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Operator
Greetings and welcome to the CareDx, Inc. first quarter 2021 earnings conference call. At this time, all participants are in a listen-only mode. A question and answer session will follow the formal presentation. Should anyone require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, Greg Hadacek from Gilmartin Group. Please go ahead.
Greg Hadacek
Thank you. Good afternoon, and thank you for joining us today. Earlier today, CareDx released financial results for the quarter ended March 31st, 2021. The release is currently available on the company's website at www.caredx.com. Red Seto, Chief Executive Officer, and Ankur Dhingra, Chief Financial Officer, will host this afternoon's call. Before we get started, I would like to remind everyone that management will be making statements during this call that include forward-looking statements within the meaning of the federal securities laws, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that are not statements of historical facts should be deemed to be forward-looking statements. All forward-looking statements, including without limitation our examination of historical operating trends Expectations regarding coverage decisions, pricing and enrollment matters, and our future financial expectations and results are based upon current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results to differ materially from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. For a list and descriptions Of these risks and uncertainties associated with our business, please see our filings with the Securities and Exchange Commission. The information provided in this conference call speaks only to the live broadcast May 5, 2021. CARE-DX disclaims any intention or obligation, except as required by law, to update or revise any information, financial projections, or other forward-looking statements, whether because of new information, future events, or otherwise. This call will also include a discussion of certain financial measures that are not calculated in accordance with the generally accepted accounting principles. Reconciliation to the most directly comparable GAAP financial measure may be found in today's earnings release filed with the SEC. I will now turn the call over to Reg.
Reg
Thanks, Greg. Good afternoon, everyone, and thank you for joining us. Welcome to CADEX's first quarter 2021 earnings conference call. We had a very strong start to the year with a record first quarter result. Our vision of being the leader in the transplant ecosystem continues to resonate as we remain focused on the transplant patient. As the largest transplant-focused company in the US, we are proud to be the leader in innovation by bringing the first and best-in-class transplant-specific technologies through Allomap gene expression profiling and AlloShore donor-derived cell-free DNA. Notably, we're again first in driving new transplant innovation. We recently introduced the first and only recognized multimodality approach with heart care, which lays the foundation for kidney care and future use in other organs. I'm proud to be leading a company that continues to invest to bring innovation, especially in the field of transplant, which is often overlooked. As the CEO of KDX, I'm continually being told, or should I say reminded, that we are the transplant company. On behalf of KDX, I'm proud to accept that title and association. For our record first quarter, total revenue was 67.4 million, increasing 76% compared to the year-ago quarter. The driver of the quarter's growth was our testing services revenue, which increased 89% to 59.3 million, and we also saw the products revenue increase 23% to 5.8 million. Digital and other revenues added 2.3 million to the top line. GAAP net loss for the first quarter was $0.07 million and adjusted EBITDA was positive $7.7 million. We remain focused on driving top line growth through increased adoption of our offerings and continue to invest in a rich pipeline across the TransLand journey. During the first quarter, we made significant progress along the following three fronts. One, advancing our testing services model. two, expanding our direct-to-patient strategy, and three, building our future pipeline through investing in specific scientific data and innovation. I'll tackle the first one, advancing our testing services model. In the first quarter, CareDx provided approximately 33,200 AlloShore and Allomap test results to transplant patients, growing approximately 121% from the first quarter of 2020. Of these, approximately 5,900 tests were part of heart care. Our focus has always been on our direct-to-center strategy, with more than 150 kidney and more than 100 heart centers using our offerings during the first quarter. We feel very good about our strategic focus on building a moat around the center. As of the end of March, over 60 kidney transplant centers in the United States have now adopted an Allishaw name testing protocol into their standard of care. We've also continued to expand our Moten Centers. With the prior acquisition of Otter, we've seen the benefit of offering transplant-specific software to improve US-based transplant centers' order workflow. In January, we announced the acquisition of TransChart LLC, an electronic health record software provider supporting US transplant center needs. This acquisition added over 20 centers using TransChart. We believe offering an efficient end-to-end solution for transplant centers will lead to further adoption of our high-value healthcare solutions. Our strategy, this strategy, the focus on the transplant centers to build adoption and protocols has been very successful. In addition, we recently started expansion to community nephrology settings. During this quarter, and now with a full team for the first time, we had more than 100 community practices start using AlloSure in the last quarter. with several already starting protocols. Our community dedicated team is doing a great job. Although early, we've been very pleased with the ability to continue our patient care from the center of the community with our patient care managers and through our AlliCare app. This focus on innovation was evident firsthand as the recently announced Universal Solid Organ Transplant LCD by Palmetto Moldex now provides a pathway for our future pipeline and multi-modality surveillance approach to be introduced. We are proud to be leading the way, especially with multi-center and prospective data sets to generate the clinical ability and utility for patients, physicians, and payers. It takes a leader to invoke change, and we are grateful as leaders to all the patients, physicians, coordinators, caregivers who have worked with us as leaders in leading change and bringing much-needed innovation to the Transplant journey. We talked about our shoreline update in Q3 at our last earnings call, but the recent universal LCD now includes the path for lung. The universal LCD can accelerate adoption for lung surveillance and our pipeline. We previously submitted our technical assessment for our shoreline, and we look forward now to a review of this submission within Q2 2021. This model also provides a path for future comprehensive multimodality pipeline development, and which we're very excited about. because this model provides how we develop kidney care and lung care and other solid organs in bridging and bringing this incremental utility as high value to physicians and centers. Our studies have been designed and developed this way. We look forward to updates on kidney care during the course of the year. On the second topic, on expanding direct-to-patient strategy. During our last learning score, I mentioned that 2021 would be a direct-to-patient theme, which makes CareDx an open-ended store in precision medicine. During the first quarter, we expanded into the pre-transplant patient journey and acquired TX Services, the provider of TX Connect. TX Connect is a cloud-based service that allows nephrologists and dialysis centers to electronically submit referrals to transplant programs, closely follow these patients, and assist these patients through the transplant waitlist process and ultimately the goal being transplantation. TX Connect now manages more than 20,000 referred dialysis patients and is fully integrated within TransShark. More than 30 transplant centers and over 500 dialysis centers are now involved with this offering. This offering will allow us to better serve transplant centers as dialysis centers refer end-stage kidney disease patients to be assessed for transplant. Adding TxConnect to our robust digital platform will help us provide more integrated care at every critical step of that transplant patient journey. On the post-transplant patient journey, Our decision for the rapid implementation of Remotrack last year as COVID is beginning to spread through the U.S. has given transplant patients the option of having their blood drawn outside the confines of a hospital or a transplant center and at the safety of their homes. Despite the number of new COVID infections decreasing in the U.S., transplant patients are still at higher risk of getting severely sick from COVID, and we believe Remotrack is the appropriate solution to limit a transplant patient from potential exposure. Our patient care managers are doing a great job and supporting patients and transplants with valuable support. With the continued impact of COVID-19, we saw the use of Rheumatrack and mobile phlebotomy above 40% for the soil. As of March 31, 2021, we had over 7,000 patients on Rheumatrack. Now on the third topic, on building a future pipeline through, again, investing in scientific data and innovation. This is the hallmark that sets us apart. Throughout 2021, We will continue to build upon our industry-leading clinical data and help to present at multiple industry events as we continue to drive innovation and be the leader in high-value op-ed solutions for transplant patients and caregivers. Our clinical team, under the leadership of Dr. Sham Dhalakia, has been exceptional. They've been very busy over the last few months as new data sets were presented and showcased at multiple industry events. We continue to generate the highest number of abstracts and presentations for a transplant company, And this centers around our focus in innovation, which is what really continues to set us apart from opportunistic entry. The testing services, we presented new transplant data in January at the ASTS conference, the American Society of Transplant Surgeons. During this conference, we sponsored two symposiums with key clinical leaders discussing real-world experiences, including AlloShore to optimize care for their transplant patients, with initial data from the ADMAL study and the rollout of the MAPLE study for AlloShore liver. For this year's ATC conference, we will have over already 30 accepted abstracts and so continue to lead with science innovation. Combining what we presented last week with over 20 abstracts at the ISHLT conference and with the 30 from ATC that will be coming up, that's more than 50 abstracts at two major conferences from CareDx. More than 50 abstracts from one company. Again, we're very proud of this. Back to Admiral. is a multicenter two-year follow-up study using patients who have had AlloSure as part of their standard of care, while CAEL1000, a study setting, is an early snapshot at the one-year mark for the first thousand patients in the CAEL study. We're really excited and proud to be bringing the first long-term and only multicenter prospective data set to the transplant community and the clinical utility they show as we cement AlloSure into the standard of care of transplant patients. In addition, During last month's National Kidney Foundation spring meetings, we hosted two well-attended programs featuring the latest kidney transplant surveillance data. The pipeline for new offerings continues to strengthen with the addition of our development program for AlloID. Early in 2021, we announced a partnership with ID by DNA to develop metagenomic infectious disease testing specific to transplant patients. AlloID will identify more than 100 pathogens and drug resistance in viruses and bacteria. Our customers have indicated a very strong interest in adding the value of this testing for managing the health of their immunocompromised, immunosuppressed patients. For the products business, we saw continued transition to our Aliceq franchise, represented by hybrid capture technology. Over half the product revenue now comes from this NGS technology. During the first quarter, we also acquired BFS Molecular, a software company focused on next-generation sequencing-based testing solutions. The addition of BFS molecular software and algorithm development will further enhance our offering of world-class bioinformatics and transplant surveillance software. And for new areas, such as AlloCell, we showcased the CareDX cellular transplant therapies portfolio at the recent TCT conference, the Transplantation and Cellular Therapy Conference in February. Included in those presentations was a poster we presented with our partner, Atara Biotherapeutics, on the potential use of Allocell to standardize pharmacokinetic assessment in a clinical trial. While this data is early, we're very excited about the value Allocell can bring to ATARA's clinical trial development of allogeneic cell therapy. Our offerings are making a significant difference in the transplant patient journey setting. We're building capabilities required to scale this business and realize the tremendous potential in front of us. During this quarter, we enhanced our leadership team with key appointments and also further strengthened our financial position. Starting with the former, we announced new senior leadership appointments to create meaningful impact across these key growth areas to build for that future and to enhance that patient journey. Included in these announcements was the hiring of Ankur Dhingra, our new Chief Financial Officer. Ankur brings extensive experience to CareDX of over 25 years of finance and accounting experience achieved in the life sciences sector. We're really excited to have Ankur join the CareDX family, and I hope you all have the opportunity to meet him during the course of this year. In the first quarter, we also significantly strengthened our cash position. We closed the quarter with 374.3 million in cash following a very successful executed public offering in January. Our balance sheet allows us to continue to drive revenue growth and take full advantage of opportunities available to us. Our capital deployment strategy remains focused on making meaningful impact in that transplant patient journey. As you look to the rest of 2021, there is lots to be excited about. With that, I will turn it over to Ang to discuss our financials and our updated 2021 revenue guidance.
Allishaw
Thank you, Reg. Hello, everyone. I'm very excited about being a part of such a dynamic organization. Over the past several years, CareDx has transformed itself into a premier diagnostics company and the leader in healthcare solutions for transplant patients and caregivers. In my first few weeks here at CareDx, my conviction has only grown stronger that KDX is uniquely positioned to realize this tremendous opportunity. Turning to the income statement, our first quarter of 2021 testing services revenue increased 89% year-over-year to $59.3 million. The first quarter testing services revenue growth was driven by Alloshore Kidney and Allomorp Heart patient results and an excellent start to Alloshore Heart. Our first quarter product revenue increased 23% year-over-year to $5.8 million, and our digital and other revenue was $2.3 million. Moving to gross margins, for the first quarter, the gross margin was 68% compared to a gross margin of 68% in the same period of 2020. The non-GAAP gross margins for the quarter was 70% compared to 71% in the prior year's quarter. As you may recall, last year in Q2, we successfully built our remote track service, which has been and continues to remain a big enabler of transplant patients to limit exposure to COVID. For the first quarter of 2021, net loss was $0.7 million compared to a net loss of $5.8 million in the same period last year. our net loss per share was one cent for the quarter compared to a net loss per share of 14 cents in the first quarter last year. On non-GAAP net income, our first quarter net income was $7.2 million compared to a non-GAAP net income of $0.2 million in the same period. The basic and diluted non-GAAP net income per share for the first quarter of 2021 was 14 cents compared to zero in the same period of 2020. As a reminder, we define adjusted EBITDA as non-GAAP net income before interest, income tax, depreciation, amortization, and other expense. For the first quarter of 2021, we recorded positive adjusted EBITDA of $7.7 million compared to an adjusted EBITDA gain of $0.2 million last year in the same quarter. Our focus remains on driving top-line growth and continuing to expand our reach in the transplant ecosystem through our innovative products, services, and a rich pipeline, and also efficiently scaling our business. Moving to the balance sheet, cash, cash equivalents and marketable securities at March 31, 2021 was $374 million. As Reg mentioned, we strengthened our cash position in the quarter as we successfully completed a public offering of approximately 2.2 million shares of common stock, raising roughly $189 million in net proceeds. In January, we repaid the CMS advance payment of approximately $20.5 million in full. Adjusting for this CMS repayment and timing of certain annual outflows, our operating cash flow was neutral for the quarter. Turning to guidance, we are updating our 2021 revenue expectations to reflect our strong first quarter results and continued strong demand for our solutions. As of today, we anticipate $270 million to $280 million in revenue for the year. This represents an increase of $15 million at the midpoint versus our earlier guidance. Our new guidance balances the uncertainties around the ongoing pandemic and the continued market penetration of our products and services. We're very excited about the opportunities in front of us and the team is off to an excellent start to 2021. With that, I will open the call for questions.
Operator
At this time, we will be conducting a question and answer session. If you would like to ask a question, please press star one on your telephone keypad A confirmation tone will indicate your line is in the question queue. You may press star 2 if you would like to remove your question from the queue. For those using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. The first question is from Brandon Couillard from Jefferies. Please go ahead.
Brandon Couillard
Hey, thanks. Good afternoon. Hey, Brandon. Reg and Ankur, if I just annualize the first quarter revenue, that would get me to the low end of the new range for the year, which is $270 million, which would seem pretty conservative to sort of look out over the balance of the year. What are some of the puts and takes that would get you to the high end or above that new revenue outlook for the year? And Ankur, any update in terms of some of the OPEX items for 2021? Thanks.
Reg
Yeah, Brandon, firstly, thanks for the questions. We were really excited by the point we just had. It was a great Q1, 15th Incorporation of Alice Shaw Hart for the first quarter. We've got three unique business lines which continue to grow at different rates. Really excited by the testing services, which is growing well above the 50% range. The products business, which is in the 10 to 20% range, and also we have the also in single digits, the digital business. So as we look at that, I'm going to let Ankur comment a bit about the actual guidance range that we've set.
Allishaw
Yeah, sure. So, Brendan, as we were looking at the expectations for the year and considering that we're off to an excellent start for the quarter, as Zed was saying, we saw a great execution by the team, an excellent first quarter, both on Alisher Heart, the heart care, as well as the penetration in the nephrology setting. So very, very pleased with the momentum there. And then as we started looking at the entire year expectation, kind of took our first quarter performance and then raised the remainder of the year. At the low end, you're right, we've anticipated a continued strong performance similar to what we had in Q1, represents that lower end. and then high-end that represents our ability to continue to penetrate in that market, especially around the nephrology setting. Our aim is to keep working that, and as we continue to make further progress on the nephrology market, we'll keep looking at it through the year.
Brandon Couillard
Gotcha. Then in terms of Alisher Hart, the 1,500 tests that you ran in the first quarter, What's the capture rate in terms of number of heart patients that are getting an Alisher Heart test as well? And has the mix changed at all in terms of, you know, Medicare versus commercial payers? And have you begun a dialogue with some of those commercial payers yet, or is that, you know, not less of a near-term priority? Thanks.
Reg
Yeah, we were, again, Alisher Heart was, we had the first full test. three months. And for us, it was really exciting to have that fully rolled out, particularly as we looked at the different attachment rates increased during this quarter. I'll hand over to Ang to make a full comment.
Allishaw
Yeah, from a heart care perspective, we saw slightly north of 80% attach rate for our new product there on AlloShore Heart. And we're still There is a Medicaid mix in it, and there is a fairly high sizable mix of commercial participation there as well. We expect the commercial side to slowly convert to revenue over a period of time. Very good. I'll leave it there. Thank you.
Operator
One moment, please, while we poll for questions. The next question is from Andrew Cooper from Raymond James. Please go ahead.
Andrew Cooper
Hey, guys. Thanks for the questions. I guess maybe first I want to focus in on gross margins for a second here on the testing services side. It was down sequentially, you know, but you had more tests and importantly, you know, more allosher apart that I would have thought would really be driving that number higher. Is there anything to think about there, whether it's you know, some of the data generation costs and sort of R&D costs that are captured in gross margin, or how should we be thinking about that metric? Because I would have expected all else is equal, that maybe it was trending a little bit higher than sort of what we've seen in the last two quarters.
Reg
Yeah, maybe I'll just clarify first, then I'll hand it over to Dan. As a reminder, with, you know, Alisher Hart, we had, prior to getting commercial approval, We had 60 percent of these tests being done on a research basis, and now it's up to, as Ankur mentioned, above 80 percent. So we've actually – the tests previously that were on the research side were not included in terms of the numbers we provided. So I think now what you're seeing with that 5,900 is including – there was a baseline, for example, of 60 percent that were there. So I'm going to hand over to Ankur to answer that.
Allishaw
Yeah. On the margin side, we don't see any structural issues there, is one. We continue to invest further in remote track with our direct-to-patient part of the journey. And that part reflects primarily in the testing services side of things. So moving forward, we do expect, as we build out remote track, there will be some more investments through the year. But overall, from our ability to drive margins purely from our testing services perspective, it remains intact.
Andrew Cooper
Okay. Okay. That's helpful. And then maybe just clarify, you know, I know you said reg 2Q for kind of the tech assessment on lung, but, you know, can you give us a little bit more flavor on, you know, what you think payment could look like when it could start and sort of you know, what the process from there is, and then maybe just lay out, you know, how you think about sort of the next phase, what's after lung, if the LCD changes sort of the way you approach CMS and approach joint MLBX timing on any of the other organs or anything to that effect.
Reg
Yeah, I think that, you know, we, again, we applaud the universal LCD. We believe as the market leader, it allows us now to, you know, bring other solid organs in a fray, and lung is obviously the next one that we'd be bringing into the transplant community. As mentioned in the prepared statements, this discussion will happen during the course of this quarter, and we're looking forward to those discussions. It sort of brings forward some of the initial guidance we've given in the prior quarter, which was we expected those discussions to have in Q3. We're really excited by this opportunity, this universal city, because it creates this pathway for a faster coverage for different solid organs. And I think you know that we also have liver as part of the MAPLE study that we have with our shore liver. And obviously, you should consider that all other organs, solid organs, a fair game in that sense that we'll be looking at as well if we haven't already started. So I think you all know us as leaders in the space, and we'll continue to bring our shore across all those solid organs. So that's probably that approach won't change. And once we do, then we'll bring the multimodality pathway.
Andrew Cooper
Okay. And just to be clear, nothing from lung included in the guide, correct? Correct.
Reg
Okay.
Andrew Cooper
I'll stop there and follow up offline. Appreciate it.
Reg
Thank you.
Operator
The next question is from Alex Nowak of Craig Hallam Capital Group. Please go ahead.
Alex Nowak
All right, great. Good afternoon, everyone. I just wanted to follow up to Andrew's last point there on the LCD change. Just any comment on how the announcement changes the timelines for kidney care here? Because this has always been, you know, Allimap kidney has always been a kind of idea out there, but it's always been a few years out. So what studies are doing on Allimap kidney? How could this pull forward any sort of announcements or reimbursement there? And just what to expect over the next couple of years?
Reg
Yeah, Alex, it's a great question because I think, you know, we're excited when we saw the universal LCD because now it lays out the pathway of multimodality but also recognizes the value that multimodality can bring by demonstrating this incremental clinical utility. And as the first and only company that's done that so far in heart care, we were really excited to see that included as part of the universal LCD. And so what that means is that we've actually, that's what we're doing with kidney care. Kidney care actually looks at the addition of multiple technologies to increase that clinical utility, and now this universal city provides that pathway. So as we learn more about it, I think this brings forward the potential for how we would view our multimodality offerings, given the, A, the precedence we've set, but B, also the guidance they provide as part of that. So I think that's probably your assumption and thinking is correct.
Alex Nowak
And the studies there are still supposed to read out end of this year, early next year on allomath kidney?
Reg
Yeah, the study will actually complete OCRO by the enrollment by the end of the year, but there are data sets we can obviously bring out. And obviously, one of the key things is developing a publication, so.
Alex Nowak
Yeah, okay. That makes sense. And maybe to preview some of the clinical utility data on Kaor, that you're going to present at the American Transplant Congress. Just any particular endpoints we should be watching for, such as EGFR improvement or graft survival?
Reg
Yeah, the KL endpoints are well described, and I think thinking of what was seen also in the Admiral study was not a bad way as a proxy of looking at it. So I think correlations with EGFR is the right way to think about it, looking at you know, the formation of de novo DSA is not a bad way of thinking about it. So, I think also looking at even, you know, what are the learnings from, you know, different types of biopsy interpretation with subclinical rejection. So, I think as you go through the different learnings, which were highlighted through ADMOR, which was also a long-term multicenter study, then I think one could expect to get some parallels in that.
Alex Nowak
All right. That's great. And just one more question, if I could, just on the vaccine data in transplant patients, we've seen the results. It's been suboptimal. How do you think that influences the use of Alisher and Alimab relative to the standard of care going forward? Because last year, and even Q1 here, it seems like there was a real pull forward of non-invasive options. Do you think the vaccine data is going to make that dynamic stick even more going forward?
Reg
Yeah, no, absolutely. I mean, I think what we've learned, and I've been in the field the last the last four weeks talking to different doctors, and that's been one of the key data points that's come up with, you know, how patients aren't fully unvaccinated, and there is, you know, concern with these patients, and how we continue to monitor them even with the vaccines that are available. So, yeah, no, actually, I think you're, again, Alex, your interpretation is correct.
Alex Nowak
Okay, understood. Appreciate the update. Thank you.
Operator
Thanks again, Alex. The next question is from Steven Ma from Piper Sandler. Please go ahead.
Alex
Great. Thank you. Congrats on a great quarter and great to meet you, Ankur.
Allishaw
Yeah, likewise. Thanks.
Alex
So, yeah, my first question. So, the patient engagement initiative, the direct-to-patient community nephrologists with Transplant Connect, Allocare, and others, patient care managers. So, these seem to be, you know, really working to drive adherence and new patient adoption. Could you give us a sense of which one of those levers is having the most impact on your volume growth?
Reg
Steve Knight's spreadsheet. No, I think all the different areas you mentioned, particularly outpatient care managers, the use of the Allocare platform, they're all contributing to managing hearings. I mean, I think as a reminder, when outpatient care managers actually do the scheduling and the calling, the adherence rate is double that of when the center does it. So there's actually this premium service that's offered and also this relationship that's built. And it's all about building this overall relationship and making that stickiness be there as well, and that's where the AlloCare platform comes in. So I think all things are contributing, but I think it all starts with the patient care manager.
Alex
Okay, got it. All right, that makes sense. And then maybe pivoting over to Allocel, can you provide any updates on your Allocel partnerships? And I know you're limited to what you can say with your partners, but maybe without naming names, could we get a sense on the number of partners you have? And how should we be thinking about the timing of new partnerships and also clinical milestones and how you're going to update investors on progress in Allocel?
Reg
You know, Al, Our self-therapy and our self-business is one which has had a lot of, as we mentioned, excitement and interest as we've engaged with partners. I think we continue to see strong interest and participation among partners. I think there are two variables we mentioned. One is when we can publicly disclose those, but the second also is we're also a bit dependent on their progression through you know, different clinical stage milestones. So, for example, if, you know, there was a partner whose study did not progress, for example, right? And so then that limited the great progress that was made there. So as we go through a new field, which we think is absolutely exciting, this progression is absolutely important for us that these partners continue to evolve through the clinic. But overall, I think, you know, we're still in a, you know, holding a strong position being the first in this space, we see strong interest. And I think it's going to be a partnership in learning, working with these different companies that are creating that breakthrough.
Alex
Okay, great. Thanks, Fred, for the color. And final one for Anchor. So, you know, we talked about remote track a little bit. You guys are currently at 40%. What do you think the steady state level of remote track will be going forward in And how do you think about the long-term impact on gross margins and your long-term goal of getting to 75% gross margins given the additional costs of the remote phlebotomy? Thank you.
Allishaw
Yeah, I think the levels that we are at now in that 40%, give or take a few points range, our expectation is that that's a good run rate. We don't expect substantial changes here in the near term. And that's our view from the long-term perspective as well, is to say the size of the investment that we've made substantially represents a good structure for us for the medium term here and enables us continuing improvement in the gross margins, especially from a path to 75% perspective. Yeah, I think we've made majority of the investment there.
Alex
Okay, great. Thanks, and congrats again. Thanks.
Operator
This concludes the question and answer session. I would like to turn the call back over to Reg Cito for closing remarks.
Reg
Again, on behalf of CADX, I want to say how excited we are to have had such a great, strong start to 2021. Our mission is clear in how we bring innovation and continue to make a difference in the lives of transplant patients in terms of increasing their long-term outcome survival of their organs. And so with that, I want to thank everyone for dialing in today and listening to how we've progressed as a company. And we'll catch you all during the subsequent follow-up calls. Thank you.
Operator
This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.
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