Nightingale Health Oyj

Good afternoon and welcome to the half-year result webcast of Nightingale Health. Today we have the following agenda. I will talk first about Nightingale Health in brief, summarizing the technology and our business. Then we go to the business target of the current fiscal year. Then we will have a business update of the first half. And then we will go to financial review. And then finally we have Q&A. My name is Teemu Sunaa. I'm CEO and founder of Nightingale Health and also interim CFO. Let's start. So Nightingale Health, our mission is to build better healthcare for everyone. Company is founded 2013, headquartered here in Helsinki, but we are a global company. We have laboratories in United States, United Kingdom, Japan, Singapore, and of course here in Finland. We serve customers in B2B and B2G segments, and the focus is preventative healthcare and medical research. So what Nightingale Health is all about, our technology is building a global standard that will enable AI-powered preventative healthcare. The problem in healthcare at the moment is that there is no globally standardized clinical great way to measure health trajectories and intervention impact. So now because we cannot measure health and the health trajectories, the healthcare system is very reactive. So healthcare system is basically waiting people to get sick, and then tries to do something about it. And the reason why it is like this is that we are missing a way to measure health and health trajectories. Nightingale's solution is that we take one blood sample, we run one test, and we get multi-disease risk detection and tracking. And this can be done in scale. I mean, for everyone. The technology has world-leading proof. We have run more than 3 million samples. There are more than 900 peer-reviewed publications. And we have multi-market regulatory approvals to be able to serve the healthcare industry. And we are running labs around the world. And about two years ago, we also started national implementation here in Finland. The opportunity with Nightingale is that Nightingale will become the globally standardized measurement layer that will power AI-native preventative healthcare applications. And now when AI is coming to all the industries, it will come also to healthcare, but the challenge at the moment is that utilizing the current data in healthcare in electronic health record systems will not work because the consistency, the data quality, it's not there. And for AI to actually work and the AI applications in healthcare to work, we need standardized data in the background. And this is what Nightingale can bring across the healthcare industry. So if you look at the solution in a bit more detail, as I said, we take one blood sample, it can be venous sample, it can be finger prick sample. Finger prick sample we collect using our proprietary device, so the whole chain comes from Nightingale. So we have like an end-to-end solution to ensure also high quality of the results with the finger prick samples. We run one test. The test itself is proprietary and only available from Nightingale. And then as a result, we detect the risk for heart attack, stroke, type 2 diabetes, chronic kidney disease, liver disease, and everything in one go. And then in addition, you get more than 40 clinical biomarkers. So Nightingale is not a traditional diagnostic company because traditional diagnostic companies and the kind of the whole diagnostic industries is basically focused in single biomarkers. And this is very effective approach if you want to diagnose a disease. But prevention does not work like that. Because the idea of prevention is that you actually want to lower the risk of developing disease when people are still healthy. So what we do, we quantify the disease risk. And then with that information, with that data, we can build preventative healthcare applications. Why the time for preventative healthcare is now? The burden of chronic diseases, the cost pressure is accelerating all over the world. And this is like the chronic diseases that are preventable, they represent something like 80% of healthcare costs. Because of this, healthcare prevention is going in mainstream. So there are more and more population scale programs that try to bring preventative healthcare into reality. And then number three, all the AI applications, as I said, they need objective standardized molecular data. to guide prevention. If you only use different kinds of proxy signals, they work, but the quality of the analysis is not there, repeatability is not there, tracking is not there. There are a lot of challenges in healthcare, particularly in healthcare, when using AI in disease risk detection. We've been building the company for more than 10 years already. Building this kind of a company, this is a long-term play. This is not something that happens overnight. I think it applies to all of the medical device industry, particularly if you have a medical device that you want to roll out in population scale. So here you can see what Nightingale has been doing in the market entry, regarding the market entry over the past 10 years. So we started from Finland. So we established the laboratory in Finland in 2015. What is the first step before we establish the laboratory? Is that we do pilots without a local lab. Then once we get some comfort with the pilots, we build the local lab. Then we go and get the regulatory approvals. Then based on that, we can win local pilots. Then based on local pilots, we can win local reference deals. Then based on the reference deals, we can win high volume deals. And then, based on the high-volume deals, we can win broad market penetration. In Finland, we have almost completed the entire journey. We are in the high-volume deals with our partner Tervestalo. More than 200,000 people have already been measured with Nightingale's technology. However, there is still one step to go, which is to adopt the technology in public healthcare and in all of the healthcare systems in a country. Now, what makes this challenging kind of doing the market entries is that you have to do the same thing in every country. So in Japan, we established a laboratory in 2019. We are... We have made good progress, but it takes years. It's not something that happens very quickly. However, you can see there that the pace is accelerating because the more we have been building different laboratories and market entries, the better we also can package the market entry, the better we can we can make it work in the market. So Singapore 2024, establishing the laboratory, and we are already quite advanced over there. UK 2024 as well, not as far as in Singapore, and US 2025. Now what we believe is that the market entries will significantly accelerate when we move forward. And we have several discussions, commercial discussions on the way to expand the laboratories also beyond this list of countries. So my point is that the current lab rollout model is well standardized and we are in a good position to enter, continue expansion in these markets and enter new markets. But building all this has taken 10 years. It's not easy, but on the other hand, it creates a very strong moat for Nightingale. Our business model, we are Nightingale Insight, meaning that we deliver our data to our customers and then they build the preventative health applications. This is to enable a very scalable model and allows us to run the technology across the world when we are not serving directly the end customer. The business model is very simply price per sample. And here we have three different tiers. So basically different customers have very different volumes. In tier one, we talk about longevity clinics. They typically have very low volumes, but then on the other hand, the unit price can be higher. And then when we go to tier three, we have their national screening programs, et cetera, where we have very big sample numbers. So the volume is high, but the unit price is low. And our cross-matching structure supports very well all of the tiers. So that puts Nightingale as a growth company, I think, in a very strong position because when we are offering our services, it has healthy cross-matching. So when we build growth, the growth has very strong financial foundations. We have multiple active pilots and late-state negotiations ongoing across the key segments. And this is basically enabled by multi-country lab availability. There is absolutely no way to do this business in a way that you try to make the deals and then you build the labs. It just doesn't work that way. You have to be in the country. You have to be present. There are some differences, for example, in Europe, within the European Union. Of course, the samples can move between the countries. But in the big picture, if you look at the global picture, you have to bring the lab capacity, the lab capability locally available. The market we are looking at here, this is when I mentioned that these chronic diseases are 80% of healthcare costs. This is the largest healthcare market in the world. And when I say that, because healthcare is such a massive thing, in many governments, the healthcare budgets are three to five times larger than the military budgets. So this is like a massive, massive, one of the biggest markets in the world. And then cardiometabolic burden to which we are focused. That's the largest preventable global disease burden. The budgets are already there. Spending is already there. What is missing and what has been missing is that how can you make prevention measurable? So many times we hear people speaking that prevention is very problematic because if you, for example, have a lifestyle improvement program, even if you use some drugs, How do you quantify the effect of prevention? And I strongly believe that this is the single biggest reason why prevention has not break through before, because these kind of technologies have not existed. But now with Nightingale, the key thing we can do, we can actually measure the impact of the actions that are being done in preventative healthcare. And then the opportunity here is that when we standardize the measurement layer, that powers prevention across the whole industry. Why Nightingale? I mentioned we have been building the company for more than 10 years. There's a lot of things we have achieved. Here is a list of selected benefits to work with Nightingale. We are heavily validated, more than 900 publications. This number, to our knowledge, it's next to none. We are global. We can actually serve our customers across the world. This is very scalable. This is built for population scale because our price point is very, very competitive against, for example, clinical chemistry. In many applications, especially when you go to prevention, we win also with the price point. We are a very efficient company when we do a pair comparison, and now I mean international pair comparison, not a local or a Finnish comparison. In international comparison, running this kind of a global operation is financially very efficient, how we run it. We are independent. This is also something that maybe people don't think about often. There are not a lot of status quo independent global assets in this blood testing because many of the diagnostic industry, many of the players, they are actually connected already to the existing system and then there are very easily some conflicts of interest. This is proprietary, only available from Nightingale from the biotechnology to the applications, it's proprietary. We are publicly listed. We have transparent operations, professional governance. We have massive database, world's largest metabolomics database, regulatory approvals. We are the first team that actually brought omics technology into healthcare. And then we are already in national nationwide use. So I would say there is a lot to like. All right, then let's move to the business targets for the current financial year. We have a single target is to increase revenue by at least 50% compared to the previous financial year. We are on track with this. Our current fiscal year, the revenue accumulation is very heavy weight on the second half. So we are reiterating this target. In the longer term, no change is here, but what we are building, we are building a global company. We very strongly believe that there is There is a huge market for prevention. It has to be done. Governments have to initiate preventative health care programs. And in that context, these goals are feasible. Then we go to the business update and I will give a brief update of all of the geographical areas that we are working at the moment. It's been the past half. It has been... The key focus, the core focus has been to ramp up the commercial activities everywhere. And I think what we have managed to do and what the team has managed to do across the world is that we have heavily, heavily increased the sales activities. And how we build up the revenue is, of course, by selling more. And why we have now started only in the first half of this fiscal year, Well, building up the readiness to really ramp up the commercial operation, it takes a long time. But I think now we are in that position. And what I will share with you today is there's a lot of indications how the sales activities are now increasing. In addition to increasing pipeline, we have done new significant agreements and we have multiple pilot projects launched. Important thing to remember is that The sales cycles remain long, but then on the other hand, what we now see in the sales and the customer feedback, I think the long-term growth prospect is very solid. So in Finland we have a lot of sales activities ongoing across public sector stakeholders to evaluate how this technology could be adopted across the public sector field. We are also doing commercial investigations to offer our remote blood testing to healthcare in Finland. Then what we managed to achieve, we have a new strategic agreement with Terveystalo. What this changes is that earlier we were working only in occupational healthcare with Terveystalo, now we are moving to all of the Terveystalo's customer segments. which is the volumes we are running with Terveystalo, it's internationally very significant. Then pilots with public sector, we have two pilots in public sector. These are very important to demonstrate how the technology also works in the public sector side of things. And healthcare is like, it's pretty much the kind of the problems are the same, but when you move across different systems, then the implementation is also pretty different. And that's why we need to start with piloting also in the public sector. In United Kingdom, we started last summer to strengthen the UK sales team on the ground. And I think this is now very important to appreciate that this only started last summer. So what we managed to do in the first half is we achieved significant increase in sales activities. We had a lot of engagements with public and private health care providers and pharma. First pilot projects are launched and several negotiations on going to initiate new pilots. Then rest of the Europe that we commercially manage as a separate business, we also started in last summer. And again, it's important to appreciate the readiness to scale this out commercially has not been strong enough because it doesn't help to run around the customers if the product is not there. But now, based on the feedback, I think the product is there and we have worked very hard to open discussions in more than 10 countries. And now, based on the feedback, we are continuing to expand the sales activities and the resourcing in sales. So several pilots already ongoing and this is I think a very good achievement because the sales cycles are very long. In a relatively short time we have managed to initiate multiple new pilots and then some of the projects are moving to production stage negotiations. Given the timelines with this business, I was talking earlier about building the company for 10 years, now putting this timeline in relation to what we've been building, I think the progress is very strong. In Singapore, we continued the investments to expand commercial team to accelerate the sales. A very significant update that we did, because we've been working in Singapore already for a while, and as I mentioned, having the right product like product market fit is like essential. So based on the feedback that we got from the market, we actually made a significant report update. So updated our product. And now we have offered the new report, which is the product and presented it to tens of customers. And now the reception is very, very strong and When I compared the difference in the conversations with the customers, I think the tone is fundamentally different. So based on this, I think there is a strong long-term growth potential in Singapore. Based on the market dynamics, it's a very significant health screening market and then the customer feedback. So now in Singapore, first clinics are already ordering services under the updated report. The sample volumes are initially modest, but this is very typical for new markets. So it goes in stages. What we try to do in the ongoing half, we are increasing the number of clinics ordering the test and with this improving the market penetration. In Japan, we also made a lot of efforts to strengthen the sales team, which we succeeded to do. Based on this, we have now new sales activities ongoing. We have also similar feedback process that we did in Singapore. We have got good feedback from the customers. We will implement some updates to the business model as well as to the clinical report. And then these changes will be gradually implemented during the current fiscal year, so in the ongoing year half, and then we expect to see the results in the next fiscal year. We also initiated expansion of presence in medical research in Japan. Japan is a very special market, so otherwise we manage medical research centralized globally from Finland, but Japan is a rather special market and that's why we have now ramped up also local capabilities to promote medical research in Japan. So recurring business in Japan is continuing and the sample volumes from key customers are continuing. We have negotiations to close more key accounts in the market. So I think due to the improved sales activities, I think we have now also good prospects to close more accounts. And then we have already signed new deals with medical research customers. So that I think it's an early validation for the decision to have like independent medical research sales capability in the Japanese market. In the United States, after the first half, we announced in February that we received the CLEP permit in New York. This is a big milestone because this is something you, of course, need to clear before entering the US healthcare market and running the samples locally. And this is the difference to our previous position. Of course, we could offer our services internationally, but now having the local capability on the ground makes a huge difference. Huge difference. There are some steps still required under the CLEP permit that we need to do, but I think maybe the biggest unknown for us we have now completed. And now we are starting to... We have planned a lot of sales activities for the current year half. And some of the deals are actually already in negotiation states and they are now based on the concept of running the samples in the New York lab. Then in the medical research market, with the team, we made a big effort aiming to increase the sales activity, so ramping up the monthly prospects. And we managed to increase the number by tens of percentages. which is a very strong result, a very strong interest towards multi-omics offering, which is a new offering, and we are continuing the investments into sales resources and activities in the current year half. We won a significant project in Italy. We won a significant multiomics deal in Denmark. And then, of course, several smaller projects ongoing. But the key message is that the prospect pipeline is growing. and that we are expecting to bring also a strong yield in winning the cases. Then we move to the financial review, so a couple of points regarding the numbers. So the revenue increased by four percent compared to last year in the first half. We are still, as I said earlier, we have strong sales pipeline to support reaching the target of 50% revenue growth. And this is supported by the Albori project, because now the revenues from that project, it takes always time before the revenues are recognized from these projects. So that's why the current fiscal year, there's a heavy weight towards the second half. And this is largely due to the Albori project. But the order book is strong and that's why we are maintaining the target for the whole fiscal year that we gave earlier. Then, couple of points regarding the first half financials. I think there is still what we have said also earlier, but I reiterate that the revenue growth target can be achieved without much pressure to increase the cash burn. So now the investments that we have done to the labs and the production capabilities we can have more load to this. We have capacity to run samples, and because we have the capacity, the pressure to increase the cash burn is low, even though the revenue can increase significantly. If you wonder the net cash change here, it was impacted by 2 million by renewal of our lease agreement in the headquarter. All right, so that was it, and we have the last segment with Q&A, and I'd like to ask our Chief Operating Officer, Rianna Ranta, to join me on stage, and I think there are some questions we can walk through now.

Yes, good afternoon Teemu, good afternoon our small live audience and good afternoon our audience also online. So let's kick off this Q&A session. I will be hosting it, so we will start with some questions that have come through online and then we'll also have the opportunity for our audience to ask questions. So Teemu, seems like there has been a lot of things going on during the H1 period. So could you tell me, did the outcomes align with what you were expecting?

Yeah, so of course, every time you hope that there is, like you can show more in the numbers that we report. However, like putting this in the scale of building the company for 10 years, I'm more looking at the size of the pipeline, amount of the sales activities, so the actual things that we are doing all the time. And with the long sales cycle, that is the indication that gives the kind of I think the best understanding where the company is going. And when I look at that, I'm actually very pleased we made a huge, huge change in comparison to like a year ago. So in that sense, I think we are in a good position. And now this work we are doing, I'm confident that it will turn into results that then we can report also with these numbers.