DermTech Inc (DMTK) 2023 Q1 法說會逐字稿

Good day and thank you for standing by. Welcome to the DermTech's first-quarter 2023 financial results call. (Operator Instructions) Please be advised that today's conference is being recorded.

美好的一天，感謝您的支持。歡迎參加 DermTech 2023 年第一季度財務業績電話會議。 （操作員指示）請注意，今天的會議正在錄製中。

I would now like to hand the conference over to your speaker today, Steve Kunszabo, Head of Investor Relations. Please go ahead.

現在我想將會議交給今天的發言人，投資者關係主管 Steve Kunszabo。請繼續。

Thank you. Welcome to DermTech's first-quarter 2023 earnings call. Joining me on today's call are Dr. John Dobak, our President and Chief Executive Officer, and Kevin Sun, our Chief Financial Officer.

謝謝。歡迎參加 DermTech 2023 年第一季度財報電話會議。與我一起參加今天電話會議的還有我們的總裁兼首席執行官約翰·多巴克 (John Dobak) 博士和我們的首席財務官凱文·孫 (Kevin Sun)。

Our call today will include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements made on this call that do not relate to matters of historical fact are considered forward-looking statements. Forward-looking statements made during this call, including projections of future performance are based on management's expectations as of today and are subject to various factors, assumptions, risks, and uncertainties which change over time. Actual results could differ materially from those described in such statements. Several factors that may contribute to or cause such differences are described in today's press release and our most recent filings with the SEC. We undertake no obligation to update these statements except as required by law. Our first-quarter 2023 earnings press release and SEC filings are available on our Investor Relations website. A recording and transcript of today's call will be available on our website later today.

我們今天的電話會議將包括 1995 年《私人證券訴訟改革法案》含義內的前瞻性陳述。本次電話會議中所做的所有與歷史事實無關的陳述均被視為前瞻性陳述。本次電話會議期間做出的前瞻性陳述，包括對未來業績的預測，均基於管理層截至目前的預期，並受到隨時間變化的各種因素、假設、風險和不確定性的影響。實際結果可能與此類聲明中描述的結果存在重大差異。今天的新聞稿和我們最近向 SEC 提交的文件中描述了可能導致或導致此類差異的幾個因素。除法律要求外，我們不承擔更新這些聲明的義務。我們的 2023 年第一季度收益新聞稿和 SEC 文件可在我們的投資者關係網站上獲取。今天的通話錄音和文字記錄將於今天晚些時候在我們的網站上提供。

With that, let me turn things over to John.

那麼，讓我把事情交給約翰。

Thank you, Steve, and thank you, everyone, for joining us. In March, we attended our most impactful and energizing American Academy of Dermatology, or AAD, annual meeting. Our booth had incredible traffic with more than 1,000 visitors, and we generated approximately 300 sales leads.

謝謝你，史蒂夫，也謝謝大家加入我們。三月，我們參加了最具影響力和活力的美國皮膚病學會 (AAD) 年會。我們的展位人流量驚人，參觀人數超過 1,000 名，並產生了大約 300 個銷售線索。

Our booth was also a fixture for key opinion leaders, or KOLs, and healthcare practitioners throughout the event. Our momentum at the AAD, again, demonstrated that precision dermatology guided by noninvasive skin genomics is being integrated into the melanoma care pathway. It's inspiring to see customers and industry leaders independently carrying our vision forward.

我們的展位也是整個活動期間關鍵意見領袖 (KOL) 和醫療保健從業者的固定場所。我們在 AAD 的勢頭再次證明，以非侵入性皮膚基因組學為指導的精準皮膚病學正在融入黑色素瘤護理途徑。看到客戶和行業領導者獨立推進我們的願景，真是令人鼓舞。

We also completed our CLIA laboratory move in March. This was a two-year project marked by the tremendous planning effort and execution of our team. We are now in a state-of-the-art facility that brings together all of our San Diego colleagues in one location. I'm proud of our entire team and what this means to DermTech's future.

我們還在三月份完成了 CLIA 實驗室搬遷。這是一個為期兩年的項目，我們團隊付出了巨大的規劃努力和執行力。我們現在擁有最先進的設施，將聖地亞哥的所有同事聚集在一個地點。我為我們整個團隊以及這對 DermTech 的未來意味著什麼感到自豪。

Our capital and energy remain aligned against a few important priorities, expanding coverage for the DermTech melanoma test, or DMT, monetizing existing demand around strong sales execution, and sustaining our cash runway. We're steadily pushing ahead towards these goals.

我們的資本和精力仍然與幾個重要的優先事項保持一致，擴大 DermTech 黑色素瘤測試 (DMT) 的覆蓋範圍，圍繞強大的銷售執行力將現有需求貨幣化，並維持我們的現金跑道。我們正在穩步推進這些目標。

First, the steps we've taken to stabilize our average selling price, or ASP, including generating more volume from reimbursed tests, are exhibiting positive signs. We're encouraged that the ASP for the DMT supported a 27% sequential increase in our test revenue to $3.4 million.

首先，我們為穩定平均售價（ASP）而採取的措施，包括通過報銷測試產生更多銷量，正在顯示出積極的跡象。令我們深受鼓舞的是，DMT 的 ASP 支持我們的測試收入環比增長 27%，達到 340 萬美元。

We continue to emphasize the DMT's clinical value proposition and enhanced customer experience, including electronic ordering of our tests, regional billing concierge services, and healthcare provider training programs. Our sales effort is structured to pull through test volumes in geographies where we've currently picked up insurance coverage, and we are exploring additional tactics to maximize our ability to generate reimbursed volumes.

我們繼續強調 DMT 的臨床價值主張和增強的客戶體驗，包括測試的電子訂購、區域計費禮賓服務和醫療保健提供者培訓計劃。我們的銷售工作旨在通過目前已獲得保險覆蓋的地區的測試數量，並且我們正在探索其他策略，以最大限度地提高我們產生報銷數量的能力。

We continue to believe the best way to reach a topline inflection point is to bring on more commercial payers. We've added 35 million covered lives since the end of 2022, roughly the equivalent of the second-largest national commercial insurance provider. We now have approximately 126 million covered lives in the US, which breaks down as nearly 68 million from Medicare and Medicare Advantage and 58 million from a broad mix of regional and governmental payers.

我們仍然認為，達到營收拐點的最佳途徑是吸引更多商業付款人。自 2022 年底以來，我們已增加了 3500 萬人的受保人次，大致相當於第二大全國性商業保險公司的規模。目前，美國大約有 1.26 億人受保，其中近 6800 萬人來自 Medicare 和 Medicare Advantage，5800 萬人來自廣泛的地區和政府付款人。

We've also begun to sign agreements with commercial payers in cases where positive coverage policies have recently been issued. Our contract announcement with the major Blues plan in North Carolina is a good example. By having both a policy and an agreement in place, we strengthen our connection with insurance providers and further reduce barriers to access because our test becomes available as an in-network benefit.

對於最近發布的積極承保政策，我們還開始與商業付款人簽署協議。我們與北卡羅來納州主要藍調計劃的合同公告就是一個很好的例子。通過制定政策和協議，我們加強了與保險提供商的聯繫，並進一步減少了准入障礙，因為我們的測試可以作為網絡內福利提供。

Following closely behind many of the positive coverage policies we announced in the first quarter, we also expect to sign agreements with TRICARE and several other large regional Blues plans. Overall, pricing for the contracts we've recently added remains in line with our long-term targets.

緊隨我們在第一季度宣布的許多積極承保政策之後，我們還預計與 TRICARE 和其他幾個大型區域藍調計劃簽署協議。總體而言，我們最近添加的合同的定價仍然符合我們的長期目標。

In addition, a countrywide alliance that serves national accounts and more than 10 Blues plans to service the self-insured and employer populations recently issued a positive coverage policy for the foundational assay of the DMT. We are eager to gain access to the millions of members served by this national platform.

此外，一個為國民賬戶服務的全國性聯盟和超過 10 個為自我保險和雇主人群服務的 Blues 計劃最近發布了一項針對 DMT 基礎分析的積極承保政策。我們渴望接觸到這個國家平台所服務的數百萬會員。

Furthermore, we anticipate finalizing an agreement with the national association of independent, locally operated Blues plans. This organization has substantial influence over many regional Blues and national commercial plans and we believe it could bring in additional policies and contracts.

此外，我們預計將與全國獨立、本地運營的藍調計劃協會最終達成協議。該組織對許多地區藍調和國家商業計劃具有重大影響，我們相信它可以帶來額外的政策和合同。

We're also making good headway bringing on Medi-Cal, which is California's Medicaid program. We're nearing the end of a long onboarding process that includes several procedural steps in getting aligned on pricing for the DMT. We already have solid test volume with this patient population and look forward to improving access for Medi-Cal's more than 12 million members.

我們在 Medi-Cal（加州醫療補助計劃）方面也取得了良好進展。我們即將結束漫長的入職流程，其中包括幾個協調 DMT 定價的程序步驟。我們已經對該患者群體進行了可靠的檢測，並期待改善 Medi-Cal 超過 1200 萬會員的可及性。

We intend to further leverage the test volume we already have by pursuing Medicaid coverage in several other states. It is important to remember that these Medicaid programs are amongst the largest governmental payers.

我們打算通過在其他幾個州尋求醫療補助覆蓋來進一步利用我們已有的測試量。重要的是要記住，這些醫療補助計劃是最大的政府付款人之一。

Our effort bringing on integrated delivery networks, or IDNs, is gaining traction as well, including the large nationally recognized payer provider with which we are conducting a successful pilot. We expect to move to the contract negotiation phase later in the year.

我們在集成交付網絡（IDN）方面的努力也正在獲得關注，其中包括我們正在與大型國家認可的支付提供商進行成功的試點。我們預計將在今年晚些時候進入合同談判階段。

As you heard, our momentum with payers remains strong across a broad mix of organizations. We continue to work closely with nationally recognized payers, although two of them reiterated negative coverage policies in recent weeks. We still have multiple opportunities this year to achieve a nationally recognized payer win.

正如您所聽到的，我們在眾多組織中與付款人的合作勢頭仍然強勁。我們繼續與國家認可的付款人密切合作，儘管其中兩家最近幾週重申了負面承保政策。今年我們仍有多次機會獲得全國認可的付款人勝利。

Importantly, two independent economic assessments are being performed by the affordability groups related to national plans. The outputs from these assessments are looking favorable and we believe they could positively influence coverage.

重要的是，與國家計劃相關的負擔能力小組正在進行兩項獨立的經濟評估。這些評估的結果看起來不錯，我們相信它們可以對覆蓋範圍產生積極影響。

One of the chief ways that our visibility with payers goes up is through advocacy channels, including professional societies, physician, and legislative efforts in individual states. It's important to note that bills mandating insurance coverage of genomics testing, or so-called biomarker bills, are expected to be effective in multiple states in late 2023 and early 2024. These states are just the latest in a growing list that recognize the importance of improving access to potentially life-saving genomic tests.

提高我們在付款人中的知名度的主要方式之一是通過宣傳渠道，包括專業協會、醫生和各個州的立法努力。值得注意的是，強制基因組檢測保險的法案，或所謂的生物標記法案，預計將於 2023 年末和 2024 年初在多個州生效。這些州只是越來越多的州中最新的一個，這些州認識到了基因組檢測的重要性。改善獲得可能挽救生命的基因組測試的機會。

Additionally, our visibility with payers is also improved through independent assessors of healthcare technology. As noted previously, we've already received a favorable policy from the second-largest lab benefits manager in the US.

此外，通過醫療保健技術的獨立評估員，我們在付款人中的知名度也得到了提高。如前所述，我們已經收到了美國第二大實驗室福利管理公司的優惠政策。

We also recently received a favorable recommendation from a well-recognized non-profit technology assessment firm that conducts technology evaluations to improve the safety, quality, and cost-effectiveness of care across all healthcare settings. We believe this favorable recommendation could influence coverage by commercial payers.

我們最近還收到了一家知名非營利技術評估公司的積極推薦，該公司進行技術評估，以提高所有醫療機構的護理安全性、質量和成本效益。我們相信這一有利的建議可能會影響商業付款人的承保範圍。

In addition, a large regional payer conducted their own economic assessment using the framework from the Optum economic study. This payer discovered their costs for adjudicating pigmented lesions were even higher than the Optum study. We believe these independent efforts affirm the robust clinical validation and health economic data that has already been published for the DMT.

此外，一家大型地區付款人使用 Optum 經濟研究的框架進行了自己的經濟評估。該付款人發現他們判定色素病變的成本甚至高於 Optum 研究。我們相信這些獨立的努力證實了 DMT 已經發布的可靠的臨床驗證和健康經濟數據。

Our TRUST 2 study, which we initiated in 2022, should provide additional evidence in support of our payer discussions. This is a prospective study designed to follow a cohort of 2,000 to 3,000 patients with negatively tested lesions for up to one year. This study also assesses the histopathologic diagnosis of up to 1,000 lesions that tested positive with the DMT and includes the analysis of the TERT add-on test.

我們於 2022 年啟動的 TRUST 2 研究應該提供更多證據來支持我們的付款人討論。這是一項前瞻性研究，旨在對 2,000 至 3,000 名病變檢測呈陰性的患者進行長達一年的跟踪研究。這項研究還評估了多達 1,000 個 DMT 測試呈陽性的病變的組織病理學診斷，並包括 TERT 附加測試的分析。

We expect to release topline results in the second half of 2023. The resulting data, if positive, may potentially allow us to re-engage with the two national payers that recently reiterated their negative policies.

我們預計將在 2023 年下半年發布主要結果。如果得出的數據是積極的，我們可能會與最近重申其負面政策的兩個國家付款人重新接觸。

Overall, we're pleased with the progress we've made since the end of 2022 and we've expanded coverage for the DMT by nearly 40%. Our sales team also executed well into the first quarter and coming out of the AAD, we were on track for healthy total sample volume growth.

總體而言，我們對自 2022 年底以來取得的進展感到滿意，我們已將 DMT 的覆蓋範圍擴大了近 40%。我們的銷售團隊在第一季度也表現出色，在 AAD 結束後，我們有望實現總樣品量的健康增長。

However, we have begun to shift our focus to driving reimbursed volumes and ASP versus driving total test volumes. Driving ASP is one factor which helps preserve our cash runway. This change in prioritization aligns with our strong payer progress.

然而，我們已經開始將重點轉向推動報銷量和平均售價，而不是推動總測試量。提高平均售價是有助於保持我們現金跑道的因素之一。這種優先級的變化與我們強勁的付款人進展相一致。

As an example of the steps we've taken to implement this strategy, we've realigned our support infrastructure including concierge services in territories where we have insurance coverage for the DMT. In addition, we have dissolved certain sales territories to align our focus on reimbursed samples. Further, given our recent increase in covered lives, we've also equipped our sales team with payer-mix data to allow them to target providers with reimbursed billable samples.

作為我們為實施這一戰略而採取的步驟的一個例子，我們重新調整了我們的支持基礎設施，包括在我們有 DMT 保險的地區的禮賓服務。此外，我們還解散了某些銷售區域，以將重點放在報銷樣品上。此外，考慮到我們最近承保壽命的增加，我們還為我們的銷售團隊配備了付款人組合數據，以便他們能夠針對提供可報銷的計費樣品的提供商。

Lastly, we recently stopped testing samples from pediatric patients and certain Fitzpatrick skin types based on guidance from our lab-accrediting organization. We are working on a plan to reintroduce testing for these patient cohorts with an extremely low incidence of melanoma.

最後，我們最近根據我們實驗室認證組織的指導停止了對兒科患者和某些菲茨帕特里克皮膚類型的樣本進行測試。我們正在製定一項計劃，為這些黑色素瘤發病率極低的患者群體重新引入檢測。

Due to all these factors, we expect billable sample volume for 2023 to be relatively flat compared to last year, but ASP improvement should increase revenue. I want to emphasize that we continue to look for additional cost savings, preserve our cash runway, and optimize our operational and organizational footprint.

由於所有這些因素，我們預計 2023 年的計費樣品量與去年相比相對持平，但平均售價的提高應該會增加收入。我想強調的是，我們將繼續尋求額外的成本節約，保留我們的現金跑道，並優化我們的運營和組織足跡。

In closing, we've made great progress bringing on payers and executed well to drive fundamental demand for the DMT. We're now prioritizing generating reimbursed tests versus overall demand growth. We're also aiming to be on the first best footing possible with two national payers that we still expect to hear from later in the year.

最後，我們在吸引付款人方面取得了巨大進展，並在推動 DMT 的基本需求方面表現出色。我們現在優先考慮生成報銷測試與總體需求增長。我們還希望與兩家國家付款人建立良好的關係，我們仍希望在今年晚些時候收到這兩家付款人的消息。

Substantially, all our capital and energy is focused on the DMT to expand reimbursed test volumes and commercial coverage and boost ASP. We believe these steps are important as we look to sustain our cash runway and capitalize the business going forward.

實質上，我們所有的資金和精力都集中在 DMT 上，以擴大報銷測試量和商業覆蓋範圍並提高 ASP。我們相信這些步驟非常重要，因為我們希望維持我們的現金跑道並利用未來的業務。

As a final note, we are in the late stages of identifying my successor and we expect to announce something soon. This may very well be my last earnings call, and if it is, I have enjoyed working with you all.

最後一點，我們正處於確定繼任者的最後階段，我們預計很快就會宣布一些消息。這很可能是我最後一次財報電話會議，如果是的話，我很高興與大家一起工作。

With that, I'll turn the call over to Kevin for a more detailed financial review.

這樣，我會將電話轉給凱文，以進行更詳細的財務審查。

Thanks, John. Good afternoon, everyone. I'll start by summarizing our key financial and operating metrics for the first quarter, then recap how we're thinking directionally about our 2023 outlook. I'll wrap up by outlining our liquidity profile and cash runway targets.

謝謝，約翰。大家下午好。我將首先總結第一季度的主要財務和運營指標，然後回顧我們如何定向思考 2023 年的前景。最後，我將概述我們的流動性狀況和現金跑道目標。

Billable sample volumes were up 24% year over year and 2% sequentially for the first quarter to approximately 17,800. Test revenues dipped 3% year over year to $3.4 million, largely due to a $0.5 million downward revenue adjustment due to changes in collection estimates for samples reported in prior periods, but was up 27% sequentially.

第一季度的計費樣本量同比增長 24%，環比增長 2%，達到約 17,800 個。測試收入同比下降 3% 至 340 萬美元，主要是由於前期報告的樣本收集估算發生變化而導致收入調整 50 萬美元，但環比增長了 27%。

Contract revenue was $0.1 million during the first quarter, down from $0.2 million in the year-ago period. Contract revenues remain uneven as it's closely linked to the clinical trial progress of our biopharma customers.

第一季度合同收入為 10 萬美元，低於去年同期的 20 萬美元。合同收入仍然不平衡，因為它與我們的生物製藥客戶的臨床試驗進展密切相關。

Total revenue for the first quarter fell 6% year over year to $3.5 million, primarily on lower contract revenue. Total revenue was up approximately 16% sequentially.

第一季度總收入同比下降 6% 至 350 萬美元，主要是由於合同收入減少。總收入比上一季度增長約 16%。

Let's more closely examine our test revenue drivers. First, ASP was $192 per sample in the first quarter, down 22% year over year, but up 25% sequentially. Medicare ASPs continue to trend higher due to last year's code edit update. Non-contracted commercial payers continue to reduce their payment rates, leading to the downward adjustment for the quarter. Normalizing for these adjustments, first-quarter ASP would have been $219.

讓我們更仔細地研究一下我們的測試收入驅動因素。首先，第一季度每個樣本的平均售價為 192 美元，同比下降 22%，但環比上漲 25%。由於去年的代碼編輯更新，醫療保險 ASP 繼續呈上升趨勢。非簽約商業付款人繼續降低付款費率，導致本季度下調。如果這些調整正常化，第一季度的平均售價將為 219 美元。

We still expect variability going forward, primarily due to the lag in recognizing financial benefit from new payer coverage and fluctuating payments from non-contracted commercial payers. It's important to remember that in all cases where we are awarded coverage, the financial benefit could be delayed by one to two quarters or more, as additional administrative contracting and billing steps need to be taken by both parties.

我們仍然預計未來會出現變化，這主要是由於認識到新付款人覆蓋範圍的經濟利益存在滯後以及非簽約商業付款人的付款波動。重要的是要記住，在我們獲得承保的所有情況下，財務福利可能會延遲一到兩個季度或更長時間，因為雙方都需要採取額外的行政合同和計費步驟。

Second, we had approximately 2,550 unique ordering clinicians in the first quarter, up 5% from the fourth quarter. With approximately 4,340 unique ordering clinicians during the last 12 months, we've penetrated 48% of our current total market -- target market of 9,000 dermatology clinicians.

其次，第一季度我們大約有 2,550 名獨特的訂購臨床醫生，比第四季度增長 5%。在過去 12 個月裡，我們擁有大約 4,340 名獨特的訂購臨床醫生，已滲透到當前總市場的 48%——目標市場為 9,000 名皮膚科臨床醫生。

Third, our average quarterly utilization or average number of tests ordered per unique ordering clinician was 7.0 billable samples in the first quarter versus 7.2 in Q4 and 7.0 in the year-ago period. Fourth, our Medicare proportion of total DMT volumes was 23% during the first quarter compared to 24% for both the year-ago period and the fourth quarter of 2022.

第三，第一季度我們的平均季度利用率或每個獨特訂購臨床醫生訂購的平均測試數量為 7.0 個計費樣本，而第四季度為 7.2 個，去年同期為 7.0 個。第四，第一季度我們的醫療保險佔 DMT 總量的比例為 23%，而去年同期和 2022 年第四季度的比例均為 24%。

Focusing next on operating expenses, cost of test revenue was $3.8 million, a 7% year-over-year increase, yielding a test gross margin of negative 11%. The increase in cost of test revenue was primarily due to increased test volume. The reduction in test gross margin from 0% in the year-ago period was primarily the result of lower ASP.

接下來關注運營費用，測試收入成本為 380 萬美元，同比增長 7%，測試毛利率為負 11%。測試收入成本的增加主要是由於測試量的增加。測試毛利率從去年同期的 0% 下降主要是由於平均售價下降。

Sales and marketing expenses were $15.4 million, which was essentially flat compared to the previous year. The largest component for this OpEx line is employee-related costs. Research and development expenses were $4.4 million, a 30% decrease from the year-ago period, primarily due to lower lab and clinical study costs.

銷售和營銷費用為 1540 萬美元，與上年相比基本持平。該運營支出線的最大組成部分是與員工相關的成本。研發費用為 440 萬美元，比去年同期下降 30%，主要是由於實驗室和臨床研究成本降低。

G&A expenses were $11.9 million, 39% higher compared to the first quarter of 2022. The increase was driven by higher infrastructure costs for our new building and increased employee-related costs for headcount added throughout 2022.

一般管理費用為 1,190 萬美元，比 2022 年第一季度增長 39%。這一增長是由於我們新大樓的基礎設施成本增加以及 2022 年全年增加的員工相關成本增加所致。

As John noted, we're targeting additional demand-based and discretionary savings to cash operating expenses in 2023. Net loss for the first quarter was $31.3 million, which included $4.7 million of non-cash stock-based compensation expense, compared to a net loss of $30.1 million for the same period of 2022, which included $3.9 million of non-cash stock-based compensation expense.

正如 John 指出的那樣，我們的目標是在 2023 年將額外的基於需求和可自由支配的儲蓄用於現金運營支出。第一季度的淨虧損為 3130 萬美元，其中包括 470 萬美元的非現金股票補償費用，而淨虧損則為 470 萬美元。 2022 年同期虧損 3010 萬美元，其中包括 390 萬美元的非現金股票補償費用。

Moving now to our outlook for 2023. We expect DMT volumes during 2023 to be relatively flat compared to last year. ASP is stabilized and we're starting to see payments from recent coverage wins, but ASP remains difficult to forecast due to potential additional delays related to recent coverage wins. As a result, we're not providing revenue guidance until we have better visibility on these factors.

現在展望 2023 年。我們預計 2023 年 DMT 銷量與去年相比相對持平。 ASP 已經穩定，我們開始看到最近贏得的承保付款，但由於與最近承保獲勝相關的潛在額外延誤，平均售價仍然難以預測。因此，在我們更好地了解這些因素之前，我們不會提供收入指導。

And lastly, a review of our liquidity profile and balance sheet. At quarter end, we had cash, cash equivalents, restricted cash, and marketable securities of $108.4 million. Based on expected additional operating efficiencies and our revised forecast, we believe we have sufficient cash resources for our planned operations through the third quarter of 2024.

最後，審查我們的流動性狀況和資產負債表。截至季度末，我們的現金、現金等價物、限制性現金和有價證券為 1.084 億美元。根據預期的額外運營效率和我們修訂後的預測，我們相信我們有足夠的現金資源來支持 2024 年第三季度的計劃運營。

Now, I'll turn things back to the operator for Q&A.

現在，我將把事情轉回給接線員進行問答。

(Operator Instructions) Mark Massaro, BTIG.

（操作員說明）Mark Massaro，BTIG。

Hey, guys. Thank you for taking the questions. John, again, you'll be missed. It was great hanging out in La Jolla. I guess, would you be willing to share what you and the Board are looking for in the next CEO? I mean, what types of characteristics do you think would be expected of the new CEO?

大家好。感謝您提出問題。約翰，再次，我們會想念你的。在拉霍亞閒逛真是太棒了。我想，您願意分享您和董事會對下一任首席執行官的期望嗎？我的意思是，您認為新任首席執行官應該具備哪些類型的特徵？

Hey, Mark. Thanks for the question. I think we'll leave that to when we announce the final candidate, and I'll just stick with what I said now and our comments from the prior periods.

嘿，馬克。謝謝你的提問。我想我們會在宣布最終候選人時再討論這個問題，我會堅持我現在所說的以及我們之前的評論。

Understood. So I would love to dig in a little bit to the commentary about going after reimbursed volumes. Maybe can you walk us through how many territories were dissolved, and is the total number of reps, were they allocated for the territories that were disrupted? Were those folks redeployed into another territory, or maybe was that a source of cost savings?

明白了。因此，我很想深入了解有關追求報銷數量的評論。也許您可以向我們介紹一下有多少區域被解散，代表總數是多少，他們是否分配給了被破壞的區域？這些人是否被重新部署到另一個地區，或者這可能是節省成本的一個來源？

We had approximately 70 sales reps. We're down to approximately 65. And the way we're looking at these things are sometimes we can merge a territory, and we might continue with somebody in that territory in the larger merged, or we might just cut the territory whole. We're still going through the process. It's early days in this. We've just recently started it in the last few months, so we have more to look at doing that. But right now, we think that's the best effective way to raise our ASP.

我們大約有 70 名銷售代表。我們已經減少到大約 65 個。我們看待這些事情的方式是，有時我們可以合併一個領土，我們可能會繼續與該領土上的某人進行更大的合併，或者我們可能會整個領土被分割。我們仍在經歷這個過程。現在還處於早期階段。我們最近幾個月才剛剛開始，所以我們還有更多的事情要做。但目前，我們認為這是提高平均售價的最有效方法。

As you all know, we do a lot of non-reimbursed tests, and that costs us money. And now, since we've broadened this footprint of payers, we really think that we can start to target more reimbursed samples. And although our total volumes may be not quite as robust as they have in the past, it should yield a higher ASP and better revenue, and that's fundamentally why we're looking at this.

眾所周知，我們做了很多無償測試，這需要花錢。現在，由於我們已經擴大了付款人的覆蓋範圍，我們確實認為我們可以開始瞄準更多可報銷的樣品。儘管我們的總銷量可能不如過去那麼強勁，但它應該會產生更高的平均售價和更好的收入，這就是我們關注這一點的根本原因。

[Anything] to add, Kevin?

[有什麼要補充的嗎，凱文？

No, it's just that we consistently evaluate the sales deployment to optimize the ROI and to execute our strategy, and we'll continue to do that as we see necessary. But by focusing on ASP and revenue growth versus overall demand growth, that will help with a cash runway.

不，只是我們不斷評估銷售部署以優化投資回報率並執行我們的戰略，並且我們將在我們認為必要時繼續這樣做。但通過關注平均售價和收入增長與整體需求增長的對比，這將有助於現金跑道。

Excellent. And I know you're not providing 2023 revenue guidance. However, if volumes are roughly flat and ASPs are up, is it really reasonable to think that we should aspirationally be thinking about revenue being slightly up for the year?

出色的。我知道你們沒有提供 2023 年的收入指導。然而，如果銷量大致持平而平均售價上漲，那麼我們是否應該熱切地考慮今年的收入略有上升，這真的合理嗎？

That would be the reasonable assumption. But again, we're not comfortable yet giving guidance on exactly what that would be. We are seeing some good payments from recent wins with the regional Blues plans and the Lab Benefit Manager policy we received.

這將是合理的假設。但同樣，我們還不願意就具體內容提供指導。我們看到最近贏得的地區藍調計劃和我們收到的實驗室福利經理政策帶來了一些豐厚的回報。

And we are also near kind of the expected implementation date of key procedural steps with TRICARE, and that should allow us to receive payments from them more consistently. We're just not prepared to give definitive guidance on ASP and revenue until we've got more data on the actual payment rates for these recent wins.

我們也接近 TRICARE 關鍵程序步驟的預期實施日期，這應該使我們能夠更一致地收到他們的付款。在我們獲得有關最近這些勝利的實際支付率的更多數據之前，我們不准備就平均售價和收入提供明確的指導。

We talked about that last year, Mark. We kind of got burned with the ASP forecasting, and so we just want to see the numbers. We do like the trends that we're seeing, and we do think that the recent payer wins are improving those trends, but we just want to see them before we tell you guys anything because we just don't want to get into where we were last year.

我們去年討論過這個問題，馬克。我們有點被 ASP 預測搞得焦頭爛額，所以我們只想看看這些數字。我們確實喜歡我們所看到的趨勢，並且我們確實認為最近的付款人勝利正在改善這些趨勢，但我們只想在告訴你們任何事情之前看到它們，因為我們只是不想進入我們的狀態去年。

Excellent. Maybe the last one, you talked about two large payers that you're hoping to hear from later in 2023. Can you give us a sense for timing? Is it Q4, or do you think some of that could be sooner? And I would say, how advanced are you in those discussions?

出色的。也許在最後一篇中，您談到了您希望在 2023 年晚些時候收到的兩家大型付款人的消息。您能給我們介紹一下時機嗎？是第四季度嗎？還是您認為其中一些可能會更早？我想說，你在這些討論中進展如何？

The timing, we can't put out a timing that's more closer than just sort of the second half of the year because we've talked about -- we don't often know exactly when these reviews take place. But I would say what's happening with these payers, which is different from the other two that happened earlier in the year, is they've really taken a deep dive into the economic analysis, and they're doing their own claims analysis through their affordability groups.

時間安排，我們無法給出比下半年更接近的時間安排，因為我們已經討論過——我們通常不知道這些審查何時進行。但我想說的是，這些付款人所發生的事情與今年早些時候發生的另外兩個不同，他們確實深入研究了經濟分析，並且他們正在通過自己的承受能力進行自己的索賠分析組。

And so there's been a fair bit of activity on that front. The analysis they're doing are looking favorable, and we think that will be influential. And that's really the big difference and what's happening with these plans, these national plans in the back half of the year. So we're looking forward to the final output of those affordability group analyses and what they might do to influence things, and that's very different than the other plans.

因此，這方面已經開展了相當多的活動。他們所做的分析看起來是有利的，我們認為這將會有影響力。這確實是很大的區別，以及今年下半年這些計劃、這些國家計劃所發生的情況。因此，我們期待這些負擔能力群體分析的最終結果，以及它們可能對事情產生哪些影響，這與其他計劃非常不同。

I would also say, we think that we have some publications coming out. We also expect to get that TRUST study done and get that published. And that's more data to go back with the payers that we've already talked to. And they can always re-look at things because of the new data, and we think those are going to be -- those publications coming out are going to be impactful.

我還想說，我們認為我們已經出版了一些出版物。我們還希望完成 TRUST 研究並發表。這是我們已經與付款人交談過的更多數據。由於新的數據，他們總是可以重新審視事物，我們認為這些出版物將會產生影響。

All right. Thanks, guys. I will hop back in the queue.

好的。多謝你們。我會跳回到隊列中。

Thomas Flaten, Lake Street Capital Markets.

托馬斯·弗拉頓（Thomas Flaten），湖街資本市場。

Hey, guys. Appreciate you taking the question. Just to dig into this strategy revision on the field force, if I understood it correctly, you're going to overlay territories with those geographies that have good or better payer coverage, if I understood that correctly. Could you just maybe drill into the details a little bit? Are you sending reps in to ask for specific business, kind of what you were trying to do with Medicare? And then how do you judge the success rate from a penetration perspective, particularly given the experience with asking for Medicare business?

大家好。感謝您提出問題。只是為了深入研究現場部隊的這一戰略修訂，如果我理解正確的話，你將把區域與那些具有良好或更好的付款人覆蓋範圍的地區重疊（如果我理解正確的話）。您能稍微深入了解一下細節嗎？您是否派代表來詢問特定業務，就像您試圖在醫療保險方面做的那樣？那麼從滲透的角度，特別是有申請醫保業務的經驗，如何判斷成功率？

So we're not going to try to get the doctors to use a test on any specific patient. That's too difficult. But we can identify, as I mentioned in the prepared remarks, doctors that have payer mixes that are aligned with our payer coverages.

因此，我們不會試圖讓醫生對任何特定患者進行測試。那太難了。但正如我在準備好的發言中提到的那樣，我們可以確定具有與我們的付款人承保範圍一致的付款人組合的醫生。

And so we can have our sales force go after those accounts where the payer mix more aligns with our current coverage. And that's the tactic. We now have that data. We now have, with all those payer wins, we can start to do that and do that meaningfully.

因此，我們可以讓我們的銷售人員去尋找那些付款人組合更符合我們當前覆蓋範圍的賬戶。這就是策略。我們現在有了這些數據。現在，隨著所有付款人的勝利，我們可以開始這樣做，並且做得有意義。

The vast majority of our usage is in commercial payers. And I know we've talked about having in commercial patients. I know we've had some challenges in growing the proportion of Medicare as high as we would like.

我們的絕大多數使用是在商業付款人中。我知道我們已經討論過在商業患者中進行治療。我知道我們在將醫療保險比例提高到我們想要的水平方面遇到了一些挑戰。

But because the test is already used more significantly in commercial payers, we don't think it's going to be quite the same challenge. That's where the doctors like to use it in that younger cohort that's on the commercial side. So we think that by targeting the right doctors and going after those covered reimbursed samples will yield a better ASP and help our revenue growth.

但由於該測試已經在商業付款人中得到更廣泛的使用，因此我們認為這不會是完全相同的挑戰。這就是醫生喜歡在商業方面的年輕群體中使用它的地方。因此，我們認為，通過瞄準合適的醫生並追求那些可報銷的樣本，將產生更好的平均售價，並有助於我們的收入增長。

And we can also use the overall commercial efforts to really target in those covered areas as well. So it could be things between conference attendance to raise awareness. It could be around the speaker programs to, again, raise awareness.

我們還可以利用整體商業努力來真正瞄準這些覆蓋區域。因此，這可能是通過出席會議來提高認識的事情。它可以圍繞演講者節目再次提高認識。

We've already restructured and reconfigured our concierge services so that they have the areas that do have reimbursed and coverage have higher levels of support and service. So it's really -- it's not just sales reps. It's really the entire commercial effort that we would go focus on these covered areas to generate better ASPs.

我們已經重組和重新配置了我們的禮賓服務，以便他們在可報銷的領域和覆蓋範圍內提供更高水平的支持和服務。所以這確實是——不僅僅是銷售代表。我們實際上將整個商業工作重點放在這些涵蓋的領域上，以生成更好的 ASP。

Got it. That's super helpful. And out of curiosity, what does the Venn diagram look like between your historically most productive physicians and the remapped territories?

知道了。這非常有幫助。出於好奇，你們歷史上最有生產力的醫生和重新繪製的區域之間的維恩圖是什麼樣的？

Well, a lot of our volume, as we've stated before, are in Sunbelt areas and along the eastern seaboard. And so we're going through that process now of kind of remapping things in and seeing how they overlay.

嗯，正如我們之前所說，我們的大部分銷量都位於陽光地帶和東部沿海地區。所以我們現在正在經歷這個過程，重新映射事物並看看它們如何重疊。

So the recent coverage wins that we've announced in the Carolinas, those are helpful. Obviously, we had a smaller plan in New York, which we have good volume in New York. And then we've got the historical or older coverage policies of, say, Texas and California and Illinois.

因此，我們最近在卡羅來納州宣布的報導獲勝，這些都是有幫助的。顯然，我們在紐約有一個較小的計劃，我們在紐約有很好的銷量。然後我們有德克薩斯州、加利福尼亞州和伊利諾伊州的歷史或更早的承保政策。

So as more plans start coming on board, as Arizona is another state where we've recently announced coverage and we actually have good historical volume, we're going through the process now to make sure that we can best and most efficiently target the right physicians and drive the ASP as best as possible.

因此，隨著越來越多的計劃開始實施，亞利桑那州是我們最近宣布覆蓋的另一個州，而且我們實際上擁有良好的歷史容量，我們現在正在經歷這個過程，以確保我們能夠最好、最有效地瞄準正確的目標醫生並儘可能地推動 ASP。

And then one final one for me, Kevin. The sequential increase in sales and marketing and G&A was pretty pronounced. Were there any one-timers in there, stock-based compensation, bonuses from last year, anything like that, that we should be cognizant of? Or is this a new base of spending for those two line items?

然後是我的最後一件事，凱文。銷售和營銷以及一般管理費用的環比增長非常明顯。其中是否存在我們應該認識到的一次性薪酬、基於股票的薪酬、去年的獎金之類的東西？或者這是這兩個項目的新支出基礎？

There were some one-time items from a sequential basis. So bonus was one where we did not achieve our corporate goals in 2022, and therefore there was a negative bonus adjustment in Q4. And as we're now have revised goals for 2023, we are accruing for those bonus payments as well.

有一些連續的一次性項目。因此，獎金是我們沒有實現 2022 年公司目標的一項，因此第四季度的獎金調整為負。由於我們現在修改了 2023 年的目標，因此我們也會累積這些獎金。

Also, the move to our new headquarters triggered higher rent expense. April will be the last month that we have to pay for two facilities as our lease expired on the old facility. And it is important to note that book expense can be different than cash outlay based on accounting rules.

此外，搬遷到新總部也引發了更高的租金支出。由於舊設施的租約到期，四月將是我們必須支付兩個設施費用的最後一個月。值得注意的是，根據會計規則，賬面費用可能與現金支出不同。

Cash burn for Q1 was under $22 million, the lowest in the last four quarters, and compared to a cash burn of over $26 million in Q1 of 2022. So again, year over year, we generated 24% higher volume with 18% less cash burn, demonstrating our commitment to improving efficiency. We're going through a forecast process to find additional savings throughout the year, and it's to align with our reprioritization and our updated operating plan.

第一季度的現金消耗低於 2200 萬美元，是過去四個季度中最低的，而 2022 年第一季度的現金消耗超過 2600 萬美元。因此，與去年同期相比，我們的業務量再次增加了 24%，現金減少了 18% burn，展示了我們對提高效率的承諾。我們正在通過預測流程來尋找全年的額外節省，這與我們重新調整優先級和更新的運營計劃保持一致。

Excellent. Appreciate you taking the questions. Thanks, guys.

出色的。感謝您提出問題。多謝你們。

Daniel Brennan, Cowen.

丹尼爾·布倫南，考恩。

Great. Thank you. Thanks for taking the questions. So I just wanted to follow up on the last question just regarding the negative gross margins and the OpEx. So what is the plan as it currently stands for this year in terms of getting gross margins positive and what OpEx spending can we assume? I know you've talked about cash sustaining yourself through the third quarter of next year. I'm just wondering how does that look for 2023?

偉大的。謝謝。感謝您提出問題。所以我只想跟進最後一個關於負毛利率和運營支出的問題。那麼，就實現正毛利率而言，今年目前的計劃是什麼？我們可以假設多少運營支出？我知道您談到了明年第三季度的現金支撐。我只是想知道 2023 年情況如何？

Yeah. From a COGS basis, we said previously that we expected COGS to increase in the near term for a couple of main reasons. As we get into the new laboratory, it's a larger laboratory that has more capacity. And so we'll obviously have to start absorbing into that capacity to reduce the per-unit COGS.

是的。從銷貨成本來看，我們之前說過，由於幾個主要原因，我們預計銷貨成本將在短期內增加。當我們進入新實驗室時，它是一個更大、容量更大的實驗室。因此，我們顯然必須開始吸收這種能力，以降低單位銷售成本。

We also had inflationary items around wages and inventories and supplies to run the test that typically happen at the beginning of the year. So our plan will be as we get more absorption with volume and efficiencies throughout the lab, we can reduce the per-unit cost that way.

我們還有圍繞工資、庫存和供應的通脹項目來進行通常在年初進行的測試。因此，我們的計劃是，隨著整個實驗室的體積和效率得到更多吸收，我們可以通過這種方式降低單位成本。

And then, again, the ASP is going to be the biggest factor. By increasing it, it'll be the biggest factor to improve our overall gross margins, which is why, again, we are focusing on ASP and driving reimbursed demand this year.

然後，再一次，ASP 將成為最大的因素。通過增加它，這將是提高我們整體毛利率的最大因素，這就是為什麼我們今年再次關注平均售價並推動報銷需求。

In terms of OpEx, we have previously said that we expect OpEx to be down slightly compared to last year. And given the progress we've made thus far in Q1 from a cash-OpEx perspective, we are continuing to find additional savings and we'll continue to find a better runway there. But we aren't giving specifics around OpEx guidance for the year yet.

在運營支出方面，我們之前曾表示，我們預計運營支出將比去年略有下降。從現金運營支出的角度來看，考慮到我們在第一季度迄今取得的進展，我們將繼續尋求額外的節省，並將繼續在那裡尋找更好的跑道。但我們尚未給出有關今年運營支出指導的具體信息。

Got it. And if you map your covered lives, it sounds like it's not necessarily easy thing to do where you've got coverage across the United States in different regions. But if you were to map those covered lives, the 126 million covered lives, where could pricing go to absent getting these national payers? If you looked out over the next 18 months, I'm sure you've done the math. What's realistic if you are successful at really restricting a lot of the zeros and focusing on where you guys get paid?

知道了。如果您繪製您的承保生活地圖，聽起來好像在您覆蓋美國不同地區的情況下不一定是一件容易的事情。但如果你要繪製出這些受保障的生活，即 1.26 億受保障的生活，如果沒有這些國家的付款人，定價會到哪裡去呢？如果您展望未來 18 個月，我相信您已經算好了。如果你成功地限制了很多零並專注於你們獲得報酬的地方，那現實是什麼？

Yeah. As we mentioned, there's a lot of in and outs around ASP. And again, our long-term targets for ASP would be to maintain Medicare pricing as much as possible. As we've been able to maintain that with contracts we've recently received, we are still favorable on our ability to do that in the long run.

是的。正如我們提到的，圍繞 ASP 有很多進出。再說一遍，我們的 ASP 長期目標是盡可能維持 Medicare 定價。由於我們已經能夠通過最近收到的合同來維持這一點，因此從長遠來看，我們仍然看好我們這樣做的能力。

How quickly now the contracts we have approach and get towards that Medicare rate, it's hard to say. So what we do know is that the areas that we will focus on, again, think of where we have high volume and think of where we've got the coverage. Those are the areas we're going to focus on first to try to drive that ASP as much as possible. But we're just -- we're not going to give any ASP guidance yet until we see some of these data trends play out.

現在我們簽訂的合同要多快才能達到醫療保險費率，很難說。因此，我們所知道的是，我們將重點關注的領域，再次考慮我們擁有高容量的領域並考慮我們覆蓋範圍的領域。這些是我們首先要關注的領域，以盡可能地提高 ASP。但在我們看到其中一些數據趨勢出現之前，我們不會提供任何 ASP 指導。

And in terms of the plan, if you don't get national contracts signed in the next 15 months, or it's unclear from our vantage point, not knowing where that realized ASP can go to, how much leeway do you have to cut further? If the cash gets you through third quarter of next year, how are you contemplating what the options are? Is it just further cuts? Is it highly dilutive equity offering? Just it's not that far away. So I'm sure you've got contingency plans. How do investors think about those contingency plans?

就計劃而言，如果你在未來15個月內沒有簽署全國性合同，或者從我們的角度看不清楚，不知道已實現的ASP可以去哪裡，你還有多少餘地進一步削減？如果現金可以讓你度過明年第三季度，你會如何考慮有哪些選擇？僅僅是進一步削減嗎？這是高度稀釋性的股權發行嗎？只是距離並不遠而已。所以我確信你已經制定了應急計劃。投資者如何看待這些應急計劃？

I'll just make a general comment that there are a lot of covered lives out there outside of the nationals. And as we talked about on the call, we've got a tremendous amount of momentum across all that broader payer mix. So we'll continue to grow that covered lives.

我只是做一個一般性的評論，除了國民之外，還有很多被報導的生活。正如我們在電話會議上談到的那樣，我們在所有更廣泛的付款人組合中都獲得了巨大的動力。因此，我們將繼續擴大覆蓋範圍。

And the more we can focus on those covered billable samples, the higher we can grow that ASP, which will obviously improve our revenue and the cash runway. And that's the most important thing. I mean, we want to get a national payer win because it's an example of obtaining coverage in that group of payers.

我們越能專注於那些涵蓋的計費樣本，我們的平均售價就能越高，這將明顯改善我們的收入和現金跑道。這是最重要的事情。我的意思是，我們希望獲得全國付款人的勝利，因為這是在該付款人群體中獲得保險的一個例子。

But there are a lot of lives, like we talked about the Medi-Cal and the Medicaid, that's a huge number, right? There are about 60 million to 70 million Medicaid patients out there and we already have volume in those areas. And now we're finally getting momentum in that group of payers. So there are a lot of lives to get out there that can still help us grow that ASP, particularly as we focus on those reimbursed samples.

但有很多人的生命，就像我們談到的 Medi-Cal 和 Medicaid 一樣，這是一個巨大的數字，對嗎？大約有 6000 萬到 7000 萬醫療補助患者，我們已經在這些領域擁有了一定數量的患者。現在我們終於在這群付款人中獲得了動力。因此，還有很多生命可以幫助我們提高平均售價，特別是當我們專注於那些報銷的樣品時。

Kevin, do you have anything to add?

凱文，你還有什麼要補充的嗎？

Yeah. So, I mean, again, the first focus would be focus on improving ASP, which will help preserve the cash runway. As we mentioned, we're targeting additional demand-based and discretionary savings in our cash operating expenses. And we do expect to deploy the ATM as needed in the future while being mindful of the cost of equity capital in the current environment. And we're also evaluating other options as it relates to capitalizing the business in a thoughtful way and extending our cash runway.

是的。因此，我的意思是，首要重點是提高平均售價，這將有助於保持現金跑道。正如我們所提到的，我們的目標是在現金運營支出中實現額外的基於需求和可自由支配的節省。我們確實希望在未來根據需要部署 ATM，同時注意當前環境下的股本成本。我們還在評估其他選擇，因為它涉及以深思熟慮的方式對業務進行資本化並擴大我們的現金跑道。

Got it. And then maybe just final one, just on the -- even though, John, to your point, that there's a lot of opportunity for ASP realization here as you execute and monetize what's in front of you. So the national payers are helpful, but it sounds like you've got a lot of opportunity.

知道了。然後也許只是最後一個，儘管如此，約翰，就您的觀點而言，當您執行面前的內容並將其貨幣化時，這裡有很多實現 ASP 的機會。所以國家付款人很有幫助，但聽起來你有很多機會。

But just on the national payers, since you did bring up that you got this negative decision from two of them and you have this trial upcoming, how pivotal do you think that trial is? How should investors view this trial outcome as a potential lever towards securing one of these national payers or not?

但就國家付款人而言，既然你確實提到你從其中兩個人那裡得到了這個負面決定，而且你即將進行這個審判，你認為這個審判有多關鍵？投資者應如何看待這一試驗結果作為確保這些國家付款人之一的潛在槓桿？

Look, I think it is a very large trial. It's real-world data, and it's a prospectively designed trial. Some of the criticism of one of the first TRUST study was that there was a retrospective cohort in there. But in this case, it will be all prospective. So we're going to put down that criticism.

聽著，我認為這是一個非常大的試驗。這是真實世界的數據，也是前瞻性設計的試驗。對第一項 TRUST 研究的一些批評是其中有一個回顧性隊列。但在這種情況下，一切都將是前瞻性的。所以我們要放下這種批評。

We believe it will reaffirm our very high negative predictive value in the real world. And it will also reaffirm the fact that we are finding the high-risk lesions that are melanoma and melanoma-related in those positive samples. So we do think it will be an important publication that payers will pay attention to. More data is always good. So I do think it will be helpful.

我們相信這將重申我們在現實世界中非常高的負面預測價值。這也將再次證實我們正在這些陽性樣本中發現與黑色素瘤和黑色素瘤相關的高風險病變這一事實。因此，我們確實認為這將是付款人會關​​注的重要出版物。更多數據總是好的。所以我認為這會有幫助。

We're frustrated with what the nationals, how they look at our test. In our opinion, they purposely ignore key data and the merits of that data. So we've got to keep putting more data in front of them. I think they also mischaracterize the way the test is used, and they obfuscate our NCCN.

我們對國民的看法以及他們如何看待我們的測試感到沮喪。我們認為，他們故意忽視關鍵數據以及這些數據的優點。所以我們必須繼續向他們提供更多數據。我認為他們還錯誤地描述了測試的使用方式，並且混淆了我們的 NCCN。

So we'll keep working to clear that up. But this is their tactic, right? They like to delay, and it's part of their omission bias. But we think all this momentum, with all these other broad payer mixes coming on board, it's going to ultimately force their hand for those that want to play that game.

因此，我們將繼續努力解決這個問題。但這就是他們的策略，對嗎？他們喜歡拖延，這是他們遺漏偏見的一部分。但我們認為，所有這些動力，加上所有其他廣泛的支付組合的加入，最終將迫使那些想要玩這款遊戲的人出手。

And so again, as I said, the fact that the other nationals are really taking a deep dive on the economics, we think that's a very differentiating feature from the other ones. And that's why we're more optimistic there.

因此，正如我所說，事實上其他國民確實在深入研究經濟學，我們認為這是與其他國民非常不同的特徵。這就是為什麼我們對此更加樂觀。

Great. All right, guys. Thank you very much.

偉大的。好吧，伙計們。非常感謝。

Mason Carrico, Stephens.

梅森·卡里科，斯蒂芬斯。

Hey, guys. Thanks for taking the questions. A lot has been asked, so I'll maybe only ask one or two here. Thinking about the technology solutions and EMR integrations, that strategy that you guys have talked about, any updates on where that stands today or how things are going there? And any framework or metric you can give us to help us understand the progress on that?

大家好。感謝您提出問題。問了很多，所以我在這裡可能只問一兩個。考慮一下技術解決方案和 EMR 集成、你們討論過的策略、目前的情況或進展情況有什麼更新嗎？您可以向我們提供任何框架或指標來幫助我們了解這方面的進展嗎？

Yeah, Mason. Hey, thanks. So we have implemented what we call kind of a Phase 2 of that EMR integration, which is the EMR that's used by the most dermatologists. And that integration allows us to more easily get medical records from the physician and relieves the burden of the physician's offices of having to do that.

是的，梅森。嘿，謝謝。因此，我們已經實施了所謂的 EMR 集成第二階段，這是大多數皮膚科醫生使用的 EMR。這種集成使我們能夠更輕鬆地從醫生那裡獲取醫療記錄，並減輕醫生辦公室必須這樣做的負擔。

So that obviously plays into the strategy where the more medical records we get, the more appeals that we can file and have a higher likelihood of success of those appeals. And it lays into our desire to try to go after better ASP and improving ASP.

因此，這顯然符合這樣的策略：我們獲得的醫療記錄越多，我們可以提出的上訴就越多，並且這些上訴成功的可能性就越高。這也體現了我們追求更好的 ASP 和改進 ASP 的願望。

Now, if those appeals are something that is for non-contracted payers, we don't always win those appeals, but at least gives us that opportunity to do it. And again, it puts pressure on the payers that they have to deal with these appeals. So all of that is going really well.

現在，如果這些上訴是針對非簽約付款人的，我們並不總是能贏得這些上訴，但至少給了我們這樣做的機會。這再次給付款人帶來了壓力，要求他們必須處理這些上訴。所以所有這一切都進展順利。

Got it. Thanks for that, Kevin. And on the national payers who issued the negative policies, is there any additional color you can give behind their decision? Do they provide detail on the reasons behind that? Did they cite a specific study or what they are looking for? Is there any incremental detail you can give us on that?

知道了。謝謝你，凱文。對於發布負面政策的國家付款人，您是否可以為他們的決定提供任何額外的信息？他們是否提供了背後原因的詳細信息？他們是否引用了一項具體研究或他們正在尋找什麼？您可以向我們提供任何相關的詳細信息嗎？

I mean, you can look at the policies. They're online. They're not that different from the policy they've issued before, which shows they didn't really meaningfully update it. They tend to omit key pieces of data as opposed to criticize the data that we have, which is the most frustrating part.

我的意思是，你可以看看政策。他們在線。它們與之前發布的政策沒有太大不同，這表明他們並沒有真正有意義地更新它。他們傾向於忽略關鍵數據，而不是批評我們擁有的數據，這是最令人沮喪的部分。

In one case, we spent all this time educating the payer that this is a rule-out test. And the first thing that comes out is that this is a rule-in test for melanoma, which is a complete mischaracterization of how it works.

在一個案例中，我們花了所有時間來教育付款人這是一項排除測試。首先得出的結論是，這是黑色素瘤的常規測試，完全錯誤地描述了其工作原理。

So those are the things that we're dealing with them. There's nothing you can hang your hat on to say, oh, if we just did this, that's it. But I think it's just about more data, more payer wins. It's going to force their hand. This is just a tactic, a delay tactic that the national payers will often employ.

這些就是我們正在處理的事情。沒有什麼可以讓你掛著帽子說，哦，如果我們這樣做了，就這樣了。但我認為這只是更多的數據，更多的付款人獲勝。這將迫使他們採取行動。這只是國家付款人經常採用的一種策略，一種拖延策略。

Okay. Got it. Thanks, guys. Appreciate it.

好的。知道了。多謝你們。欣賞它。

(Operator Instructions) Alex Nowak, Craig-Hallum.

（操作員說明）Alex Nowak，Craig-Hallum。

Hey, guys. This is Chase on for Alex. Thanks for taking the questions. A lot's been asked, but I guess kind of teasing at ASPs a little bit with these 34 million covered lives added since the start of the year here. How much benefit from those did we see in Q1, that sequential increase in Q1 of ASP? What should we expect in Q2? Is there, obviously, additional more benefit from those 34 million lives that still need to come into the model?

大家好。這是亞歷克斯的追逐。感謝您提出問題。人們提出了很多問題，但我想自今年年初以來新增的 3400 萬受保生命有點對 ASP 的嘲笑。我們在第一季度看到了多少好處，即第一季度 ASP 的連續增長？第二季度我們應該期待什麼？顯然，這 3400 萬人的生命還需要納入模型中，是否還能帶來更多好處？

Yeah. The recent payer wins had very minimal benefit to ASP in Q1, but we are starting to see more payments in April, and we do expect to see additional benefits throughout Q2. There will still be some variability that we expect going forward related to fluctuating payments from non-contracted commercial payers.

是的。最近的付款人獲胜對第一季度的 ASP 帶來的好處非常小，但我們開始在 4 月份看到更多的付款，並且我們確實期望在整個第二季度看到更多的好處。我們預計未來仍將存在一些與非簽約商業付款人的付款波動相關的變化。

But as I mentioned, there's things that are coming up here, whether it's Medicaid, whether it's being able to process TRICARE, whether it's being able to monetize some of the VA volume. It's all starting to hit, but it's just starting to hit mostly in Q2.

但正如我提到的，這裡即將出現一些問題，無論是醫療補助、是否能夠處理 TRICARE、是否能夠將部分 VA 金額貨幣化。一切都開始受到影響，但主要是在第二季度才開始受到影響。

And again, until we can really get some data behind us to see what that trend really looks like, we're just not ready to give guidance around ASPs beyond that. But it is all positive signs of all this hard work that's taken many, many months and many, many years to get those wins.

再說一遍，在我們真正獲得一些數據來了解這一趨勢的實際情況之前，我們還沒有準備好提供有關 ASP 的指導。但這都是積極的跡象，表明所有這些努力都是經過許多、許多個月和許多、許多年才取得這些勝利的。

And then again, like we said, it does take a quarter or two to get the benefit. We are starting to see it now, and we're hoping to kind of accelerate those benefits here as we go forward.

話又說回來，就像我們說的，確實需要一兩個季度才能獲得好處。我們現在開始看到這一點，並且希望在我們前進的過程中能夠加速這些好處的實現。

Yep. That's fair, Kevin. That makes sense. And to ask that question again, John, in maybe a little bit of a different way, I mean, is there any feedback that you heard from those two payers that reaffirmed negative coverage decision that I guess informs your data generation strategy to maybe reattack them at some point? Any color there would be helpful.

是的。這是公平的，凱文。這就說得通了。再次問這個問題，約翰，也許以一種不同的方式，我的意思是，您是否從這兩個付款人那裡聽到了任何反饋，這些反饋重申了負面承保決定，我想這會通知您的數據生成策略，以便可能重新攻擊他們在某一點？任何顏色都會有幫助。

I wish they could tell us what's the one study they want us to do that would put any issues to rest, but we really just don't get that. I think one plan talks about we haven't done a mortality trial, and we've explained to them that there's no way to do a mortality trial in this area.

我希望他們能告訴我們他們希望我們做的一項研究可以解決所有問題，但我們真的不明白。我認為有一個計劃談到我們還沒有進行死亡率試驗，我們已經向他們解釋說沒有辦法在這一領域進行死亡率試驗。

In early-stage melanoma, we found that the survival rate's 99%. Even the current pathway has never done a prospective mortality trial. And what that just tells us is they're just trying to find some reason, no matter how unreasonable, just so that they can justify their position. They aren't saying we have to do one, but those are things they might allude to.

在早期黑色素瘤中，我們發現存活率為 99%。即使是目前的途徑也從未做過前瞻性死亡率試驗。這只是告訴我們，他們只是想找到一些理由，無論多麼不合理，只是為了證明自己的立場是合理的。他們並不是說我們必須這樣做，但他們可能會提到這些事情。

So we don't think that's realistic. There are very few tests that do mortality trials in this area and in any genomic test, so we don't think that's going to happen. But we wish we could find out what is the one study we could do.

所以我們認為這不現實。在這一領域和任何基因組測試中進行死亡率試驗的測試很少，因此我們認為這種情況不會發生。但我們希望能夠找出我們可以做的一項研究是什麼。

We do think the TRUST study, the way it's designed now, there's always been pushback that a chunk of that study had a retrospective cohort, a smaller prospective cohort. And the fact that we now have a large prospective cohort in that TRUST too, that will put down some of the comments that we've seen around that study.

我們確實認為 TRUST 研究，按照它現在的設計方式，總是存在阻力，因為該研究的大部分內容有一個回顧性隊列，一個較小的前瞻性隊列。事實上，我們現在在該信任中也有一個龐大的前瞻性隊列，這將消除我們在該研究中看到的一些評論。

Yep, got it. That's helpful. I think, Kevin, just the last one for me. I just want to put a finer point on that G&A increase. It sounds like that remains in the model at somewhat current levels. You get a little bit of relief starting after April with that additional rent payment coming off the P&L. Is that a fair way to put it?

是的，明白了。這很有幫助。我想，凱文，這對我來說只是最後一次。我只是想更詳細地闡述一下一般行政費用的增加。聽起來模型中的這一點仍保持在當前水平。從四月份開始，您會因為損益表中扣除的額外租金而稍稍鬆一口氣。這樣說公平嗎？

Yeah, again, we're not giving specific guidance on any line item, but our efforts to try to find more cost savings will help overall. And I'd say there's kind of some catch-alls in G&A too that just don't fit in other areas. So as we start utilizing certain systems or certain spaces or things like that, then those costs get allocated around.

是的，再說一遍，我們不會對任何訂單項提供具體指導，但我們努力尋找更多成本節約的努力將在總體上有所幫助。我想說，G&A 中也有一些包羅萬象的內容，但不適合其他領域。因此，當我們開始利用某些系統或某些空間或類似的東西時，這些成本就會被分配。

But again, there's a big piece of that that's really the difference between accounting expense and cash usage. And again, specifically related to the building, right? I think most people understand that you've got to straight line the expense, even though when you have a cash rent obligation that increases over the life, and we have a 10-year life, we're taking much more book expense today than a cash outlay. And then by the later terms of the lease, it's more cash outlay than it is book expense.

但同樣，其中很大一部分實際上是會計費用和現金使用之間的區別。再說一次，具體與建築物有關，對嗎？我想大多數人都明白，你必須直線計算費用，即使當你的現金租金義務隨著生命的推移而增加時，而且我們有 10 年的壽命，我們今天的書本費用比以前多得多現金支出。然後根據租賃的後期條款，現金支出將超過賬面費用。

So that is a big driver, and that's why we would say focus more on the cash-burn metric versus the overall OpEx. But regardless, we are working to get all of the OpEx line items to find savings in all of them and improve the cash runway as well.

所以這是一個很大的驅動因素，這就是為什麼我們會說更多地關注現金消耗指標而不是整體運營支出。但無論如何，我們正在努力讓所有運營支出項目都能節省成本，並改善現金跑道。

Got it. Thanks, Kevin. Thanks, guys.

知道了。謝謝，凱文。多謝你們。

Andrew Brackmann, William Blair.

安德魯·布拉克曼，威廉·布萊爾。

Hey, guys. Good afternoon. Thanks for taking the questions. John, since this is the last call, best of luck. It's been fun.

大家好。下午好。感謝您提出問題。約翰，因為這是最後一次通話，祝你好運。這很有趣。

Maybe we could just start on the shift in strategy here, and it's been asked somewhat, but maybe just to be more specific. Can you maybe just talk a little bit about any change, specific changes in rep incentives moving forward, and how might those be changing with this new plan? Thanks.

也許我們可以從這裡開始改變策略，有人提出了一些問題，但也許只是為了更具體。您能否簡單談談代表激勵方面的任何變化、具體變化，以及這些變化將如何隨著這個新計劃而改變？謝謝。

Historically, we've incentivized reps on just overall demand growth, and what we've implemented recently is a focus on some of the other key drivers to drive the relevant needs of the overall plan. And we're continue to evaluate changing the incentive structure going forward as well.

從歷史上看，我們只是根據整體需求增長來激勵銷售代表，而我們最近實施的做法是關注其他一些關鍵驅動因素，以推動總體計劃的相關需求。我們還將繼續評估未來激勵結構的變化。

But we want to make sure there's good alignment with the strategy and the prioritization of covered samples, reimbursed samples, and driving ASP growth. But we haven't implemented anything on the incentive side other than what we've done just recently.

但我們希望確保與戰略和覆蓋樣品、報銷樣品的優先順序以及推動 ASP 增長保持良好的一致性。但除了最近所做的事情之外，我們還沒有在激勵方面實施任何其他措施。

Okay. Thanks for that. And then maybe more of a technical question here as it relates to actually running those non-reimbursed tests. How should we be thinking about your guys' efforts to maybe shield those away from actually being run when they get to the lab, or will that be more up front in the funnel where you're trying to disincentivize those being tested? Thanks.

好的。感謝那。然後，這裡可能更多的是一個技術問題，因為它與實際運行這些無償測試有關。我們應該如何考慮你們的努力，以保護那些在到達實驗室時不被實際運行的人，或者這會在你們試圖抑制那些正在接受測試的人的漏斗中更前沿？謝謝。

Well, I mean, we're going to have to run the samples at the doctor's order, even if they're non-reimbursed, but that just wouldn't be good from a customer-relation perspective. I think the better way to approach that is what we've talked about is trying to target physicians that have a payer mix that aligns more with our reimbursement profile so that we increase our proportion of covered samples that we're running.

嗯，我的意思是，我們將不得不按照醫生的指示運行樣品，即使它們是無償的，但從客戶關係的角度來看，這並不是什麼好事。我認為解決這個問題的更好方法就是我們所討論的，嘗試針對那些付款人組合與我們的報銷情況更加一致的醫生，以便我們增加我們正在運行的覆蓋樣本的比例。

But we just can't not run tests that are provided. We don't want to do that. That's just not good form with our customers.

但我們不能不運行所提供的測試。我們不想這樣做。對於我們的客戶來說，這並不是一種好的形式。

Okay. Thanks for that clarification, and thanks for the question.

好的。感謝您的澄清，也感謝您的提問。

This concludes today's conference call. Thank you for participating. You may now disconnect.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連接。