Kestra Medical Technologies (KMTS) Q1 2027 earnings call transcript

Thank you, Lateef. Good afternoon. Thank you for joining KESTRA's first quarter fiscal 2027 earnings call. With me today are Brian Webster, President and Chief Executive Officer, and Viseem Mbou, Chief Financial Officer. This call includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Statements made on this call that do not relate to matters of historical fact should be considered forward-looking statements. These statements are based on KESTRA's current expectations, forecasts, and assumptions, which are subject to inherent uncertainties, risks, and assumptions that are difficult to predict. Actual outcomes and results could differ or materially from any results, performance, or achievements expressed or implied by the forward-looking statements due to various factors. Please review KESTRA's most recent filings with the SEC, particularly the risk factors described in our Form 10-K for additional information.

Any forward-looking statements provided during this call, including projections of future performance, are based on management's expectations as of today. KESTRA undertakes no obligation to update these statements except as required by applicable law. During today's call, we will also discuss non-GAAP financial measures. These non-GAAP financial measures are in addition to and are not a substitute for or superior to measures of financial performance prepared in accordance with GAAP. Please refer to our earnings release for a reconciliation of these measures to their most directly comparable GAAP financial measures.

With that, I will turn the call over to Brian.

Thanks, Neil. Good afternoon, and thank you for joining us on today's conference call. We're excited to discuss the strong financial performance we had in the first quarter and the continued progress we are making on our key operational objectives. I'd like to begin, though, with a reminder of the purpose behind our work, that is providing innovative, intuitive medical technologies that protect and support at-risk patients.

That mission guides both the technology we create and the experience we deliver, helping patients remain engaged, connected, and protected throughout their care. One patient's experience this quarter demonstrates how those forms of protection work together.

The patient was prescribed the Assure WCD for protection during the high-risk period between removal of his implanted defibrillator and scheduled lead extraction. Shortly after fitting, the Assure system recorded more than 120 diverted therapies in one night, prompting immediate outreach from our Heart Alert Services team. The team learned the patient was driving alone through rural Utah with his two dogs. He initially resisted seeking care. Partnering services remained in close contact until he agreed to go to the nearest emergency department. The team sent his clinical reports ahead to the support team at the emergency department. Upon arrival, clinicians determined he needed to be airlifted to a Las Vegas hospital for specialized electrophysiology care. After eight days in the hospital, he underwent a successful lead extraction and received a replacement device.

This case demonstrates the differentiated value of our integrated care model. Assure provided continuous protection and clinical insight, while Heart Alert Services turned that insight into action, Moving a patient from unseen risk to urgent specialized care, in this case, across state lines. This is the cardiac recovery system platform in action. Therapy and protection, clinical insight, and responsive support working together when it matters most. I would now like to turn our recent financial performance. In the first quarter, we continued to reach more patients at risk of dangerous cardiac arrhythmias while delivering another quarter of strong financial performance. Revenue advanced sequentially off a strong fourth quarter and grew 60 percent year-over-year to $31 million. Gross margin of 56.5% increased over 10 points year over year and 175 basis points sequentially.

This was the 11th quarter in a row of sequential gross margin expansion, demonstrating the attractive unit economics and volume leverage of our business model. Based on the progress today, we are increasingly confident that KESTRA can achieve mid-70s gross margin percentage in the next few years. This represents a meaningful increase from our previously communicated target of 70%.

Importantly, though, KESTRA is not simply a gross margin story. With strong revenue growth and gross margin expansion, we are enhancing the operating leverage in our business. This leverage supports investments we are making in key growth drivers that we believe will yield significant earnings power and long-term value for KESTRA and its stakeholders in years ahead. We have been deliberately building towards this point. For example, we have invested in building the foundational technology stack needed to scale the business, including cloud platforms, enterprise data capabilities, workflow automation, and system integration layers. Those investments are now enabling the next phase of value creation through AI and automation.

Our AI roadmap is highly disciplined and firmly grounded in measurable business outcomes. Every initiative is linked to a specific operating KPI and evaluated based on its ability to improve growth, efficiency, or enhance scalability. We are initially prioritizing three areas where we believe AI and automation can create significant value.

First, patient support and adherence, where AI-powered patient support agents and automated outreach can help maintain patient engagement and aware compliance while increasing the productivity of the KESTRA team supporting a rapidly growing patient base.

Second, revenue access and collections, where automating intake, prior authorization, and reimbursement workflows can improve our fittings to client conversion and collections while materially reducing administrative effort. And third, commercial demand acceleration, where AI assists our sales representatives with call preparation, follow-up, account prioritization, and clinical documentation. The objective here is straightforward. Increase rep productivity as measured by patient fittings per rep without requiring a proportional increase in headcount.

Together, these initiatives demonstrate the leverage in the technology foundation we have built and how AI and automation can improve key operating metrics while bending the operating expense curve as transaction volumes continue to grow.

Turning to our commercial organization, our territory managers are continuing to win share in competitive accounts while simultaneously expanding the WCV market as prescribers increasingly recognize the benefits of protecting more patients than they have historically. Our newest reps are ramping faster than prior cohorts, while our legacy reps continue to generate strong growth and same-store sales. In some of our largest markets, we have been deliberate and strategic about splitting high-volume platinum territories to go deeper and reach more prescribers in existing accounts. We are finding that when we split a territory and add a clinical account specialist, more feet on the ground closer to the customer compounds growth.

It's how we ultimately turn a foothold into a fully penetrated account and put both territories on a path to becoming high-volume, platinum territories. This is a powerful model for growth and operating leverage. Higher territory manager productivity is a meaningful driver of operating leverage and also positions us to more effectively capitalize on a significant growth opportunity ahead of us, given how underpenetrated the WCB category remains. As we have previously noted, despite the overwhelming evidence that an external refibrillation shock is effective at terminating dangerous cardiac rhythms, WCD therapy remains underutilized.

In 2025, six out of seven patients that were indicated for a WCD were not protected by one. This statistic speaks to the enormous potential in front of us. The innovation and clinical evidence we have brought to the category is beginning to change this. Based on our financials and those of the incumbent, the WCD market grew approximately 14% on a dollar basis in the 12 months end of July of 2026. We believe we are still in the early innings of market expansion, and we see this category growing into a multibillion-dollar market in the years ahead.

Turning to market access, we continue to bring more payers in-network while also making progress on improving our RCM capabilities. At the time of our IDO 18 months ago, approximately 70% of our fittings were for patients with in-network benefits. This figure is now in the low 80s, and we expect this to increment higher in our FY27 as we sign new contracts in target markets.

Higher in-network mix meaningfully increases our team's efficiency and positively impacts all RCM metrics, including revenue per patient. About six months ago, we announced that KESTRA has been added to the federal supply schedule for the U. S. Department of Veterans Affairs. As a reminder, the VA is the largest integrated healthcare network in the U. S. and covers 9 million members, nearly 50 percent of whom are over the age of 65. Over the last six months, we have seen a steady increase in volumes at the VA and still have a significant multiyear opportunity to grow our share within these facilities. It is important to note that there are over 3,000 payers in the U. S. , so there is still a long tail of regional and local payers we are working to bring under contract.

Of note this month a significant national payer has expanded their coverage to non patients undergoing guidelines directed medical therapy This is the first time this large payer has covered both the ischemic and non patients This is significant since over 60 percent of the typical WCD populations are non We believe this is a strong signal that the recent clinical evidence is having an impact on payer policies for WCDs. Innovation also continues to be a central area of focus and investment for KESTRA. We are progressing as planned with our BioMeet Technologies Partnership to integrate noninvasive blood pressure monitoring into the Assure platform. In addition, our team is completing an exciting late-stage R&D project intended to further extend our clinical advantage with the performance of the Assure.

and also bring new first-in-category capabilities to the market. We expect to discuss those further in the next quarter. Over time, we believe innovation will help us accelerate market growth and win additional market share by further differentiating our product from the incumbent. And more importantly, by providing additional clinical value and diagnostic insights to physicians, we believe it will result in that prescribing WCDs to more of their patients that heretofore have gone unprotected.

In conclusion, the fundamentals of KESTRA's story have never been stronger. Our product differentiation is clear and compelling. Finally, the WCD market is expanding rapidly with tremendous room for further penetration. KESTRA continues to deliver top-tier medtech revenue growth. Gross margin has expanded consistently, and meaningful opportunity remains. We have a strong balance sheet, and our execution continues The foundation continues to be crisp, and the foundation we have built positions KESTRA for strong and durable growth for years to come. I'd like to thank our incredible team in the field and also here at the Home Office in Kirkland for their passion and commitment to the KESTRA mission. I will now turn it over to Vassim, who will discuss first quarter financial results in more detail, and provide our updated fiscal year 2027 revenue guidance.

Haseem?

Thank you, Brian, and good afternoon, everyone. We had a strong financial performance across the board in the first quarter. Total revenue was $31 million, an increase of 60% compared to the prior year period. Revenue growth was driven by continued WCD market expansion, competitive share gains, a higher mix of in-network patients, and ongoing improvements in our revenue We continue to see improvements in all free key drivers of our revenue model, our prescription bill rate, our bill rate, and our collections performance. As we continue to bring more payers in network, we expect to see benefits in revenue growth, gross margin, and our profitability profile. As Brian noted in his prepared remarks, we are investing in RevCycle AI tools and other Other automation projects that we believe will drive significant operating leverage as we scale the business.

Turning to gross margin, our gross margin increased to 56.5% in the first quarter versus 45.7% in the prior year period. This continued expansion in our gross margin was driven by an attractive unit economics in Taventon-Castro's business model, an increase in revenue per fit from more in-network patients, and a decline in cost per fit, driven by volume leverage, and execution of cost improvement projects.

In the quarters ahead, we expect to see steady and consistent increases in our gross margin, as our rental model benefits from higher fees. We are confident in our ability to achieve a mid-70% margin in the next few years, which is higher than our prior outlook of 70% gross margins. GAAP operating expenses were $55.2 million in the first quarter compared to $37.7 million in the prior year period. Included in GAAP operating expense are $1.4 million of non-recurring items related to a BioLeet milestone payment and one-time professional fees related to a key R&D project that Brian noted we will be discussing in detail in the next quarter. Excluding nonrecurring costs and stock-based compensation, operating expenses were $44.2 million in the first quarter compared to $30.3 million in the prior year period.

The increase was primarily attributable to growth and expenses related to the company's commercial expansion and accelerated investment in our late-stage R&D programs. Gap net loss was $44.1 million in the first quarter compared to a gap net loss of $25.8 million in the prior year period. Adjusted EBITDA loss was $24 million in the first quarter compared to an adjusted EBITDA loss of $19.4 million in the prior year period.

Our cash used from operating activities in the first quarter was $32.3 million. As expected, our Q1 cash flow was higher on a sequential basis, driven by payout of our company-wide bonus and timing of payments to suppliers. We expect our burn to decline sequentially throughout fiscal year 2027, as it did in fiscal year 2026. In July, we announced a new $200 million term loan facility. This non-loublet financing was a great outcome from KESTRA. It fortifies our balance sheet, reduces our cost of capital, and provides a significant financial flexibility to invest in our commercial strategies and expand our fleet to drive durable, best-in-class growth for years to come. Cash, cash equivalents, and investments totaled $245 million as of July 31.

Including unused committed availability under our term loan agreement, KESTRA has the liquidity of approximately $320 million. In summary, we continue to deliver top-tier MEDTEC revenue growth while significantly expanding our gross margins and fortifying our balance sheet. Our investments in the field team, RCM capabilities, and R&D initiatives position KESTRA to capitalize on the large and growing WCD market opportunity and drive you to go revenue growth for years to come. And while we are continuing to invest in our growth strategy in Fiscal Year 2027, you will see KESTRA drive increasing levels of operating leverage each year going forward. For these reasons, we have high visibility and confidence in our path to profitability over the next few years.

I will now provide updated fiscal year 2027 revenue guidance. We expect revenue of $141 million, representing growth of 48 percent, compared to fiscal year 2026. This compares to prior fiscal year 2027 revenue guidance of $137 million. We expect FedEx growth to be driven by deeper penetration within existing accounts and the activation of new accounts as we invest in the regional coverage. We expect growth in revenue per FIT to be driven by a higher mix of in-network patients and continued investments in our REC cycle management capabilities.

With that, Operator, we have concluded our prepared remarks and are ready to proceed to the Q&A portion of the call. Operator?

Yeah, hey, Nathan, thanks for the question. Our fiscal year 2027 guidance of $141 million implies a 48% growth, which is among the highest in small-cap medtech. Our revenue growth has historically been driven by prescription-widing growth, in-net work mix, and RCM improvements, and the growth of our field team. These KPIs are all tracking in the right direction and gives us a lot of confidence in increasing our guidance to 48% growth in fiscal year 2027. Higher descriptions will be driven by winning new accounts, going deeper in existing accounts, and market expansion. We expect revenue per fit to benefit from higher in-net-worth mix as we continue to make progress on their coverage. And as we said last year, same time, you know, we do expect those reps to ramp up here in the second half of the year, so we expect the second half to be faster than the first half.

Yeah, I appreciate the question. We do expect to be able to talk about it in more depth, you know, over the next quarter. We're not quite ready to do that yet, but I will say that what we expect to do with the new technology is leverage the platform that we've developed and extend that platform, give it additional capability, as I mentioned in my comments, It's a capability that doesn't exist in WCD today. And so we're excited about that. That's part of why we're investing into that, and excited to discuss that with you all over the next few months.

Yes, so just on gross margins, Matt, thanks for the question. We have now expanded gross margins 11 quarters in a row with margin increasing over 10 points year over year in this quarter. We continue to benefit from higher revenue profit based on improvements on our in-network mix and also all of the CIP programs are delivering results. As we have said previously, you should see steady and consistent sequential increases in gross margin going forward. We have good line of sight to achieving gross margins of the mid-70% that we talked about over the next few years, Driven by the attractive unit economics in the business model that we have talked about in the past. But this is up from our priority of 70 percent, and the confidence really comes from three things.

One is the reduction in cost per fit driven by the progress of the programs The volume reductions that we seeing from our suppliers Improvements in revenue per fit mostly driven by this in mix continuing to move higher And we feel really confident that, you know, the unit economics plus the volume growth that we expect over the years will help us get to that mid-70% gross margin.

Yeah, thanks, Matt. Just, first of all, I appreciate you pointing out that that's a big quarter of that last one of the year. We agree. But, you know, I think what we're seeing, we gave a couple of hints in the prepared commentary. What we're seeing is we're having success as we split some of the larger territories, and we double down into those territories. So we're seeing the rep productivity opportunity be significant as we further penetrate some of these accounts. And then the national leverage that we will get from the cohort of reps that we hired late in FY26 and here in the early stages of FY27, we'll start to see productivity in the back half of the year.

So it's a combination of those things that, you know, really gives us the confidence. Plus, a lot of the benefit we will see from some of our ongoing marketing programs that support the commercial team, and we expect the combination of all those things to lead to that kind of growth.

Yeah, so great question. We're obviously not commenting on, you know, the different elements of our previously communicated conversion rate, Mike, But we can tell you that, you know, we saw continued improvement in all of the KPIs that drive the REV-V model, which is the fill rate, the bill rate, and obviously the in-period collections.

So we feel really good about where we are. And as we have said, the best way to kind of think about, you know, the growth relative to prescription is to look at the historicals. And in the past, the prescription performance has lagged the revenue number by a couple of points. And that relationship will hold for, you know, for this year as it has in the past. And we feel really confident about looking at the data that way. So, and we will be providing you those details at the end of the year as we have promised. So, you know, overall, like I said, the KPIs are tracking all in the right direction, and we really feel great about, you know, the rest of the year as we head into the second quarter.

Yeah, that's a good question, Mike. Among the large payers, I would say this was the outlier. Most of the large payers already cover that patient population. This one had been one that had sort of held out on that for a long time and just recently came back with a new coverage decision. So there are other regional and smaller payers that have took similar positions to that large payer, and so, you know, we're optimistic that we'll also see some movement with some of them. But it's a good signal. It's a good indicator that, you know, some of the evidence around the actual risk for some of these patients is starting to make a difference as we've been able to communicate it better.

And I think that you're seeing that in the 14 percent market growth, and you're seeing that in payer coverage decisions like this.

Yeah, thanks, Marius, Brian. I'll take the R&D question and you can grab the AR question. So on the R&D question, we do believe that those expenses were one time in nature. We believe that the R&D expense line will go back down. And, you know, in my experience, when you have a multi-year RMD program that is coming close to the end of its schedule, and you have an opportunity to apply financial resources to accelerate and protect that schedule, then that's a bet I will make every day of the week. And that's what we did. And we feel good about that investment. We think that's going to net the results that we are looking for. But we do see that the R&D line, when it comes to the spend, will come back down in the forward quarters.

And I think, Ryan, just to kind of add to that, this overall commentary on kind of OPEX, we did see the OPEX came in slightly higher at $55 million than our previously communicated number. And that was really driven by, you know, the biomead milestone payment. But I think more importantly, you'll see in our overall R&D spend was up about 70 percent, which is significantly higher than what it has been historically.

And that's really to kind of wrap up or almost finalize the investment in the R&D program. And that's why we're ready to kind of talk about some of the details here in the next 90 days. We expect the GAAP OPEX for the year to be at $220 million in 2027, which reflects continued investment on the commercial side. And then I think to Brian's point, the R&D spend returning back to historical levels, which is somewhat in the, you know, 5 to 7 percent range in the second half of the year. But that 220 would still mean an OPEX growth of 20 percent in fiscal year 27 versus a guidance of 48 percent. So we will continue to drive significant operating leverage on OPEX overall, but I think a lot of that operating leverage in outer years, not this year, is predicated on some of these AI programs, but we are making investments this year that will help us bend the cost curve for revenue cycle management and improving revenue and things like that that Brian talked about in the prepared remarks.

We haven't historically, we are not providing that detail, like I said, to Mike's question. I think historically the relationship between the revenue growth and prescription has been that prescriptions has lagged by a couple points, and I think that will continue for this year.

So, again, great question, great try. I think I'm going to say it one more time, slightly differently. I think if you think about last year, this is Q1. We were just coming off of the IDEO. And if you remember at that time, we had just started to ramp up the hiring of the sales team. And that was the talk last year, which was that we know there's a ramp. We know what that ramp looks like. And as we have said in the past and we'll say today, our rent productivity continues to ramp to that model that we have discussed with you guys in the past. So yes, the 60% revenue growth in Q1 is a failable comp off of that, you know, the 19 and change number from Q1 last year.

But then at the same time, when you look at the guidance that we are providing here, you know, for the remainder of the year, the first half versus the second half is consistent with last year. So there's no difference, and that's also predicated, again, this year based on the significant hiring that we did in the last six months, and those reps ramp up and put points on the board. So there's nothing different this year than last year.

Yeah, thank you, Rick. I appreciate that question. I would say a couple things. First of all, when we look at the cost per dollar of revenue that comes from the volume-based G&A functions, That's where we see that curve starting to occur on the expense side. We've started to see that gradually here in FY27. We expect that to accelerate in FY28 and FY29 as we implement more of the technologies. We think there's a really nice opportunity in this business when you've got this many transactions and this volume impact of additional market share, then if you don't implement the automation, then you are committing yourself to, you know, human volume-based G&A investment. And so what we're trying to do is get ahead of that with the investments in the technology stack that I talked about and the AI and automation.

And we're starting to see a little bit of that benefit now, and we'll see that curve accelerate as we move into next year and the year beyond.

Thanks for the question, Stephanie. I think in terms of market growth, you know, the market is definitely accelerating. We've seen, you know, that market growth is essentially doubled since the IPO, and so we don't have any reason to believe that it's going to decelerate at this point, especially when we see that our competitor is It's spending a significant amount of energy on pushing the market growth in the category, and obviously we are doing that as well. So we expect that to continue to grow. How fast that grows or not is difficult to call at this point. We think in this most recent quarter, we're somewhere around 15% market share in the U. S. market.

And certainly when we're growing at 60% and our competitor is growing at a fraction of that, then that means that we're going to continue to capture share. And I think, you know, we in our long-range planning, we have fairly modest assumptions around market share and where that goes, and we're ahead of schedule when it comes to that. We expect to continue to see, you know, really nice gains as we field a larger team and we field some of this additional capability and innovation that we talked about.

Well, the new cohorts ramping more rapidly, I think, has to do with some of the investments we've made in both our recruiting capabilities and our training capabilities. We really made a big investment in how rigorous our training is for our new territory managers as they come into the company. And we're seeing the benefits of that. I think we've got a mix between going deeper in some of the accounts and splitting some of the territories, as I mentioned, but we're also expanding into new territories where we haven't had a presence at all. And some of the exciting growth that we're seeing is definitely coming from those expansion territories. So it will be a mix. I don't know the exact ratio right now, but I think we'll continue to see a mix between going deeper in certain territories versus expanding into brand new territories.

Yeah, so, yes, we did comment on the 70% now kind of heading north to kind of the mid-70s. We do expect that, you know, based on the current gross margin guidance, that 700-point expansion for next year is pretty solid. But as you think about the gross margin number for fiscal year 2029, we expect for the year to deliver 70 percent gross margin. And that would basically give you a pretty clear line of sight that the second half of that year is going to be gross margin that's going to be north of 70 percent. So, again, we're not talking about mid-70s in five years. We're talking about mid-70s in the next two or three years. And we're very optimistic and have a lot of confidence in our ability to get there.

Let me take the volume piece first. As I said in my previous commentary, due to the questions, since we are not commenting on prescriptions and fittings, and we committed to providing that on an annual basis, I'll just kind of close and provide more clarity. We do the conversion rate as we used to talk about was up, and all of the elements that drive that conversion rate were all trading better than expected. So the 60% growth that we delivered, you know, this quarter and, you know, was a direct consequence of that. And again, as we've said, when we give you that annual number at the end of this year on prescriptions and fittings like we did last year, You will see that the relationship between revenue and the prescriptions will hold that prescriptions being a couple points lower than the top line, and that's predicated on us continuing to make improvements in our empty cycle management capabilities and the ability to fit those patients and convert those prescriptions into revenue.

Yeah, thanks, Siraj. On the revenue fittings for sales rep, that's really a measure of sales rep productivity, so it's really about using some of those AI tools to free up time to make the rep, give them more data to be able to decide how they can. where they spend their day, where the insights are that allow them to better manage their territories. And ultimately, as we make them more efficient, then that means they can spend more time penetrating the accounts that they get into, and that then leads to the higher fittings per sales route. And, yeah, you're spot on when you say that that's a pretty meaningful metric. I think it's very clear to us that when we think about the path to profitability, that path to profitability, that road runs right through productivity.

And that's why we're investing in some of those tools, why we're investing in all the training capability and recruiting capability and all those things with regards to our commercial team. So I appreciate that question.

Thank you, and thank you all for your great questions and for attending the call. We're obviously excited by the start to the year. We're certainly bullish on our story, and, you know, when it comes down to it, when you have a product that is clearly superior, you have a category where there's an unmet need of a significant number of patients, you have the ability to expand your commercial team to cover the market, you have clinical evidence that is compelling, And you add into those new innovation, that all leads to market growth and it leads to rapid share capture. And that's what we're seeing and we expect to continue to see. We're very proud of the execution that the team has had over the prior quarters, including this Q1 that we're reporting on now.

And, you know, we're just getting the year started. It's a new year. It's a new business plan. We have new priorities this year, and as we fold those in, we're excited about executing the plan for FY27. So thank you very much, and we'll look forward to updating you again in a few months.