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spk03: Hello and welcome to the Butterfly Network second quarter 2022 earnings conference call. My name is Alex, I'll be coordinating the call today. If you'd like to ask a question at the end of the presentation, you can press star one on your telephone keypad. If you'd like to withdraw your question, you may press star two. I will now hand over to your host, Heather Goetz, Chief Financial Officer. Heather, over to you.
spk01: Good morning and thank you for joining us today. Earlier this morning, Butterfly released financial results for the second quarter ended June 30th, 2022 and provided a business update. The release and earnings presentation, which include a reconciliation of management's use of non-GAAP financial measures compared to the most applicable GAAP measures, are currently available on the investor section of the company's website at ir.butterflynetwork.com. I, Heather Goetz, Executive Vice President and Chief Financial Officer of Butterfly, alongside Dr. Todd Fruchterman, Butterfly's President and Chief Executive Officer, will be hosting this morning's call. During today's call, we will be making certain forward-looking statements. These statements may include statements regarding, among other things, expectations with respect to the financial results, future performance, development and commercialization of products and services, potential regulatory approval, the size and potential growth of current or future markets for our products and services, and the impact of the COVID-19 pandemic on our business. These forward-looking statements are based on current information, assumptions, and expectations that are subject to change and involve a number of risks and uncertainties that may cause actual results to differ materially from those contained in the forward-looking statements. These and other risks are described in our filing, made with the Securities and Exchange Commission. You are cautioned not to place undue reliance on these forward-looking statements, and the company disclaims any obligation to update such statements. I would now like to turn the call over to Dr. Fechterman. Todd?
spk05: Thank you, Heather, and good morning, everyone. This past quarter has been an important one for Butterfly, as we have seen continued growth in the market and excitement about our solution. delivering our largest revenue quarter ever. We know what Butterfly makes possible and practical, and our message is resonating with our customers. What was once just a transformative device that brought unprecedented access to imaging is now a truly transformative digital healthcare company that is showcasing before the world the value that ultrasound information brings when it becomes part of the everyday assessment and standard of care for patients everywhere. As I've said before, there's a real difference between doing ultrasound and using ultrasound, and it's butterflies charged to bring the medical community with us on this journey, where they can see for themselves that by using ultrasound and the information it provides earlier in care, they can make more informed decisions and they can deliver better experiences and outcomes. This is what Butterfly makes possible. Butterfly is the practical application of ultrasound information into the clinical workflow across all care settings. As I said, this past quarter has been an important one for our progress and trajectory as an organization. Not only are we piloting the growth of a truly disruptive technology, we're also at the heart of our evolution as a young public company, continuing to build off the changes we have made last year in how we operate, innovate, and bring value to the healthcare ecosystem. We are shifting the paradigm of care, and we know this work will take time because we are changing how ultrasound has traditionally been used and where it's traditionally been found. But we are confident, based on the signals from those in our commercial pipeline, based on the results by our current users and enterprise customers, and based on our in-the-market learning that have shaped our product roadmap and innovation to meet the current and future needs of hospitals and healthcare providers everywhere, that we will become as ubiquitous as the stethoscope. We understand the problem we are solving and have a well-defined strategy to help us deliver our value to the global marketplace. This has enabled us to understand our priorities that will lead us to success. With this focus, we were able to improve the operational efficiency of the business and to take actions regarding our spending that will help us ensure our long-term success. Our refined investing strategy is exactly aligned with our strategic priorities. It's shaped by customer feedback and the collaborative efforts we are making with current and future customers. It's enabled by our enhanced senior management team and is reflective of the macro environment. The result is a meaningful reduction in our aggregate cash spend that extends our cash runway and provides better flexibility for the company to support the realization of Butterfly's vision and mission. This led to a plan for targeted investment through reduced operating expenses and a modestly streamlined workforce. while we continue to invest aggressively behind our technology, our clinical studies, and our commercial partnerships. The talent and mission-driven dedication of our team has made these decisions challenging on a personal level, but I am confident these changes strengthen our position to capture the value of our market-leading innovation and set us up for a future where Butterfly is the standard of care everywhere. With that said, I'd like to briefly comment on the second quarter high-level financials and shift to our business update. From a revenue perspective, we ended Q2 with $19.2 million in quarterly revenues, a 16% increase versus the second quarter of 2021 and our highest quarter to date, representing continued progress as we remain on track to achieve our objectives for the year. In addition, we continue to see improvements in our maturing operational performance and organizational efficiency. Therefore, we are reaffirming our revenue guidance of $83 to $88 million and improving our adjusted EBITDA guidance. Heather will go into further detail in her remarks, but knowing the progress we are making, the pipeline we have built for the remaining quarters of the year, and the strong progress we have started Q3 with, all add to our confidence in revenue acceleration as we enter the back half of the year. I'd like to now shift to the business update. Throughout the call, I will share details on the growth in each of our four strategic pillars, including Butterfly's increased presence in renowned hospitals and medical education institutions around the world. the growing evidence in clinical research, and our continued momentum in low-resource countries and adjacent markets. Our team is laser-focused on making Butterfly easy, everywhere, and economical. These three core principles are how we will drive adoption and realize our vision. They are ingrained in our people and guide our innovation and clinical research. These four principles encapsulate the journey we are on to redefine point-of-care ultrasound in a way that only butterflies can make possible. We are transforming point-of-care ultrasound into an advanced assessment tool by making it intuitive, adaptable at scale, extremely portable, and economically appealing. not just from the affordability of our solution, but because of the economic value it brings to the healthcare system at large. I fundamentally believe Butterfly is the single most relevant platform from which healthcare can be transformed at scale. We enable ease of use across all levels of practitioners, from novice to expert, and across care settings everywhere. Decreased time to treatment, increased access to diagnostic imaging, and economic benefits that challenge healthcare's traditional toolkit and demonstrate that our solution delivers better, more informed, lower-cost care. I will now provide some updates in line with each of our four strategic pillars. Let's start with hospitals and health systems. As we continue on our journey to partner with hospitals and health systems to drive more informed, better medicine at scale, we are pleased to share Q2 year-over-year growth in the space, which benefited from momentum in software sales and from deeper penetration with current customers. We began this quarter with a number of installations in top hospitals across the country. We're proud to share that Baylor Scott & White began a scaled deployment of Butterfly Compass software, an initiative that has started with the Critical Care and Emergency Department at Baylor Scott & White Medical Center Temple, Baylor University Medical Center in Dallas, and Baylor Scott & White Medical Center Hillcrest in Waco. We will work to enhance the way their traditional ultrasound suite is managed and used. The initial focus will be on workflow best practices, device tracking, and image quality assurance. Let's move on to our international filter. We continue to make progress in markets outside of the U.S. I'm happy to share that in Q2, we added Zebra Medical as a distribution partner, a leading medical device manufacturer and distributor, largely serving the fields of oncology, pain management, and dialysis. Working with Zebra will enable us to bring Butterfly to healthcare professionals in South Africa, those within human health and those serving animal health. Beyond this new market, our teams are seeing traction with distribution partners who we've worked to onboard over the past six to nine months. We're very pleased with the momentum of Novalog in Israel and separately with Abdul Latif Jamal, who is helping us broaden the availability of butterflies in the Middle East, North Africa, Turkey, and India. Both relationships have yielded first-of-its-kind tender deals bringing us closer to putting Butterfly in enterprise-wide deployments abroad. Additionally, I'll share that Butterfly is continually being recognized for its value as part of medical education and also within the emergency medical services space. In the UK, we've added Brightman Sussex Medical School and Brunel Medical School to our medical education customer list. And in Q2, we saw in Canada for butterfly as a proven assessment tool to aid in urgent and pre-hospital care settings. Finally, our work to bring butterfly to Sub-Saharan Africa to improve maternal and fetal health, as supported by the Bill and Melinda Gates Foundation, is on track. I'm happy to share that in Q2, we deployed our product to Nairobi, and training will begin in mid-September. The remaining probes are on schedule to be shipped in the second half of the year to South Africa. I look forward to sharing more progress on this exciting and important project. We are proud and confident that our work in this region will serve as a prototype for improving access to imaging in other low-resource countries. We see this work as a critical unlock to our continued global health growth and impact related to maternal and fetal health and beyond. Our third pillar is home-based care. We know that care is moving outside the home and that we need to meet patients where they are. We continue to see a path for Butterfly to be meaningfully used for home health assessment. Butterfly is in the home today being used by caregivers. Our clinical, technology, and regulatory teams continue to assess the use of Butterfly by at-home users for bladder scanning, heart failure, lung assessment, and dialysis. Driving our development and research initiatives in this space is the belief that by capturing the same information at the same quality level, regardless of care setting, Butterfly can help to further care management and coordination into the home helping to reduce hospital visits, improve patient outcomes, and in some instances, replace a more complex workflow or expensive device. Our clinical research team has many active clinical studies underway to support this belief with objective data and to further quantify the magnitude of the improvement in clinical, economic, and patient satisfaction outcomes. Our path to home is a journey, and we're encouraged by concepts such as volume sweep imaging, or VSI, that demonstrate that novices can use butterflies to sweep over a target region to acquire valuable information. In one recent study published in the Journal of Ultrasound and Medicine, medical students at the University of Rochester Medical Center, our first enterprise-wide partner, tested butterfly for evaluation of breast lumps and found that after scanning 170 palpable lumps with the DSI protocol, that butterfly performed in line with the standard of care 97.6% of the time and had a detection rate of 100% for all cancer presenting as a sonographic mass when read by a radiologist. The machines used to represent the standard of care reported in the study are approximately 50 to 75 times more expensive than butterflies. The results of this study provide another marker in our Path to Home highlighting butterflies' clinical and economic benefits, all the while being easy to use and accessible to the masses. As many of you know, our Path to Home also includes patient self-scanning Working with Yale University, patients at home are using butterfly to scan their own bladder for bladder volume. This is particularly useful for those patients that require regular catheterization. Self-scanning the bladder means more accurate monitoring and offers the potential for less frequent catheterization, reduced infection, and most importantly, improved quality of life. We are confident this study will add another proof point to our growing pool of evidence that demonstrates the value of butterflies in the home. I look forward to providing more updates as these studies advance. Finally, as I've covered on past calls, we are exploring values in adjacent markets to healthcare, such as veterinary medicine. Last call, I shared that we welcome Petco as a partner and will bring Butterfly IQ Plus Vets across their more than 200 veterinary hospital locations at Petco pet care centers across the United States. In Q2, this work began as we implemented onboarding and launched our first enterprise veterinary solution. I'm also pleased to share that in Q2, we expanded our work with Texas Tech University School of Veterinary Medicine. Together, we've entered into a four-year partnership in which they'll embed butterfly IQ Plus vets more deeply into their curriculum and clinical training models. with a one-student to one-probe approach that will allow PTU to reinforce elements of anatomy and the physical exam by empowering students to not only read and learn, but to see and learn. Students will also leverage the butterfly probe in surrounding rural and regional communities during their clinical year and outside of school semesters. This will bring value to the community which, because of its world backdrop, struggles to have access to timely veterinary care and imaging for animals. Finally, I'm also pleased to share that the University of Pennsylvania's School of Veterinary Medicine has joined our student program customer list. I look forward to sharing more as we continue to expand the veterinary markets we are in. As I said earlier in my remarks, I believe Butterfly is the single most relevant platform from which healthcare can be transformed at scale. I continue to be encouraged by all the progress our team has made in the market. Despite some of the challenges, we are seeing that the overall economic environment, we are running the business more effectively. Our customers are realizing the elements of our solution and how Butterfly unlocks the value of real-time imaging information across care settings and arms practitioners with more complete information because they can now see what they need to know. And with that, I will now turn the call over to Heather for the financial results. Heather?
spk01: Thank you, Todd. And good morning again, everyone. Revenue for the second quarter of 2022 was $19.2 million, a 16% increase versus the prior year period and our highest quarterly revenue to date. It also represents an increase of 23% sequentially. Product revenue was $13.4 million, an increase of 3% versus Q2 2021. This increase was driven by higher average selling prices in both our U.S. and international markets, as well as higher volume in the vet and international markets. Partially offsetting this increase was a reduction in e-commerce or direct-to-user and smaller out-of-hospital sales as our business model is evolving to larger enterprise transactions across health systems. We believe out-of-hospital performance was negatively impacted by a shift in support resources, which has since been remedied. Going into Q3, our volume is strong with an increase in July quarter-to-date volume versus those Q2 and prior year Q3. Subscription revenue, which includes software and services, was $5.8 million in the second quarter, growing by approximately 66% over the prior year period. Subscription mix of 30% of revenue increased by approximately 9 percentage points versus Q2 2021. This increase is due to a higher installed base of products with accompanying subscription software as well as increased renewals. We are encouraged by the continued momentum in our subscriptions as we diversify our revenue from primarily one-time closed sales to providing annuity-based software and services that enable more informed clinical decisions. Turning now to adjusted gross profits. Adjusted gross profit was $11.2 million in Q2 2022, compared to $8.3 million in the prior year period. This increase was primarily due to product mix, reflecting a higher proportion of subscription revenues in addition to higher device prices. Also contributing to the increased margin was higher manufacturing productivity, partially offset by the increased cost of manufacturing materials. Adjusted gross profit margin was 58.5% for the second quarter, which compares to 50.2% in Q2 2021, reflecting the positive mix, higher product ASPs, and manufacturing efficiency. We expect our gross margin percentage will fluctuate quarterly along with the change in mix between product and subscription sales. We believe the second half will have a higher percentage of product revenue And as such, we anticipate a lower gross margin percentage. We do, however, expect that both our subscription sales as a percentage of revenue and gross margin percentage will increase for the full year 2022 versus 2021. For the second quarter of 2022, adjusted EBITDA was a loss of $37.8 million compared with a loss of $28.5 million for the same period in 2021. The increase in adjusted EBITDA loss was driven by investments in our commercial and R&D functions as we build out our commercial operations and products, as well as investments in future revenue streams. These investments were partially offset by increased adjusted gross margin dollars driven by the aforementioned positive product mix and ASPs. Moving to our capital resources, as of June 30th, Cash and cash equivalents were $311 million. In addition to our operating expenses, our June 30 cash position was impacted by fiscal 2021 annual bonus payout, capital expenditures for the build-out of our headquarters, the annual renewal of insurance premium and inventory purchase obligations. As Todd mentioned, we more tightly managed expenses during the second quarter, informed by the better understanding of our strategic investment priorities, appropriate operating intensity, and reflective of the broad macro environment. Beyond the cost we avoided during Q2, we are implementing additional savings that will reduce cash expenses by approximately $3 million per month when fully implemented, giving us an extended cash runway. This plan provides greater flexibility for the company to support the realization of the vision and mission of Butterfly through targeted investment, allowing us to continue to build on a commercial organization that will support our revenue growth as well as invest in R&D to create future revenue streams. Looking at our 2022 guidance, we are reaffirming the previously issued annual revenue guidance of $83 to $88 million and updating the adjusted EBITDA guidance to a loss of $155 million to $145 million from a loss of $195 million to $175 million, an improvement of $35 million at the midpoint. As a reminder, we expected about 55% to 60% of our revenue in the second half of the year, or growth of approximately 45% to 55% versus prior year. The increased growth in the second half is due to a shift of our business from e-commerce to institutional purchases, our evolving product offering, and operating our business more effectively in the marketplace. In time, we believe these changes will not only accelerate our growth, but will also allow for more predictable growth expectations. To close, in addition to seeing continued top line growth in the second quarter, we tightly managed expenses and put in place a plan to reduce future cash consumption. We are well positioned to support the realization of the vision and mission of Butterfly. We have a solid cash position and we plan to continue to invest in a targeted manner to maintain our momentum and continue to capitalize on this attractive market opportunity. And with that, I will now turn it over I'll call back to Todd for closing remarks. Todd?
spk05: Thank you, Heather. I hope we provided you with greater context into the accomplishments of Butterfly this quarter. I am immensely proud of what Butterfly has built and achieved, and we are now singularly focused on changing how healthcare is delivered. To support this future, we made the tough decision to focus our investments and streamline our workforce. As a leadership team, we are confident that the changes we are making will ensure we have the resources to fund our strategic plans, ensure our long-term success, and help us advance the innovation and value we bring to healthcare. I want to thank you for your time and support today and everyone at Butterfly for their contributions to making all this possible. Thank you for joining today's call. Let's open it up to Q&A.
spk03: Thank you. As a reminder, if you'd like to ask a question, please press star one on your telephone keypad. If you'd like to withdraw your question, please press star two. Please ensure you're unmuted locally when asking your question. Our first question for today comes from Josh Jennings of Cohen. Josh, your line is now open.
spk02: Hi. Good morning. Thanks, Don, Heather, for taking the questions. I was hoping to just start off on the... Good morning. The reiteration of 2022 revenue guidance and just wanted to get some help just thinking about the cadence of revenue progression in the second half and how we should be thinking about seasonality in 3Q. If there's any incremental color you can share.
spk01: Good morning, Josh. So, in the second half, obviously, we have typically Q3 is a little bit softer than Q4, but the momentum that we're seeing coming out of Q2 going into Q3 we believe will give us some strength relative to prior year. So on a year-over-year basis, I would expect that to be a higher growth order than Q4, but then I would expect to see additional growth sequentially from Q3 to Q4.
spk02: Great. That's helpful. Thank you. And just thinking about the momentum that you guys are citing and the acceleration in the back half. You laid out a number of initiatives that you made progress on, but maybe just to better understand some of the drivers of the second half revenue growth acceleration in the enterprise channel, international channel, and that is... Jerome, to start with just the international channel and thinking about some of the partnerships with major hospital systems, IDNs that you've already established, and just how should we think about revenue contributions in 2Q for maybe Rochester and South Carolina, and then how those revenue contributions build in the back half, and maybe the same type of question for Petco on the vet side.
spk04: Thanks for the multi-part question, Josh. So I guess if I would break it down, you know, first and foremost, I think you need to step back, right? I think there's an element of time, right? So people are starting to realize the power and the potential of ultrasound information in the It's Butterfly that makes that possible at scale. We have a momentum building in the marketplace where people are starting to really understand that. I think that's really powerful. Secondly, the evolution of our solutions. Our compass software is really what's enabling encounter-based workflow. and really ultrasound deployment at scale, which is really important. And then our blueprint, you know, which really brings the elements that are required between software, hardware, and services to do that. This recognition is really starting to build in the marketplace in combination with the talent that you see. So that's building, and that's what we're seeing from Rochester, from MUSC, from Beller, Scott, and White. And as you're starting to see more and more institutions understanding that there's value in this, but there needs to be a way to realize it, and Butterfly is the way to realize it, both in hardware and software. And then, you know, we're evolving, like I said, and maturing as a company, so we're getting better at helping our customers through a more effective sales force through our activities that are supporting and being able to do that. And then getting better at the way we are executing our business, both directly here in the U.S. and in partnership outside of the U.S. And you're seeing those things happening as we're getting traction and penetration in markets outside of the U.S. where we have health systems and working with governments outside of the U.S. with our value proposition and drive for that. and building momentum, both in developing and developed markets. And then similarly, we're doing this in veterinary. Our deployment with Petco went really well. They're fully trained. The enterprise software is up and live. So our ability to execute, do this, get our customers up and running and realizing the value is really coming into its own And that's really starting to pick up and drive our operations in the back half of the year. And Heather, I don't know if you want to comment additionally.
spk01: Less specifically on the larger deals, we've increased our pipeline quite significantly over the second quarter going into Q3. And, um, that momentum has showed in the deals that we've closed actually in July already. We're well ahead of prior year, July, as well as the first month of April. And all of that, um, lends itself to the momentum we've talked about that we're building.
spk02: Understood. Thanks. Thanks for those details and congratulations on the, uh, contract with Baylor Scott and White. I was hoping to better understand. I know I, uh, a partnership like the one you established with Baylor and then this Compass Software adoption, it seems like it's another element of the business model and the revenue-generating opportunity. How should we be thinking about this agreement? I mean, initially, they're adopting the Compass Software platform. How should we think about revenue contribution one? And then I know, Todd, you've spoken about the blueprint and compass is going to be a backbone for which some of these enterprises can then start hanging Butterfly IQ devices from. And is that how we should be thinking about this Baylor Scout and White contract as well? Sorry, another multi-part question for you.
spk04: Thanks, Josh. Absolutely, right? Like, I think if you take it, I think this is what I've been talking about the whole time with Butterfly, right? It's about the practical application of ultrasound information into the workflow and how we enable that. So there's an element of hardware, an element of software, and then an element of what I will buttonize as services that enable people to bring this to life, right? So there has to be a way to get people there, and that's what at the end of the day, Butterfly is able to do. There's elements within how we break those things down that get people through the journey but you know right now i think it's really important that our compass software is what lets people work the way that they need to work in an encounter based workflow manner that lets them start realizing the value of ultrasound that's why there's real value in compass and compass really establishes a platform in which you can get the value out of point-of-care ultrasound and then that evolution of point-of-care ultrasound to a vast assessment tool in workflows all throughout clinical practice. So we see a lot of value in this, and our customers are starting to see value in it. It then allows us to work with our customers to help them move away from a doing ultrasound conversation to a using ultrasound conversation and then incorporating Butterfly, which is really, one of the best solutions to be able to do encounter-based workflow using ultrasound information into the workflows. So it's a really important foundation for us, and it's a way that we see value as we go about expanding our offering into the healthcare system.
spk02: Great. And I just wanted to ask a follow-up on just investing into the build-out of the commercial team. Any update just on the status of where the commercial team stands in the U.S. and how you see the build-out progressing from here or whether or not you feel like that build-out has been established and you're comfortable with where the commercial team stands?
spk01: Yeah, Josh, the structure of the sales organization hasn't changed since we previously talked about it. We'll continue to add territories and areas where we think that we can get, I would say, quick hits in a large market because that will benefit, obviously, the revenue growth. And this is an area that this year and going into the future we will continue to invest in to strengthen the field force as well as grower revenue.
spk02: Just on, you know, in this era, investment hyper-focused on cash burn. You have some initiatives in place for cash conservation. But have you disclosed publicly that this is an out-year target potentially, but just in terms of the revenue run rate, where you expect it to achieve cash flow or EBITDA positivity? Thanks for taking on the questions. Yes.
spk01: No problem. You're welcome. No, we have not put that out publicly, obviously, with the cash conservation. And given the macro environment, our goal was to extend our runway. And the actions we have taken have positively impacted that. And we feel that we have plenty of cash to invest in the areas that we need to within R&D and the commercial organization in order to grow revenue.
spk03: Thank you. As a reminder, if you'd like to ask a question, that's star 1 on your telephone keypad. OK, we have no further questions for today, so that concludes today's conference call. Thank you for joining. You may now disconnect.
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