Okay, thanks everyone for joining us this morning. A pleasure to have with us GeneDx. We have CEO, Katherine Stueland. I'm Vijay Kumar, the life science diagnostic analyst at Evercore. Katherine, thank you so much for spending the time with us.
Thank you for having us today.
Just, you know, because I'm not, you know, very familiar, just give us a high-level overview of GeneDx. I know you guys play in, you know, offer sequencing services within rare diseases, but just explain what are your key products, what do you do?
Absolutely. GeneDx is the leader in delivering diagnoses predominantly today for children with rare diseases. We utilize mainly whole exome sequencing and whole genome sequencing, which is technology that we pioneered just over a decade ago. So we have, after emerging from the NIH 20 years ago, really put into place the industry-leading platform for diagnosing the most complex diseases. Underlying that is an incredibly rich data asset that is enriched for rare disease patients, without a doubt. But we believe that it's the largest rare disease data asset, in part because it is informed by more than 500,000 exomes.
So we're really proud of the platform that we've developed, of the impact that we can have on the lives of, of many families who are really desperately seeking a diagnosis for their child. But ultimately, where we want to be able to go with the business is not only providing a diagnosis, but providing a connection to a treatment or to a clinical trial, so we can help improve the overall outcomes for these children.
That's helpful. And you did mention you're a leader in rare disease diagnosis. Who else competes in this market? How are rare diseases identified right now, and what do you bring to the table?
Certainly. In the world of rare diseases, I would say the absence of testing is probably one of the biggest barriers that exists right now. As soon as children are experiencing symptoms, parents go on what is called a diagnostic odyssey, and that diagnostic odyssey entails seeing countless physicians, many different tests, scans, and it costs not only a lot in terms of the healthcare system, but it is causing a lot of physical and psychosocial damage for these children and for their families. So right now, the biggest barrier that we have is the absence of testing. Now, by the time a parent finally gets to a geneticist, on average, it's been about 8-10 years.
So this is many, many years of a lack of answers, and we then are able to provide an answer through whole exome sequencing or whole genome sequencing. In this space, competitively, there is Invitae, which provides whole genome sequencing, mainly off of panels. There is Baylor College of Medicine. They have an offering that's used in the outpatient setting as well as in the inpatient setting, which are the two places where we most commonly provide our services. And then, beyond that, there's Rady Children's, and they do whole genome sequencing in the inpatient setting.
That's a helpful overview. And since you mentioned you're the leader within the space, is that because of the number of samples you process? Is that because of the database? Help us characterize what market leadership means?
So market leadership is how many patients we do help. So we dominate about 80% of the market today. We're doing that because of that underlying data asset that is informed by 500,000 whole exomes. So our interpretation platform is delivering more conclusive results with fewer variants of unknown significance. And what we've been able to find is that we actually have a higher diagnostic yield in whole exome sequencing. So that's 17.5% diagnostic yield compared to panels, which are about 10.3%. And that's something that I think was not a commonly understood, or it's really a myth related to panels. The panels would have fewer variants of unknown significance because there's fewer genes, but we're actually proving that that's not the case.
And we have some data being presented tomorrow at the American Epilepsy Society that further establishes how important it is to get an exome as the frontline test versus a panel.
Mm-hmm.
So we've got data being presented that is not only showing that panels are leaving many, many children behind in the epilepsy setting. I think 75% of patients who get an exome in the epilepsy setting have had a prior genetic test, and so part of what we're trying to do is drive utilization of our services upstream, so you can rule in or rule out whether or not there's an underlying genetic disease. What we've also found is that reimbursement for whole exome and whole genome sequencing is actually better than reimbursement for these panels.
Mm.
From an access standpoint, there's great benefit for these patients as well.
... Fantastic. You've brought up a number of points, but before we get into guidelines and the diagnostic yields, just on the TAM itself, like because these are rare diseases, how should we think about the testing opportunity in TAM?
So I think one of the misconceptions about rare disease is that it is really, truly rare. It's a bit of a misnomer. Rare diseases impact one in ten of us.
Mm.
So, as we're doing more and more testing, throughout the United States, in particular, what we're learning is that there are more genes that are correlated with disease, and that they impact more and more patients. We've seen that across every therapeutic area, whether it's in hereditary cancer or if it is in rare disease. The segment that we are really targeting in terms of the pediatric addressable market is about $3 billion. About two-thirds of that is in the outpatient setting, and about a third of that is in the inpatient setting.
How do you arrive at the $3 billion? What assumptions are you making to get the $3 billion?
Yeah. So the assumptions right now are based on number of beds in the NICU, as well as the number of children who are going in and seeing a pediatrician, seeing a pediatric specialist, seeing a pediatric or medical geneticist. So what we've done is we've taken a look at some of the coding data just to understand the market as it exists today, in terms of total diagnoses. And then, given the fact that right now there's a dearth of testing, we've taken a more comprehensive view of that as well.
Understood.
I think the really important opportunity that's ahead of us as well is in newborn screening, and we're doing a study with Wendy Chung, who's now out of Boston Children's. She was at Columbia before. The GUARDIAN study actually is looking at 250 or 300 different conditions in healthy newborns. What we've been able to find in the 13 months that we've been doing this study, 75% of parents who were offered to enroll have enrolled. We have been able to screen 5,000 healthy infants, and we found a 4.3% positive rate.
Wow.
We went back and looked at our database to say, for these conditions, what was the average age of diagnosis historically? It was 7-11 years old. So we're now able to intervene, and some of the interventions are as simple as adding zinc to a diet, or putting a child on a ketogenic diet in order to prevent the progression of disease or at least protect the child. So, we're very proud of that as a future state that I think suggests that whole genome sequencing actually has a population-level positive impact.
Fantastic. And when you cite the $3 billion, did that include this newborn screening option?
It does not, no.
When can we expect to see the data, formal publication of this, GUARDIAN study?
So Wendy actually just presented some data at an infant screening conference in London. She presented some data at ACMG, so she'll continue to provide rolling updates at conferences.
Is this study, the level of clinical data, is that enough to change guidelines in that segment?
Absolutely. I think that what we've seen over the years is a lot of interest and skepticism in terms of whole genome sequencing being able to impact a healthy population, and there's been some iterations of the study in the past, frankly, that raised more questions than answered them. So I think what Wendy is really doing expertly is figuring out how what information should be shared with a parent. Again, all of these conditions are medically actionable today, so we're not providing information that will impact children in the future. And importantly, figuring out, from a psychosocial standpoint, how to really support parents as they navigate the healthcare system beyond a diagnosis.
I think those data, in addition to generating health economics data, will be incredibly helpful in terms of being able to set, state and federal policy and really help us determine the right way to handle the reimbursement for this.
Fantastic. And then moving on to your current offering within rare disease, right? What are current guidelines when it comes to whole genome or exome sequencing for rare diseases, and are you guys part of the guidelines?
Yeah. So guidelines today are through ACMG, NSGC. These are all of the medical societies that govern the medical genetics and genetic counseling worlds. The American Epilepsy Society has endorsed the ACMG and NSGC guidelines for using exome as a frontline test versus panel. So we have very good support within the genetics communities. As we think about broader adoption, though, going back to that diagnostic odyssey for a family, part of what needs to shift is utilization of this testing in the pediatrician setting, because that is, of course, the first call point for a parent when they have a child who's experiencing a symptom. That market is gonna take longer to develop. The American Academy of Pediatrics guidelines are outdated. They're 10 years old.
Use of testing, like chromosomal microarray, continues to be kind of the first line test for a lot of these children in that setting. Once you get into the specialists, like pediatric neurologists, pediatric cardiologists, and then into the geneticists, that's where exome is more commonly utilized, and more broadly utilized.
And you did, you know, bring up reimbursement is better. So there are established reimbursement mechanisms. What is your coverage currently?
So 70% of commercial payers today pay for exome and genome services. The medical policy is part of what we continue to work on. We have a market access team that is continuing to work with all of our payer partners to ensure that we can continue to drive exome and genome as a frontline test and remove any requirement for prior genetic tests. What we have seen, and we've talked about this on our calls, we have major efforts underway to reduce the number of denials, or in other words, improve how much, how often and how much we're getting paid.
And I'm pleased to say that the efforts that we have put into place are indeed having an impact, and we're starting to see the rate at which we're getting paid continue to improve.
Can you give us some metrics around what were denial rates maybe a year or two year ago? Where are we right now?
So the denial rates have been at 65%, and at Q3, we shared that it was at about 60%. So we're continuing to improve and get down below that, thanks to a lot of cross-functional efforts that our billing team has put into place. We have a new revenue cycle management leader who has joined the company in September that is bringing a lot of industry knowledge and helping us further refine exactly how our billing processes are set up. And importantly, we're also having really constructive conversations with payers about how we can continue to work in a more collaborative way, so services are rendered to their members, and we're getting paid for those services.
You mentioned RCM. Are you making any changes to the RCM system, or just elaborate on what changes you're driving?
So we're taking a look at the entire RCM process and every touch point in, in our billing operations to really understand, from an internal policy perspective, do we have the right mechanisms in place? When and how are we doing prior authorizations? And there's been, frankly, a lot of room for improvement on things that are internal to GeneDx. And I think what's really positive about that is, that is all within our control. And so there's a heavy lift underway, but as I mentioned, it's already starting to pay off as we've seen, month-over-month improvements there.
And because a lot of these are controllable, any sense on once these changes are done, what that means to the revenue model? What happens to denial rates? How much further improvements can we see?
So, I think there's a couple of things that are embedded in this. What does good look like? We're not in an industry where we get paid 100% of the time-
Yeah
... for all services rendered. And ideally, we wanna be able to get to a place where we're at being paid 65%-70% of the time versus being denied at those higher levels.
Gotcha. Is there a timeframe on when perhaps we might get to those levels?
You know, as we think about the next several years, it's gonna be a several year process.
Okay.
As I mentioned, we're seeing month-over-month improvements, and that's what we're keeping an eye on. You know, as we think about the mix, commercial payers are really important partners for us. But really driving institutional payment as well is an opportunity for us, and where that happens is mainly in the inpatient NICU setting. That's where we have most of our institutional contracts. We're scratching the surface on that opportunity, so we wanna continue to really open up that market. Some of the barriers that really exist in that NICU setting today, it's a lack of genetics expertise, and the more that we can embed from a technology standpoint, how do you navigate which patient should be given whole-genome sequencing and which patient shouldn't?
Ensuring that there is the support for interpreting a report, and in fact, part of what we need to do is change the report so it's more understandable for a non-genetics expert. So there is some work to do from a technology and product perspective that we can put into place that we think will open up those markets in the longer term. But given the fact that these are rapid genome tests, that we're turning around verbal responses in 3 days, their institutional payment, so we get paid in a predictable way. We think that that's a really important market.
Understood. And you did bring up clinical data, how better test performance is a differentiator. Can you go through those metrics? I think no pass and diagnostic yields were some of the numbers you mentioned.
So diagnostic yield and the number of Variants of Unknown Significance are probably the two biggest differentiators. And for exome and genome sequencing, the diagnostic yield is at 17.5% versus panels at 10.3%. And so what that tells a clinician is the more patients that you test, the more that we're gonna be able to provide you with a conclusive view on whether or not there's an underlying genetic disease.
These are. When you look at that 17.5, first, I mean, those are some big numbers, right? When you say panels, like, was this, are there different panels? Like, what was the comparator here?
Yeah, the panels range from—on average, they're probably about 10 to 100 different genes on some of these panels. Most common, you would—we would take a look at epilepsy panels, as well as some other broader conditions, autism panels. And so as more and more discoveries are being made about genes that have disease-causing correlations, certainly testing companies are adding more and more genes to their panels. But we've been able to develop a really cost-effective approach to look at the entire genome, to be able to deliver more conclusive results as quickly as a panel.
Wow.
So we're now at about four weeks for our turnaround times there.
Four weeks turnaround?
Yeah.
You mentioned the database, largest database, 500,000 samples analyzed, whole exome samples.
Yes.
How has that enabled you to become better at what you do? Like, do you own the data, or can you go and mine the database? Explain what the database means for GeneDx.
So the database is a critically important element to our day-to-day operations, our ability to continue to improve that gap between a conclusive and a variant of unknown significance. And importantly, it helps us from a biopharma perspective, be able to really connect patients through their clinicians with a clinical trial or an FDA-approved therapy. So the way to think about the underlying data asset and how it informs our interpretation platform, it's a pay-it-forward kind of strategy. So for every patient that we're running through, our underlying algorithm is getting smarter and is able to reduce the numbers of variants of unknown significance for that next patient. So the more patients we're running through, the smarter our interpretation platform is becoming, thus leaving more competitors at bay.
So that interpretation platform is the single most important element of what sets us apart, thanks to that, the data set that is underlying it. As we think about mining data, what continues to be kind of a lovely surprise when you're meeting with biopharma companies, they have preconceived notions of how many patients are out there, for a rare disease that they may be developing a therapeutic for. And we tend to have orders of magnitude larger than what they're-
Mm
... expecting. And so part of what we are still in our nascency of developing is that rare disease data market that we've seen play out in the oncology setting. So, the ability to really take and mine that data to inform not only clinical development of therapeutics, but also to inform a commercial strategy, ultimately a patient-centric one, that ensures that patients are getting access to, to a treatment that will uniquely work for them, that's what we really need to continue to, to develop over the next several years.
Is the biopharma a revenue stream for you guys right now, or how big is biopharma partnerships?
It's a small part of our revenue today. We expect it will continue to be a small part of our revenue mix in 2024. But as I think about 25 and beyond, that's where I think there's gonna continue to be some bigger contributions from the biopharma data side of the business. We have a partnership with an online marketplace for clinical trial data that is proving to be a really nice channel for us. Ultimately, we wanna be able to partner directly with many of these companies, which we've started to do. But I think as the market continues to develop, we wanna be there as a trusted partner. I think about what Regeneron has done expertly in terms of investing many dollars into developing their own genome center.
No biopharma company should have to do that. They can partner with GeneDx, and we can work with them to really embed genomics into their drug development and commercialization strategies.
Understood. You did mention a few clinical studies. I think you went through Guardian. I mean, Guardian was pretty interesting. I didn't realize how meaningful this could be. It's kind of rare, to be honest, in this space where companies are doing prospective trials.
Mm-hmm.
So thank you for doing that. You also have, like, collaborations with PacBio, I think another study called SeqFirst. What are these studies, and could they be meaningful?
So SeqFirst is a study that we're doing in partnership with University of Washington and Illumina, that really takes a look at the impact, including from a health economic standpoint, of exome sequencing in the outpatient setting, as well as in the inpatient setting. What we've been able to do is run that study with PacBio to really take a look at the impact of long-read sequencing and understand exactly how much more we're able to get by way of diagnostic yield in these patients. We're already seeing the positive results of that study.
Wow.
And, I'm sharing anecdotally that we've been amazed at the power of the PacBio platform to be able to find things that we would have missed elsewhere.
And these are larger scale structural variants that you're picking up?
Yes, exactly.
Your diagnostic yield right now is 17%. Are we going to cross 20% because of long-read?
That's exactly what we're aiming to prove or disprove. I would say that we are on a path to continuing to increase that diagnostic yield.
Gotcha.
I should say we're also extending the work with Montefiore in New York, which ensures that we continue to have a diverse patient population that is commensurate with our overall population in the United States.
Gotcha. That, that's... And just to level set, sorry, your tests, are they all on short-read, or is there a mix between short and long-read, right?
There's a mix. It's predominantly short-read today. But we do have a Revio set up in our lab, up and running and currently working on these samples.
Do you see that mix between short- and long-read changing, or is that going to depend on what the study is going to show up?
That's exactly what we're intending to understand. If I had to predict today, I think it will continue to be a blend, but but it really comes down to what that additional diagnostic yield is and can we continue to drive the gross margins that we're seeing? Our exome today has gross margins of 60% and higher. And that leverage that we have with the overall business, you can see it in the percentage of revenue versus the the percentage of volume. The ability to shift from panels and other testing to that exome is tremendous for patients. It happens to be the better test for patients, and it's the better test for our business, and that's a really important balance that we continue to be very proud of.
Yep. That was gonna be my next question on whole exome, whole genome. I mean, I think that bucket grew well north of 60%. It's been very fast. Is this what's driven those strong growth? Is that just converting your existing panel-based test into whole exome, whole genome? Are you seeing a market expansion?
We are most definitely seeing a market expansion. We are expanding the market. So, historically, the GeneDx commercial team was very focused on the medical geneticists, and they continue to be the most important influencers in the space. Every other clinician type looks to the genetics experts to say, "What are you depending on? Who are you depending on, and who should we trust in the space?" So working really closely with our genetics medical genetics experts and genetic counselors continues to be a priority for us. It's in that setting where they also know best, and so they know when to use an exome, they know when they would want to use a microarray or a panel.
So there's a lot of work being done with our team and our medical science liaisons to continue to convert that clinician segment to exome and genome. The next segment out are pediatric neurologists, and they are the clinicians who are most likely to utilize exome upfront. They don't have a preexisting perception of exome, and so we're able to go in and get them to utilize it upfront. For those clinicians who have been using sponsored testing panels from Invitae, such as their Behind the Seizure program, what we're able to do is go in and say... and especially after the data being presented this weekend at American Epilepsy Society, we're able to go in with data that says, "Use an exome upfront. Four out of five patients won't have it out of pocket.
70% of commercial payers are paying for it." And so we're able to take all of the barriers off the table for those clinicians. The longer pull in terms of market development will be in the pediatrician setting, and that's gonna take guidelines, it's gonna take continued education. It's probably gonna continue to take the focus of our sales force, but we've really focused our team on the segments that are more ready to order our testing today versus that segment for the future.
Gotcha. And then, I know, we've spoken about higher diagnostic yields, but also, I think the other point you mentioned, fewer variants of unknown significance, right? Do we have some numbers around, like, you know, what is that number with your test versus, you know, competition?
We took a look at exome and genome and compared it to panels. The VUS, or variant of unknown significance, rate for exome and genome was 22.5. In panels, it was 32.6. A higher rate of VUSs in those panels, which really defies, I think, the conventional belief that fewer genes, smaller panels, you're gonna have a more conclusive outcome and fewer VUSs. But we actually disproved that through some of the data we've been able to generate.
Huh. And you also have—I think when you break out your test volumes, there's whole exome, whole genome, and then there is hereditary and other bucket, right? What are those tests, and how do you see that market evolving?
So our other testing bucket is one of our favorite topics to dig into. So our test menu today has about 900 tests on it. We're aiming to continue to reduce the number of tests that we offer, and ultimately get to one or two tests. So an exome or a genome is ultimately the place that we want to be at. We actually did some research with customers in the fall to say: Is the market ready just to go completely to exome and genome? And the answer was no. It's gonna take a few more years to get to a place where the market will be ready for that, which only validated the fact that we need to continue to offer additional tests.
That being said, we are going through a process of shutting down a few hundred tests in January that will essentially take off of our menu negative gross margin tests or just gross margin neutral tests that are of low volumes. But there's, of course, a cost to having these tests continue to be a part of the test menu. So we are reducing the total number of tests, and we'll continue to do that over time, to the point where we are only an exome and genome shop. Hereditary cancer is an offering that we're very opportunistic about. So we have a few testing partners that are institutional in nature that rely on us for hereditary cancer testing.
As the market has continued to commoditize, it's not an area that we're putting any commercial focus into, but we continue to provide services to a number of testing partners who need the hereditary cancer offering.
Understood. And, sorry, just on the testing menu, those actions you're undertaking, is that happening in next year or-
Yeah.
Okay.
Yep. So we'll be retiring about 250 or 300 tests in January. And we'll continue over time to retire tests. The criteria that we think about, we've put a rubric into place to really establish a process for test menu retirement. And the first question is: Is this test providing a unique benefit to patients and clinicians? And then there's a series of financial questions that follow.
Mm-hmm.
How often is it being utilized? What are the gross margins on this test? What does reimbursement look like? Is there some other strategic nature for this sort of tests? For instance, confirmation. There are some tests that just require confirmation, and therefore, confirmation testing will be a part of our test menu until there's not a need for it. So we're really proud of kind of the operational rigor and financial rigor that we've put behind really rationalizing the test menu to get to a one or two tests future.
Understood. What's the financial implication of... I'm assuming these are all, like, lower gross margin tests. What does it mean for fiscal 2024 margins?
So we are gonna continue to expand our gross margins. This will have no impact on our view of margins moving forward.
But it should certainly aid-
It will improve, if anything.
Got it.
It'll improve our margins, and it will improve our operating expenses.
Or maybe another way to ask, is, do we know what the drag on margins were in fiscal 2023 by offering these tests? I, I don't know if you have that number off the top of your head.
I don't. But if you look at one test we will continue to offer is chromosomal microarray, which I've mentioned, CMA. That is an important test today in the genetic setting. That was a gross margin negative test. Now, thanks to some of the work that we've been doing on revenue cycle management, we're gonna be able to get that to a place of being able to not have a negative impact on our gross margins. We'll see an improvement there. So the tests that we're removing all would fall into the category of gross margin negative. Can't quantify impact on this year, but the goal is to continue to drive gross margins north of 60% over the next several years.
Gotcha. And I know you brought up about NovaSeq X. Have you validated the system, and how should it benefit gross margins, you know, once you have rolled out your test menu on NovaSeq X?
So, X, we have two that are currently running in the lab. We have a fleet of NovaSeqs that continue to operate about eight machines, and we'll be retiring those and replacing those with X's next year. And so the impact on our gross margins, it's a fantastic way for us to lower our COGS. We haven't broken down exactly to what extent, but as we saw in the third quarter, we had cost reduction efforts underway that were ahead of plan that had a positive impact on COGS. We'll only continue to see that, thanks to the Illumina machines that we're bringing online.
I'm curious, when you do these replacements, are they one-to-one swap, or are you replacing two?
No. We have 8 of the NovaSeqs, and we will have 4. It's not a one-to-one.
Fantastic. And, are you, the amount of consumables to use on these instruments, is that declining, or is that going up when you, when you make these transitions? I think that's been a debate on the sequencing side.
Depending on the consumable, we're seeing a reduction. I think we're continuing to see really good innovation in that space that is giving us additional pockets for COGS reductions. We're really happy with our operations team and the way that they're thinking about really continuing to drive overall lab efficiency, and continue to have a best-in-class approach to COGS and gross margins.
Gotcha. I saw in the third quarter, you did lower the fiscal guidance.
Mm-hmm.
Was that, I'm curious, I mean, some of your genomic peers have cited the macro, I think testing volumes utilization has been strong, so what went behind that guidance cut?
We're really, really happy with the growth that we've had this year. It's a testament to all of the teams that are continuing to focus on converting as much testing to exome as possible. I think what we have learned this year is that it will take some time to continue to build this market. As I mentioned, we did research to say: Is the market ready for exome and genome today? The answer is no, it's not. What that means is, we're gonna continue to see utilization of additional tests. Our medical science liaisons and medical affairs team, they are critically important, and we just built that team out in the middle of this year.
They are deployed with the sales folks to be able to go in and really have the more in-depth conversation with clinicians. So clinician-to-clinician conversation that helps to shift their thinking from microarray to exome. But those conversations are taking longer, and we have some more work to do. So I think we had our sight set on an accelerated conversion to exome in the second half of the year. And while we're seeing really, really healthy growth in the market, the market's there, it's just taking us a little bit longer to develop.
Understood. I know you brought up gross margins a few times. Q3 gross margins expanded nicely, 48%. What is being implied for Q4, and how should we think about gross margins for fiscal 2024?
Yeah. So some of the COGS reduction efforts that I mentioned came on earlier than we anticipated, which is always a great thing, so it meant that our gross margins were approaching 50%. We expect it'll be in the mid-40s% in Q4, and that will continue to drive even stronger gross margins throughout the course of 2024.
We should see further expansion in fiscal 2024?
Yeah.
What should GeneDx look like, right? When I take a step back, medium term, what should the financial profile of this company look like? What should revenue growth look like? I think you've laid out breakeven, but maybe just, you know, tease it out a little bit on the path to, you know, achieving breakeven.
So we did indeed announce that we expect to be breakeven in 2025 and turn to profitability. What is underlying that assumption is continued healthy revenue growth, and we've modeled even slower growth than what we saw this year in order to get there. Knowing that we are gonna continue to drive an aggressive approach to converting the market to exome. In fact, we've brought in some new commercial leadership that is really helping to strengthen the foundation of our commercial team to be able to continue to drive, I would say, a view on account profitability that is optimized for exome, which is that healthy 60% gross margin product.
So, if we think about continued healthy growth over the next several years with improving our average reimbursement rate, which we've already started to do, continuing to focus on lowering our COGS, which we'll do not only in the labs, but importantly through automation. Continuing to focus on automating as much of the process as possible. And then the final piece is continuing to bring our cash burn down, which we just announced on Q3 that we were doing a $40 million reduction. And we have gotten very good at continuing to identify costs that we can take out of the overall operations.
All of that gets us to a future state in 2025 that puts us closer to exome and genome and that product profile, and that being a foundation for being able to continue to diagnose in the pediatric segment, while then starting to shift and invest into new markets as well.
That breakeven in fiscal 2025, is that an exit rate or a breakeven for the full year?
Full year.
Full year.
Yeah.
Fantastic. That sounds pretty compelling, given your growth profile. We'll wish you all the best on the journey. With that, I think we're out of time. Thank you for spending the time with us, Katherine.
Thank you so much. Appreciate it.