoted in ResMed and the people we hired into the company to do this. But our operating model is about being product-led, customer-centric, and brand-enhanced. What does that mean for investors, for stakeholders? That means you're gonna see increased product velocity, you're gonna see increased profitable growth, and you're gonna see increased brand awareness. An emotional brand, a loving brand, but also a brand that has a clear ROI. Every single experiment is gonna have to show that we increase brand awareness, but also that person or patient or physician or provider who's aware makes that moment of truth decision to prescribe ResMed, to buy ResMed, to engage with our smallest, quietest, most comfortable, most connected, and most intelligent product.
So I will not introduce all fifteen of my team. You're gonna meet many of them here today. They're gonna get up and talk. I will just say this: It's an incredible handpicked leadership team. They are the best in the medtech industry. They're certainly the first in the world for sleep health, breathing health, and health technology at home. But it's not just them. We have a team of 10,000 ResMedians selling in 140 countries worldwide. We have the best culture on the planet of engaging with people in the field of sleep health and breathing health, and I hope you feel that throughout your day today. So I'll leave you with the three messages I started with. ResMed has an incredible market opportunity.
We have extraordinary track record, and I know with this team, with these products, with this technology, we'll be able to do so ahead. And the 2030 strategy, you're gonna dig into details with Hemanth right next, our Chief Strategy Officer, but you're gonna hear from everyone throughout the day. I hope you agree with me that ResMed is the innovation machine. ResMed's the innovative leader, and is gonna help one in four people on the planet to sleep better, breathe better, and live a better life in their home. With that, thank you.
Please welcome Chief Strategy Officer, Hemanth Reddy.
Hello, everyone. Welcome. Thank you so much for joining us today. On behalf of the entire ResMed team, we are incredibly excited to introduce our 2030 strategy to all of you today. The key takeaways from our 2030 strategy are, first, that it is a patient-centric, innovation-driven strategy that builds on ResMed's long track record of market-shaping innovation. It's a strategy that focuses on us on large, growing, and under-penetrated markets, with 2.3 billion people having unmet sleep health and breathing health needs.
Third, it's a strategy that changes the base of competition yet again. We've done this many times in our history. We're gonna do it once again, building on our market leadership, our strengths, our distinctive capabilities, in particular, our data assets, and harnessing the latest advances in AI. Fourth, we have an increased focus on accelerating market growth through an expanded set of drivers, and you'll hear more about that. And finally, we are poised for strong growth and sustained operating leverage through discipline and focused execution. This slide introduces our 2030 strategy, and I get there's a lot on it, so we'll sort of take it piece by piece, but it's a summary of our 2030 strategy.
It sort of captures the key underpinning choices that represent our 2030 strategy, and it really is the synthesis of a tremendous amount of work by so many ResMedians across our company, some of whom are actually in the room today. It represents our best thinking, our best insights, as we look to develop not only a winning strategy, but an executable strategy, and most importantly, a strategy that we're all incredibly passionate about. In fact, we've started rolling out the strategy across our company over the last several weeks, and it's been incredibly well-received. Our ResMedians across the company are incredibly energized by its vision and are so motivated to get going with the execution of the strategy, and we're getting going. Let's take a closer look at some of the key choices that are underpinning our strategy, starting with our vision.
Our vision highlights our focus on the individual, the person centricity, and the incredible restorative, energizing, and rejuvenating power of better sleep, better breathing, and care at the home. Our mission highlights the impact we seek to have with the words life-changing. It highlights our innovation focus with the words health technologies, and it highlights the relationship that we want people to have with our products with the word love. You heard about this earlier, but we really do want to create products that people look forward to using because they're simple, easy, delightful to use, and make such a profound impact to individuals on a daily basis in terms of improved health and well-being. Our focus areas are sleep health, breathing health, and health technologies at home.
The core focus of our strategy remains sleep apnea, and within sleep health, we're gonna continue to focus on sleep apnea, but also explore and expand into sleep health adjacencies such as insomnia and COMISA, where we can establish a strong and clear right to win, while also generating strong returns. In breathing health, we will continue our focus on home-based ventilation, leveraging the tremendous scale that we have across our devices, our digital solutions, and our commercial capabilities with sleep health. And health technologies at home represents an umbrella term that captures our devices, our masks, and our software solutions for individual consumers as well as for providers, including our residential care software portfolio.
And within this portfolio, we're gonna continue to focus on driving very strong financial performance, strong top-line growth, and continued strong operating leverage, but also have a renewed focus on unlocking the full synergy potential we have across the software portfolio in our sleep health and breathing health franchises. You'll hear a lot more about our plans in these areas from Justin, our Chief Product Officer, and from Bobby Ghoshal, our Chief Commercial Officer for the residential care software segment. Turning to the core of our strategy, the core of our strategy is really premised on two key concepts. One is products that people love, and two is seamless, personalized pathways. There's a lot more to unpack here, and we'll get to it in a few more slides, and in addition, we'll also cover how we're looking to accelerate market growth through an expanded set of drivers.
Turning to our core capabilities that underpin our strategy, we really have distilled it down to three key capabilities: our talent, our technology capabilities, and our trusted brand. These are long-standing strengths of ResMed's, and through our 2030 strategy, we're gonna continue to build on these strengths and extend them even further. Excuse me. When it comes to our talent, we're gonna empower our talent through our new operating model to drive much faster and more focused execution against a tremendous amount of innovation opportunity that we have. As it relates to technology, we're gonna continue to drive AI adoption, responsibly, of course, across all of what we do, across our innovations in terms of our health technology solutions, but also internally across our enterprise to unlock productivity gains.
Turning to building trust, we're gonna continue to drive our trust across our brand through leadership across clinical science, privacy, security, information security, quality, regulatory compliance, and sustainability. Turning to our goals and what we're looking to accomplish with this strategy, our financial goals are to deliver top-tier revenue growth, profitability, and financial returns. Our impact goal really captures the important and exciting journey we're on to empower 500 million people in the year 2030. Our strategy is grounded in our values, our refreshed values, and our refreshed behaviors. These have been guiding the choices that we've made across our strategy, and they are our cultural tenets. So with that, hopefully, you got a very quick overview of what the strategy is about.
There's a lot more that I'll touch on briefly, as well as the rest of our team will touch on, but let's get to the core of the strategy. As I shared earlier, the core of our strategy is really premised on two key themes. ... products that people love, and seamless and personalized pathways. So how do we deliver those? We have an incredible portfolio of health technology solutions that are widely adopted across one's health journey. We have market-leading therapies, market-leading consumer engagement solutions, and market-leading provider solutions, provider software solutions. Millions of consumers use our therapies and our consumer engagement solutions on a daily basis to sleep better and breathe better, and hundreds of thousands of providers use our solutions on a daily basis to in turn care for millions of people.
These solutions generate a tremendous amount of data, which Mick touched on earlier, which give us really great visibility into how an individual uses our products, but also how they navigate their journey, their healthcare journey, and what we're going to do through our 2030 strategy is a few key things. We're of course, going to continue to build out and drive the adoption of our healthcare solutions, and we're gonna continue to build our unmatched data assets, but we're really looking to drive three key shifts as a way to change the basis of competition. The first is, we're gonna drive much greater intelligence across our solutions through the use of AI. We're gonna drive intelligent therapies so people get much more personalized algorithms and personalized treatments.
We're gonna drive intelligence across our consumer engagement solutions, so folks get much more personalized coaching, nurturing, guidance, and motivation through their health journey. And we're gonna drive much more intelligent provider solutions so that people ultimately get much more personalized care. But our intelligence solutions also drive a greater level of workflow efficiency and automation for providers, and will also drive a much higher level of clinical decision support, with a particular focus on risk identification for sleep apnea and other sleep and breathing conditions. In doing so, we're gonna drive much more intelligent and personalized solutions. Second, we're going to connect our solutions much more deeply as one single integrated health technology ecosystem across an individual's patient journey. In doing so, we're gonna drive much more personalized and digital-enabled pathways.
So, driving pathway innovation to help many more people, more seamlessly and effectively get through the journey of diagnosis and ultimately treatment setup and treatment success. And the third thing we're gonna do is we're gonna embed a deep consumer design philosophy across all of our solutions, inspired by the best consumer brands and the best consumer health tech brands, to truly make our products simple, easy to use, and lovable. You got an early sneak preview of some of those in our product showcase. We're just getting started on that journey. Collectively, across these three shifts, we're gonna make our products much more intelligent and lovable, and we're gonna drive much more seamless and personalized pathways, and in doing so, shift the basis of competition. So what could that look like in practice?
You saw some snippets from the intro video that we just played, but imagine an individual waking up one morning with possible sleep apnea risk of their watch. They engage with our intelligent consumer engagement solution, a solution like Dawn, to learn more about sleep apnea, what it means to have sleep apnea be untreated. What are the risks of that? What are the potential ways to treat sleep apnea? How might they go about getting diagnosed or treated for sleep apnea?
They, in turn, get connected with a physician who's using Somnoware as a way to onboard the patient digitally, manage their patient workflows, get the individual diagnosed through a home sleep apnea test like NightOwl, and once the positive diagnosis comes back, engage with the individual, offer them the range of treatment options, agree with them that PAP, PAP is probably the best treatment option for them, and then e-prescribe their prescription to an HME via Brightree, also integrated with Somnoware, as a way to seamlessly ensure that an individual gets PAP therapy, starts using their PAP therapy, and has success with their PAP therapy. So that's the provider side of this.
From a consumer side of this, our digital consumer engagement will continue to nurture them, nurture them to diagnosis, from diagnosis into treatment setup by orienting them to PAP therapy, helping them get acclimated to PAP therapy, and once they start PAP therapy, ensure ongoing success with PAP therapy. In addition, we're gonna reinforce the motivation through integrations with the likes of Apple HealthKit, so they can see their myAir score in HealthKit and equally see their HealthKit data in myAir, and in that, drive greater reinforcement as it relates to how they're sleeping, their physical activity, and other key metrics. And so that's just one example, a very high-level example of how this could come to life in terms of driving more seamless and personalized pathways.
Ultimately, what we're looking to do is engage many more people earlier in their health journey, guide them in a more personalized and scalable manner through technology, to a seamless pathway to get diagnosed, treated, and be successful with treatment. In doing so, grow the market. In addition to our product and solution innovation and pathway innovation, we are also gonna accelerate market growth through a few key drivers. The first is branded omni-channel engagement with consumers and prescribers. We're gonna engage with consumers to really make them much more aware about sleep apnea and sleep apnea's risks, motivate them, nurture them, guide them through the pathway to our marketing engagement. Second is, we're gonna target prescribers to make them more proactively screen for sleep apnea and help them ensure that individuals are getting the right treatment for them.
The next key driver here is in addition to ongoing efforts to continue to grow our core geographic markets, we're gonna put more of a focus on accelerating growth in our fastest growing high potential markets. Markets like China, where we see tremendous opportunity to drive long-term growth. The third is we're gonna pursue strategic partnerships with consumer tech companies, with medtech companies, and with other health tech companies, as a way to more proactively identify folks who may be at risk of sleep apnea, and engage them on their journey to better sleep and better health. We're also gonna pursue M&A in a very disciplined fashion, with a specific focus on tuck-in M&A to further expand our portfolio of offerings.
And finally, we've had some really important and exciting successes with respect to new channels and business models in markets like Australia, China, and India, and we're gonna take learnings from those markets and apply them to our major geographic markets around the world in a way that's appropriate for those contexts. And in doing so, across these integrated sets of drivers, really reach out to many more people, expand our markets, grow our markets, and allow us to engage with individuals where they are to best serve them. We're gonna do all of this while driving operating leverage as well, and that's a core concept in our strategy. And the way we're gonna do that is through very focused and deliberate resource allocation.
This slide is representative of a framework we're using internally as a way to guide our strategy execution and our resource allocation. What we do each year, and this is really a feature of our new operating model, and, so what we do each year is engage with our leaders across the company to identify what are our highest priorities? What are the few key things we absolutely have to succeed with to achieve our 2030 aspirations? We call these our strategic imperatives. And what you see in this slide at the very top is six white boxes that represent our strategic imperatives for our fiscal year 2025. We complement that with what we call our key initiatives, our product roadmap initiatives, and our capability initiatives, and collectively, these things represent our growth investments.
We put a very strong discipline across these from a governance perspective with clear teams, leadership, accountabilities, our clear outcomes, well-defined metrics to define these outcomes, milestones along the way so we can pivot resourcing as needed, and apply the right governance model across these to drive their execution in a very deliberate manner. As importantly, we've got this red bar at the bottom, which represents our run the business activities. This, in fact, is the vast majority of what we do as a company, which is run our business day in and day out. Our colleagues who are sort of responsible for this activity really are tasked with two key things.
One is to ensure that we keep running our enterprise in a world-class fashion, while also continuing to drive efficiencies through scale and through productivity gains, so we can free up funding to invest our growth investments while also driving strong operating leverage. And in doing so, we drive strong growth while also driving strong operating leverage. And so hopefully that gives you a very quick overview of our strategy, some of the key aspects of our strategy that set us apart, and how we're gonna drive strong growth and operating leverage. And just to recap, this strategy is an incredibly exciting strategy. It's patient-centric, it's innovation-driven, it focuses us on large, growing, and under-penetrated markets. It's a strategy that changes the basis of competition, yet again, leveraging the distinct assets, capabilities, and strengths that ResMed has.
It's a strategy that is focused on accelerating market growth, and it's a strategy that's ultimately gonna drive not only strong revenue growth, but also consistent operating leverage. Thank you.
Please welcome Chief Product Officer, Justin Leong.
Thank you, Hemanth. Good afternoon, everyone. I'm thrilled to be here with all of you today to share more about how we bring to life our 2030 strategy with products that people love. I'm gonna start with three things that I'd love you guys to remember. First, we are laser-focused on growing the market and growing the market faster, as well as creating new sources of competitive advantage with our product strategy. Our addressable market, as you heard from Mick, is still highly under-penetrated. Second, we have a balanced portfolio of investments that will strengthen our core sleep apnea business in the short term, while also enabling us to enter attractive adjacencies in the long term. I'll detail how this product roadmap is structured to deliver strong returns over a multi-year timeframe.
And third, we have spent the last year benchmarking the best technology companies in the world, the Amazons, the Apples, the Atlassians, because we wanted to understand how they do product management. And we have accordingly built a team, a future-focused team, that is delivering intelligent, lovable products, most importantly, at high velocity. I'm gonna play a short video that's gonna give you a sense of our team's innovative and entrepreneurial spirit. I hope you enjoyed that. We had fun making that video. So, on this slide, I want to talk about how we're gonna drive growth and value creation. Through our product-led approach, we're gonna transform ResMed from being the leading sleep apnea company to the leading sleep health and breathing health company in the world.
The strategy starts with our core business, our sleep apnea core, and our number one priority is to grow that business and grow it faster because we have significant runway ahead. There are one billion people in the world with sleep apnea, and today we only serve a fraction, around 5% of the one billion. We believe we can accelerate our penetration of this market globally by delivering on our new product roadmap. Our second priority is to take the assets and capabilities of that sleep apnea core business, that great franchise we have, and grow new businesses in the broader sleep health and breathing health markets. And this is an area where we think ResMed can be the clear winner where there isn't one today.
Our world-class team and significant data assets, guided by our product-led mindset, will help us solve consumers' most important problems, driving significant growth and value creation. So that opportunity starts with the strong foundation we have today, the strong leadership position we have today. We are the clear leader in devices and masks globally for sleep apnea and COPD. And you can see on our left, our AirSense 11 and our AirCurve 11 devices, which have clear market leadership today. And we've also been known always for our incredible masks. Mick referred to that in the beginning, our heritage of amazing masks. And in the middle, you'll see our new mask, our AirFit F40, which is a great example of our continued innovation from our R&D team.
It is the most compact, full-face mask in the market, and the first mask you see here with a fully flexible cushion that molds to your face in any sleeping position, and it's really great for people who sleep on their side, and it's actually the mask I use every night, and I love it, and I was in Chicago about ten days ago on customer visits, and we heard amazing feedback from DME companies, from physicians and patients, and this mask is doing really well in the market today. Now, on the right-hand side, you see some of our digital tools, which have seen record adoption in the market. We have myAir, which consumers use, and AirView for providers.
Our current portfolio of market-leading products generates high levels of recurring revenue, scale economies in manufacturing, strong margins, cash flow, and valuable data that we can then use to create our AI products. So today, we have the smallest, quietest, most comfortable products in the industry. And as you heard, over the last ten years, we've changed the basis of competition, and we've built on this product advantage by connecting our devices to the cloud and by developing these software tools like AirView and myAir. And our connected ecosystem has unlocked tremendous efficiencies and higher revenues for providers through labor savings and improved patient compliance. And this has made ResMed the preferred ecosystem for physicians and DME companies, resulting in significant brand preference.
It's also enabled us to collect all that data on the right-hand side, including the 19 billion nights of data, sleep data, which in itself is a major source of competitive advantage. So you're probably wondering, what's next? On this slide, you'll see our new product strategy, and we're gonna change the basis of competition again. First, we are going to redefine PAP therapy with more personalized, intelligent, lovable products, designed in a consumer-centric manner to appeal to a broad audience globally. Second, we are simplifying care management with an ecosystem of intelligent software solutions that makes it easier for providers to diagnose and help people get set up and stay on our therapies. Third, we are transforming the experience for our consumers and patients, with a more consumer-centric, omni-channel go-to-market approach.
And fourth, we are expanding beyond PAP into new frontiers in sleep health, breathing health, and broader health adjacencies. So let's talk about the first point. As we redefine PAP therapy, we're gonna drive a shift from population management to personalized precision medicine. Artificial intelligence will make our therapies, therapy algorithms, more effective and more comfortable for patients. And these efforts, we think, will redefine gold standard PAP therapy, lifting adherence and widening the gap between our devices and competitor devices. Now, many of you have had the opportunity to check out our product showcase on the left, on my left and right, and we're incredibly excited. I think you've seen our new mask, the AirTouch N30i, which we just launched today. This mask was actually 15 years in the making, and it demonstrates our shift to consumer-centric design.
We think patients will love this mask, and it's gonna bring more people into the CPAP ecosystem. By incorporating advanced technology into a really compact, visually appealing design, I think it looks pretty cool up there. We've really pushed the boundaries of textile and manufacturing innovation to deliver superior performance, durability, and comfort. We think this mask, our first fabric or textile mask, will redefine what comfort means in the CPAP industry, and that is super important. That's gonna bring more people into our ecosystem. Now, not only are we gonna make our devices and masks better, we're gonna continue to simplify care management for our providers. Now, you can see three of our software products on the screen here: Somnoware, Brightree, and AirView. Now, individually, each of these software products delivers tremendous productivity for physicians, sleep labs, and DME companies.
They enable these providers to save money on labor, increase throughput of patients, get faster insurance verification, and ultimately provide better service to our patients. Now, our unique advantage is we own all three of these assets, which go across the full patient pathway. And what we're doing is, we're increasingly integrating them together. So we are making them fully interoperable, evolving them from point solutions to an ecosystem that gives provider an end-to-end view of the patient journey. And my colleague, Bobby, he's gonna talk more about this in his presentation, but this is a really important piece of work that our software engineering team is already working on today. Now, beyond that, we also understand that consumers' expectations of healthcare are changing.
The way they want to interact with the healthcare system is becoming more consumer-like, with the proliferation of all these products that you can use to track your health and track your well-being. So we're gonna transform the experience for our consumers with a more omni-channel approach that reaches them where they are. In many of our markets outside the U.S., we've already made this shift, and I wanna highlight three examples, actually from my previous role, leading Asia and Latin America, to show some of the learnings that we can take from there to other countries. So you'll see three pictures on this slide. First, on the left, this is a picture of one of our stores in Australia or New Zealand. We actually have about thirty physical stores in these countries, selling products directly to consumers.
And you can see it looks very much like the product showcase here in this room today. Now, Australia and New Zealand is largely a cash pay market. And from a design perspective, these stores look very much like, you know, the best retail stores in the world, and that's where we've taken inspiration from, the best consumer and the best technology stores. Since we launched this new channel and turned on our consumer marketing engine, we actually managed to double the growth rate of our business and the entire market. And now Australia and New Zealand is one of the best performing and most profitable markets for ResMed globally. Now, second example in the middle, that's about China, where we've also instituted an omni-channel approach.
So consumers in China, if they want to treat their sleep apnea, can go through the traditional hospital channel, or alternatively, they can order a home sleep test through a WeChat mobile app and purchase a device directly from a ResMed e-commerce store, so a purely digital pathway. And in the middle here, you can see a picture of actually our own ResMed live streamers explaining our products online, directly streamed from our office, our ResMed office in Hangzhou, China. And this capability and team actually came to ResMed through an acquisition, a very successful acquisition we did in 2022. Today, e-commerce is the fastest growing channel within our China business. And since I joined ResMed, our total business in China has actually grown 10, around 10 times, making it one of the most important markets for us outside of the U.S.
I'm bringing these learnings to my new role as Head of Product for ResMed globally, and we're developing more of these new omni-channel pathways and increasing investments in demand generation alongside our marketing, Katrin's marketing team. And we're doing this also hand in hand with Mike's revenue team. In the US, we are working alongside our existing channel partners to drive efficiencies and better outcomes for patients and providers, and we're also piloting some new models that will help create a more seamless and intuitive journey for our patients. Now, lastly, on the right-hand side, in Australia and New Zealand, we actually have teams of sleep coaches, so people that guide consumers through their journey, and we've augmented this sleep coaching capability by creating Dawn, and Mick, Mick already talked about Dawn. Dawn is our generative AI digital concierge.
We've launched this in Australia and the US, and this chatbot has actually reduced contact inquiries by around 40%, providing customers with timely, actionable feedback, and Dawn's large language model was actually trained on our own internal data. So as you can see, we've got a really clear plan to grow our core sleep apnea business. But we think there's a significant opportunity for ResMed to capitalize on the growing trend for people to all over the world to look for better overall sleep, not just to treat their sleep apnea. Like obesity, sleep is seen as a lifestyle problem because it causes significant physical and mental health issues in society. For example, poor sleep is one of the major causes of depression. So on the left-hand side, you can see sleep economy is massive.
People are spending more than $85 billion in this market, including spending on smart mattresses, supplements, snoring devices, sleeping tablets. It's really huge. Our annual, our ResMed Annual Sleep Survey, conducted earlier this year, reinforces that poor sleep is really a global problem. 40% of people, so four out of ten people, report less than three nights of good sleep, and 56% of women reported disturbed or broken sleep. Survey also told us that one-third of people are tracking their sleep with wearables, like the Apple and Samsung watches, which now can also host our myAir app. I recently met with some doctors from Stanford, including Dr.
Pelayo, who's in the audience at the back here, and they're actually working with champion athletes like Olympic swimmer Katie Ledecky, NBA teams, NFL teams, and all these great athletes understand that sleep can be the difference between winning and losing at the margin. Our goal is to make ResMed the leading brand in all sleep health. Let me tell you a bit more about what we're going to do beyond that. Beyond sleep apnea, we think we can extend into three areas: sleep health, breathing health, and overall health. We've actually set up a dedicated incubation group within my product organization to evaluate each of these areas in a disciplined way, utilizing lean startup methodologies. Sleep apnea and insomnia are by far the two biggest problems in sleep health, but right now, we only really address half of that equation.
There are 860 million people in the world that suffer from insomnia, with the main treatments being pharmaceuticals and cognitive behavioral therapy. Now, in 2022, we acquired Mementor, a startup with the first reimbursed digital treatment for insomnia in Germany, based on cognitive behavioral therapy, and we're currently investigating other markets to deploy this product. Now, in breathing health, we are building on our leadership in non-invasive ventilation for COPD patients to develop the high-flow therapy market. So high flow, high-flow therapy is widely used in hospitals today, but we are now generating evidence for its efficacy for use in the home. Beyond sleep and breathing health, we believe that sleep can be the window to your overall health, your cardiorespiratory health, your metabolic health, and even your mental health.
Beyond wearables, like the Whoop and the Oura Ring, we believe there's an opportunity to develop holistic medical-grade wearables, and ResMed has the right to win in this space based on our expertise in sleep and breathing, which are obviously two of the key pillars of overall health. Now, how are we gonna do all this? I'm gonna provide a little bit more detail on how we've organized ourselves to execute on this product strategy. So we've transitioned away from a traditional medtech structure. We've actually organized ourselves in product teams, much like the structures of leading tech companies. We've brought together our hardware and software teams to create a more seamless experience for users. And we've given our product leaders the responsibility to run the products as businesses.
Our product leaders manage full stack autonomous teams, which have clear missions based on solving specific customer problems. The governance around this is centered around agile methodology, where work is based on sprints, program increments, and we measure progress in quarterly business reviews, QBRs. A great example of this approach was our new product, Dawn, the generative AI chatbot, which was launched in less than six months. That's really incredible for a very innovative product like that. This new structure has helped us attract incredible talent as well, particularly into our AI ML team, which now is about 50 people. How will this translate into financial results? Our product roadmap is designed to deliver value for our shareholders by growing by accelerating revenue growth and creating margin expansion.
On the left-hand side, by increasing our product velocity, we'll drive higher consumer adoption and enhance penetration in the sleep apnea market. Creating more seamless pathway and increasing patient adherence will capture the demand from our new marketing initiatives led by Katrin's team. Through our expansion beyond PAP, we will develop new long-term growth engines for ResMed. Then on the right-hand side, we'll introduce new high-margin software offerings and develop new sleep health products that will increase the lifetime value of our existing patients. We will also continue to focus on high return on investment mask and consumables projects, with the capacity to scale this up if required. To conclude, our product strategy will not only redefine ResMed, but it's gonna revolutionize how the world breathes and sleeps.
As I mentioned at the beginning of this presentation, we are laser-focused on growing the market, growing it faster, as well as creating new sources of competitive advantage. Second, we have a balanced portfolio of investments to strengthen our core sleep apnea business while expanding into attractive adjacencies. And thirdly, we've structured our mission-driven product teams to deliver intelligent, lovable products at high velocity. So with that, I'll turn it over to Bobby Ghoshal to discuss the exciting work he's leading in our residential care software business. Thank you.
Please welcome Chief Commercial Officer, Residential Care Software, Bobby Ghoshal.
Thanks, Justin. That was a very exciting vision of the future. Good afternoon, everyone. I'm really happy to be here and excited to be here in slightly sunny New York. My name is Bobby Ghoshal. I'm the Chief Commercial Officer of our Residential Care Software business. Let's discuss ahead about what our business has been doing. Continuing with the theme that you've heard earlier, software plays a critical role in the future of ResMed. In the software business, we have been focused on solving provider problems, using intelligent software and data solutions, with an aim to improve patient experience and their health outcomes.
We are equally focused on delivering business outcomes for our customers and play an important role in the overall, lowering the overall cost of healthcare, while slowing the progression of chronic disease among our patient population that our solutions serve. As noted by my colleagues before me, there are significant pressures on our healthcare system, both here in the US and indeed globally, and particularly relevant to our industry, there are certain macro trends that I'd like to draw your attention to. For example, the number of seniors over the age of 65 in the year 2040 will be more than double the number it used to be in the year 2000. That's over 80 million people. And that, ladies and gentlemen, is the silver tsunami. I'll be there in a few years, and that our healthcare system, you know, faces.
Consequently, the demand for physicians and clinicians are increasing significantly. And as you couple that with an increased demand with the challenges of labor shortage, we know that we have a problem that we have to solve, and we think that this solution lies in AI and using technology and digital health, which we think will play a very critical role in the future of healthcare. And we expect that there will be an acceleration of virtual care moving towards the home setting, and more of the administration and documentation tasks will really be done by automation and AI. So really, those were the industry dynamics and the macro environment that we are operating under, specifically for our ResMed software business, focused on residential and home care.
We are strategically positioned, though, to take advantage of this direction, overall direction of the industry. And just as a reminder of our scale, which, you know, across the care continuum, crosses residential care, home care. We have millions of patients who are managed by providers who use our mission-critical software, ranging from electronic health records, ERP, and comprehensive billing platform, as well as ancillary software, data, and service solutions. And we do this both in the U.S. market through our leading Brightree and MatrixCare brand of products, and more recently in Germany through our MEDIFOX DAN brand of products. Our platforms process over $48 billion of claims annually in the U.S. alone, and with over 700,000 active users who log in daily to our systems to take care of patients.
We believe that the TAM for our industry is now over four billion, including Germany, and that has grown tremendously since our last Investor Day conversation. Before I get into some of the exciting growth drivers for our software business and our view of the future, I just wanted to take a minute to reflect on the transformation and the strength of the ResMed software business. Over the last few fiscal years, we have executed consistently to grow both our top-line revenue and through the successful integration of MEDIFOX DAN acquisition. We exited Q4 of FY 2024, the last fiscal, with 10% fully organic top-line growth, and we are projecting high single-digit to low double-digit growth in FY 2025.
Our growth is driven by our expanding customer base with new accounts, as well as growth within our existing account base as our customers adopt more technology solutions and expand their digital footprint. While we have worked hard to accelerate our top-line growth, we have simultaneously focused on profitable growth, and we've expanded the margins for our software business pretty significantly. Both gross margin, which is accretive overall to ResMed Group, as well as net operating profit. We expect to continue this momentum of accelerating profitable growth, projecting double-digit net operating profit growth in FY 2025. We are focused on driving scale efficiencies across our portfolio, investing in growth areas, and maintaining expense discipline across the business.
Last but not least, we've been making active portfolio management decisions in a disciplined way to ensure that our investments and our resources that are targeting the areas that achieve maximum benefits for our customers, our patients, and indeed, our business. So in the next few minutes, I'd like to share some key insights about our software business, and specifically the tremendous synergies that we have with our core business, the sleep business. And we believe that these are key growth drivers for our 2030 strategy. Now, some of these synergies may not have been apparent, and hence, I wanted to highlight those today. So there are several categories of these synergies with our sleep business.
Two that I'll go into deeper, are the revenue synergies through our resupply platforms, and in the longer term, our OSA identification initiative within the patient population across our care settings. Another important one, that I'll discuss today is the infrastructure leverage that we get the benefit from the scale of ResMed. There are several others, but let's take a deeper look at these three case studies, which I hope will clarify for you how the software business and the sleep business are uniquely aligned to bring the benefits to providers and patients alike. So let's look at resupply. You've heard resupply throughout this presentation, and by now you're well aware of the importance of resupply for our patients for the treatment of sleep apnea.
This is the biggest area of synergy between our software and our sleep business, and one that has grown tremendously over the last few years, accelerated mainly by the acquisition of our tuck-in solution, Snap, and its integration onto the Brightree platform. For our provider customers, resupply plays a very important role in the overall patient experience. But really, the process of patient management begins much earlier at intake. Here, our industry-leading Brightree platform plays a really important role in ensuring efficiency and continued improvement of patient health outcomes and provider business outcomes. The unique advantage we have is our ability to help a large segment of HME customers who utilize our Brightree platform, and that they run their business end-to-end on Brightree.
We have delivered significant value to the HME industry by automating, digitizing, and all the way starting from e-prescribe, which is at the referral end, through the very complex patient intake process. This includes insurance authorization, documentation, logistics, inventory management, and patient setup. Following patient setup, this is, we have the tracking of compliance and then filing of the insurance claim all the way through automated resupply. The way we have worked this, this is no touch, end-to-end, all the way from e-prescribe to resupply, and this is really the ecosystem that just Justin mentioned. Right. So, our Brightree resupply platform supports several million patients, and helping adherence to therapy, as well as, and results in masks and accessory revenue for our sleep business.
In order to deliver a seamless patient and provider experience, we have invested very heavily, both in the Brightree platform, overall platform, as well as our resupply solutions, such as Snap, and connected it to AirView and MyAir, and created this very unique and powerful ecosystem. Our plan is to further infuse automation and AI across this entire process, and specifically, to reduce friction at the patient intake side around documentation, authorization, and billing. Resupply is a key driver for our future growth, both for our software and our core business alike. We are planning to launch a Snap platform in this fiscal year aimed at HME providers who are not on our current Brightree platforms. We are also evaluating the potential of taking this power of resupply across, beyond the US as well in other markets.
Next area of revenue synergy is related to the large population that we have across our care settings, such as skilled nursing, home health, and long-term care. We have a rich data set of contextual clinical data, and we are able to determine through our analysis that on average, only about 4% of patients have been diagnosed, and even fewer who are being treated for sleep apnea. Now, we know from our adherence studies or prevalence studies that OSA can be as high as 56% in this segment of the population. Given our expertise in this area, we have been in conversations with provider customers about the importance of treating these patients with the right therapy. We are really encouraged by the feedback from our customers.
And given the low treatment rate that we see currently, we feel that we can help a large number of patients with solutions for the treatment of sleep apnea. And the virtual end-to-end patient pathway that Justin described earlier has immediate applicability. And the neat thing is this is all within our ResMed ecosystem, and I feel that the potential is very large within this underserved population. The third case study is around leveraging the infrastructure and technology platform the capabilities that we have across our software and our sleep business. And there are three main components that I'd like to highlight to you today. The first is the technology infrastructure and benefits of scale in areas such as cloud computing, cybersecurity, and privacy. And second focus area, no surprise, data and AI, and finally, interoperability.
ResMed has a very strong practice in cybersecurity and privacy, and our software business has benefited immensely from this capability across all our acquired assets, and we've raised the bar in each of these critical practice areas. By building on a common cloud platform, we've seen the benefits of scale, cost efficiencies, as well as velocity of innovation. Our plan is to continue to standardize on this common platform, accelerate the speed of innovation further, eliminate redundancies across our software solutions. Moving on to data and AI, as Mick mentioned earlier, this is a huge area of emphasis and value creation for us.
We have incredibly insightful data across our care settings, both clinical and operational, and these become even more powerful when we are able to join the data, the de-identified data sets across all of our solutions. And ResMed is really unique in our ability to bring together data from our residential care software solutions and therapy, and to provide very unique, actionable insights that improve patient outcomes. And we do this by leveraging a common data platform across all of these. Our ResMed data science team is able to innovate on new AI solutions built on top of this platform. And one example of this is our AI-driven routing and scheduling solution from MEDIFOX DAN called AdiutaByte.
And this is a solution that we are piloting across many of our solutions, and we've seen material improvement in efficiencies in our home health business, as well as our German home care business, where we are piloting these new AI capabilities. That's just one example of several where we are leveraging our portfolio across our solution set. And finally, interoperability, which is a critical enabler across our ecosystem, both within our ecosystem as well as our third parties who integrate with us. And having a consistent longitudinal view of the patient as the patient moves from care setting to care setting is a game changer, and this is something that's unique to ResMed, and we bring tremendous value overall to the healthcare ecosystem through this capability.
So finally, three takeaways that I want you to remember from this: We are deeply committed to improving patient experience and outcomes and reducing cost of care. Number two, our track record of delivering strong financial performance, disciplined portfolio management, and our continuing efforts to maximize value for our provider customers. Third and final, the significant and growing synergies between our residential care software and our core sleep business. Well, thank you, and I think we're gonna take a quick minute to set up for Q&A. Amy, over to you.
Thanks, Bobby. Awesome. Well, thank you. I hope you've had a chance to get your questions ready. We're ready for our first Q&A session of the afternoon. So we have about thirty minutes. We do have mic runners, so we do wanna encourage questions from the room. Just raise your hand, somebody will bring you the mic. Please introduce yourself with your name and your firm, and give the panelists a chance to answer your questions. For those of you joining us online, please go ahead and use the submitted question box to send your questions in. We have a team of folks who'll be looking after those, and we'll get your questions asked live if we haven't already asked and answered.
And with that, I'd like to go ahead and invite our morning panelists, or sorry, our first half panelists back to the stage. Mick, Bobby, Justin, Hemanth, and we'll get going.
Do you want us to come out?
Come now.
Okay. All right.
Awesome. All right, so who wants to go first? Anthony.
Thank you for having us at the Stock Exchange today, and for a detailed first session. We appreciate all the detail. Anthony from Mizuho. First, my wife did tell me to come home with the AirSense 11, to prevent more-
We will charge you, Anthony.
Yeah, I-
We're gonna charge you.
I may take up on the offer.
Accepted.
But first, there was a lot on just the funnel, Mick, in several of the sessions, and maybe just at a high level and zeroing in on the U.S. market. I think we have 45 million or so patients in total sleep apnea in the United States, and there's a lot of debate on what that true diagnostic rate is today. And then there were several sessions where we're speaking about unlocking that further and widening the funnel. So what percent of that 45 or so is being actively diagnosed today, and where do you think that can go in the next three years? And I'll have one follow-up.
Yeah, no, it's a good question. So I mean, I think the latest epidemiology is in the range of 50 to 70 million Americans who have obstructive sleep apnea, and their AHI above five with symptoms or 15, with or without symptoms. And so, yeah, 50 to 70 million. Yeah, look, our penetration rate into that in the U.S. is somewhere in the 15%-20% range, so 80%-85% of the opportunity is still in front of us. But the real question isn't so much about how big is that? Because it's, it's always been our opportunity. There's a big number of people suffocating, and they don't know about it. What's changed since our last Investor Day three years ago is that Big Tech has invested a lot in this.
Samsung invested eight months and has now got FDA De Novo clearance. Apple had to come up with a brand-new technology to get sleep apnea detection because they couldn't use the pulse ox. And I'm just excited about that. You look at Whoop and all the different wearables, Garmin, all the others are starting to have sleep health, but also sleep apnea screening capabilities.
Our big challenge is, and you'll hear more about this later from Katrin, is it's not just demand generation, demand gen, it's demand capture and demand conversion into our pathway and helping scale home sleep apnea testing, diagnostics procedures, and set up capability to the sort of digital models that you heard about from Justin that we're using in some of the other 140 countries we look at. Because I think the U.S. is. It literally is the most. It's the best healthcare system in the world if you're really, really sick. We have the best doctors in the planet, at Stanford, at Harvard, at Mayo, but the inefficiency of how to get from A to B is incredibly bad. We see that.
It's difficult to find access to physicians, access to care, to diagnostics, to payment, to procedures, and so bringing seamless, frictionless pathways is our goal, and that's how we're gonna move 50, 75, 100 basis points above standard market growth, leveraging this tidal wave of patients from consumer and from pharma. But look, maybe I'll hand down the line. I don't know, Justin, if you have anything to add or Hemanth to that?
Yeah. I mean, Anthony, I'd just add, you can probably see on the table in the middle over there, our NightOwl home sleep test, which is available in the US. This is an incredibly simple, and also affordable sleep test. So as we see more and more people coming to the top of the funnel, we can really scale with these types of new technologies that can diagnose patients in a really quick and easy way.
And just to follow up, I'll hand it off. When we think about Samsung and Apple, I believe today they cannot prescribe CPAP from the wearable. So is the idea the wearable drives it to NightOwl, Itamar, and then they prescribe? And then as we look forward, you know, how will ResMed work with Samsung and Apple to open that up further? Thanks.
Yeah, these are screeners. They are not diagnostics. I don't think any payer in the country is gonna say: "Oh, yeah, from the wearable, write yourself a prescription, go for it." And we don't want that. Actually, even in Australia, where you don't require, you do not require a prescription for a CPAP. We work with the physicians to get a prescription. Try to get an Aussie to spend $1,500 on a device, a consumer medtech device without a prescription. They won't do it. And we think it's the right thing because empowering someone that this is medical care with a physician and working with them is actually 100% the right thing to do. But to your point, yeah, many people. The hardest thing we had was people were in denial. I don't snore. I don't stop breathing.
I don't have suffocation. And you can deny your bed partner all you like. "No, I don't. You're lying. You're just saying that 'cause you want..." Really? Why would they? They're trying to save your life. But now, you've got a little piece of tech on your wrist, and it is telling you objectively, "Not only do you suffocate, it's 15 times per hour. This is really. I don't care about your symptoms. Go to the doctor now." Yes, turning that, we're gonna need scalable home sleep apnea testing, scalable systems to help patients through the pathway, and we're gonna partner with our industry to do it. You just heard from Bobby. We bought Brightree 2016, eight years ago. We brought more efficiency to home medical equipment through the purchase of Brightree that combined with the efficiency we do through smaller, quieter, more comfortable devices.
So we think about the industry holistically. We're not just gonna sort of throw a bolus of patients at the industry. We're gonna help partner with them on these types of methodologies. But to answer your first question, you have to pay for the AirSense 11, Anthony. Like, but, you know, come on.
Out of pocket.
Out of pocket. I see two over here.
Right here.
Okay.
Hey, Mick. How are you?
Good.
Brett Fishbin from KeyBanc Capital Markets. So you guys spent a decent amount of time talking about, you know, broader goals to become leaders across both the sleep and breathing health markets beyond your current products in OSA and COPD. So maybe just, focusing on insomnia specifically, you know, can you just provide a little more detail on how you think that market's underserved today? What you think ResMed's goal can be over time? Just as a follow-up to that, if you think this initiative is more driven by organic R&D or if you need to do more acquisitions?
I'll say one thing first is that the epidemiology of 860 million, that came from ResMed's research with key opinion leaders in the field, like you'll hear from later today. Everybody knows insomnia is a problem. There's a large pharmaceutical industry based around drugs that get you to sleep and other ones that wake you up. And so you take this pill to go to bed, this pill to wake up, and a pill for everything. And as we were investigating cognitive behavior therapy, which is really counseling and stress relief and mental health, and I think during COVID, people really realized the impacts of mental health and other aspects on healthcare, and leads to depression, suicide rates, as well as car accidents and others. But insomnia is an incredibly large disease.
It's eight hundred and sixty million people. Yes, we bought Mementor, and we have Somnio, the app. We're scaling it, being paid by the German government through that experiment. It's a paid experiment to test, does it work in Germany? Can we copy and paste to other parts of the EU? For sure. Can we copy and paste to every country? I don't know. Will we need more tuck-in acquisitions? Probably. I think there's a lot more than just an app and engagement to get insomnia treated, but Justin, your team's looking at this really broadly. What are your thoughts on, on insomnia?
Yeah, I mean, I think it's a huge unmet need. I mean, there are sleeping tablets. Most people don't wanna take sleeping tablets. Dr. Pelayo can probably talk about this more later. Cognitive behavioral therapy is the gold standard, but not many people have access to that either, and it doesn't work for everyone, so there is a lack of solutions in this space, right? Actually, people in my team are currently talking to and working with some of the leading insomnia experts in the world, trying to understand insomnia better and think about new solutions in this area, and there are some new inventions that are currently available on the market, so we want to help the industry develop more solutions in this area. That's how ResMed was founded. We, you know, commercialized an incredible invention from Colin Sullivan.
So we think there's a big opportunity here.
Look, you don't have to draw too far to stretch. I think the attendees here will get a giveaway of a sleeping aid mask, right? You can feel how comfortable that is. I've been. I thought it was a little corny, so I wanted to have the gift myself a little earlier. So I've been using it the last month. I can't sleep without it now. I need my AirMini, my AirSense, and now this sleep mask. If we're a company that can create wearables, we have wearables that you wear at night for a minimum of your whole duration of sleep, if you're getting proper treatment. Why wouldn't insomnia require just a little bit more than the coaching? Why wouldn't there be some temperature, some light, some engagement with you?
So I think there's incredible organic tech ResMed can bring, and expertise, knowing all the physicians and the research on the planet. However, probably there's some technology here and there that would be good to add to our portfolio. But I think that COMISA part alone will pay for the work we'll do in insomnia. The insomnia stuff is upside, the pure psychology, or neuropsychology-driven lack of ability to get to sleep and stay asleep. I don't know who's handing the mic, so there's two hands here, and there's two over here, and a few online. Sorry, you didn't come to New York. No, please do whatever Amy said.
I think over here.
Hello, Laura Sutcliffe from UBS. Thank you very much for having us here today. Could you talk a little more about what we should expect from high-velocity new product launches, over the, let's say, medium term? Is it all focused on masks, which you flagged as high ROI? Are you not gonna do so much on the devices side? Should we be thinking more about stuff outside of OSA? Sort of, where should we be looking?
I like the question 'cause velocity is speed plus direction, so she's asking for a little bit of direction. Justin?
Mick, Mick tells me every day he wants higher velocity, so that's the message of the team. It's both, Laura. It's gonna be higher velocity devices, and, and masks. We want the... And we think there's-
And digital.
And digital. And digital as well, obviously. We think there's incredible potential in all three categories to accelerate our innovation. And that's why we've, you know, reorganized in these autonomous product teams, much like these tech companies, to do things at pace. And that's really the key direction to our teams.
I was reflecting on Justin's remarks earlier where he said, you know, 15 years to get a mask to market. I saw some people in the room like, "What?" The materials science that it takes, like we do medical grade liquid silicone rubber manufacturing on a scale that no one else on the planet does, in Singapore, Sydney, and parts of the US, Atlanta, and so on. But manufacturing a plastic, like, to create that pneumatic seal and keep someone perfectly breathing with the pneumatic stent all night, is a science we know incredibly well for 35 years. Bringing a material, like think a bedsheet, like a material like that, that you sleep with, that you should want on your mask.
I was like, "Oh, yeah, you can have it on the headgear and all around that," but here you can't have it touching the nostrils, the nares, the most sensitive part of the face, and has to form a perfect seal. So this is why some of those technologies are long lifecycle, like the material science of a wearable that feels like a bedsheet that's now on your face. But the digital clock speed of that, the velocity on that should be super fast. I love that we're in the Apple Health ecosystem, healthcare, Apple Watch, Samsung. As all these tech companies come, we need APIs both ways. Their data into us, to Anthony's point, you screen, now what?
Our insights into theirs, because they're gonna have access to data on cardiac, and exercise, and diabetes, and everything, and the consumer, the person, should be able to access their whole healthcare.
Maybe one more, if I can. Will GLP-1s or wearables make a bigger contribution to the funnel? Sorry, that's a horrible question.
No, it's not horrible. It's I think, I just look at the scope and reach of the different companies. Apple alone, what? $3+ billion market cap, Samsung, about that. They, they're just so much bigger, the consumer tech companies. They have so much more reach to people. Pharma spends a lot of money on D2C advertising, but I question, I mean, I know it's effective. Obviously, they keep doing it, so it must be. But you watch that, and you say, we know a whole lot more people are showing up at primary care physicians, driven by pharma.
We're seeing that, and we've seen 811,000 patients that we're tracking, that, the deidentified data we know that if they get their GLP-1 prescription and a CPAP prescription, you've higher propensity to start, a high propensity to order it one year and two years. It's the early days. Samsung just got their clearance a couple of months ago, you know, Apple, like a couple of weeks ago. I look forward to... These companies are very good. It's all cloud-based. It all rolls out. People will just start finding out they've got it.
What I've challenged the team is, we've got to be ready to capture all these balls that are thrown in the air and make sure they land in the right buckets because I don't want people, "Oh, I've got a problem, but I'll deal with it next year when I get an appointment with a doctor." It should be, "No, I can deal with it now with a pathway, and I'm in that pathway." Something like those experiments we talked about in Asia, Australia, and China were the two examples you heard from earlier today.
Hi, I'm Mike Matson from Needham & Company. So I think it makes sense that, you know, the point you just made about the GLP-1s and the, you know, the wearables kind of adding to the, you know, the top of the funnel. But, you know, I guess I'm concerned about the ability to get those patients out of the bottom of the funnel. Is that a limiting factor? And, you know, do we need to see more, you know, primary care doctors kind of prescribing CPAP? And, you know, to what degree are they playing, you know, right now in doing that?
Yeah, so primary care, I mean, look, there's it depends on how broad you go with the term PCP, right? But there's primary care physicians, maybe 300-350 thousand of them in the United States alone, if we just take this country that we're in right now. In terms of specialist, sleep specialist physicians, it's more on the order of 5,000, and we know all of them, and all of them know us. Scaling from, you know, 5,000 to 350,000, we can't and won't invest SG&A to do that. However, we do know who are the high-velocity GLP-1 prescribers. These data are known. There's IQVIA, Inovalon, Doximity, all these companies and all these doctors engaged in these ecosystems.
So if we know the 10%, the 35,000 PCPs who are doing this, and if they're engaged in GLP-1s and they're interested in this potential new indication for use from a company in Indianapolis, and their drug that may or may not get an IFU in November, plus or minus a month, then we can look at the subset that we think have a high propensity to do that, and the subset of them where there's a scalable sleep apnea pathway already established that we don't even have to go. So you start overlapping the circles like we're doing with sleep apnea and insomnia around that, you can start to get down to a couple of 10,000 physicians. And I just don't s o we're not gonna engage all PCPs.
But a GLP-1 prescriber who has a propensity and a pathway to digital sleep apnea care in their area, and that they've used it before, even if they used it once, once a month, and a sleep physician's used it 100 times a month, they're at least aware of it. And they've, you know, checked that box that I want to be talked to by folks, right? 'Cause then, if Doximity or IQVIA don't have them, we don't know who they are. But if they've checked that, that's a very engaged group of physicians, and I think we've always wanted to unleash the power of primary care physicians to get involved in this industry. And you can't keep up with even the number of fellows coming through the program. ResMed sponsors fellows to come through the American Academy of Sleep Medicine.
There just aren't enough doctors to keep up, but the digital, the capability, and our ability to create pathways that are new, I think can empower tens of thousands of primary care physicians who have already said they want to get involved, and they're already looking at weight loss, which has always been a part of sleep apnea treatment, and CPAP, and the overlap's there.
Okay, got it. Thanks. And then just in terms of the other, you know, you've been talking about these other respiratory diseases for a long time, and, you know, I maybe there's something I've missed, but I don't really know of any kind of material revenue that's being generated from those. So, you know, are there any specific things you could point to in terms of your pipeline or timing, in terms of products or software you're planning to, you know, to launch, to really try to, you know, capture some of that revenue opportunity?
I think it's a great question for Hemanth.
I'm happy to get started, and so I'd say a couple of things. One is our respiratory care portfolio, our breathing health portfolio, is actually a meaningful contributor to our revenues today. So our non-invasive ventilation for the home, addressing respiratory insufficiency for COPD, obesity, hypoventilation, and many other conditions, represents probably a double-digit portion of our revenues today. That's a segment that we're gonna continue to grow through scale across our sleep health and breathing health platforms. And in that, you may well see sort of new modalities that we're testing and launching in different markets to further expand.
And so we're gonna continue to invest from a device and therapy perspective to grow that portfolio in a measured way, looking across the set of opportunities we have across sleeping health and breathing health and residential care software to drive collective growth of the enterprise, but it remains a focus for us.
Awesome. We're gonna go to a question from the online audience. Bobby, this one's for you. So you mentioned that Snap Resupply will be going to HME providers not on Brightree. How will they access Snap, and what percentage of HMEs are not currently on Brightree? And this is from Craig at RBC.
Yeah. So, the last part of the question first is, we have maybe about 55% market share. A couple of thousand of the top HMEs in the country use Brightree. In terms of Snap software, and, you know, a lot of them leverage Snap software. What we've done now is to decouple the integration you know, deep integration we had built for Snap, yet bring the benefits of resupply to those customers who are not necessarily using Brightree for their billings platform, and they may be using something else, they may have some homegrown systems, but they'll also benefit from the incredible algorithms that are built into the Snap platform. So that's the product we are launching in this fiscal.
There's a couple up front here. I'll trust the process.
Thanks. Matt Taylor from Jefferies. So I don't wanna steal all of Brett's thunder, but so far you've talked about your markets growing mid- to high-single digits over the long range plan and trying to outgrow that. And Mick, maybe I'll ask you, if you are to outperform those goals, what do you think would be the most likely sources of outperformance? And if you were to miss those goals, what were, what are the biggest risks to missing them?
Yeah, so and Brett will go a little more detail into, you know, some long range forecasts and what we wanna do with the bottom line, clearly get leverage and be ahead of top line growth. Clearly, the three mega trends I spoke about are how we're planning to outperform. And so consumer awareness and engagement, the fact that there will be tens of millions, hundreds of millions of people finding out the problem, and that they now cannot deny it, that it's visible and it's not gonna go away. These sleep health apps are gonna go further and further, and the big pharma are bringing people into the funnel more than ever before. So the opportunities are there. These patients are coming. The success or failure will be our ability to drive.
Well, demand gen for us will be capture of it, so demand gen, demand capture to get them into the funnel, and can we truly work with our partners in the field in a big country like the U.S. to scale the screening pathways, the diagnostics pathways, and the setup pathways? As you heard from Bobby, I think once someone's in the ecosystem, resupply and you know those tools and scalability is already there, but it's those front parts, screening, diagnosis, and setup, that we are absolutely working with our physicians, with providers, with healthcare systems to say, "Be ready. There's a lot of people coming." There's a huge ROI of treating these people because every hour of sleep on a CPAP reduces ER visits and costs by 7%, all the way up to seven hours of sleep.
So you can get up to 50% saving payer provider through this. So they're coming, let's work on scaling the inbound part. So I think that's where success or failure of beating just the accepted market growth that we've seen will come from. But yeah, the tidal waves of patients are coming, but our success or failure will be on those, the screening, diagnosis, and setup. Can we truly digitally scale that?
Great. Thank you. I want to follow up on that.
Yeah.
So on the slide that you presented before, you talked about the, you know, the silver wave, right? And on there, you did mention the physician, demand has to scale by 42%, and there's gonna be a nursing shortage. So is that how we should think about the risk, is just the getting the support, basically, to get people on therapy and through the funnel, like Mike was asking about? And I guess, how much can you move the needle there with things like home sleep testing and easing the pathway?
Yeah, so look, the aging population is happening in almost every developed country, so that's there, and sadly, for all of us, that means all sorts of parts of the healthcare system, costs will go up, and you will need preventative care. Like everything you heard about from us, sleep apnea, COPD, insomnia, these are all preventative care that if they are treated, they lower costs of the healthcare system, so there's actually an incentive for healthcare systems to do preventative care, and now it's almost becoming existential for them to do this 'cause they won't be able to keep up with the flow, but yeah, you're exactly right. It's scaling these digital models, helping the physician shortage, the nursing shortage, the respiratory therapist shortage. We've got so many digital products.
I mean, I think about Brightree and how we've scaled MEDIFOX and how we've scaled to do things that were paperwork and were done by humans that are now being done by the tech. So that conversation about, "Hey, let me walk you through this new pathway to better sleep, better breathing," it can be done by a human, by a doctor, by a nurse, by an RT, and all the admin stuff is done by the bots. But it's not there yet. As I said, it's a sick care system mostly, but we are fixing the bits we can, and we know how to scale screening. We know how to scale diagnosis, and we know how to scale setup of sleep apnea care. We've done it! Can we bring it to each of the fifty states here with five different payer systems? Yes. Is it easy?
No. But, I mean, that's, that's our job, and we're gonna make it happen. And in all hundred and forty countries, we're gonna find the best models to adopt here.
Suraj Kalia from Oppenheimer. Gentlemen, thank you for taking the time. So first question, I'll send both of them your way upfront. First is for Hemanth and for Bobby, and the second one is for Justin and Mick. So Hemanth, Bobby, you guys talked about the digital ecosystem, end-to-end solutions, customer onboarding, consumer patient capture, demand capture, you know, all the words that we are looking for, right? One of the things that caught my attention was customer retention is not mentioned in there, and I'm using it as a synonym, but compliance. So help us understand, as you look at 2030, where does customer retention? Because, you know, if there was one knock on ResMed or CPAP, right? That's the issue. So I'd love to get your perspective on that.
Mick, Justin, it's interesting you brought up insomnia, right? So OSA and Mick, OSA is a mechanical problem, right? CPAP is a mechanical solution for a mechanical problem. Insomnia is a neurohormonal issue, so I'm curious why insomnia, and if you could give us a flavor of how, not CPAP looking for insomnia. I'm just curious, what product are you looking, mechanical product, to solve a neurohormonal issue? Any color would be great.
Do you want me to get started?
Yeah. I can get started on the first question, Suraj, and it's a super question. You talked about customer retention or attrition. So what we have done is we talked about the AI solutions across this ecosystem. The first is around we have a solution called Compliance Coach, and this is around the ninety-day compliance window. And that is an AI-infused solution that helps keep the patient working towards compliance in the ninety-day window. Beyond the ninety-day window, we look at it as a resupply problem. How do we keep patients on resupply? And we know that when the patients stay on resupply, it's good for them. And so we have some AI solutions that we are working on currently in order to reduce the attrition of patients who are currently on resupply.
That's by bringing both the behavioral data on myAir, the usage data from the therapy, as well as what we know about the patient through our Brightree platforms. We bring all of that system together and provide interventional suggestions to the providers to say: We think these set of patients are most at risk of attriting, and these are the things that the patient might respond to in order to stay on therapy. Those are all actively being worked on.
Suraj, just to add, you know, it's fantastic that you put a spotlight on customer retention. I use the term therapy success as part of my presentation as a way to convey that very concept. It's a key part of our innovation focus, all the way from when we added connectivity to our Air Solutions platform. myAir as a patient engagement solution, AirView as a managed by exception solution. The way we design our algorithms across our devices, the way we design our masks to make them more comfortable, are all designed to ensure long-term retention and success with therapy.
In addition, we're dialing that up with AI solutions that Bobby talked about, dialing in integrations with healthcare and other wearable-type solutions, digital health solutions, consumer tech solutions, all to drive motivation for the individual, you know, so they can see the feedback and get the feedback they need to stay successful with therapy. It's a core driver of our business.
And we wanna make CPAP care, APAP care addictive, right? And it is symptomatically addictive. You look at people, we use the term love, people who get through those first 90, 180 days generally stay on for life. There is some attrition, but if you get them there and they have that, "Save my job, save my marriage, save my life" moment, they can't sleep without it. Almost like it becomes so important 'cause they know how bad it is to wake up having suffocated all night. Now, they know what that's like, and they see what the change is. But for the asymptomatic patients, it is harder, and so, you know, the adherence rates there. So we use other information. We coach, we engage. The myAir uses AI to know which videos to show. Carrots versus sticks, right?
Your sex life will be better 'cause neurohormones, such as estrogen and testosterone, are released during REM sleep. That motivates some people. Your exercise will be better. You'll be a better runner, a better swimmer. Other people want to avoid bad things, and so then you can use engagements of: Well, actually, here's the, survival curve is up 39% or the other way. 39% increased death rate after one year on CPAP, non-adherent patients versus adherent patients from ALASKA study. So people are motivated by different things, better life or avoiding death or better quality of life. The more we can get that information to people, the better, and the payer-provider systems are hungry for this information. Their consumers rate them on how well they inform them about their healthcare. We know so much about sleeping and breathing.
If we can just get it into a way that can get to that consumer, that person, the healthcare system is, will actually support us in doing that rather than fighting for adherence. Let's go get the patients adherent ourselves. And we already know the difference between AirView and myAir, just patient engagement on myAir is a 17% increase in adherence in the first 90 days. How does that work on adherence at year one, year three, year five? We sort of know, and we do, and the algorithms are getting better and better. I see we're at zero time. You're more succinct than me, Justin. Answer the second question.
Yeah. So on insomnia, I think you're right, Suraj. There aren't great solutions out there today. It is more of a psychological condition, often caused by anxiety. I mean, there is a bit of evidence saying that even just, you know, more sort of constant, consistent breathing can help calm you down and maybe put you to sleep better. There's also some brain stimulation devices out on the market. So I think there are some different solutions out there apart from pharmaceuticals. But we want to help the medical industry develop the next generation of insomnia solutions or take whatever's currently available and make them better and more useful to patients. So I think still early days, but we think there's honestly something that we need to help the world with.
And part of the reason is, through our demand generation efforts, we don't go out there asking, you know, "Hello, everyone, do you have sleep apnea?" We ask people, "Are you having trouble sleeping?" And we get so many people coming through our own demand generation channels saying that they have insomnia or they have insomnia and sleep apnea. And, you know, as a company that's obviously very purpose-driven, we don't wanna give someone half the solution. So that sort of COMISA population and all the people coming to us with insomnia, we think we need to find a way to help them.
So if you walk around the product showcase in the break here, go and have a look. There's like lavender, there's teas, chamomile. Like, people are spending $85 billion a year, and it's not all science. So how can ResMed, as a science-driven company, bring some science to help 860 million people through a channel that we already know, through physicians we already know? And the ROI, if you're just thinking like with the... I'm wearing the New York Stock Exchange hat today, it's in there in COMISA. We'll get adherence rates for just treating insomnia there.
But if we can scale it to the other five hundred million, even if we don't charge much for that app, or if there's a wearable, we find a way to get it through the channel as a global company that can manufacture at scale better, I think the opportunity itself is huge. There's a little bit of altruism, but it's overlapped with the profit motive because it's exciting and it's right in front of us. It walks into our clinics.
Awesome. Thank you. Thank you, Mick, Justin, Bobby, and Hemanth. So we're gonna go ahead and take a ten-minute break. So come back about 3:10 P.M., 3:11 P.M. Stretch your legs, grab a drink, grab a snack, have a chance to engage with your panelists, and we'll be back.
Our program is about to begin. Please take your seats and silence all devices. Please welcome SVP, Chief Investor Relations Officer, Amy Wakeham.
All right, we're gonna get started with the second half of our event. I love to see all the chatter and the discussion, and I know we left a number of hands raised with your questions unanswered. So there will be another Q&A session, and then following the event, there's a cocktail reception where you'll have the opportunity to connect with any of the ResMed executives. But I'm really excited to welcome a panel of ResMed leaders to the stage to talk to you about how we're gonna execute on our 2030 strategy and really drive commercial enablement and execution. And I'm pleased to welcome to the stage a longtime ResMed partner and the head of Capital Markets at Breakwater Strategy to moderate our panel. So Mark Hayes, please join me on stage.
Hi, good afternoon. I have the distinct pleasure of welcoming to the stage to join me, Katrin Pucknat, ResMed's Chief Marketing Officer. Mike Flis, ResMed's Chief Revenue Officer, and Dr. Carlos Nunez, our Chief Medical Officer. Thank you for being on the panel today. Carlos, let's start with you.
Oh, goody!
How do you see the market for sleep apnea growing in the context of wearables, as we described earlier?
Did you ask me that question because I'm the nerdiest doctor in the world? Technology is an area of great interest for me, and obviously a great area of great interest for ResMed. You heard Bobby mention the silver tsunami. We'll call this the technology tidal wave. You know, the two largest consumer companies in the world, Samsung and Apple, have entered the sleep apnea market in a way that is extremely complementary to the work that ResMed does. We now have the most popular wearables on the planet telling people, "You may be at risk of sleep apnea. You need to see your doctor." As Mick described earlier, we need to be ready to capture this tidal wave of patients who are gonna be showing up.
You know, a few years ago, actually, more than a few years ago, about seven years ago, ResMed joined the Consumer Technology Association, and the industry probably scratched their heads a little bit, wondering: Well, what is ResMed doing there? But when we go there, and we sit on the Health Division board of the Consumer Technology Association, we're sitting with companies like Samsung, Apple, Microsoft, Dexcom, Elevance, a payer. There are four not-for-profit health systems that are members of the Consumer Technology Association. And the reason we are all there, having probably the most impactful conversations about digital health, is because the consumer doesn't make that distinction in their mind between what's consumer tech and what's health tech.
They have personal technology, many of whom have become completely digital natives in many ways, that they rely on for so much, and they demand that their personal technology works the way that health tech should. You know, my eighty-four-year-old mother wonders why she can order groceries on her Amazon app, and they show up in two hours, but she still struggles to make an appointment with her PCP on the somebody's EHR app. And so ResMed is perfectly suited to capture this and to play in this really interesting space where consumer tech and health tech are colliding. Mick said it earlier, we talk about patient centricity, but it's really people centricity. A billion people suffer from sleep apnea, and two point three billion suffer from the other conditions that we talked about.
But most of them, and we're talking about sleep apnea, don't even know they have it. You know, in the U.S., 80% don't even know they have it. They're undiagnosed and untreated. But in some of our fastest growing, most under-penetrated markets, you know, it might be 1% that are being treated. So we have an amazing opportunity to use the world of technology that is pervasive and has now entered our space in a complementary way to drive patients into the funnel.
Carlos, thanks for setting the stage. Mike, what is our near-term plan to drive revenue growth in that context?
Yeah. Thanks, Mark. The 2030 strategy is, as you've all heard, that's gonna enable us to drive revenue growth, but also to increase our operating leverage. And so that means for us, consecutive or consistent execution across the next 20 quarters. From a revenue leadership team and a revenue team that hopefully you had a chance to speak with in the product showcase, but a team that is known for delivering and execution. Specifically, if I think through the last 18 quarters since March of 2020, at which point our healthcare systems changed, the way our patients ended up on therapy changed considerably, the way we do business changed, but also the competitive landscape had changed quite a bit, right? Throughout that time.
And it was about a year ago, so last summer, when we started to get a good feel, we felt, for what the competitive landscape was gonna look like going forward. And I was in a meeting with Jeff, who runs our sales team in the U.S., and Ben, who runs our global sales ops. And in that meeting, we had a long discussion about what the market needed from us going forward to drive that same level of execution that we're used to, right? And how it was different from what we needed in the past. So at that point, what the team did was they just reestablished what our roles and responsibilities for the team that you're seeing here, what those roles and responsibilities would be, but they also needed to free up resources because...
Now, I'm a bit biased here when I say this is a best-in-class, a world-class sales organization and revenue team that we have. And what our team wanted to do, what Jeff specifically wanted to do, was put them in the place where they could leverage our competitive advantages, right? So we know that global scale is a competitive advantage of ours. We know that our consistent innovation, right? We're gonna continue to invest 7% back into research and development, but also our market expertise, right? This team is very, very skilled. Our teams are very, very skilled at not just being able to articulate, but also to optimize the value that our solutions can bring to payers, providers, and to the end users.
So when I think about how are we gonna be successful near term, Mark, it's about our execution, and it's about efficient execution with the teams.
Mike, thank you for that. Katrin, to you, how are we adjusting marketing strategies to engage consumers and really support revenue growth?
Mm-hmm. I think we've heard in the last sessions a lot about the funnel, and so this is really where marketing starts to change the way we've done marketing in the past. So historically, ResMed has focused very much on our B2B audiences, our healthcare provider customers. We're looking at the funnel from two sides now. You have a patient, a consumer, who, you know, wants to become aware of the problem, get diagnosed, seek therapy, and stay on therapy, but that's not a singular journey. You also have to match that against a provider journey that's happening on the other side of that funnel, right? If that patient doesn't get caught by a PCP, by a specialist, by an HME, that can help that patient become successful on therapy, it won't work.
So we have constructed a new model in marketing, where we're actually addressing both sides of the funnel very effectively by looking at bringing people into the funnel and then converting them through the various stages. And I heard in one of the questions was about retention. That's actually a huge focus of ours because that's very low-hanging fruit for us to really drive retention with patients, reminding them of the value that this therapy creates for them and their health.
So that's kind of how we're addressing the change in dynamics in the market. With that, we've run a couple of experiments because it's not just about us turning into a consumer marketing company. It's very expensive, and a lot of companies don't do it successfully. So what we're doing, we're very responsible in how we're thinking about scaling some of our experiments. We're running a lot of experiments with our new team to really understand what it takes to bring people in, and it's very encouraging because we're seeing that what Mick talked about, demand capture, is actually very possible because there are so many people out there who have a problem, and they're looking for a place to land. We just need to create that landing pad for them.
Demand generation is another tactic that we're employing, and again, it's very, being very thoughtful about where we wanna spend the dollars and what allows us to scale. So we're very hyper-targeted in our thinking. We're using a lot of data and analytics. We brought in an incredible team to build a data analytics platform in marketing and a martech infrastructure that really allows us to do hyper-targeted outreach to these patients and these consumers and bring them in. And so again, these first experiments we've been running over the last couple of months have really shown that we have a very high ROI in doing that, and now we're starting to slowly scale these experiments to then drive that growth across the business.
Mm-hmm. Thanks for that, Katrin. Staying with you for a moment, where did some of the new folks who joined your team come from?
We look like a Formula One race car. We actually really recruited people best in class in their space from all over the industry, whether it's Microsoft, Coca-Cola, Amazon, you know, just to name a few.
Mm.
But again, it wasn't so much about sort of the legacy of brands they worked for. What we were looking for was for all the functions we now have in marketing to find incredible subject matter experts that really know their field better than anybody else, and so we feel very good about the team we've assembled over the last couple of months.
Yeah, thanks for walking us through that, Katrin. Carlos, back to you. How would you describe some of ResMed's scientific strengths, and how do those translate into our ability to be successful longer term and as sustainable competitive advantages?
Sure. So as many of you probably know, for the last thirty-five years, ResMed is the undisputed scientific leader in our field. We have published over a thousand peer-reviewed publications, and present dozens of research studies every single year. We're actually more prolific than some universities and academic centers. I like to encourage the team by saying, you know, "We are the most prolific industrial research team on the planet." And over the time that I've been at ResMed, approaching a decade now, we have evolved just as science has evolved.
We still do the typical types of randomized controlled trials and registries, but we also have built a world-leading team. Actually, the leader of that team is sitting back there, and you can ask her all about this stuff during one of our breaks, Kimberly Sterling. That world-leading team of data scientists, health economics, and outcomes research, patient-centered research with behavioral science and other epidemiology and other, disciplines, and it has started to pay incredible dividends. Not only the work that we do that helps us talk to all of you, the eight hundred and eleven thousand patients that Mick refers to, but some of the other studies.
ALASKA study that showed that if you and I are diagnosed with CPAP today, and you use your device and I don't, I have a 39% higher risk of dying this year from any medical cause than you do. So research like that, that leads the industry. The, the number one billion, we talk about one billion people with sleep apnea. That's ResMed research that we published in 2019. And I remember when it was quoted in The Wall Street Journal and not referenced to our study, as the doctor scientist, I got a little angry, and Mick said to me, he says, "No, that's a good thing because your research is now common knowledge.
There are a billion people with sleep apnea, and everybody believes it, so that legacy of scientific leadership leads the way that my team also works with Katrin's team or with Mike's team, with Justin's team. We have a dedicated team of scientists that support early stage product development, the research team I talked about that supports near-market and post-market research, and then the work we do on everything from due diligence when we look at new technologies, all the way through to helping design these beautiful pathways that Mick talked about as we get better at things like behavioral science, patient science, trying to understand things like how cognitive behavioral therapy can be implemented more broadly.
I have the best job in all of ResMed because I get to work with the brightest scientists, the most amazing statisticians, and gifted clinicians, and people who just love what they do, love their patients as much as people love their CPAP. And as a CPAP user myself, that science has not only led to me being happier and healthier, but boy, my wife loves my CPAP, too, because now I don't snore, and she can sleep.
Carlos, thanks for walking us through that. Katrin, coming back to you, and Carlos ended that with using the word love. When we think about some of what we heard about earlier, about GLP-1s, wearables, and increasing awareness of sleep health, how are we thinking about that in the context of our brand?
So, we were actually very intentional, and Mick pointed to that earlier about choosing the word love, because it's very different to create products that people love, to create products that people like. To love something, it has to be intuitive, it has to be really thoughtful, it has to become pretty much an integral part of yourself. I think Apple does it, for instance, really well. So we've hung the bar really high for us and our teams, and we wanna convey that through the brand. I think the second aspect of the brand, though, that is equally important, is the fact that we wanna become... Well, we are, and we wanna remain the trusted brand. I think ResMed already has incredible brand equity with its users around the world. We wanna scale that to all these people that are out there.
But what people really appreciate about our brand is the fact that they can trust our quality, they can trust our efficacy, they can trust our attitude towards data privacy and data security. And this is something where we've led over the last couple of years, and we'll continue to do so. So we'll bring that together, creating this brand of products that people love, pairing that with the trust that we can bring. I would say that, though, the most important piece is the greatest brands in this world weren't just made by somebody coming up with a brand name or a fancy logo. It's about making a promise to a customer. When we all see a brand, we infer certain things with that brand. We expect something from the brand, and the best brands in the world consistently deliver on those promises.
That means that customer service, you know, clinical efficacy, product design, all have to consistently deliver on that brand promise, and we are just the ones in marketing, really, who need to be sending the message out there.
Mm-hmm. Can I just-
Mm.
Real quick, I just wanna tie the two things together very quickly. You know, I mentioned there are a billion people with sleep apnea, and just to make the math easy, let's say eight hundred million are undiagnosed and untreated. I could publish eight hundred million more papers. Those people aren't reading scientific journals. It's the work that Katrin and her team are gonna do, based on the evidence that we do, the research that we do, to help people understand why this is so important. Those eight hundred million people deserve to breathe better and sleep better, and this new focus on the way we do marketing, communications, and brand is going to bring them into the funnel in ways that we never imagined before.
Right.
Carlos, thanks for walking us through that. Katrin, just sticking with you for a moment, how do we think about building a global marketing strategy and then having that manifest itself in some of our local markets?
Mm-hmm. The marketing organization changed about a year ago, so we've restructured the entire marketing team to be a functional team of, you know, as I talked about, subject matter experts that really understand their space. They work together in agile teams. Justin talked about that. So we're not just agile in product, we're actually employing those same mechanisms in marketing to be very flexible, very fast, very adaptive.
We are conceiving strategy, campaigns, and content at the global level, with the ability to then deploy that very fast into local geographies. So that doesn't mean that we're not catering to the unique needs of any market, but what we're not doing is coming up with bespoke solutions for a hundred and sixty countries around the world, because that would be highly inefficient as an organization. I would say the only caveat is China. Justin pointed to that. China is an incredible opportunity for us. Things are different in China, so we have in China, a standalone, full stack marketing team.
But we're collaborating heavily and really sharing those insights and learnings between our global teams outside of China and the China team, and bringing the best of both worlds together.
Mm-hmm. Katrin, sticking with you for one more question. You just mentioned Justin. Can you talk a little bit about how your team works with Justin's team and Mike's team to really bring some of the marketing to life?
I think what we really love is the fact that we, as, as three teams, kind of operate as one team. When you think about the concept of Agile, it's not just that you assemble different squad teams from different functions within a function, so not just within marketing. We actually partner and collaborate across multiple functions. Carlos talked about that. So I'll give you an example. When we derived some of those new campaign experiments that we've done, we partner a team from medical affairs, from product, from revenue, from marketing, and we bring them together to really think about what we wanna achieve, how we're gonna achieve that.
Then once we have that global strategy done, we are very fast at then implementing those first pilots and executing them, and we've actually done that now a few times, and we're very happy. Now, you know, what's really good is, too, that because we have such a good relationship, we can also work through the, I would say, the issues that come up with such a new way of working. Not everything is smooth in the beginning. You have to work through sort of making everybody appreciate and understand this new way, and we've been able to work through that pretty well.
Thanks for walking us through that, Katrin. Mike, Katrin talked to us a little bit about how we're actually focusing globally in terms of our marketing strategy but also locally. Can you talk to us a little bit about how we're growing revenue in some of our major markets?
Sure. If you think about our established markets, the way we've got to grow is the story that I referenced earlier. We've got to continue to optimize the customer engagement, right? So we need to make sure that we have the right people calling on the right customers. We also need to make sure that we continue to deliver that top-tier experience that our customers are used to getting from us. So I'm gonna go on a little bit of a personal journey here with all of you. I've been with ResMed for over twenty-two years, and in those twenty-two years, they've all been customer-facing roles. And to Katrin's earlier point, when you talk to our customers about our products, they embrace our products, they appreciate our products, but they trust our products, right?
And that is a very important piece of who ResMed is. And I was with Justin. He mentioned how he was in Chicago 10 days ago, talking about product. So Justin and I went and rode with Bridget, who's our strategic account manager, and the goal was for us to talk to these key opinion leaders and these HMEs and these providers about what we're doing going forward. We also happened to bring Charles with us. Charles was on the product team that brought the F40 to market. The minute they heard that message, that commandeered the beginning of the call, right? They wanted to talk about how ResMed solutions have impacted a patient, how this product has changed the way they do setups. So after 35 years, we still have customers that are excited and trust our products.
So we need to continue to put our team in the position to position those products going forward in those established markets. And when I think about our high growth markets, now that's our omni-channel presence and some of the products that you've seen over there. We've got a broad portfolio of products that we sell in those markets. So that allows us, you know, not just to drive the revenue growth and have free cash flow generation, but it also allows us to get a good feel for the user journey.
We get to participate in the user journey from the patient first finding out, just the critical role that sleep plays in their overall health, all the way through helping them to improve their adherence, to the question earlier, to improve their adherence, so slightly different strategies in the markets, but great opportunity.
Can I add something to that?
Sure.
We're partnering heavily between marketing operations and sales operations to create a data and technology infrastructure that allows us to digitalize actually a lot of those initial efforts that used to be done by sales, to scale our sales capabilities. And with new audiences we need to talk to, we mentioned PCPs earlier, the sheer volume of those PCPs is impossible to call on with a sales force the size we have. So we have to establish these digital tactics to do that, and so we're partnering together on making that happen.
Thanks, Katrin. Talking about the future, Carlos as we become more of a health technology company, what role does in-place innovation play as part of our 2030 strategy?
So innovation is key. As you saw, the way to continue to grow our core business is innovating in that PAP space, making our devices better, more connected, more lovable. But thinking back to Justin's slide, where there is, you know, the core business, then what do we do to innovate beyond PAP? How do we then innovate beyond PAP, you know, to sleep, to sleep health and greater health? My teams, the teams that do research in ResMed, are focused across the gamut of solutions that we're looking at. And as I mentioned, we have a team focused on helping product delivery, accelerate product delivery, through evidence generation, through due diligence, bringing new technologies, evaluating new technologies. We have connections to the top key opinion leaders and subject matter experts around the world.
We bring in advisory boards of everything from payers to patients to providers to understand. And so from my perspective, from the medical, the scientific, and I also lead our government affairs, so from policy and reimbursement, we view innovation through that lens on how can we bring it, and how can we help support the company's quest to continue to be the most innovative sleep and breathing company on the planet?
Carlos, thank you for that. Mike, back to you. You talked a little about how we're gonna drive revenue in the near term. We talked a little bit about how we're operationalizing that in some of our major markets. How are you thinking about growth longer term?
So growth longer term, I mean, that's a collaborative effort, right? That's 10,000 ResMedians. That's working very closely with Katrin and with Justin. It's also capturing that market demand that we've talked about, right? The mega trends and also the work that Katrin and her team are doing. When you think about how ResMed therapies are going to capture that demand, and I keep doing this, but I'll do it one more time. ResMed therapies, the advantages we have: we're safe, we're effective, and then we're connected. Right? So if you think about some of the slides you saw earlier from Bobby and from Justin, and just the amount of data we have, we have a really good view of the user experience.
When you overlay that with our market expertise and some of the partnerships that Hemanth's talked about that we have in the markets, that gives us a really good picture overall of where our sales team can spend their time, where they can pinpoint where they need to spend their energy in order to yield the highest return. So the other piece of that, right, is feeding that information back, as Katrin said, through our operations teams and getting it back to Justin and his team, so they can continue to innovate the products at the areas where they're gonna have the highest impact. So thinking again about our long-term growth strategy, that's on all of us, but we have a path to get there.
Thanks for walking us through that, Mike. Katrin, back to you. As we think about the long term, how are we ensuring that our marketing strategies are remaining flexible in order to take advantage of the considerable market opportunity ahead?
Mm-hmm. So I talked earlier about the marketing structure, and one of the key things that I personally believe in, if you have really good process, it's almost like liberating, because if good process, it actually gives you that ability to be flexible. We also have technology, which we're actually moving away from using some monolithic systems we had in the past to some more cutting-edge technologies that we're using for demand generation and things like that. A fundamental aspect of it is data. So with the marketing data team that we formed, and then, again, the person that we have leading that team, we not only have real-time analytics today, but we can also start to look at predictive analytics into the future. What are the social media trends? What are we seeing on search? What is sort of social listening telling us?
That allows us to tailor our outreach and our messaging to what's happening in the market. I also mentioned that we are doing a very hyper-targeted approach, so we're overlaying different levels of data on both the provider and the consumer side to make sure that we're very, very specific and intentional around where we're spending the dollars
And again, that ability gives us the platform to say, "Okay, if we need to shift something, if we need to shift something into another geography, if we wanna turn up or down the dial in on a certain topic," we can do that very, very quickly now.
Katrin, thank you for that. Let's stick with you for a moment. You mentioned before we had run some tests.
Yes.
Can you give us some color on how those turned out and what we've learned?
Yeah. So, we ran a couple of experiments over the last couple of months. Some were just about better understanding the opportunity behind demand capture, and Mick mentioned that, so demand capture is the people that are floating around there that have a need and that kind of need a landing space. How good are we at giving them that landing pad, so that was one aspect of the pilots we've run. We've looked at how good are we actually from that initial demand generation, so doing outbound marketing, bringing somebody in, to actually getting them on therapy, and measuring that and establishing that, and then we've run some initial pilots where we're trying to bring people in the door and then help find them a landing space with telehealth providers and other service providers.
And so again, I don't think it's the right place to go into number details, but what we're seeing is way above and beyond what you would expect as in industry. So, we're very encouraged by those experiments, but again, the experiments, you know, we're looking at, you know, hundreds of patients that we're seeing come through in the funnel. But we're now starting to slowly dial those up, and as we dial up those experiments and we see we can hold those ratios of return on investment, that it would be extremely positive.
Thank you for that. Mike, we're now gonna turn to our wrap-up. What's one final thought you'd like to leave investors with?
Final thought. I guess I'd start by saying thank you, right? Thank you for spending, you know, half your day with us here today, so I appreciate that. I'd also like to say, after 35 years, I still... you know, ResMed is still uniquely positioned to drive efficiency, capture share, and drive long-term shareholder value.
Thank you, Mike. Carlos, how about you?
I'm gonna have to say two things.
Two things?
Yeah. Um-
Two final thoughts, Carlos.
Yeah, two quick. So you saw the slide earlier, the 19 billion days and nights of sleep and respiratory data, the 28 million patients that are sitting in our myAir database. Think about that. Every single day we wake up to tens of millions of new data sets, and that data is so powerful. As we know, the new economies are built on data, and we have built a research team inside of ResMed that takes advantage of these data to do really meaningful evidence generation. You know, real-world evidence studies published in the top journals in the world. So, you know, for me, that's one thing that gives me so much promise. The other thing is, everybody sleeps and everybody breathes, and no one does what we do better than we do. No one innovates better than we do.
This team, as Mick mentioned, is the best in the world, and I'm talking about the 10,000-strong team, not just the few that you see on the stage. And together with the data, with the in-culture of innovation, the hundreds of millions of patients, billions of patients who are struggling to breathe and sleep every night, ResMed couldn't be better positioned for this, not just next five years, but the next 50 years, of the future of health tech.
Appreciate that, Carlos. Katrin, in terms of fair play, two final thoughts from you.
That's fine. I think that if you distinguish between good and great companies, great companies have two things going for them. One is, they're highly relevant. Their offering is highly relevant to their audience, and the second piece is, that they're highly distinguished from the competition, and I think we have both. Now, the job we have to do, especially here in marketing, I'm very selfish right now, I'm talking about my function is that we have to help people who have that relevance to actually see that we are the place that can get them help. And the other piece is to then draw attention to all the things that differentiate us from the other solutions that are out there.
That can be done, though, and I think that with now doing this in a very professional, scalable way is a huge game changer for us in the future.
Katrin, Mike, Carlos, thanks so much. Appreciate the time. Terrific panel. Amy?
Thanks, Mark
Thank you, guys. I don't know about you, but I could listen to the three of them all day long. It's super exciting to hear them talk about how they're gonna bring our strategy to life. So we're next gonna hear from Brett Sandercock. I know this is the moment you've all been waiting for. You wanna get to the financial drivers, so let's get right to it. Brett? Please welcome Chief Financial Officer, Brett Sandercock.
Yeah. Thank you. Good afternoon, everyone. It's great to see you all in New York. I'd like to spend a little bit of time talking about our strong financial health and foundation that will enable our 2030 strategy. We have a significant financial capacity to grow our unmatched sleep franchise, capitalize on market opportunities in the broader sleep health and breathing health adjacencies, and continue to build out our integrated digital ecosystem, a key component of our competitive advantage. We have a solid track record of delivering value for ResMed shareholders, and let me highlight four key elements to this. First, we have created sustained value. We have consistently generated top quartile return on equity, and we've expanded our presence and market share in key markets, and continue to innovate in next-generation products.
Since our last Investor Day, we've generated a revenue CAGR of 14%, and our return on equity in FY 2024 was 23%. Second, we remain focused on execution and improving operational efficiency. We've benefited from our new operating model, improved cost structure, and built a resilient supply chain in the face of many challenges over the last several years. Indeed, since our last Investor Day, we've expanded our operating margin by 157 basis points. Third, we generate significant free cash flow and remain disciplined on capital allocation. Our capital allocation focuses on R&D investment, strategic acquisitions, dividend growth, and share repurchases. Fourth, we continue to practice prudent financial management. We set clear and realistic targets. We have an exciting strategy, and importantly, an executable strategy, and we maintain a strong balance sheet to support our growth aspirations.
We have sustained history of strong revenue results with a five-year revenue CAGR of 12%. Drilling down on revenue by product, you will see that device revenue represents just over half our revenue, while our mask and residential care software revenue, which can largely be considered recurring revenue, represents almost half our revenue. On a geographic revenue split, our domestic market remains our single biggest market. However, we have significant revenue outside the U.S., and these are major markets with the opportunity for higher growth through omni-channel pathways that Justin highlighted earlier today. At the same time, we've also delivered operating leverage with a five-year operating profit CAGR of 16% and an EPS CAGR of 16% as well. This also reflects operating margins consistently at or above 30%, and these results compare favorably to our peers.
ResMed is in the top quartile of our peer group across key financial metrics, including EBIT margins, EPS growth, and return on equity. This really reflects the enormous market opportunities we have, combined with strong and focused execution, delivered by a committed team over many years. While we are performing in the top quartile, we still believe we have opportunities for gross margin expansion and operating leverage. Our gross margin has improved over the past four quarters, and we expect to make further steady progress over the medium term with a pipeline of initiatives, including delivering through economies of scale, new product introductions, transition to the AirSense 11 platform, and manufacturing efficiencies. Additionally, product mix, which has been unfavorable over the last few years, is likely to be a tailwind going forward. These combined should more than offset cost inflation impacts on components, labor, and freight.
More recently, we have seen stability in component costs, and with ongoing product lifecycle part qualifications and engineering efforts, this may also provide some tailwinds to gross margin over the medium term. For SG&A, we expect to make incremental investments in demand generation and demand capture activities that you've heard about today. And to support our strategic goals, these should be offset by economies of scale, automation, and AI applications, and back office productivity. Our new operating model also facilitates a more centralized and coordinated approach in areas such as marketing that Katrin touched on, where we can develop campaigns and programs centrally and then deploy them for local market execution. This has and will deliver programs more efficiently and effectively. In relation to R&D, we've always remained committed to sustained and significant long-term investment through economic cycles and market vagaries.
As Justin outlined, this will continue to be a fundamental element in our 2030 strategy. We will ensure our level of investment delivers on new product velocity and drives our competitive advantage in the marketplace. Finally, I would like to make the point, that we have a degree of flexibility through our P&L, and as you heard from the team today, we have significant opportunities ahead of us. We are alert to capitalizing on future opportunities that have the potential to unlock additional growth and value. This may involve additional investments in our R&D program or our marketing and commercial activities. As an example, the growing macro awareness of sleep health, increasingly driven by things like wearables and GLP-1s, are creating a much larger top-of-funnel opportunity, as Mick, Justin, and Katrin described.
If these trends gain momentum faster than we expected, we're prepared to move quickly to scale investments to capture that rising demand. Essentially, we will be proactive to maximize growth and shareholder value. We generate robust operating cash flows with low capital requirements. We expect our annual capital expenditure will continue to be modest and in the range of $100 million-$150 million. Our key liquidity measures and cash conversion are very solid. In particular, our debt-to-EBITDA ratio is now less than one times, and our free cash flow conversion in FY 2024 was 114%. We also have unused borrowing capacity of almost $1.5 billion. In short, we maintain a strong liquidity position. Our capital allocation strategy prioritizes innovation.
First and foremost, we focus on core innovation, those that deliver high returns, and we will continually track and evaluate our product roadmaps, milestones, and funding requirements. Currently, we invest over $300 million a year in R&D, representing almost 7% of our revenue, and this is invested across core innovation in sleep health, breathing health, residential care software, and incubation activities. Second, we look for strategic tuck-in acquisitions that enhance value creation. We have a disciplined approach to M&A, with a focus on post-acquisition integration and synergy realization. Recently, our areas of interest have been in digital health, diagnostics, and residential care software. I've listed several of these acquisitions on the slide, and these have added significant value as we build out our digital health, resupply capability, and diagnostics ecosystem. Third, we look to maintain a conservative debt-to-equity ratio.
As you can see from the chart on the right, of the slide there, we have prioritized debt repayments during FY 2024, representing around 52% of our operating cash flow. Additionally, 20% was distributed as dividends, 11% in share repurchases, and 7% in CapEx. Looking forward, given our current debt levels, we expect to return capital to shareholders through modest dividend growth and continuing our share repurchase program. We will likely increase our quarterly share repurchases during FY 2025. Finally, we do not expect the current interest rate cycle will materially impact our capital allocation framework. We have established a leadership position in residential care software, driven by key acquisitions including Brightree, MatrixCare, and MEDIFOX DAN.
Residential care software now represents approximately 13% of group revenue or around 600 million in annualized revenue, and we project revenue growth year over year will be in the high single digits to low double digits. Operating margins are approximately 28%. We have delivered significant revenue and cost synergies, and Bobby has articulated some of those examples earlier today. We've deployed over 2.7 billion in capital. We've done this while maintaining a strong balance sheet. Going forward, we are focused on delivering revenue growth and expanding operating margins. Additionally, we will likely make further tuck-in acquisitions to create additional shareholder value. Today, we've provided long-term targets driven by our 2030 strategy and strong financial foundation.
You are familiar with our near-term guidance, on the left of the slide, gross margin of 59%-60%, SG&A at 18%-20% of revenue, and R&D at 6%-7% of revenue. In addition to this, on a 5-year outlook, we expect revenue growth to be in the high single digits and earnings growth to be higher than our revenue growth. These targets are underpinned by our 2030 strategy, increasing overall market growth, optimizing the patient pathway to diagnosis and therapy, delivering on our pipeline of next-generation products, and continuing to drive operating excellence. Thank you very much, and I'll hand back to Amy for the Q&A session.
Fantastic. Thank you, Brett. So I'd like to go ahead and invite our panelists, all of our presenters and panelists back to the stage. So we're going to have everybody on. To ask a question, just like last time, raise your hand, we'll bring a mic to you. We'll give a minute to get set up here, and then I am going to start with an online question because we've had a couple come into the queue, so I want to give them a chance to get their questions started? Okay, I'm going into audience mode thirteen, fifteen. And we have about thirty minutes for this session as well, and it will follow with our medical panel.
All right, I think we're set. All right, so our first question is, comes from Lyanne Harrison from BofA, and she asks about, you know, the strategy of attracting more patients into the funnel. And she's curious about: Is it easier to attract new patients or to bring back those who had previously desisted or stopped therapy? And then, can ResMed re-engage with patients who had previously stopped therapy?
It's a great question. I've got a whole panel here. Katrin, you start. I'm the backup speaker.
It's actually, I would say that capturing the demand, the demand capture of patients that are out there and looking for that landing pad is probably the lowest hanging fruit right now. At the same time, we have run experiments, rescuing patients back into therapy, so patients who had previously quit therapy, and you really have to look at what the reason was why they were quitting. Some need an alternative therapy, which in Europe we've run some really successful trials, where we actually have routed patients back into other therapies like Narval, our mandibular repositioning device. Some of the patients just couldn't handle the mask. It was lack of support. There's a pretty high chance to get patients back onto therapy as well.
It costs a little bit more effort to really understand what the cause is and how to then triage them, and the best solution to bring them back. But the capture of demand from patients that are already out there and looking for a landing pad is definitely the lowest hanging fruit for us right now.
I've got a, just a quick add.
One of our key opinion leaders, Dr. Jean-Louis Pépin, out of France, actually did a small study looking at what is the most common alternative therapy for someone who fails PAP, and it was PAP. People will fail, they will try other stuff, and they will come back. So it is difficult to often find them, but when they come back, more often than not, they end up on PAP therapy.
All right. Hey, just a question from me, Brett Fishbin, again, from KeyBanc Capital Markets. So on the financial outlook, I think that's what everyone's interested in, you gave a high single digit, five-year revenue outlook. Just curious if that's an organic target, and then what's the algorithm to get there, given mid-single digit market growth in devices, which is still the largest piece of the business? Thank you.
Brett, you wanna start?
Yeah, I mean, that really, that's organic. That is, that's predicated on organic growth on that. And really through growing the overall market through demand generation, through demand capture on that. And really, they're driven by those megatrends that out there that we're seeing, particularly around wearables, around pharma. There's that top of funnel, and it's up to us in terms of demand capture, to make sure we capture them and get those patients on the therapy. So that's what we're building out and the ecosystems that we're building out to allow us to do that.
I mean, I'd color that maybe there's some tuck-ins. Like, you think about the Snap technology which was within Brightree. It was software as a service revenue within our residential care software, but it was also resupply revenue. So it was a two for one in terms of two parts of our business, and it was a tuck-in. I look at Mementor and Somnio.
If we're able to work with insomnia and get any improvement, the overlap of those patients who have insomnia and OSA will have a benefit to the software business that will get paid for the app, in addition to our core business. So a lot of those types of synergies we can get by looking at tuck-ins that are technology driven, but they can drive revenue across ResMed's global reach. I would say, you know, we're sort of envisioning we should be able to create or buy tuck-ins that can do both of those. But yeah, it doesn't include major M&A.
Uh, good-
There's lots of hands up, people. Oh, yes, just go.
Yeah, good afternoon. Dan Hurren from MST Financial. A lot of discussion about having patients love your products and a lot of love in the room. I mean, as I understand it, in most of your markets, it's the payer, the distributor, or the clinician who really decides what therapy the patient will get. Are you suggesting the markets are evolving, or are future products gonna have more of a patient choice involved in the channel?
You wanna start? 'Cause I, I've got a lot of thoughts-
Sure.
Go on, then, get it.
So what we are observing is that patients become much more vocal about what they want, and yes, there is in many markets around the world. I can specifically speak, for instance, to Europe, where I'm from. The payers or the HME have an impact on what devices ultimately dispensed, but when patients ask for a specific device, it's all about making sure that patient ultimately is happy on therapy. And so what we observe is that there is quite a flexibility on the side of the partner to give the patient what they need to become adherent to therapy. That being said, in the future, if the devices are so good that people actually love them, we will see a propensity to also pay for those technologies out of pocket, but I would defer to Justin, actually, to talk more to that.
Sure. I mean, in our non-reimbursed markets, CPAP is absolutely more of a consumer product.
So people are doing their research, and they're going to, you know, buy the device they want. In the reimbursed markets, you're still seeing that behavior as well. So you're seeing people do the research before they go to the doctor or after their diagnosis. They're looking to see what are the best devices out there in the market. They're reading all the reviews, and I think absolutely they would, you know, like to express a preference often for ResMed. So I think, you know, whether it's attracting more people or, you know, making people love their product so that they stay using their product for longer, I think that's the real intention here.
Look, I'll pile on. You're gonna have a key opinion leader physician on the next panel from Stanford. Ask Dr. Pelayo if a patient comes in and requests A, B, or C. What will you say? Because and I actually don't know. I haven't prepped him. But I've known him for decades. I'd love to hear what he says. But as we look at the market, ResMed's 35 years old. We've always created the product that the end user, the person who's suffocating, will love. Because it actually overlaps with everything. If the patient loves it, the physician loves that 'cause they adhere to it, the payer loves that 'cause they stay out of hospital, and the bed partner loves it most of all. So there is a lot of love in the room.
And it is driven by the ultimate customer, who's that person who suffocates. And so if you take care of that and you add on the other parts, then you can get, I think, accelerated revenue. Consumer-driven markets, absolutely always driven by that end consumer. But I would say even where there are HMEs, HCPs, physicians, and payers, and providers there, we've done, for three decades, a very good job of making sure that product is so good that it works with that system. But I think the mega trend, one that I talked about earlier today, that consumers are more engaged in their healthcare, is global. I do not think that's only in cash-driven markets that ResMed operates in.
I think everyone all around the world has more access to more information than they've ever had, and now has technologies that can convert even complex stuff like peer-reviewed published evidence about epidemiology or outcomes of healthcare. They can ask in English and get a response that works with them and converses with them. So I think, you know, as I said, we're changing the basis of competition again in our field, and it's based on GenAI and AI and ML, and ResMed's got the best opportunity to do that. Empowering consumers, physicians, providers, and payers will be a huge part of that, and I think the future of medicine is patient-led, is person-led. It always has been. Doctors have always wanted that, and I think tech is gonna enable it more, and ResMed's gonna leverage that.
Great, Anthony from Mizuho. Thanks for the presentation. One on strategy for Mick, and then a couple on modeling for Brett. Maybe strategically, we spoke about software a bit, quite a bit today, but wondering about orals and hypoglossal nerve stimulation. What's your latest thinking there? You have minority investments in Apnimed as well as in Nyxoah. And then the modeling questions we're getting pinged on, just when we think about high single-digit growth, where do devices fall on that? Where do masks fall on that? Are devices, let's say 7-8%, and resupply is 10-12%, and then if you reverse engineer earnings, operating margin flushes out to 35-36% by 2030. Does that sound right?
So the first question, you know, I have a whole panel here. Anthony, you get to hear from me every quarter. Strategy, I would hand to my Chief Strategy Officer, Hemanth.
Thanks, Anthony. Yeah, so we're obviously tracking the innovations that are happening across the sleep apnea therapy landscape, and frankly, we welcome it. I think the more innovation that goes on in our market, the greater the awareness is, the, and the broader the range of solutions are to ultimately help a billion people sleep better and breathe better over the course of the night, so we're tracking earlier-stage companies, more established companies, as they innovate in our space, and because there's a whole host of new form factors and modalities coming into play, we've decided to pick and choose some of the more interesting ones for our minority investment activities, and so we are minority investors in Apnimed, as you've noted, and in Nyxoah.
That gives us visibility into how the implant space is developing, how the pharma space is developing, and we'll continue to do that as we see innovative new approaches to treating sleep apnea. Often what we're starting to see is a better together proposition. That these solutions don't fully address the sleep apnea, and there could well be a better together proposition that helps drive longer-term adherence to CPAP therapy, and so that's a potential possibility as well.
Yeah. I mean, what we're saying here is we think we continue to get operating leverage through that period, so it will mean an expansion in our operating margins. We're not putting a number on it, but you can kind of make some assumptions there. And then if in terms of kind of devices and masks, think about that. We think we can improve the kind of historical industry growth rates, but that'd be both devices and masks moving up.
Thank you. Mike Polark from Wolfe Research. Maybe for Bobby. Bobby, you mentioned some interesting stats on resupply. I think several million patients, kind of in the network today, 55% market share. My question is: how penetrated are those folks on resupply in the US? And you also brought up the opportunity of bringing Snap to non-Brightree customers. What's a bigger opportunity on resupply? The non-Brightree customers or still the base? How could you quantify it?
That's a great question. It's both actually. So within our customer base, we still have some runway in terms of adoption of Snap itself. There are still customers who have not yet gone on the full platform, so that's one segment. The other truly is around customers who are not getting the benefit of the overall, you know, Brightree ecosystem. However, they may wanna just go for resupply, and we wanna give them an option to try Snap and also get the benefit of resupply through that platform without having to go for the entire billing platform of Brightree, which, in my opinion, still is the best, the combination of the two. But there's still runway and significant opportunity ahead for both inside our install base as well as looking outside.
And if you look sort of top-down, like from a payer's perspective, payer-provider perspective, as we get more and more of the literature and frankly, the interaction of the data from our database with Kaiser Permanente or Intermountain or any sort of ACO, IDN that's created payer-provider type capabilities, they can actually track the data that I was saying earlier, that for an adherent patient has a lower mortality rate, has a lower rehospitalization rate, and for every hour of sleep, you get 7% reduction in ER visits. And so it becomes...
actually a way that, sure, we'll work with our home care providers to help them get better at it, but actually doing that and having the payer come down from their perspective, and then thirdly, the patient empowered to know, "Oh, wow!" I saw a photo from Professor Pelayo, just we were just catching up, hadn't seen each other for a number of years, and he showed me a picture of a mask a patient brought into his lab, and I'm not breaking any HIPAA laws by saying this thing was two generations old, and it had been glued together in duct tape. The person didn't know they had ability to get it. So as people, "Oh, you know, you've maxed out resupply." No!
In Stanford, one of the most educated parts in the Bay Area, a person going to Stanford Medical Clinic did not know they had a chance for a new mask. HMEs haven't done outreach as well as they could. Patients themselves haven't been empowered by ResMed. I take some responsibility for that, too. So I think we've got good work to do in tech, with Brightree and Snap and beyond. I think we've got a better job in leveraging 8.3 million on myAir. So if you've clicked that box saying, "I want to hear," why don't we tell people, "You are due for a new mask. Your copay would be this. You know, click here if you want to have that happen"? And so I think the opportunity is huge. And, you know, we've spent this whole question on the US.
We're in a hundred and forty other countries, and there we have, you know, lots of interactions with those patients. I think resupply is far less leveraged in those countries as well.
Can I add one little tidbit? We've also published a study that shows that when patients receive regular resupply, they are more adherent to therapy. So it is actually better because if you're more adherent, you're less likely to show up in the hospital, less likely to be admitted. You cost the health system less. So for the cost of a couple of masks a year, you save thousands of dollars in healthcare costs. So resupply is an important, important part of the care paradigm.
Microphone's coming on. Someone's tapping a mic.
Hey, it's Matt Taylor from Jefferies. So, Brett, I wanted to ask you about some of the assumptions for the long-range plan.
Yeah.
Obviously, you're implying you're gonna gain market share, and you have a high market share now. So maybe just talk about how you could do that and whether you contemplated Philips coming back in those plans?
Yeah, I mean, really, really the strategy is around growing the overall market, right? 'Cause we have significant shares, so the aim is to grow that market through demand generation, then capture that demand. So that's what we're focused on. You know, with the new product introductions, with the innovation that we have, we still think we've got a significant competitive advantage. So do we think we'll take some share along the way? Yes, but it's predominantly about growing that overall market. That's where I think we'll get... That's what's gonna drive the strategy on that. And then in terms of Philips, yeah, look, it... Yeah, that's factored in. The base case, we get, you know, come back in FY 2026.
But really, the basis of competition or the landscape's always been there, and if Philips are not there, if Philips come back to us, it's just in the overall mix of the competition. We've got to continue to innovate, you know, through products, through channels, through demand gen and demand capture activities, through our ecosystem, which we think is a very significant competitive advantage. If we continue to do that, that's really the basis of competition, is that value proposition. So that's what we'll focus on. But to you s pecifically, yeah, we've you know, we factored them coming back in at some stage.
They're already back in many countries tens of countries in Europe and Asia.
They've had to catch up. Number five, four, three, two position, and really, I mean, you know, six, twelve, eighteen months in different countries, it's been a non-factor. I mean, we—I don't know, but most of this, you know, today has been looking forward. Looking back, I'd like them back Monday, so that we don't get the question. Yep, they're back. Still winning, and we'll continue to. But it's about growing the demand, getting more patients in, and making sure they find their pathway through and looking forward. And that's where the future is.
I think, David Rescott with Baird, you talked a lot about the opportunities to drive market accelerating growth across the broader segment. And so, you know, my question is to the team, you know, does that mean that market growth accelerates toward the higher end of what these different growth buckets are for SaaS and for devices and masks? Or, you know, could that be that device growth goes into the high single digits or SaaS goes more above the double-digit numbers? And when you think about what the guidance is set out there over the next five years, does that imply that the market does accelerate, or would acceleration be upside to that outlook?
Look, I think if we're talking about with our market share position, that we're going to accelerate the market, it does mean the market accelerates right where we're at. And we are not quantifying down to the 50, 75, 100, 125 basis points. We've got so many models coming out from our finance team. We know we're gonna beat what the world would think marketable growth would be if you didn't have not just the 15 people you're seeing today, but the 10,000 ResMedians doing what they're doing. But it's gonna be product leadership, revenue leadership, marketing leadership, and really changing the game of how patients flow through the funnel. So it will be higher than those basis rates. It has to be. But mathematically, it doesn't have to go that much higher.
You think of device growth can be sort of linear, but then you get sort of exponential on the masks and accessories with a patient with a resupply rate. And on the software side of the business, residential care software, you heard Bobby talk about high single digit and low double-digit growth and top line, and certainly getting double-digit growth on the bottom line. So you can sort of look at it and see us able to achieve, you know, Brett's pretty broad guidance over those five years. And, you know, if you haven't felt it so far today, we have a lot of confidence in being able to achieve this to meet or beat these goals.
Okay, and then, to follow up, I guess, on some of the... Yeah, turned off. Oh, there we go. On some of the other questions, just-
Don't turn him off when he's halfway through a question. That's rude. I think his battery on that mic might be gone.
Okay. You talked a lot about either M&A or partnerships or R&D, and obviously the numbers on the undiagnosed opportunity is a lot bigger than that of what you could recapture from those that either are going to third line therapies or improving the adherence rate. So when you think about the investment across those three buckets, you know, where do you see the biggest opportunity for ROI to drive, you know, this longer term growth? Again, either from bringing more in, you know, keeping some of those from falling out. Just any color on that. Thank you.
Yeah, happy to take that and so, you know, in general, we get strong ROIs across our investments across the board. Organic investments in particular deliver a very strong ROI because they're not nearly as capital intensive but what I'd say is we wanna take a very disciplined approach to our investments, and we wanna ensure that our investments really reinforce each other so we get a multiplier effect across our investments so marketing reinforced by product reinforced by commercial investments with strategic partnerships and potentially some M&A all accelerating the patient flow through the pathway, right and so that's the approach we, we think about versus one-off investments and evaluating them on a one-off basis so that's, you know, broad strokes, how we think about the investments we're making, M&A versus partnerships versus organic.
They really are, you know, they feed each other and reinforce into each other as a way to drive strong ROIs. It's ultimately in the spirit of driving the strategy.
All right, we've got a question from the online audience. This is from Peter Thompson at Coho Partners, I think probably for Brett or for Bobby. So you've talked about the growth rate of SaaS. Where do you think SaaS could be as a percentage of total revenue by 2030 if it continues to grow at a higher rate?
Brett, do you wanna start?
Well, I-
I wanna say this. I don't want it to grow because I want the core business and SaaS, you know, our residential care software business to grow so well together.
Yeah.
You can stay at 12-14%, and we all grow incredibly strong. It's not either/or, but it's both and, Brett first and Bobby.
Yeah. I mean, it's, we've got, you know, high single digits, low double digits there, so you think it will probably, you know, that's growing a little bit faster in terms of our outlook or guidance, I guess, for long term. You know, we, we do wanna make some tuck-ins, particularly in the residential care software, and Bobby's they've proved, you know, really, really effective in bringing capabilities in and, and driving revenue. So, you know, if we get some upside from those tuck-ins, you know, maybe that goes a little bit faster, and it sort of it edges up. But look, the reality is our core business is growing really strongly. So kind of inroads as a percentage of revenue, I think, will take time.
But yeah, it should, you know, it should edge up, edge up over time, I think. Tuck-in acquisitions maybe accelerate that a little bit. Bobby, I don't know, what do you think?
Yeah. So we continually evaluate build, buy, partner, right? So how do we bring most value to our customers and their customers, the patient, the ultimate customer. And through this rubric, we always try to figure out what is the best way and the fastest way we can reach value and get the value. I do think, as Mick has mentioned, we are gonna grow high single digits to low double digits, and we aspire to always meet the market growth rates in each of our care settings, and we'll continue to do that, and we'll do that profitably. So one of the, you know, clear focus areas is how do we get leverage in the business?
We just want to not just grow, but grow really profitably and ensure that our margins are expanding continually as well.
If there's one slide that speaks to that, which wouldn't be achieving this go up higher as a percentage of some internal pie, is the fact that Bobby could identify. I mean, I personally visited a MEDIFOX DAN customer, a nursing home. 500 residents, right? Take the average prevalence of people in their seventies, eighties, aging in place in a nursing home, and I said to the head of the nursing home, walking around, great software, MEDIFOX DAN scaling. I said: "Well, how many patients do you have?" I didn't say on a ResMed CPAP, I just said: "How many patients do you have on CPAP here? 500 residents." "Oh, we have one, you know, Mrs. Smith or." I said, "What? One out of all this?" I, like, I was with Bobby, like, this day, like.
I think one of the biggest opportunities here is, yeah, grow the core with the capabilities of the software and share that great growth together. So, that metric is not one that Bobby or anybody is measured on. It's a good one, it's an interesting one, but it's not nothing, no one internally should be measured on that, 'cause you grow more patients in the funnel, and you grow that business. It's both and, not either or.
Hello, Laura Sutcliffe from UBS. This is a demand capture question. Every time we talk to sleep doctors, they say: "My waiting list is getting longer and longer. People are showing up." But you guys don't make any more money unless someone actually writes a script, right? So how do you help that bottlenecking situation? And then I have a related question for Brett after that.
You want me to. S o I think that the first part is that the bottleneck is different in different regions, right? So in the U.S., if you look at the different states, we have different situations in terms of wait time. So when I mentioned earlier, we're looking to target our marketing activities, we can actually overlay that with capacity in a given region. So we don't wanna create a lot of demand in a market where patients then have to wait forever. So that's number one. Number two, in terms of business model innovation, we are looking to partner with companies that help accelerate that throughput in the pathway by offering alternative ways to get onto therapy, get that prescription. But those are the two elements that I think make the difference. But-
Mike, I don't know if you want to talk to. I mean, we've got partnerships with people who are scaling models that aren't all facility based, that look at home sleep apnea testing, that look at telemedicine, that look at remote patient setup, and these are at scale, but they're regional. And Mike, do you wanna talk to some of those?
Yeah. This comes back to the answer I had given earlier, where with the data that we have now and the sales, the market expertise of the sales team, we're able to identify those areas and where the hang-ups are. And then, as I said, that's part of our go forward strategy is discussing that with Justin and his team, because it's a product solution in many cases, not just, you know, or an access solution. So we continue to evaluate those partnerships and find out the ways regionally that we can expedite that process for patients.
So the revenue team is seeing where there are capabilities up, and then the marketing team's looking from MarTech down to say, "This group of PCPs have this scalable model. They are GLP-1 prescribers, and they have a sleep channel, and they're open to being communicated with." As I was saying earlier, that sort of overlap of those three circles. Pretty high-tech stuff, and scaling it, and you test, you find out did it work. If it does, you accelerate. If it doesn't, you find another region and go again. But it, it'll be...
I mean, it's an exciting time because we've got tools that we didn't have five years ago, and we've got a world post-COVID, post-pandemic, where people are open to digital medicine, remote medicine, digital screening, and remote patient setup, and digital health like never before.
So it sounds like those are things that could take some time, depending on what they are. So my question to Brett is whether the growth you've mentioned is back-end loaded in some way?
I mean, the demand, I think it'll build over time, right? 'Cause the wearables have just come out, GLP-1's coming out. So I think that'll be a cumulative or gradual build through that. It's not gonna just suddenly kind of like snap your fingers and it's there next quarter. So I think it'll build through that, and it does, I think, give us a bit of time to build through some of these, you know, virtual pathways, and we're building out the ecosystem. We've made some strategic investments with Somnoware, which is around sleep physician software, around Ectosense, NightOwl for home sleep testing. So we're quite active in building out the ecosystem and what we think is the infrastructure we need.
But you know, I wouldn't quite go that it's back-end loaded, but I think it will be kind of linear or be gradual as these build. And then we'll build behind it, but we wanna move pretty quickly on those. And that's why we're so active in trying to build these partnerships and these pathways and making some of these strategic acquisitions, 'cause we really wanna set that infrastructure up. The patients we think will be identified, and then it's up to, you know, it's really up to us to make sure those pathways are there, they get diagnosed, and they get on therapy. So that's-
Yeah, I think this is gonna go pretty fast.
Yeah.
I mean, you look at the flow of how a consumer technology product rolls. It's a software upgrade to a phone. It rolls out. So the flow of patients is gonna come in very strongly.
Yeah.
How fast we can scale up these experiments and pivot, that's, that's on us, and that was like earlier, the question was, what's success or failure here? Success and achieving these goals is making this happen and pivoting with an agile team that can test, try, if it works, double down, if it doesn't, reassess. And it's not rocket science, and we've got the team to be able to do it. I, I... It's a once in a generation tidal wave of patients, and we will be able to achieve this. And it's, this isn't, oh, all 2029 to 2030. No, this will start January 1, 2025. There'll be patients starting to flow in. It'll start Monday morning slowly, right? But it, it will be an exponential wave of patients.
They're just coming, and so now on us, stretch the system, educate the system, and make it happen.
Actually, just one more comment. This is very U.S.-centric, but outside the U.S. and some of those high growth markets, we're actually not constrained by capacity issues. So there, the charter on us is really just to make sure that the demand generation and demand capture efforts we are doing are sensible in terms of cost. We don't wanna spend incredible dollars on customer acquisition costs. We wanna be really good at, you know, tailoring it in the right way and really understanding the right model, and so we've been developing a lot of intelligence right now on that, but we're already scaling some of those efforts outside of the United States.
So we've got two minutes, maybe a lightning round.
Yeah. So we've got one question from online. I think this is probably gonna be our last question. "So how do you see the evolution of your product mix in the future, especially as you think about now having more software and leaning more into health tech at home?
Mm. Justin?
Yeah. I mean, now, our core sleep apnea business is always gonna be the, the engine that drives our business, so we think that's gonna continue to grow. We'll continue to bring out more devices and more masks, so you'll see both of those grow, and we also expect our software offerings to grow. I mean, the, the key thing, back to Laura's point, to increase capacity in our pathway is better use of the software tools that can make, you know, sleep labs more efficient, DMEs more efficient. I mean, we see with our new Somnoware sleep lab software, that sleep labs are actually able to perform more sleep tests once they have the software than before, right?
It's these software tools that sort of underpin the patient pathway that are gonna create the extra capacity, and as we, you know, increase the velocity of the product launches and devices, mask and also, you know, within Bobby's area, you'll see that adoption being able to be captured through that pathway.
What Brightree was to HME efficiency and growth, Somnoware will be and should be towards sleep lab growth. We have both assets, and as the team said, this is one. The interoperability, they're all within the ResMed ecosystem, and the tech teams across ResMed are tightly looking at that interoperability, making sure it's seamless and therefore can provide the capacity to deal with this tidal wave of patients. That's a close.
That's the close.
Thank you.
Thank you.
Thank you.
Thank you.
All right, folks, we're in the home stretch. Very excited to introduce our next session. We've got a wonderful panel for you. Carlos Nunez, our Chief Medical Officer, will be joined on stage by Dr. Pelayo from Stanford.
Thank you.
All right. Thank you, Amy. All right. So thank you, all. To wrap up the day, I think we've got a really, really interesting conversation here. And I'll give a very, very brief introduction to what we're gonna talk about and to Dr. Pelayo, but we'll start by letting him introduce himself. But as you've heard, my name is Carlos Nunez. I'm the Chief Medical Officer at ResMed, and Dr. Pelayo is at Stanford University, as you've heard mentioned a couple of times today, and he and I have only physically met three times, and two of those were last night and today. I've met him once before the pandemic. We did not prep for this other than we talked in general that we're gonna have a nice conversation. I've asked him to be as open and honest.
He is a practicing physician, scientist, a teacher, an accomplished world-renowned key opinion leader in the world of sleep, and we're gonna start by having him introduce himself and tell you a little bit about him, and then we're gonna ask him some questions. So go ahead. You're-
Thank you so much. Yeah, my name's been mentioned a few times already. No pressure for me, but I'm impressed with the questions that you guys have been asking the analysts. I'm not an employee of ResMed. I don't own any stock in the company. I don't have any grants from this company. So if your first conclusion is I'm a lousy business person, you're right, I'm not a business person. I didn't understand any of what the CFO was talking about, really. I couldn't follow any of that, and also, my university does not allow me to endorse any products. I'm not endorsing anything here. My job is to take care of patients and to teach other doctors how to take care of those patients, and to teach younger people about the importance of sleep health.
So my professional loyalties are to my patients and to my students, and I'm happy to talk to you guys about any aspect of sleep. What happened with me was, over twenty years ago, I wrote a letter to the founder of the company, Peter Farrell, and asked him, simply said, "Thank you, because your products are making my life easier as a doctor because the patients are doing better with them." So that's how, that's how it all began with me. So I just found out about doing this. I never heard of an Investor Day. This is the first time I heard about this. First time I've ever been here. I'm from New York. I was born here. Puerto Rican family, and live in California now.
But I'm just kinda glad to be here with you guys, so I'm happy to answer any of your questions. Some of them are very clinical questions and very insightful questions, so I'm happy to go over this stuff with you folks.
Yeah. And he's being a little modest also in some ways. So Stanford, you know, we talked about Colin Sullivan, the inventor of CPAP in Australia, but Stanford is where sleep medicine was essentially invented.
We had a really interesting conversation earlier, where Colin Sullivan, the developer of CPAP, and Dr. Dement from Stanford, they were sitting in Dr. Dement's backyard, and the two of them were discussing who was gonna win a Nobel Prize, and-
Yeah. Yeah.
Just, it's amazing to think that, you know. And you were like the fly on the wall. It was just to hear the story and to see your face light up was great. And, you know, Stanford, again, because of this legacy in sleep medicine, has attracted some of the most important KOLs. And another thing, just to mention, just to give you some props, I learned recently that he, Dr. Pelayo is very involved in the efforts to delay start times for schools because, as we know, sleep for younger people is so important. They need more sleep than those as we get older, and so he's an internationally renowned figure in helping students sleep better and do better.
So the first question is kind of open-ended, and I just want you to talk about whatever excites you about the field of sleep. Maybe a little more specific towards sleep apnea, but what do you see that's exciting today? And then looking five, ten years in the future, what gets you the most excited?
I've been saying for some time to my students and my patients, that we're living now in the golden era of CPAP. It's just never been better. I mean, I've been saying that for a long time, that it just hasn't gotten better. When I first started, people didn't know what sleep apnea was. I told people I was a sleep doctor, they assumed I was an anesthesiologist. They had no idea about this field. And now that it's much more mainstream, that there are medications approved for all these different sleep disorders, it's amazing thing to just see this process begin. We had a big black eye with that Respironics recall, and I'm actually grateful how ResMed responded to that, that they didn't cut us off, that you still went through the effort.
I know they made a lot of work on that to get the chips to get it going, that I didn't have to prescribe other brand machines. The question earlier about that the mask is the machine selection is driven by the DME. That's ridiculous because they're always gonna pick the cheapest machine, the highest margin that they have. The prescription is written by the physician, so we need physicians who know what they're doing and specify what they want for their patients. Nobody's coming to Silicon Valley to cut corners. That's not what's happening. They want the best available, and that's what we're just gonna try to do for them. So we're just gonna pick whichever the individual physician thinks is the best tool available to treat that patient. That's what we're doing.
So that's where I think we're at right now. I think it's. CPAP's never been better, and that's actually a misnomer to think of it as just CPAP. We keep calling it CPAP traditionally, but it's not CPAP. It's not a continuous pressure device at all. It's an automatic machine. So this is a dynamic condition. There's been a lot of talk about the GLP-1s. I'm sure we'll talk about it later, but if you take a GLP-1, you're not gonna cure your sleep apnea tomorrow. It's gonna take years, if at all, if it's gonna happen at all, and you need a device that's gonna be dynamic and change with the patients. We've already had this experience because we deal with patients who are pregnant.
Pregnant patients have dynamic changes in their breathing, and we need a machine that's gonna adapt with them as they go through their pregnancy. It's gonna be the exact same situation here. So this is a great opportunity for this. There's a lot of other things I can talk about. I'm not sure-
Oh, no, keep going.
As I'm up on the stage. I mean, this comes up. This has been happening over and over again in the conversation I'm hearing around here. I think three or four times I've heard of the death knell of CPAP. This is not gonna happen. It happened to us when the radiofrequency stuff came out. It happened to us when bariatric surgery came out, and patients were told, "Once you have your surgery, you won't need the CPAP," and nobody bothered checking whether they still have residual sleep apnea. Happened to us with medications, too, it's happened before. It happened to us with the hypoglossal nerve stimulators. This came about also, that the patients would be using these devices. So patients routinely would come in now, and I've seen a bunch of patients like this.
They come in saying they saw the commercial on TV for Inspire, and those commercials make fun of the CPAP use, and the patients say, "I came here because of that commercial." And I said, "Fine, great. I'll refer you to our surgeons for the Inspire device. We have a hypoglossal nerve stimulator program at Stanford. We have surgeons devoted to just doing that, so I'm happy to refer you to that." And they go, "Wait, nobody said anything about surgery." I'm like, "It's an implantable device." And they said, well, they didn't want that.
And I said, "Well, would you like to see what the new CPAPs look like and the new masks?" So more often than not, when somebody comes in and asks because of the commercial, because it's on TV, they leave with a prescription for a CPAP machine and CPAP device. So this is happening over and over again. I think the same thing's gonna happen on the GLP-1s. Patients are gonna be looking for them, we'll be prescribing them. I'm gonna learn how to manage pancreatitis, apparently. But what'll happen after that is that these patients will probably be using these devices anyway as a bridge. So I think there's gonna be a lot of use of this stuff going on. There was actually...
If I may make. So, you made a slight mistake in what you said earlier, and so sorry to be critical of you. I guess, obviously, I don't work for this company, I can say whatever I want about you. But, yeah, you referred to the Apple Watch as a screening device, and I'm in Silicon Valley, that's Cupertino is right next to us. And the guy that helped do that work, Dr. Matt Bianchi, he's a friend of mine. He actually volunteers at Stanford, and he went over the white paper with me. He actually tutored me a little bit on the device last Thursday, and he said, "We don't call it a screener." And you referred to a screener because it's actually set up...
A screening device has high sensitivity, and they made something with high specificity, which that means is that if it's gonna... A sensitive device will have false negatives. The specific device will minimize that. So they picked a device that has, it's more for moderate to severe sleep apnea. And that's important to know that because it's kind of easy to pick moderate to severe sleep apnea. You don't need a watch. I mean, the best detector is your bed partner, your spouse. I think that's who is your best detective at. And I tell my patients all the time, patients come in and say, "My wife claims, or my husband claims that I have sleep apnea." And I'm like: Go home and give them a kiss. They may have just saved their life. You know, they, they, they...
I've not seen a spouse be wrong yet. So their device is set up to detect moderate to severe sleep apnea, and I think it's a good thing because people are gonna come in with it, so we're gonna have even more people coming in all the time, and they will avoid some of these arguments, you know. The other minor thing I noticed today, I did not know you'd have the new mission statement, if I may. That's a good statement, but I'd add one phrase to it because it says, "At the home," period. I'd say, "Home and wherever they sleep," because you've got great devices people use. This happens to me all the time.
Patients say, "I use my CPAP at home, but not when I travel." I'm like, "What, you're not gonna get a heart attack when you travel? I mean, this is ridiculous," and people do this all the time. You know, so it's whenever they're sleeping, and I think that's a good tool to think about. I would add that.
Yeah, it's a good point because when you think of our residential care solutions, some of those patients, their home may be a nursing home or an assisted living facility. So it truly is wherever you call home or wherever you happen to be sleeping that night. So let's talk about the condition a little bit. In the break, you mentioned that one of the questions really resonated with you from one of the analysts.
So, I wanna talk about the prevalence and the lack of penetration in the market, but we'll talk about it from sort of a medical way, and this is a line I've been saying recently a lot: You know, there are a billion people with sleep apnea, 80% plus are undiagnosed and untreated. I mean, there is no condition as prevalent in humans where we tend to be okay mostly ignoring these patients. And then, when you look in popular media and you see a PAP device or a mask, depicted in media, it's often the butt of a joke, right? They don't look like that.
It's the big Darth Vader mask that hasn't been in the market for twenty years. A device this big probably hasn't been in the market for twenty years. It is a joke, and it's amazing to think that we're okay ignoring eight hundred million patients and making fun of the most effective therapy. How do you work with your patients to help get past the stigma that most of them bring about PAP therapy, and help them understand that, guess what? Adherence to PAP therapy is actually better in most cases, or can be better in most cases, than adherence to medications.
Several points to that. Actually, I went to a comedy show with a national. I won't say that person's name, but the fact that he finished his routine. He's a nationally known comic with a whole routine about CPAP. It was actually good because that meant that it was funny enough that it was mainstream, that he could make jokes about it. Actually, I lost my train of thought thinking about that comedian a little bit. I'm sorry, guys.
No, about the big,
Yeah
... how you help your patients understand-
A few things about this.
Important.
Yeah. Well, people say things like, if it's somebody single, they think, "Oh, I'm not going to be attracted to my bed partner." And Dr. Dement, the founder of our field, said that the fountain of youth is in your bedroom. And in fact, if anything, the CPAP machines bring couples together. And actually, a lot of weird, innovative things happened. I remember when the first CPAP machines came out, the first remote controls came out. The engineer is not from this company, but from another company. What would happen is, the remote control worked on a single frequency. So when you turned on your machine, you also turned off the machine. The engineers did not anticipate that a couple would both be using CPAP. So if you turn yours on, you turn off your partner's. This would happen.
Now I tell patients, "No, there's a remote control built into it. It's your nose. Now you turn on the machine automatically when you do it." So, if anything, the CPAP brings couples together. This happens more and more. In fact, the marketing photos of your newer masks show couples in bed a lot with a smiling bed partner. This is very common. So CPAP brings couples together. This happens all the time, so it's actually a good thing to do. People think that they're really noisy machines, and they're not. I'd mentioned earlier, I got out of a speeding ticket one time because I was going fast. I was giving a lecture, and a police officer pulled me over.
I was with my son in the car, and he said, "Why are you speeding?" I said, "I was giving a lecture." He goes, "What's the lecture about?" I said, "I was talking about sleep." And he goes, "Ah, I have one of these things." And that's become the universal hand gesture for CPAP. And I go, "Well, it's not like that. It's kind of like this," but that's not a good symbol either. But I had one in my car, so I pulled it out of the car, and I showed it to him. I plugged it in, and my car is a hybrid, and I showed it to him.
He gave me a hug, he got me out of the ticket, and he said to me that his, his, he actually was separated from his wife because of his snoring was so loud, and he was actually gonna exchange places. So I think we just have to let people know that it's a much better product than it's been. It's never been better. I tell patients all the time, the people say, "Do I have to use this thing?" I says, "No, you get to use this thing. You don't have to, you get to use it." And one of the common questions I'll ask my patient when the first time they come in with the device. I do a lot of second and third opinion work.
People say things. First thing I ask them is: "Do you snore with it on?" And they'll say, "Well, I'm not sure." I go: "Well, ask your partner," you know? "Well, I snore less." We have to snore zero, and I teach that all the time. If you snore even a little bit, it's not set up correctly. The machines that are set up correctly, it's like getting glasses. Your vision should be 20/20 immediately. The CPAP works right away. That's what we're talking about. I tell them all the time, it's the best bang for the buck in that sense. It works right away. You know, compared to any of the medication you're gonna be using, those are more tools.
It's good news that we have medication choices that they'll be developing, but this is still considering how much the cost of the device. It's actually really good. There's a great value to the patients. I think so.
Yeah. I heard a conversation with two couples, and they were talking. One guy who had sleep apnea and was being treated, another person had it, but didn't wanna be treated. "It's not sexy. I don't wanna go to bed..." But the wife of the other couple said, "You know what's sexy? That he doesn't snore." And he doesn't put the mask on until it's time to sleep. No one is sleeping when you need to be sexy. So, you know, it works. It really worked for these couples, and it convinced the other guys, like: "You know what? Maybe that's a good thing 'cause it's not too sexy when she kicks me out of the room to the couch.
Dr. Dement used to say the same joke, and I'll repeat the joke. He said when he first got the CPAP machines, the first couple he met, he said, because the hose came on the front of the nose, he says, "We may look like elephants, but now we screw like rabbits." That's what he said. That was his quote. So, sorry, you know, that's what he said.
Not a ResMed employee. I didn't say that.
Yeah, yeah, exactly. Yeah, yeah.
I didn't want that.
But that was Dr. Dement. Dr. Dement said that. He's passed away, but this is a sure thing he said. People don't realize it-
That's awesome
... that it's a rejuvenating thing.
That's amazing.
Make people feel better.
Yeah. No, that's amazing. No, and it's, you know, that getting past that stigma is important. One of the things that we've heard when we've talked to patients, and maybe you've heard the same, you know, some patients d on't. Like you said, they don't want surgery. They don't want a drug. They want something that feels natural, and we've started to remind people, this is just air and sometimes water, and it's not invasive. And if one out of eight humans has obstructive sleep apnea, this is a part of the human condition. This is not some rare corner case. And just like some people have flat feet or are nearsighted or farsighted, if you wanna run a marathon and do your best, you might have to get insoles for your running shoes.
Just like if you wanna breathe, sleep, and perform your best, you may need a little help keeping your airways open. And that's. I think that's an important message for patients. So thank you. It's really important. Let's talk about tech a little bit more, and then we'll talk a little bit about pharma as well. You mentioned the Apple Watch, and we have a lot in common, so we're both Hispanic, we're both born in New York, we're both physicians, we both moved to California, and he gets to live in Silicon Valley, which is really cool. So he's near all these tech companies.
What do you think is going to be the result of the Galaxy Watch and the Apple Watch now detecting sleep apnea? You know, will you start to see more patients? Is this going to be this tidal wave that we're predicting?
I believe so. I should mention, I volunteer with the National Sleep Foundation, and Samsung is one of the people that helps with the National Sleep Foundation. We're seeing it now. We've been seeing it for some time now, patients coming in with their sleep tracking devices and asking questions about it, "And, my score is low." We're also getting a lot of patients coming in with fears of dementia. That's happening more and more, that they're coming in saying: "Hey, what's happening? Somebody in my family has this horrible disease to have, and improving my sleep can prevent this?" When I first started, we would talk to cardiologists, and they would literally laugh at us when you say, "Hey, listen, this is... Sleep apnea is bad for the heart. It can lower the...
Treating sleep apnea can lower blood pressure," and they would laugh at it. Now, one of the biggest drivers of our visits, it's about one year wait now to see, for appointments with me. It's ridiculous. We have a lot of patients. It's been growing. It's patients with atrial fibrillation coming in. They're now routinely being told, "You should get your sleep evaluated." So we're seeing more and more of this. So though the funnel is wide open, there's not enough of us to take care of these patients. So, I don't view any of the tech stuff as a threat to my job security. So anything, we want more primary care doctors involved in this and nurse practitioners and more people to do this, 'cause in the end, this is everybody sleeps.
This should be a primary care problem, a primary care condition. That's what it has to be. So the tech is actually just increasing awareness of sleep, in improving sleep health, and I think that's a good thing.
Yeah.
I'm happy with it.
And you mentioned atrial fibrillation. Just, to verify with you, 'cause it's something that I've heard many cardiologists tell me, there are quite a few cardiologists who believe that a large proportion of atrial fibrillation is a result of sustained, untreated sleep apnea, that the repeated hypoxic insults to the tissue of the heart leads to these arrhythmias. Is that something that you think is supported by your practice?
I think it's become routine for cardiologists to refer anybody with atrial fibrillation for an evaluation of their sleep apnea, and I think it's. I don't, I'm not sure the exact number, but I think if they, if they've had an ablation or if they've been cardioverted from the AFib, 40% chance of them going right back into it if the sleep apnea is not addressed. So now it's just good practice in cardiology to get patients treated for their sleep apnea or checked for it at least. We get a lot of patients like that saying, "I don't know, nothing's wrong. My cardiologist sent me here.
Oh.
It happens. That's now a very routine patient for us now, for the atrial fibrillation, and it really was something that they would refuse to send us for many, many years. Now it's routine. So we just keep seeing that change and it improving.
The tech is important. I have a relative who works in a safety sensitive industry, and he is not allowed to work unless he submits his sleep apnea data to a physician every either three or six months so that he can continue to work in his job, so I'm sure you see patients like that, too.
Yeah, the transportation industry and stuff like that, I think this comes up a lot. The trucking industry, stuff, things like that, of course.
Yeah. So we've got about six minutes left.
Oh, okay.
Let's talk a little bit about about pharma. You know, we've talked, we've touched a little bit about GLP-1. Someone asked about Apnimed. I'll tell you the line that I have been saying, and actually, I can't take credit for this line. So Dr. Atul Malhotra, who we both know was asked this question about GLP-1s: "If these drugs can help make sleep apnea less severe, do I just put patients on these drugs and forget everything else?" And what Dr. Malhotra said is what I'll repeat, and I have been repeating a lot, is, you treat the whole patient.
And if someone shows up who is struggling with their weight and also has sleep apnea, you don't put them on a drug that may help them a year from now, knowing that they could get into a car accident today. Just like if they showed up with hypertension and obesity, you wouldn't just put them on a GLP-1 in the hopes that their blood pressure might go down because they could have a devastating stroke today.
How is, you know, this conversation and the realities of GLP-1s affecting your patients and the way you treat them?
I think I welcome it. It's good news. I mean, we're gonna have patients who in the past couldn't tolerate CPAP because they were so big that the pressure was not adequate for them. They needed a special machine for that, and if these patients lose weight, we may be able to use a different kind of machine. Again, the importance is that we're dealing with automatic CPAP devices, so these machines will adapt with them. As a patient loses weight, hopefully they'll lose weight, the machine will adapt with them. And they're not necessarily gonna cure the sleep apnea. Part of the thing, you know, a phrase that get used a lot today was COMISA, comorbid insomnia with sleep apnea, and I like the term. It's a cute phrase now that we use it. People say: What is that?
To think back on the history of our field, I got to learn from the founders of our field, Dr. Dement and Dr. Guilleminault. Dr. Christian Guilleminault is the one who coined the phrase obstructive sleep apnea syndrome. Not obstructive sleep apnea disease, obstructive sleep apnea syndrome, because he was. It was 1970, I think, maybe 1971, and he was saying, "You know, these people, yes, they can be overweight and have sleep apnea and choke in their breathing," but there was a whole bunch of them who were thin, who had insomnia, too. Somebody asked earlier, "Well, this is a mechanical disease, how come they have insomnia?" You have to think about how these people think. You know, what's it like for you to be in bed?
Most of us are only alone with our thoughts when we're in bed. And if you wake up being tired, and now tomorrow's an important day, and I'm gonna be tired tomorrow, now that leads them to think a certain way, and that can build the insomnia. Or what wakes them up for one reason, then they stay awake ruminating about other things. So these things tie in together. So I think it's gonna be really, really good that we can maybe lower the severity of these patients' illness, at least some of them, or many of them, hopefully. But we're not gonna correct the entire problem, especially certain populations. In the Bay Area, we have a large Asian population, and our Asian population of sleep apnea patients tend not to be obese.
They just have small jaws and a different shaped skull. So think about that also, what kind of patients we're dealing with. It's not just overweight people. That's a mistake. That's kind of almost our original sin in sleep apnea because it came from the Pickwickian syndrome, in which were these overweight people. It's more the overlap syndrome that Mick mentioned earlier. Most of our patients aren't overweight. I tell patients all the time, "Just sit in the waiting room." Most of our patients are not obese. You know, they're not. You know, especially children. We didn't talk about children today, but children typically are not obese when they have sleep apnea. Yes, overweight people can have sleep apnea, but they're not necessarily that way. There's more to it than that.
Yeah. No, I mean, obstructive sleep apnea, I mean, as it sounds, obstruction, it is an anatomic problem first and foremost and as you said, many people, it's the anatomy that they're born with, whether or not they have, you know, a few or more extra pounds. One of our colleagues, we were talking earlier, another researcher in Europe, says that, you know, his primary risk factor that he sees is age. As people age, they're more likely to have sleep apnea. It's not conditions like obesity that are his driver.
If I may, actually, we published a paper last year. I'm not the first author in it, but we talked about the possibility of preventing sleep apnea in adults by treating it in children with orthodontics and the idea of bringing the widening the palate. So these ideas that we maybe not only cure disease but also prevent it from happening, because we want to be comprehensive in our approach. You know, it. I work with kids and adults, and if you see a kid with sleep apnea, you have to ask about their parents. You see an adult with sleep apnea, ask about their kids, because this is a familial disorder. So this happens all the time. You have to ask about them all and go across the generations.
It's unlikely you're the only one in your family who has sleep apnea. I teach at a college level, and I ask my college students. I have 200, 300 students sometimes. I say: how many of you have parents who snore? Watch them raise their hands. I go: Guess what you're gonna do when you're older? You're gonna snore, too, right? They laugh at their parents snoring, but they're gonna be in that same position, too. So you gotta think about this. So we may be able to prevent sleep apnea by being more aggressive treating it in children. So I think it's a great time to be involved in sleep medicine.
Thank you. Yeah, no, it's familial for me. Grandfather, mother, me. So for sure. We've got about a minute and a half. Any last thoughts you'd like to leave them with?
I'm just grateful for the chance to be talking to you guys here. I appreciate this chance to be here today. So, I mean, you know, I'm sure there's things we can make better for this. I wish the product cycle was faster, you know, because I'm always excited when new stuff came out. Like, I did not know that a new mask was being launched today. I really don't work for this company. I'm like, "You have a new mask?" Because the reps, they know that, so I was, like, really happy to see what it's gonna look like. I'm looking forward to... I've already sent pictures to my coworkers, "Look, this is new mask is coming out today. We gotta start using it.
See what you guys think about it. Yeah, I think it's a good time to... If you're gonna have sleep apnea, now, you know, now's a better time to have it because there's better tools than ever for it.
Thank you.
Thank you.
That was excellent. All right, and I think we are at the point where we're going to break and have one last. Oh, no, not break. We have one last-
I'm gonna do a one-minute closeout.
Oh, look at that. All right.
Thank you, everybody.
Thank you all.
Thank you, guys.
Rafael.
Thank you. That was great.
Thank you.
Thank you.
That was awesome.
Thanks, Rafael. That was awesome.
Thank you.
I'm gonna close with the three points that I started with, and I just hope they. You felt them, heard them, got a chance to dig in, and of course, you'll have time to look at the products and talk to the team one-on-one, and stay for a cocktail maybe. Those of you on virtual know. Three takeaways: One, we have an incredible market opportunity here at ResMed. Over 2.3 billion people, one in four on the planet, that can be treated by us, our current products or future products and adjacencies. Two, we have a sustainable competitive advantage and an excellent track record of success, but even more exciting, future ahead. And three, that we've got a phenomenal 2030 strategy together. It's about an innovation machine. It's about our existing channels and new channels.
Thank you very much for coming here live to New York, and hope to see you at the breakout. Thank you very much.
Awesome. Well, thank you all. For those of you who lasted the entire afternoon, you are amazing. We appreciate it so much. Just a reminder, the video webcast replay should be up within 15 or 30 minutes. I believe the slides and all the press releases are now available on the investor relations website. And for those of you who are here, I think you deserve a drink. So cocktails to my left. Visit the showcase. We've got an amazing mask giveaway for you, and the items at your desk or your table are for you. Thank you so much.