Semler Scientific, Inc.

Good afternoon, and welcome to the Semler Scientific Second Quarter 2022 Financial Results Conference Call. All participants will be in a listen-only mode. So, if you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then one on your touchtone phone. To withdraw from the question queue, please press star, then two. Please note, this event is being recorded. I would now like to introduce Doug Murphy, Tutorian, CEO of Semler Scientific. Please go ahead.

Good afternoon, everyone. Thank you for joining us for our second quarter 2022 results call. It is my pleasure to introduce you to Renee Comer, who joined Schlemeler in May as head of corporate communication and business strategy. Renee has had extensive experience in finance and accounting and was most recently on the buy side. Some of you have had the opportunity to speak to her already. Please welcome Renee.

Thank you, Doug. Good afternoon and thank you for joining us today. I'm excited to be here and looking forward to engaging with the investment community and our shareholders. In addition to Doug, with me today is Andy Weinstein, SVP, Finance and Accounting. Dennis Rosenberg could not join us today because he's battling COVID. We wish him a speedy recovery. Doug, Andy, and I will be available for Q&A following today's prepared remarks. Before we begin, I need to remind you that certain comments made during this call may constitute forward-looking statements and are made pursuant to and within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 as amended. These include statements regarding our expectations for expansion of our business and additional products, as well as our financial guidance. Such forward-looking statements are subject to both known and unknown risks and uncertainties that could cause actual results to differ materially from such statements. Those risks and uncertainties are described in the press release and our SEC filings. The forward-looking statements made today are as of the date of this call, and we do not undertake any obligation to update our forward-looking statements. If you do not have a copy of today's release, you may obtain one by visiting the investor relations page of our website, similarscientific.com. We're pleased to report that during the second quarter of 2022, the company reported record quarterly revenues and cash balances. We are beginning to see traction from the independent peer-reviewed study on Quantiflow, which was published in June 2022 in its final form. Orders from existing customers are increasing and we are receiving orders from new customers. I would now like to turn the call over to Andy to describe our financial performance in more detail. Andy?

Thanks, Renee. Please refer to the financial results described in the press release that was distributed at market close today. For the quarter ended June 30th, 2022, revenue was $14.8 million, an increase of 4% compared to the corresponding period of 2021 of $14.3 million. Fixed fee revenues were $8.5 million, an increase of 12% year over year. Variable fee revenues were $6 million, a decrease of 8% year over year. Equipment and other revenues were $300,000, an increase of 40% year over year. Our staff and many of our customers and prospects experienced a higher than normal rate of employee absenteeism due to illness from the COVID-19 pandemic. which we believe had a slowing effect on our sales cycle in the first half of 2022. All these absences lessened during the second quarter compared to the first quarter of 2022. On the variable fee side, our results are being compared to a record quarter of revenues in the prior year. As we have discussed before, we saw seasonality for the first time in 2021 in our health risk assessment or HRA business. We believe testing by our customers and thus variable fee revenue for us was pulled forward for fear that there could be further COVID-19 related lockdowns later in the year that would prohibit performing in-home evaluations. Therefore, in quarter two of 2021, variable fee revenues were unusually strong during the year-over-year comparisons. We believe in 2022 there still may be some seasonality, but not to the extent we saw in 2021. Furthermore, we also had a 40% increase in equipment sales to all HRA customers during the quarter, which supports our thesis about seasonality of 2022 compared to 2021. In the second quarter of 2022, our two largest customers, including their related affiliates, comprised 38 and 32% of revenues. In the first quarter of 2022, revenue for our largest customer, including their related affiliates, was 39% of revenues. Our original reporting of Q1 revenue from our largest customer did not include all of their affiliates. Operating expenses, which includes the cost of revenue, were $9.6 million, an increase of 23% year over year from $7.8 million. Operating expenses increased over the prior year period, primarily due to increased headcount in line with our business expansion plans, wage inflation, increased insurance and professional fees, and the expiration of COVID-19 related payroll tax credits received in the prior year. We had income tax provision of $1.1 million or an effective tax rate of 22% compared to an income tax benefit of $200,000 or an effective tax rate benefit of 3%, which partially accounts for the difference in net income between the two periods. The change was primarily due to lower tax benefits associated with stock-based compensation plans. Net income was $4.1 million a decrease of 39% year-over-year from $6.7 million. Net income was $0.51 per diluted share, which compares to $0.83 per diluted share at the same time last year. For the quarter ended June 30, 2022, weighted average basic share count was $6.8 million, and weighted average diluted share count was $8 million. We repurchased 99,000 shares for $2.8 million during the quarter at an average price of $28.75 per share. We had cash and cash equivalents at the end of the quarter of $40 million. Now on to guidance. Second quarter 2022 revenue came in with our guidance range while operating expenses were lower than our guidance. As such, we have made some adjustments to our full year guidance. We continue to expect annual revenue will be in the range of 58 to $60 million. We have changed our expectation for operating expenses, which includes cost of revenue, to a range of 42.5 to 44 million, which is less than our other guidance of 44 to 46 million. Given the uncertainty around the extent of seasonality this year, We are not giving specific Q3 guidance. We do believe revenue growth will accelerate in the second half of 2022 to 14% to 21% compared to the second half of 2021. We are confident in our guidance given the increased orders received in Q2. We see customer interest in our product increasing, and the Nevada paper should further support growth. We do not expect revenues from the Quantaflow product extension or Insolent Insights to be material in 2022, but should provide growth next year in 2023. For the remainder of 2022, Semler expects continued profitability and generation of cash from operating activities. At the end of the second quarter of 2022, headcount was 121 employees, compared to 122 at the end of the first quarter of 2022. In 2021, we expanded our staff and operating expenses to pave the way for the return to higher revenue growth rate. In the first half of 2022, we were able to achieve operating efficiencies in our sales organization that allow us to also predict increased growth at a lower operating expense than our previous guidance. We do expect to follow our quarterly report on Form 10-Q on or around August 5, 2022. Now I'll ask Renee to continue the discussion and provide concluding remarks. Renee?

Our R&D goals continue to be to upgrade the existing product and data services, to commercialize other internally developed services and products, and to in-license or distribute new services and products, which we believe can provide enhanced value to our customers. Our business development goals are to make new additions to our customer base, expand orders from existing customers, introduce additional products to our customers, both through upgrades to existing product and data services and new products, and further establish our Quantifo product as a standard of care in the industry. We believe that the market for vascular disease testing is larger than our current market penetration, so there is room for continued growth. We continue to invest in R&D with the goal of providing innovative products that enhance value to our customers now and in the future. Last quarter, we reported a large customer had published the data underscoring the benefits of using Quantiflow on asymptomatic patients, which we refer to as the Nevada paper. Formally published in June 2022 in the Journal of Vascular Surgery, we're currently introducing the data and findings of the Nevada paper to existing and potential clients. While nothing happens overnight, when the message permeates the medical community, we believe new customers might be more attracted to use Quantiflow and we'll move further to our goal of having Quantiflow become the standard of care. Among other things, The study showed a positive PAD screen with Quantiflow has the potential for PAD risk management at the population level. Semler Scientific believes that this study supports the use of Quantiflow and highlights the benefits that the product brings to our customers and the patients they care for. Thus, it might drive further adoption of Quantiflow by existing in new customers. A link to the study can be found in the investor relations section of our website under press releases. We also announced last quarter that Quantiflow can now be used as an aid to identify patients who would benefit from further evaluation for another cardiovascular disease. We believe this extension of Quantiflow through our internal development efforts may make it even more valuable to assist the medical community in the future, including Medicare Advantage providers. We intend to sell this extension to our existing customer base and others as an upgrade to our software-as-a-service business model. Other key points regarding this extension are the unserved clinical problem may be as important as PAD. A medical aide performs the test in a primary care setting similar to how one uses Quantiflow for PAD. It uses the existing FDA clearance as we anticipated this extension many years ago. The technology is protected by trade secrets. We have submitted the data to a peer review journal for publication. We're very excited to share the data with you and we'll share it as soon as it is published. Because the peer review and publication date are controlled by the publisher, the timing is not under our control. We can update at this time that the process of selling the product has begun. We are far along in discussions with a handful of customers. These customers represent a range of sizes and feedback has been very positive. The product is on the shelf and ready to ship as soon as the contracts are signed. Regarding Insulin Insights, we continue to be in beta launch with several smaller customers. The initial feedback has been positive, and if all goes well with the beta launch, we plan to market it to our established base of customers. There is minimal revenue included in our fiscal 2022 guidance for Insulin Insights. You may recall that Insulin Insights is a software program that a healthcare provider can use to optimize outpatient insulin dosing of diabetic patients. It is a glycemic management software program that runs on the desktop of primary care physicians to help manage insulin-dependent patients with type 1 and type 2 diabetes. The algorithm is designed to analyze the data from glucometers in combination with patient information and meal patterns. The software is used to provide patient-specific insulin dosing to the clinician in order to adjust and maintain optimal blood glucose levels. It will be sold under a SAS model based on a per patient per month fee. There is no hardware involved. I'd like to take a moment to frame the diabetes market. Around 12% of the adult population, or over 30 million people in the U.S., have diabetes. The occurrence in adults over 65 years old is even greater at approximately 25% of the population, or over 15 million people. Of that population, around 30% are on insulin and another 40% on another medication to manage diabetes. Both of these groups are our initial target market. During the quarter, we acquired two outstanding convertible notes from private parties of Melitus Health, Insulin Insights' owner, for a purchase price of $179,000. In addition, we loaned Melitus $1 million through senior secured promissory notes. In regard to share repurchases, we were actively buying back our stock in the open market during the quarter. Year to date, we have repurchased just under $3 million or 100,000 shares. We have $17 million remaining on the board authorized stock repurchase program. The timing and amount of any future transactions will be subject to our discretion based upon market conditions and other opportunities that we may have for the use or investment of cash balances. Our goal is to maximize shareholder value. During the quarter, we participated in numerous investor calls, and during Q3, we plan to participate in investor conferences and virtual non-deal roadshows. including presenting at the seventh annual Needham Virtual MedTech Diagnostics one-on-one conference the week of August 15th, the H.C. Wainwright Global Investment Conference on September 12th, and Lake Street's sixth annual Best Ideas Growth Conference on September 14th. Thank you for your interest in the company and your continued support. Now, operator, please open the lines. Doug, Andy, and I will be happy to address your questions.

Thank you, we will now begin the question and answer session. To ask a question, you may press star then one on your touchtone phone. If you're using a speakerphone, please pick up your handset before pressing the keys. To withdraw your question, please press star then two. At this time, we'll pause momentarily to assemble our roster. Our first question comes from Brooks O'Neill from Lake Street Capital Markets. Please go ahead.

Thank you. Good afternoon, Doug and Andy, and welcome, Renee. I just want to say, Renee, you've already given us more information by far than these other two guys have given us in all the time I've covered the company. So I'm excited to have you here.

Thanks, Brooks.

Yeah. So I have a few questions for you. Obviously, a pretty strong quarter, which is great. Do you see the seasonality last year? I know once. you know, quite extreme and obviously in response to the very unprecedented impact of COVID. But do you see any indication at all that either your fee per test clients or your fixed fee clients have lost any enthusiasm for using Quantiflow to test their patients?

No, we haven't. And I would say that it's quite the opposite. You know, we are seeing increased interest both from new customers and existing customers in the product. And one of the things in particular that we highlighted in our remarks was that the sales for equipment revenue to our HRA customers did increase 40% during the second quarter, which is one of the reasons that it gives us you know, confidence in both our revenue guidance and in thinking that the seasonality this year will be less severe than it was last year.

Yeah, that's great. Let me ask you another question that I just struggle with all the time. Obviously, in my view, the use of Quantiflow by Medicare Advantage health plans is both clinically appropriate and is a complete and utter no-brainer from a business perspective in my view. Are you seeing additional health plans begin to recognize what your two largest customers have seen and known for several years now? Or maybe I should ask you also, what do you think it is that's causing some of these other health plans that aren't really stepping up to the party to stay away at this time because it's such a, both a clinical no-brainer and it's a financial no-brainer from my perspective.

Right, yes. No, I think that, you know, we are seeing interest from other customers. And one of the things that, you know, I think has, you know, maybe prohibited or paused some people in the past is that they don't have access to the data that our largest customers have. And one of the things that we're really excited about this Nevada paper is it actually is from one of our largest customers. It spans a multi-year period, so from data starting in 2016. So it really provides the market and others out there with some solid data on the results. And certainly the results that they've seen and what's published in there should be compelling to have more customers adopt it.

Okay, that's good. Let me ask just one more and I appreciate it. And I don't know if Andy or Doug wants to say anything about this one, but I'm just curious if your initial efforts to sell this line extension or make it available to your customers, are you actually selling the product to your customers today? I mean, have you seen any willingness to pay incremental dollars to buy this product? And if so, can you give us any feel for sort of the pricing dynamics and how it might affect the business when it does begin to contribute revenue to the company?

Sure. Why don't I start and then, Doug, you can add some in here on this. You know, as we mentioned, we are far along in speaking with customers. So, you know, we haven't signed contracts yet. We aren't disclosing our pricing yet on this, but we do see that customers are, you know, excited about this product. And obviously it's new, so they want to see how it's going to fit within, you know, their current business. And so, you know, we will expect also to update you guys on what this is as soon as this publication is out there. So, Doug, do you have anything else to add or Andy?

I think we feel that it's got a value proposition that is going to be exciting to our customers, but we have to get the first contract signed and turn it into reality. So more to add later on in the quarter.

Okay, thank you very much for taking my questions.

The next question comes from Mark Weisenberger from B. Reilly Securities. Please go ahead.

Good afternoon. Thanks for taking the questions. Just following up on Brooks' question in terms of maybe additional payors and the Nevada paper, previously some of these other payors have considered Quantiflow experimental payers. Has this Nevada paper, to your knowledge, changed that classification from any of these payors so far?

I can't comment on that they've changed their classification. And I know that a lot of them come out once a year on what's qualified as experimental or not. But I do know that they are receiving this well. Doug, I don't know if you have any other comments.

I think that you said it all. I think we anticipate this Nevada paper and the determination of asymptomatic patients that need a test to maintain that they have increased risk for anything if they have a positive test. It's important to understand it justifies additional payments from CMS, and it justifies the additional risk, which you apparently can do something about if you know it. If you don't know it, you can't do anything. So I think it's going to be convincing to anybody. And for the few or maybe only guys that are thinking it's experimental, it's going to be very convincing.

Understood. Thank you. And then you guys talked about the strength in the equipment sales that provides confidence in your HRA and variable fee business. I'm wondering if you could give us any indication on how many Quantaflow units maybe have been shipped out, but not yet activated. And I think I'm specifically referring to kind of the fixed fee channel. And maybe if you could kind of put that in context relative to the units that are actually in the field and generating revenue.

Yeah, so Mark, I think you know in the past that we haven't really talked about the units that we have out there, nor the units we ship. So at this time, I think we're going to remain, you know, not talking about our unit numbers.

would you say that you have the same level of confidence in the fixed fee business that you have talked about in terms of the variable fee in the back half and going forward? Yeah.

So we're seeing momentum in both of them. And obviously the fixed fee, you know, we give those to our fixed fee customers instead of sell them. So you're not seeing that on the revenue line.

Okay. And then any sense if the, the target, patient populations for testing has changed or the frequency that your customers are looking to test their patient populations?

No, we have not seen anything in terms of changes of, you know, the age or the, you know, difference in the population. And also, I think, you know, with the past two years, as far as, you know, the disruption, especially in the HRA market and some of the tests being performed virtually instead of, you know, in person. There was some disruption in there. And so while we are suggesting that all of our patients should be tested every year, in practice, you know, it could be every year. It could be every other year. It could be longer. And it's really dependent upon, you know, the direction of the HRAs and then also their payer clients.

Understood. Just a few more from me. You mentioned the insulin enzymes product, but I didn't hear anything about your discern Alzheimer's test. And I think there was a recent press release talking about commercial launch in Texas. I'm wondering if you could expand on that and maybe potential revenue opportunities this year and maybe into next year.

Yeah, sure. So From our perspective, you know, we really didn't have an update. So we are an equity investment in Synapse, which is Discern's parent company. So we don't have a distribution agreement. So at this time, we won't be recording any revenue from them since it's only an equity investment.

Got it. Understood. And then just the final two for me. What are your expectations for headcount growth in the back half of the year, if at all? And then I think there was a $2 million increase in your non-current assets that I don't think you addressed either in the prepared remarks or the press release. And what was that for? Thank you very much.

Sure. So on the expense and headcount side, So, you know, as you know, we did ramp up our hiring in 2021, you know, in anticipation of this Nevada paper and then also the new product launch. And we are fairly set on our headcount, but we do have some open positions. So, you know, if you look at our expenses from H1 to H2, they are expected to ramp a bit, but that's all within our plans. Uh, so you might see some, some headcount, uh, go up and then, um, for the, um, oh my gosh, I can't believe we did this. The, the second question.

Uh, the, the $2 million increase in, oh yeah, the two minutes.

Sure. So that was just a request from current assets and that was, uh, related to insulin insights and prepaid, uh, license fees for our distribution agreement.

Great, thank you very much.

You're welcome.

This concludes our question and answer session. I'd like to turn the conference back over to Renee Cormier for any closing remarks.

Thank you everyone for joining us today. We remain optimistic about our future and look forward to updating you soon on our continued progress. Have a good night.

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.