Perfect. Morning, everyone. It's a pleasure to have all of you on the call this morning. I'm especially pleased to have Rob Douglas, COO of ResMed, on the line with us. Rob, I'll let you have the floor. We'll jump into the fireside chat.
Thanks, Suraj. Just a brief intro to ResMed. We're the global leader in connected and digital health. We've got three main businesses: sleep apnea, treating sleep apnea or sleep suffocation, respiratory care, treating COPD and other chronic diseases. Our software-as-a-service businesses, you know, providing the operating system for the providers of out-of-hospital care services, now around the world. These are all incredible businesses with really strong growth profiles. You know, the number of patients around the world with sleep apnea is approaching 1 billion people. Only a tiny fraction of those people are even aware that they have the condition, and that treatment would be a good option for them.
Our long-term strategy really is to accelerate and enable access to those patients, particularly using digital and connected solutions, to get those patients onto treatment for the long term. Once they're on treatment, they continue to be, you know, our customers, through needing mask replenishment and updates like that. We think there's probably 500 million people with COPD, and 300 million with asthma around the world. These are, these are conditions that are really devastating for people, very expensive for the healthcare system. Our treatments can really improve outcomes there. With, with our connected strategy, we're seeing a whole lot of data now come out as real-world evidence.
We're really showing that these types of treatments actually improve outcomes for patients, they lower costs for healthcare systems, and they reduce the trajectory of chronic disease. We've really got some great solutions there. We're very confident in our outlook for our future growth.
Great. Rob, can you hear me all right? I know I'm having some technical issues on the audio side. Hopefully, you can hear me all right.
I can hear you, Suraj. It's a little soft. If you speak up, it would be helpful.
Hopefully, hopefully this is slightly better, Rob. I'll just kinda go closer to the microphone. Hey, Rob, obviously you guys have done very well over the last, you know, couple of years, even through COVID, you know, and a variety of headwinds, right? One of the things that is foremost on investors' mind is Philips. You know, everything going on in the Philips side. To the extent, you know, I remember, you know, Mick and y'all at one point, I think, it was 18 months or almost two years ago, you know, highlighting somewhere close to $750 million, like, immediate pickup op-opportunity. Fast-forward now to today. Walk us through, you know, how should we think about the share capture? How should we think about stickiness, especially related to Philips?
Yeah. It's a good, it's a good question, and it's one that gets a lot of attention, as you can imagine. When Philips announced their recall, they announced that they expected it would take a year to correct it, and during that year, they would lose EUR 800 million of sales while they were out of the market for their devices. We actually, you know, people were very uncertain how much of that we would capture. We actually unusually gave some guidance around that and said, you know, we'd capture a fraction of that, around $300 million. The reason why it was a fraction was because of the challenges at the time with chip supply. We were in a period where there's, you know, it happens every few years.
We have a cyclical challenge with chip supply. Our usual risk management procedures, the processes of inventory and long-term commitments, see us through that cyclical electronic shortages without us having to talk to investors about it and saying that, you know, it could affect our sales. We can generally manage through it. In fact, had Philips not all of a sudden taken themselves out of the market and we saw a huge uplift in demand, again, we wouldn't have been talking to the world around the challenges of supply chain that we were having 18 months ago. We would've been managing it through our usual risk management processes.
Since then, you know, very much the discussion has been how much share could we get, and it was largely driven by how much we could put through our supply chain. We had just commissioned a new factory. We also had the AirSense 11 coming ready to launch, and we accelerated the launch of that as well. In a sense, we had two manufacturing lines, and production capacity, both able to meet what would've been our normal market share, which would've been more than, more than the total market share, market available.
Unfortunately, the electronic shortages really challenged us with getting those numbers through, we had to adopt a number of strategies, including at one stage, when we had a lot of decommits on really the connectivity components from our suppliers, that we then launched the Air10 Card-to-Cloud, as you know. In some markets, notably the U.S., that was really well taken up and through there. What we've said now, as time's gone on, our processes, we've redesigned components, we've got alternate suppliers. There's still more to come in that. At this stage, we have the Air10 Connected device off allocation to our customers in most markets. We've launched the Air 11 in major markets, although it is still on allocation.
But we're pretty confident that by, you know, the end of this year, we'll have all of the connected devices that our customers could want and available to them for that. In terms of share, earlier on, we took relatively modest share. Since we've been able to ease the constraints on supply, that share has continued to improve. We would expect that the share that we have gained is sustainable, and we'll be doing everything we can to make sure that we retain that share. We have the best connected solution. We've got the quietest, most comfortable, most effective device. We've probably got the top three devices on the market with the Air 11, the Air 10 Connected, and the Air 10 Card-to-Cloud.
We're only just starting to see the value and the benefits of the new features in the Air 11, which you know, we talk about, you know, ability to interact with the patients and ability to get more engagement with the patients. We've talked about our myAir uptake being significantly greater, and we expect the Air 11 to be a device that produces even better patient outcomes in terms of staying on treatment and getting engaged with the treatment than the Air 10 did as well.
Rob, if I could drill down one more layer on Philips. Let's say you all pick a number. You all got 100 patients incremental, right? Out of the 100, how many would you say are de novo patients, first time to CPAP, that you'll capture? How many were existing Philips patients with DreamSense One or whatever? Do we have an idea on that? Just trying to drill down to the next layer of stickiness in this whole picture.
Yeah. I would say that most of the patients we've had over the last few years have been new patients. Firstly, with the shortage of devices, we saw that there was quite a deferral of so-called repat. That is people who'd come up to their five-year usage on their device. They were not given priority for access to new devices. You know, the devices can operate for longer than five years, of course. That was one aspect of it. The second aspect of it was that our allocation strategy, and again, we had to have very principled approach during this critical shortage. Our principled approach was put patients first, which meant we'd allocate our resources to the higher severity devices treating more severe diseases, ventilators and devices like that.
Our other priority in our principles was that we'd respect our existing business relationships and work with people we knew looked after patients well. We had long-term relationships there. We ended up with an allocation process that was based on historical business with us. Providers who had not been with ResMed traditionally, actually, we were unable to allocate products to them, unfortunately. We weren't out there actively trying to convert Philips patients. New patients were probably more likely to be referred to our customers because they had more supply than Philips customers. That was where we saw the share shift, really, in the referral patterns. We would think that that referral shift is relatively sustainable.
Got it. Fair enough. Rob, in your comments now and also in the last quarterly call, Mick also referenced this, and Brett also referenced this. You know, in terms of the... I believe the phrase you all used was a moderating supply environment, if memory serves me right. Rob, can you expand on that? What does a moderating supply environment mean? You know, just the different components and how should we quantify, supply moderation?
Yeah. I mean, it's very hard to put sort of a single thing on supply. You know the story in a manufacturing environment, if your product has 100 components on it and you've got great supply of 99 of them, you still can't ship your product. What we're seeing is when we talk about moderating or improving environment is that chip providers were not decommitting anything like the rate they were. Decommits have always existed in these supply chains. A decommit is where some supplier has promised you supply, and then at some stage they say, "No, we actually can't do that." That might be to tell us that next year, you know, they can only deliver us 90% of what they promised us next year.
It also might be that next week, what they promised us isn't gonna turn up. They're very hard to manage in terms of managing your supply chain. You've seen us put things in place. We've talked a lot about design. We now have options for different supplied components in order to create the connectivity features that we need. A simple look at our balance sheet will show our entry levels have increased quite a bit during this period. That's been a deliberate strategy to increase our, you know, our overall component supply, so that when we break one bottleneck, we don't immediately run into another one. Long term, we'll look to revert that to our normal risk management processes around inventory and run that through.
We also are working hard with these suppliers in terms of long-term relationships, and we've put in longer-term commitments than what we used to be able to do. The nice thing about our business with its really solid growth trajectory and really a clear understanding of the patient needs is that it's a very low risk for us to put these long-term commitments into our suppliers. By the way, the chip suppliers like us because we can give long-term commitments, and we tend to have very steady growth profiles on products, and our products last a relatively long time, say, compared to consumer products. It's good for them in terms of their production runs as well.
All of that says in terms of the net of things and how well our risk management is working, yeah, have more confidence in our supply that we can increase our volumes, both in terms of the normal volume growth of patients and also in terms of risk management for when other things happen, like a competitor drops out of the market or anything like that.
Rob, if I remember correctly, last year your CAGR was approximately 14%. I'm just jogging my memory on that number. You know, somewhere in the mid-teens. Now the supply chain is moderating. Should we necessarily, you know, think as the year progresses, the fiscal year progresses and next year, you know, does it necessarily mean the CAGR upticks even higher? How should we think about it? Because you all fared very well in a tough macro backdrop, right? You managed as best as you all could. Now things are improving. Does it necessarily mean 14% to, I don't know, whatever percent? Or is that too much of a leap at this stage of the game?
Yeah. I mean, we wanna be careful about, you know, sort of short-term predictions, but if you look at our last publicly announced quarter, we had growth rates of 20%, and in the U.S., they were much higher than that. You know, they're not long-term sustainable, those types of growth rates. We just use up the patient flow. We always revert that CAGR back into how we think about sort of the patient inflows into the businesses. When I talk about nearly 1 billion untreated sleep apnea patients, and we only have treated a fraction of them, we've got an incredible opportunity really to drive awareness and activate those patients through the healthcare system, and then to keep them on treatment long term. That should drive our CAGR.
Short term, you know, while, you know, supply chain normalize, while there's sort of a fair bit of lack of clarity around the competitive structure, given the nature of, you know, what our competitors recall going on, you know, there could be good opportunities for us. Long term, we'd say that ResMed's a long-term, steady growth company. We think that those billion patients, and it's actually the same in our respiratory care and the same in our SaaS business opportunities. Long term, all of those industries are gonna see steady demand driven by increases in patients into the healthcare settings for which we're providing the technology. There's unlikely to be sort of sustainable inflection points of dramatic increase in growth or a huge upstep in patients because you need infrastructure to look after these patients.
You know, we talk about patient awareness, being aware of going to their primary care and having primary care who can refer them to say, in sleep apnea case, a sleep specialist, who can test them. Usually will get a positive test, and then to a provider who can look after them long term. Then, all of those are, as I say, are bottlenecks, and our digital solutions are all about breaking those bottlenecks and driving demand at each of those points. When we break one bottleneck, we sort of hit the next one and work on that. That nets into what we would say, you know, the sleep...
That really the sleep business and these other businesses should be long-term, high single-digit growth businesses, markets, and we should be able to do better than that as we drive our strategy.
Got it. Rob, one of the things that, you know, as an engineer, I thought your visit, it was a brilliant move with the Card-to-Cloud, right? You know, in terms of managing, getting around the component shortages, and then just technically or engineering-wise, it's a, it's a pretty brilliant, you know, move. Walk us through where we are in terms of Card-to-Cloud conversion in the U.S., if I could just broadly categorize it, all U.S., just in terms of adoption rates, how are things going? Also if you could quickly tie it together in terms of how you see it in terms of margin improvements quantitatively over time?
Yeah. For us, Card-to-Cloud was a reaction to shortage. I talked about our guiding principles, which was, you know, put patients first. We felt that we couldn't, you know, be in a situation where patients were on treatment because we couldn't supply them with a connected device, where patients were not on treatment because we could not supply them with a connected device. As much as our strategy is around making sure we're connected with the patients and we're driving better outcomes for them over the long term, we felt that we actually had to do something to try and get treatment available to these patients. With Card-to-Cloud, in a sense, that was actually how most patients were managed prior to 2014 or 2015 when we launched the AirSense 10 connected device.
In some markets, they still had good experience on how to do that and could manage that well, and notably, the U.S. market took it up well. Other markets where, you know, they've had pretty tight, really staffing constraints were their main problem. It's a main problem in nearly all of these healthcare settings actually. The contrary more is, well, we know we used to work with the card-to-cloud, but we know it doesn't get as good outcomes, and we know it's more effort and work. For our staff who are already too busy, to set up those patients. We didn't see strong uptake on that.
That said, in the markets where we did see strong uptake, it was incredibly successful, and we got an awful lot of patients on treatment that otherwise would have still been on waiting lists. Though, you know, late last year and early this year, as we've sort of managed to get better access to AirSense 10 components for connectivity, and put in some alternate components there as well, we've been able to take AirSense 10 off allocation in major markets. As we do that, we'd much rather sell an AirSense 10 connected device, if we can, than a Card-to-Cloud device. We'd say that Card-to-Cloud's pretty well served its purpose, done a fantastic job for us getting patients onto treatment, and now we move forward with our connected strategy as much as possible.
In terms of margin, particularly talking around gross margin, you know, clearly it's been a challenging time. You know, our usual strategy of leveraging our volume growth to really leverage cost reductions in the base platform are challenged when you're really begging for components from suppliers. It's not the time to ask for cost reductions. As things normalize, we'll get back to that setting, and we will have our long-term volume growth. There's a few other things going on there. You know, the Air 11, we always introduce new platforms with an ability to improve sort of the basic cost proposition as the volumes increase.
At the moment, while we're running two platforms at major volumes, as I say, it's been a wonderful thing for us, but it does mean that we're not getting the usual volume leverage that we would. Somewhere down the track, we'll see us return to that as well. A few other things in the margin, the freight has also been a factor. We've seen that improve a lot, but because of the inventory levels, you haven't actually seen the, you know, the financial impact come through in reported results yet. That will happen.
Got it. Rob, You mentioned AirSense 11, Air 10. Where are we in that adoption curve? And also, if I could tie into myAir, right? That is now the myAir app. Just kind of, if you could encapsulate all of this and talk to us in terms of specific adoption rates.
Sure.
Ultimately, you know, how do you all see the progression towards compliance rates, you know, within the CPAP category for ResMed?
If you look on our website in our investor deck, you'll see reports on studies on compliance rates, and we're producing incredible data around there. When we launched the AirSense 10, and we launched the myAir app with it, really as a tool to improve patient engagement. It's a direct interface to patients, but we do need the providers to encourage the patients to take it up, to log in and use it. We were thrilled with the AirSense 10's performance of myAir take up around 25%, which is much higher than what you'll often get for optional supporting apps for things. The providers quickly saw that patients who used myAir didn't need to call them back as often with problems because they could have things debugged for them with videos.
myAir could say, "Look, we notice you have a leak. Why don't you try this and that?" We also, and we published data on this, we saw that patients who used myAir were more likely to stay compliant. In the U.S., in particular, they were more likely to meet the Medicare compliance rules earlier in the 90-day window that they have, all of which helps our provider customers with their billing and their efficiency and all of that. With Air 11, we're super excited to see on Air 11 that the myAir uptake has more than doubled. It's over 50%, which is really good. You've got an even higher population of patients who are digitally engaged with your app, and also more likely to stay on treatment long term.
Earlier on, with some smaller studies we published, we showed that, you know, with patients who are using myAir and providers using AirView and keeping up with the track, the types of compliance levels they could achieve, in terms of the short-term Medicare compliance would be close to 90%, which is way better than any other reported numbers have been talking about. We, you know, continue to back that up, and we've actually shown similar types of performance over the first one and two years that we've published in there. These are very significant. The more we keep these patients on treatment long term, as we said, the more they're gonna need masks.
Actually staying in a resupply program, and keeping your mask up to scratch actually really helps improve your long-term compliance out-outlook as well. All of this continues to build on itself. In terms of our sort of technologies, you know, we do have data come from the devices and from the interactions with the myAir app, we're out to see what type of solutions work well for which patients. We're actually able to take that data and anonymize it appropriately, so we're all safe on the privacy front and keeping that very secure and private, then use that to allow our systems to learn what are the best ways of interacting and what are the best interventions that should start driving better long-term compliance improvements into the future as well.
Fair enough. Rob, let's move on to the M&A aspect. you know, you all have done phenomenally well on the SaaS side or the, or the connectivity part of the equation over the last few years, multiple acquisitions in the space. I'm curious, as we think about ResMed and, you know, obviously you all have been efficient stewards of capital. When we specifically think about M&A, should we think about more SaaS tuck-ins? Are there other, tangential, you know, targets out there that you think, you know, you all are absolutely open to?
Look, our sort of M&A strategy is very much aligned with our company strategy. So we definitely will be staying focused on the areas of business that we're in. Particularly, you know, over the last few years, our best acquisitions have really been around the SaaS area and tuck-ins in the SaaS area. It doesn't mean that we're not interested in other technologies. We consider ourselves, you know, a sleep and chronic disease management company. So strategies around that would be possible. You know, we're proud of our track record of discipline, and we've got a really balanced recent history of sort of capital allocation, you know, into R&D, which is actually the best investment that we can make given our technologies.
A balance into appropriate M&A, and then also appropriate dividend and capital return. We'll absolutely remain focused on sort of that discipline and balance approach. In terms of opportunities that come up, you know, for a long time we said that we liked our SaaS business. We think we can create a lot of value there. We always think globally, and we were really thrilled to be able to execute the MEDIFOX DAN deal and get that going and start to view SaaS on a broader scale than predominantly U.S., which it was, where we've been successful. Those SaaS teams, you know the structure of the SaaS businesses. They build up quite an ecosystem around them.
We interact with and resell actually a lot of other solutions as part of our overall SaaS thing. We actually get to identify bolt-on targets quite well in that area as well. Those SaaS bolt-ons are, particularly when you've already had them integrated with your system, are really great integration and really value accretive. There aren't any particular SaaS areas that we, you know, in terms of that out-of-hospital care operating system and electronic health record and efficiency improvements, there aren't any areas that we need in order to execute our strategy.
If the right thing comes up and it's in the appropriate out-of-care setting, and it's an organization that has the right culture, and one that we believe we can add value to by managing it well and getting, really, integration leverage out of, then absolutely, yeah, we'd be interested in those as well.
Perfect. Rob, I know we are almost up on time. I guess one last question from our side. Rob, Mick mentioned, you know, the 250 million lives by 2025, if I remember, and I know I asked a question about this, maybe if I could just push you a little more, and I promise this is the last. What all needs to be done between where we are today to touching 250 million lives, let's say in the next two and a half years?
Yeah. The, the 250 million lives is really, you know. That's, that's our reason for being. It's why people work for ResMed. It's, it's why we do what we do. Pretty well everyone I talk to has a friend or relative who's suffers from sleep apnea, and many of them have friends or relatives who are really happy on treatment from ResMed, and that's incredibly motivating for the team. Similarly with our SaaS businesses, pretty well everyone has elderly relatives or people who are in need of long-term care, and they're really motivated by that. The 250 million is made up of devices that we sell to patients via our providers.
masks that patients need in order to stay on treatment, also all our ventilators and those other devices as well. Also the number of patients that we improve or help their life really by a transaction or something through our SaaS businesses. We'll see growth in all of those through there. You can do the CAGR of going from, you know, high 100 up into 250 over the next few years. There's a significant CAGR through there. Really for us, we just need to execute well to keep that growth going.
Great. Rob, it has been always, some tidbits here or there, you know, in, you guys' commentary. Congratulations again for, I know, a tough macro backdrop, and you guys have navigated it exceptionally well. Do appreciate the time this morning. Thank you so much.
Thanks, Suraj. I really appreciate it. Thanks, everyone.