GeneDx Holdings Corp (WGS) 2023 Q3 法說會逐字稿

Good day and thank you for standing by, and welcome to the GeneDx third quarter 2023 earnings conference call. (Operator Instructions) Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Sabrina Dunbar at GeneDx. Please go ahead.

美好的一天，感謝您的耐心等待，歡迎參加 GeneDx 2023 年第三季財報電話會議。 （操作員指示）請注意，今天的會議正在錄製中。現在我想將會議交給今天的發言人，GeneDx 的 Sabrina Dunbar。請繼續。

Thank you, operator, and thank you to everyone for joining us today. On the call, we have Katherine Stueland, President and Chief Executive Officer, and Kevin Feeley, Chief Financial Officer.

謝謝運營商，也謝謝大家今天加入我們。總裁兼執行長凱瑟琳·斯圖蘭 (Katherine Stueland) 和財務長凱文·菲利 (Kevin Feeley) 出席了電話會議。

Earlier today, GeneDx released financial results for the third quarter ended September 30, 2023. Before we begin, please take note of our cautionary statement. We may make forward-looking statements on today's call, including about our business plans, guidance, and outlook.

今天早些時候，GeneDx 發布了截至 2023 年 9 月 30 日的第三季財務業績。在我們開始之前，請注意我們的警示聲明。我們可能會在今天的電話會議上發表前瞻性聲明，包括我們的業務計劃、指導和前景。

Forward looking statements inherently involve risks and uncertainties and only reflect our view as of today, October 30, and we are under no obligation to update. When discussing our results, we refer to non-GAAP measures, which exclude certain items from reported results.

前瞻性陳述本質上涉及風險和不確定性，僅反映我們截至今天（10 月 30 日）的觀點，我們沒有義務更新。在討論我們的結果時，我們指的是非公認會計準則衡量標準，這些衡量標準從報告的結果中排除了某些項目。

Please refer to our third quarter 2023 earnings release and slides available at ir.genedx.com for definitions and reconciliations of non-GAAP measures and additional information regarding our results, including a discussion of factors that could cause actual results to materially differ from forward-looking statements.

請參閱我們在ir.genedx.com 上發布的2023 年第三季度收益報告和幻燈片，以了解非GAAP 指標的定義和調節以及有關我們結果的其他信息，包括對可能導致實際結果與前瞻性結果存在重大差異的因素的討論。尋找陳述。

And with that, I'll turn the call over to Katherine.

然後，我會將電話轉給凱瑟琳。

Thanks, Sabrina. We have a lot of news to cover on our call today, so I'm going to jump right in.

謝謝，薩布麗娜。我們今天的電話會議有很多新聞要報道，所以我要立即介入。

Our third quarter results were strong with $53 million in revenue, gross margins of nearly 50%, and a 52% year-over-year reduction in cash burn. We also saw the highest mix of exomes as a percentage of total volume coming in at nearly 30% in September.

我們第三季業績強勁，營收 5,300 萬美元，毛利率接近 50%，現金消耗較去年同期減少 52%。我們也看到 9 月外顯子組組合佔總數量的比例最高，接近 30%。

Our industry-leading exome and genome drove almost two thirds of our revenue this quarter. And we continue to grow the market and offer clinical insights to more and more patients. And at the same time, we are materially reducing our cost structure in effective and scalable ways.

我們在業界領先的外顯子組和基因組幾乎佔本季營收的三分之二。我們不斷擴大市場，為越來越多的患者提供臨床見解。同時，我們正在以有效且可擴展的方式大幅降低成本結構。

The fundamentals of our business have never been stronger. We have organized our entire team around three major efforts, one, increasing exome and genome volumes; two, reducing claim denial rates to increase revenue per test; and three, driving down our cash burn. Our exome focused strategy is taking hold.

我們業務的基礎從未如此強大。我們圍繞著三項主要工作組織了整個團隊，一是增加外顯子組和基因組的體積；二是增加外顯子組和基因組的數量。第二，降低索賠拒絕率以增加每次測試的收入；第三，減少我們的現金消耗。我們以外顯子組為重點的策略正在紮根。

Our goal is to transform the market from single-gene tests, multi-gene panels, and micro rays to exomes and genomes. And with exome representing 63% of our revenue in September, we're well on our way. This quarter, we saw a 12% increase in the number of clinicians ordering exomes in an outpatient setting, with the fastest growing clinician count coming from neurology, representing 18% quarter over quarter growth.

我們的目標是將市場從單基因測試、多基因組和微射線轉變為外顯子組和基因組。 9 月份，外顯子組占我們收入的 63%，我們進展順利。本季度，我們看到在門診訂購外顯子組的臨床醫生數量增加了 12%，其中增長最快的臨床醫生數量來自神經科，環比增長 18%。

Pediatric neurologists continue to make up the largest portion of our new ordering clinicians. But building markets takes time. This year, we had our sights on an aggressive growth trajectory in the second half of the year centered around a faster conversion of single and multi-gene tests to our exome business. With $50 million in core revenue in Q3, we expect continued growth in Q4 and full year revenue now in the range of $187 million to $192 million.

兒科神經科醫生繼續占我們新預約臨床醫生的最大比例。但建立市場需要時間。今年，我們的目標是下半年實現積極的成長軌跡，重點是單基因和多基因測試更快轉化為我們的外顯子組業務。第三季核心營收為 5,000 萬美元，我們預期第四季將持續成長，全年營收目前在 1.87 億美元至 1.92 億美元之間。

We have just moved through the final stages of shutting down the former Sema4 business that took longer than we anticipated but is officially complete. Excluding those final shutdown costs and one-time severance costs, our cash burn in Q3 from continuing operations was approximately $25 million. That is today's steady-state burn rate from which we plan to improve moving forward.

我們剛剛完成了關閉前 Sema4 業務的最後階段，該階段花費的時間比我們預期的要長，但已正式完成。不包括最終關閉成本和一次性遣散費，我們第三季持續營運的現金消耗約為 2500 萬美元。這是今天的穩態燃燒率，我們計劃繼續改進。

Today, we announced that we've effectuated a cost reduction plan of approximately $40 million from the Q3 base, which includes vendor spend as well as a reduction in force. We are prioritizing efforts that support economic genome growth and increases in paid claims.

今天，我們宣布，我們已經實施了一項從第三季開始削減約 4,000 萬美元的成本計劃，其中包括供應商支出以及人員削減。我們正在優先考慮支持經濟基因組成長和付費索賠增加的努力。

We'll continue to invest in the teams responsible for these efforts as we're seeing that they are making tangible progress. Thanks to the addition of some key leaders across commercial, operations, finance, and product and technology. Some of the efforts that have been de-prioritized include R&D and other longer-term strategies that we'll earn our right to invest in once we get closer to profitability.

我們將繼續投資負責這些工作的團隊，因為我們看到他們正在取得實際的進展。這要歸功於商業、營運、財務、產品和技術領域一些關鍵領導者的加入。一些已被取消優先順序的工作包括研發和其他長期策略，一旦我們接近獲利，我們將有權投資這些策略。

Today, we also announced that we have entered into a debt facility of $75 million with Perceptive Advisors, and we're grateful to them for believing in our team and the strength of our business in the near and long term. This fortifies our balance sheet and with the reduction of burn that we have just effectuated, provides balance sheet flexibility in 2025.

今天，我們也宣布與 Perceptive Advisors 簽訂了 7,500 萬美元的債務融資協議，我們感謝他們對我們團隊以及我們近期和長期業務實力的信任。這增強了我們的資產負債表，並透過我們剛剛實現的資金消耗減少，為 2025 年的資產負債表提供了靈活性。

Balancing our investment and growth, while removing cash burn from the business is no easy task, but with the plan we've assembled, I'm confident we are making the right choices to ensure we grow our leadership position in the most cost-effective way possible.

平衡我們的投資和成長，同時消除業務的現金消耗並不是一件容易的事，但根據我們制定的計劃，我相信我們正在做出正確的選擇，以確保我們以最具成本效益的方式提升我們的領導地位方式可能。

I know we're not alone in navigating these waters. Other companies are facing similar challenges, but I'm proud of how our team has come together in close partnership with our Board on a clear-eyed view of the market we're living in, in meticulously focused strategy that prioritizes growth of our exome and genome offering and course correcting as we move forward. You have our commitment that we'll continue to do so in order to drive shareholder value.

我知道我們並不是唯一在這片海域航行的人。其他公司也面臨類似的挑戰，但我感到自豪的是，我們的團隊與董事會密切合作，對我們所處的市場有清晰的認識，並製定了優先考慮外顯子組增長的精心聚焦的戰略隨著我們的前進，基因組提供和路線修正。我們向您承諾，我們將繼續這樣做，以提高股東價值。

I want to extend an immense thank you to our teammates and leaders past and present who have invested their time and passion to get us to where we are today. And I thank you to the incredible team who continue to stay committed in our mission despite the one it has people navigating.

我要向我們過去和現在的隊友和領導者表示衷心的感謝，他們投入了時間和熱情，讓我們取得了今天的成就。我感謝這支令人難以置信的團隊，儘管有人在引導我們，但他們仍繼續致力於我們的使命。

No path to profitability is easy, nor straightforward, particularly when introducing a new technology to improve healthcare. But with the generous support and patience of our shareholders, we're all grateful for the opportunity to make a meaningful impact on patients and are committed to delivering value for those shareholders that continue to entrust us to realize that vision. Kevin?

沒有一條獲利之路是容易的，也不是直截了當的，特別是在引入新技術來改善醫療保健時。但在股東的慷慨支持和耐心下，我們都很感激有機會對患者產生有意義的影響，並致力於為那些繼續委託我們實現這一願景的股東創造價值。凱文？

So I'll repeat what Katherine said. It was a strong quarter. Total revenues were $53.3 million for the third quarter of 2023. Revenues from continuing operations were $50.4 million compared to $47.2 million in the third quarter of 2022 and $45.2 million in the second quarter of 2023. Excluding a one-time appeal benefit in the third quarter of 2022, revenues increased 14% for this third quarter.

所以我會重複凱瑟琳所說的話。這是一個強勁的季度。 2023 年第三季的總營收為5,330 萬美元。持續營運收入為5,040 萬美元，而2022 年第三季為4,720 萬美元，2023 年第二季為4,520 萬美元。不包括第三季的一次性上訴福利到 2022 年，第三季營收成長 14%。

Whole exome and genome volume this quarter was over 13,000 tests, which represents a 71% increase year over year and 11% increase compared to the second quarter of this year. We generated $34 million this quarter from exome and genome testing, a 42% increase year over year and 18% compared to the second quarter of this year.

本季全外顯子組和基因組檢測量超過 13,000 次，較去年同期成長 71%，與今年第二季相比成長 11%。本季我們從外顯子組和基因組測試中獲得了 3,400 萬美元的收入，年增 42%，與今年第二季相比成長 18%。

Adjusting for the same one-time appeal benefit in the third quarter of 2022, revenue specific to exome and genome increased 61% year over year. In the third quarter of 2023, adjusted gross margin from continuing operations was 48%, up from 37% in the second quarter. The margin expansion is coming from three places.

在 2022 年第三季相同的一次性上訴福利進行調整後，外顯子組和基因組的特定收入年增 61%。 2023年第三季度，持續經營業務調整後毛利率為48%，高於第二季的37%。利潤率的擴張來自三個地方。

The first is test mix. To level set, our adjusted gross margin for exome remains over 60%. Exome and genome represented 23% of all tests in the third quarter with a high of 28% in the month of September. Total gross margins will continue to benefit as exome picks up more share of our overall test production volume, replacing lower margin and in some cases, negative margin products.

首先是測試組合。依照設定的水平，我們的外顯子組調整後毛利率仍然超過 60%。外顯子組和基因組佔第三季所有測試的 23%，9 月最高達到 28%。隨著外顯子組在我們整體測試產量中佔據更多份額，取代利潤率較低且在某些情況下為負利潤的產品，總毛利率將繼續受益。

The second is on cost per test. We now have to lower cost per test, Illumina X Plus machines live, and we will aim to replace the remainder of our APs legacy NovaSeq fleet at the right time over the next several quarters. We also have recently received our first PacBio Revio machine. Beyond our long-read sequencing collaboration, the team here is excited about the potential use of this technology to lower costs by replacing older orthogonal confirmation platforms.

第二個是每次測試的成本。我們現在必須降低每次測試的成本，Illumina X Plus 機器已上線，我們的目標是在未來幾個季度的適當時間更換剩餘的 AP 傳統 NovaSeq 機群。我們最近也收到了第一台 PacBio Revio 機器。除了我們的長讀長定序合作之外，該團隊還對這項技術透過取代舊的正交確認平台來降低成本的潛在用途感到興奮。

Additionally, we've now completed the consolidation of disparate library preparation platforms to a lower cost solution offered by Twist Biosciences. And while we are pleased with where exome costs are today, a number of initiatives are already underway or planned to further improve the cost base.

此外，我們現已完成將不同的文庫製備平台整合為 Twist Biosciences 提供的低成本解決方案。雖然我們對目前的外顯子組成本感到滿意，但許多措施已經在進行或規劃中，以進一步改善成本基礎。

Automation and AI across review analysis report writing and certain genetic counseling steps offer real near and long-term cost reduction opportunities. And third was from average reimbursement rates. The fully loaded average reimbursement rate on the exome and genome portfolio was over $2,500 in the third quarter, slightly up from over $2,400 last quarter.

審查分析報告撰寫和某些遺傳諮詢步驟的自動化和人工智慧提供了真正的近期和長期成本降低機會。第三是平均報銷率。第三季外顯子組和基因組組合的滿載平均報銷率超過 2,500 美元，略高於上季的 2,400 美元以上。

The excellent portfolio operates at over 60% gross margin today despite a high denial rate that we know has opportunity to be improved upon. As Katherine mentioned, new leaders have been brought into the company to lead billing, market access, sales, product and technology, and finance related teams to bring enhanced experience and new perspectives specific to these efforts. The majority of our denials, we continue to believe are addressable. Let's now move down to operating expense.

儘管拒絕率很高，但我們知道仍有機會改進，但如今，優秀的投資組合毛利率仍超過 60%。正如凱瑟琳所提到的，公司引入了新的領導者來領導計費、市場准入、銷售、產品和技術以及財務相關團隊，以帶來針對這些工作的增強經驗和新視角。我們仍然相信，我們大多數的否認都是可以解決的。現在讓我們轉向營運費用。

Total adjusted operating expense was $49.4 million for the third quarter of 2023, down from $91.8 million in the third quarter of 2022, and $60.1 million in the second quarter of 2023. That's a reduction of 46% year over year and 18% from last quarter. We once again delivered reduced costs as we further separate from the legacy Sema4 business and search for efficiency.

2023 年第三季調整後營運費用總額為 4,940 萬美元，低於 2022 年第三季的 9,180 萬美元和 2023 年第二季的 6,010 萬美元。年減 46%，季減 18% 。隨著我們進一步脫離傳統的 Sema4 業務並尋求效率，我們再次降低了成本。

For awareness, this quarter includes a $1.8 million onetime benefit. This baseline will further reduce over the next couple of quarters with the cost rationalization plan affected earlier today. On the bottom line, total company adjusted net loss for the third quarter of 2023 narrowed to $21.1 million compared to an adjusted net loss of $69.8 million in the third quarter of 2022 and $38.6 million in the second quarter of this year. Improvements of 70% and 45%, respectively.

為了提高知名度，本季包括 180 萬美元的一次性福利。隨著今天早些時候影響的成本合理化計劃，這一基線將在接下來的幾個季度進一步降低。整體而言，該公司 2023 年第三季調整後淨虧損總額收窄至 2,110 萬美元，而 2022 年第三季調整後淨虧損為 6,980 萬美元，今年第二季調整後淨虧損為 3,860 萬美元。分別提高了 70% 和 45%。

Our third quarter cash burn at $42 million, including nearly $17 million in final Sema4 payables and one-time costs, and otherwise would have been approximately $25 million for the quarter. Our total cash, cash equivalents, marketable securities, and restricted cash were $115 million as of September 30, 2023. And today we announced that we have entered into a new five-year senior secured credit facility with Perceptive Advisors.

我們第三季的現金消耗為 4,200 萬美元，其中包括近 1,700 萬美元的 Sema4 最終應付帳款和一次性成本，否則本季的現金消耗約為 2,500 萬美元。截至 2023 年 9 月 30 日，我們的現金、現金等價物、有價證券和限制性現金總額為 1.15 億美元。今天，我們宣布與 Perceptive Advisors 簽訂了一項新的五年期優先擔保信貸安排。

This agreement provides for up to $75 million in capacity consisting of an initial tranche of $50 million, which was drawn on October 27, 2023, and an optional second tranche of $25 million, which is committed through December 2024, so subject to certain criteria.

該協議規定提供高達7500 萬美元的資金，其中包括於2023 年10 月27 日提取的第一筆5000 萬美元，以及可選的第二筆2500 萬美元，該筆承諾截至2024 年12 月，因此須遵守某些標準。

Interest is payable at a rate of SOFR plus 7.5%. And under the terms of the agreement, Perceptive will be issued warrants to purchase 800,000 Class A shares of the company's stock at closing, with an exercise price equal to the 10-day VWAP. That price is $3.17 a share. upon borrowing of the subsequent tranche, Perceptive would be issued warrants to purchase an additional 400,000 Class A shares.

利息以 SOFR 加 7.5% 的利率支付。根據協議條款，Perceptive 將獲得認股權證，在收盤時購買該公司 800,000 股 A 類股票，行使價等於 10 天成交量加權平均價格。該價格為每股 3.17 美元。在藉入後續部分後，Perceptive 將獲得額外購買 40 萬股 A​​ 類股票的認股權證。

Personally, I want to thank the Perceptive team for the hard work involved in the transaction. We are excited to have yet another strong thought partner in the mix, and giving rise to the net proceeds of the initial tranche, our pro forma cash on hand at September 30, 2023, is $163.7 million.

就我個人而言，我要感謝 Perceptive 團隊在此次交易中所做的辛勤工作。我們很高興能有另一個強大的思想合作夥伴加入其中，並產生第一批淨收益，我們截至 2023 年 9 月 30 日的預計手頭現金為 1.637 億美元。

Now turning to guidance, we expect to end 2023 with full year revenue from continuing operations in a range between $187 million to $192 million. We're narrowing the expected cash burn guidance for the second half of 2023 to a range between $75 million to $79 million, inclusive of servicing obligations of the exited business activities.

現在轉向指引，我們預計到 2023 年底，持續營運的全年收入將在 1.87 億美元至 1.92 億美元之間。我們將 2023 年下半年的預期現金消耗指引縮小至 7,500 萬美元至 7,900 萬美元之間，其中包括已退出業務活動的服務義務。

As a reminder, in December 2023, the next scheduled installment payment of $5 million will be made with respect to the legacy Sema4 payer settlement. And as we have expressed, the outlook to turn profitable in 2025 remains unchanged. So while we're not providing specific long-term guidance beyond 2023 at this point, I did want to speak to how we view that path to profitability by the end of 2025.

提醒一下，2023 年 12 月，將針對遺留的 Sema4 付款人和解金支付下一筆 500 萬美元的分期付款。正如我們所表達的，2025 年實現盈利的前景保持不變。因此，雖然我們目前沒有提供 2023 年後的具體長期指導，但我確實想談談我們如何看待 2025 年底之前的獲利之路。

There are three primary drivers. The first is rationalizing the operating expense base. Our current adjusted operating expense is roughly $50 million a quarter or run rate of $200 million annually. We're taking out an additional $40 million in specifically identified costs to get down towards $160 million over the next several quarters. We firmly believe these cost reductions will not impact our ability to drive excellent growth.

有三個主要驅動因素。首先是合理化營運費用基礎。我們目前調整後的營運費用約為每季 5,000 萬美元，或每年營運費用為 2 億美元。我們將額外支出 4,000 萬美元的具體成本，以便在接下來的幾季將成本減少到 1.6 億美元。我們堅信，這些成本削減不會影響我們推動卓越成長的能力。

The second is by expanding gross margin. We just reported Q3 adjusted gross margin, 48%. Remember our blended exome gross margins are greater than 60% today. So as exome test continue to make up more of our revenue, our total margin moves towards that 60%-plus. We also believe exome margins can expand beyond their current level given COGS reductions and reimbursement work.

二是擴大毛利率。我們剛剛報告第三季調整後毛利率為 48%。請記住，如今我們的混合外顯子組毛利率已超過 60%。因此，隨著外顯子組測試繼續在我們的收入中佔據更多份額，我們的總利潤率將接近 60% 以上。我們也相信，鑑於銷貨成本的減少和報銷工作，外顯子組利潤率可能會超出目前的水平。

The third is revenue growth. We just reported Q3 revenue of $50.4 million for continuing operations or a $202 million run rate. Our future revenue growth is all exome and genome. And exome just grew 62% year over year this past quarter. If one were to assume even a much lower exome growth rate in the zone of 20% over the next two years, that generates a very reasonable breakeven level given the cost structure I just mentioned.

三是收入成長。我們剛剛報告第三季持續營運收入為 5,040 萬美元，即運行率 2.02 億美元。我們未來的收入成長全是外顯子組和基因組。上個季度外顯子組年增 62%。如果假設未來兩年外顯子組成長率低得多，在 20% 左右，考慮到我剛才提到的成本結構，就會產生非常合理的損益平衡水準。

That said, we certainly aim to achieve stronger exome revenue growth than now. So with the cost saving initiatives announced today, margins continuing to trend towards our current exome margin and revenue growth tracking to even moderate levels, we see a clear path to breakeven by the end of 2025.

也就是說，我們的目標當然是實現比現在更強勁的外顯子組營收成長。因此，隨著今天宣布的成本節約計劃、利潤率繼續朝著目前的外顯子組利潤率發展趨勢，收入增長甚至達到中等水平，我們看到了到 2025 年底實現盈虧平衡的明確道路。

And finally, in terms of cash, our cash burn for continuing operations was approximately $25 million this quarter. And on a go-forward basis, you should expect adjusted net loss and cash use to more closely conform to each other, except for the payer settlement, severance, and fairly minimal CapEx.

最後，就現金而言，本季我們持續營運的現金消耗約為 2,500 萬美元。展望未來，除了付款人和解、遣散費和相當低的資本支出之外，您應該預期調整後的淨虧損和現金使用將更加一致。

I'd also point you to the liability section of our balance sheet which will show a huge structural improvement as we've now put substantially all legacy Sema4 operating payables behind us. We, therefore, anticipate the new debt financing proceeds will primarily serve as balance sheet protection as we shift towards sustainable profit.

我還想向您指出我們資產負債表的負債部分，這將顯示出巨大的結構性改進，因為我們現在已經將所有遺留的 Sema4 營運應付帳款拋在腦後。因此，我們預計，隨著我們轉向永續利潤，新的債務融資收益將主要用作資產負債表保護。

I'll now turn the call back to Katherine for any closing remarks.

現在我將把電話轉回給凱瑟琳，讓她作結束語。

Our commitment to turning to profitability in 2025 is our unquestionable focus. As we've commented today, that is possible with growth, efficiency, and cash management, and our plan supports these three drivers.

我們對 2025 年實現盈利的承諾是我們毫無疑問的重點。正如我們今天所評論的，這可以透過成長、效率和現金管理來實現，我們的計劃支持這三個驅動因素。

In managing the business to this goal, we are well positioned to lead the market to diagnosing all inheritable diseases with our exome and genome backbone and ultimately realize our vision of using genomic and clinical data to inform disease diagnosis, treatment selection, and to accelerate drug discovery and development. For now by focusing our business on exome and genome, we will drive value creation for our shareholders while continuing to serve more and more patients.

在管理業務實現這一目標的過程中，我們處於有利地位，能夠引領市場利用我們的外顯子組和基因組骨幹診斷所有遺傳性疾病，並最終實現我們的願景，即利用基因組和臨床數據為疾病診斷、治療選擇提供資訊並加速藥物開發發現和發展。目前，透過將業務重點放在外顯子組和基因組上，我們將為股東創造價值，同時繼續為越來越多的患者提供服務。

Now I will turn it back to the operator for Q&A.

現在我將其轉回給接線員進行問答。

Thank you. (Operator Instructions) Dan Brennan, Cowen.

謝謝。 （操作員說明）Dan Brennan，Cowen。

Hey, this is Joe on for Dan. It seems like the exome volume growth story and the mix shift is really playing out with the 70% excellent growth in the quarter and 20% mix in September. So what do you see changing in the fourth quarter that's bringing down the implied Q4 guide?

嘿，這是喬為丹代言。外顯子組數量增長的故事和混合轉變似乎確實正在上演，本季度實現了 70% 的出色增長，9 月份實現了 20% 的混合增長。那麼，您認為第四季度的哪些變化會導致第四季度的指導值下降？

Yeah, Joe, look, I think the way we view it is we did add some new team members to the commercial field force, and that's in large part what is driving the growth in the exome portfolio. We're really happy with how the quarter played out. We've seen some pretty substantial growth in both Q2 and Q3. And so the guide is really reflective of what we see line of sight to -- October is coming in strong.

是的，喬，你看，我認為我們的看法是，我們確實在商業領域增加了一些新的團隊成員，這在很大程度上推動了外顯子組投資組合的成長。我們對本季的表現非常滿意。我們在第二季和第三季都看到了相當可觀的成長。因此，該指南確實反映了我們的視線——十月即將到來。

We're pleased with the data thus far. We do typically see a Q4 uplift in terms of ordering patterns and ASPs, we would expect that. And so, I have every confidence that we can hit the high end of that range. But the previous guidance range that we provided, particularly at the higher ends of that, we just fell short in the first couple of quarters of this year.

我們對迄今為止的數據感到滿意。我們通常會看到第四季度訂購模式和平均售價有所上升，這是我們所期望的。因此，我完全有信心我們能夠達到該範圍的高端。但我們之前提供的指導範圍，特別是在其較高端，我們在今年前幾季未能達到目標。

Really happy with how the second half of the year is progressing here. So the guide really is just reflective of how the other part of the year played out.

對今年下半年的進展感到非常滿意。因此，該指南實際上只是反映了今年其他時間的情況。

Got it. And then on ASPs, it looks like they came down about 15% in Q3 on a blended basis. Do you see pricing generally stabilizing into '24? Do you expect these kind of like 10% to 15%-ish year-over-year quarters to continue?

知道了。然後，在平均售價方面，第三季的混合價格似乎下降了約 15%。您認為 24 年價格整體穩定嗎？您預計這些季度將年增 10% 至 15% 的情況會持續下去嗎？

No, I think we view Q3 as a baseline from which to improve on, and if you've just focused in on exome, we did see improvements in Q3 versus the second quarter with average of just north of $2,500 versus the second quarter in the $2,400 range after all denials. We'd expect a similar progression in the fourth quarter with a slight uptick in the fourth quarter.

不，我認為我們將第三季視為改進的基準，如果您只專注於外顯子組，我們確實看到第三季相對於第二季的改進，與第二季相比，平均價格略高於2,500 美元全部否認後，價格範圍為 2,400 美元。我們預計第四季度會出現類似的進展，並且略有上升。

And as we mentioned in our remarks, we've got teams nearly across the entirety of the company focused on improving front end processes to bring down the denial rate and would expect that over the next several quarters, you'd see incremental ASPs improvements in exome.

正如我們在評論中提到的，我們幾乎整個公司都有團隊專注於改進前端流程以降低拒絕率，並且預計在接下來的幾個季度中，您會看到 ASP 的增量改進外顯子組。

On the other product lines, we've identified some near term opportunities, in particular with chromosomal microarray and hereditary cancer. Frankly, those are two product lines that had not received as much focus in the past couple of years as they maybe should have. So the team working on improving denial rates on those two product lines, in particular. Outside of exome and CMA and hereditary cancer, you might expect blended ASPs on the other panels to stay flat on a go-forward basis.

在其他產品線上，我們已經確定了一些近期機會，特別是染色體微陣列和遺傳性癌症。坦白說，這兩條產品線在過去幾年中並未受到應有的關注。因此，團隊特別致力於提高這兩條產品線的拒絕率。除了外顯子組、CMA 和遺傳性癌症之外，您可能會預期其他面板上的混合 ASP 未來將保持穩定。

The only thing I would add to that, and I think the way that Kevin framed it in terms of finding opportunities beyond the exome, since we saw a nice increase in exome, we are going to be retiring about 350 tests in early 2024. So again, continuing to really focus the business on the test, the differentiators that are best for patient care and that can have a positive impact on the P&L as well.

我唯一要補充的是，我認為凱文在尋找外顯子組之外的機會方面的方式，因為我們看到外顯子組有了很大的增加，我們將在2024 年初停止大約350 項測試。再次，繼續將業務重點放在測試上，這是最有利於患者護理的差異化因素，也可以對損益產生積極影響。

Got it. And then just last on the $40 million incremental cost out, where it is coming from and just if you talk about or where we'll see this in the P&L would be great?

知道了。最後談談 4000 萬美元的增量成本，它來自哪裡，如果您談論或我們將在損益表中看到這一點，那就太好了？

Yeah, that -- about half is coming from employee reductions. We took some actions midway through the third quarter and then today impacted another subset of employees with a fairly sizable reduction in force throughout the day today. The groups impacted there, primarily research and development and some product and technology and then other support functions.

是的，大約一半來自裁員。我們在第三季中期採取了一些行動，然後今天影響了另一部分員工，今天全天人員大幅減少。這些團體在那裡產生影響，主要是研發以及一些產品和技術，然後是其他支援職能。

As frankly as we've gotten further away from separating Sema4, the overall support necessary for the go-forward business is titrating down. And so, we're reacting as quickly as possible to rightsize the cost base as we move further and further away from that shutdown. And those shutdown activities are now complete.

坦白說，隨著我們距離分開 Sema4 越來越遠，前進業務所需的整體支援正在逐漸減少。因此，隨著我們距離停工的日子越來越遠，我們正在盡快做出反應，以調整成本基礎。這些關閉活動現已完成。

As it relates to the remainder of the spend there, we've taken a focus on really earning our way to longer term pursuits around research and development, and so, reductions with respect to projects that would have a longer term payoff in 2026 and beyond. And so, feel confident that everything necessary to grow the top line to expand gross margins still remains intact, and it's those longer-term pursuits with respect to R&D that have been trimmed down.

由於這與那裡的剩餘支出有關，我們重點關注真正賺錢，以實現圍繞研發的長期追求，因此，減少了 2026 年及以後將有長期回報的項目。因此，請相信，增加收入、擴大毛利率所需的一切仍然完好無損，而那些與研發有關的長期追求已被削減。

Got it. Thanks for taking the questions.

知道了。感謝您提出問題。

Mark Massaro, BTIG.

馬克·馬薩羅，BTIG。

Hey, guys. Thank you for taking the questions. I know you addressed that most of the $40 million annualized cost reduction is coming from R&D and support functions, but were there any reduction to the sales force or MSL crew? I think -- based on my notes, I think you're planning to onboard 10 new reps in the second half of this year and finish somewhere in the 65 to 70 range. Can you just maybe update us on the size of the commercial organization?

大家好。感謝您提出問題。我知道您提到每年 4000 萬美元的成本削減大部分來自研發和支援職能部門，但是銷售人員或 MSL 人員是否有任何削減？我認為 - 根據我的筆記，我認為您計劃在今年下半年招募 10 名新代表，並最終完成 65 到 70 名範圍內的工作。您能否向我們介紹商業組織的規模？

Yeah, the commercial organization is going to continue to be an area of investment for us though. So for the most part, I would say that the removal that we tried to do very surgically ensures that we are not eliminating any roles that will slow down growth or will impact the integrity of the product.

是的，商業組織將繼續成為我們的投資領域。因此，在大多數情況下，我想說的是，我們試圖透過外科手術進行的移除確保我們不會消除任何會減緩成長或影響產品完整性的角色。

So we feel really confident that the quality will remain high and ensure that we can continue to be the market leader and that we can continue to drive meaningful growth through the commercial organization.

因此，我們非常有信心，品質將保持高水平，並確保我們能夠繼續成為市場領導者，並且我們能夠繼續透過商業組織推動有意義的成長。

So no impact on sales force, no impact on MSLs. Those two teams and the commercial functions supporting them are critically important and have been doing a fantastic job this year as evidenced by the results of the quarter. The sales force -- we've got I think about 62 of those roles in sales right now. So close to being at capacity, we always expect that there's going to be a handful of roles that are open from time to time.

因此，對銷售人員沒有影響，對 MSL 也沒有影響。這兩個團隊以及支持他們的商業職能至關重要，今年的工作表現非常出色，本季的業績證明了這一點。銷售人員－我認為目前銷售人員中有 62 個這樣的角色。由於接近滿載，我們總是期望會有一些職位不時空缺。

And then we do have our team of MSLs that are fully staffed. They were just gathered in Gaithersburg last week. I had the chance to talk with them. So they are continuing, I would say, as we look towards the future commercial strategy to really hone in on working collaboratively as a team looking at overall account profitability and keeping focused on ensuring that we can continue to drive exome and genome moving forward. And those MSLs are critically important to our ability to do that.

我們確實擁有人員配備齊全的 MSL 團隊。他們上週剛聚集在蓋瑟斯堡。我有機會和他們交談。因此，我想說，當我們展望未來的商業策略時，他們將繼續努力，真正磨練作為一個團隊的協作，著眼於整體帳戶盈利能力，並繼續專注於確保我們能夠繼續推動外顯子組和基因組向前發展。這些 MSL 對於我們實現這一目標的能力至關重要。

Okay. Thank you for that. So I'm still not understanding why you lowered the full year guidance. I mean, I understand that you needed 60% of your revenue to come in in the back half of this year. We were modeling below your guidance, but still the implied Q4 is still very significantly below the Q4 consensus revenue estimate.

好的。謝謝你。所以我仍然不明白為什麼你降低全年指導。我的意思是，我知道你們今年下半年需要 60% 的收入。我們的建模低於您的指導，但隱含的第四季度收入仍然大大低於第四季度的共識收入估計。

So maybe can you just walk us through what has changed? I understand that you have been onboarding new reps. I assume maybe there initial traction in Q3 wasn't as high as you expected, but what else is going on in terms of pricing, in terms of work with payers? I would assume that some of your prior guide would have required more work from payers.

那麼也許您可以向我們介紹一下發生了什麼變化嗎？據我所知，您一直在招募新代表。我認為第三季的最初吸引力可能沒有您預期的那麼高，但是在定價方面以及與付款人的合作方面還發生了什麼？我認為您之前的一些指南需要付款人做更多的工作。

So can you just broadly give us an update on traction with commercial pay, maybe the timing of some of the new plan coverage, and maybe some of the one-time payments that you might have expected in your prior outlook?

那麼，您能否大致向我們介紹一下商業支付的最新情況，也許是一些新計劃承保的時間，也許是您在先前的展望中預期的一些一次性付款？

Yeah, I think, Mark, it's a little less around payers and pricing. In fact, we are fairly optimistic that the data in the last two months and including through today, through October, from a reimbursement and then our perspective is improving and is starting to show payoff from the efforts we've put in place around revenue cycle.

是的，我認為，馬克，付款人和定價的問題有點少。事實上，我們對過去兩個月的數據相當樂觀，包括今天到十月的報銷數據，然後我們的前景正在改善，並開始顯示出我們圍繞收入周期所做的努力的回報。

If you go back to the original guide, it anticipated that, in particular, at the tail end of the second quarter and beyond, we would start to see a fairly sizable ramp in a conversion from chromosomal microarray into exome. We had previously talked about bringing on some of those CMA tests as steppingstones or seeds for future exome. And as the commercial team has been out executing, we've added the MSL teams to engage in conversations.

如果你回到最初的指南，它預計，特別是在第二季末及以後，我們將開始看到從染色體微陣列到外顯子組的轉換有相當大的斜坡。我們之前曾討論過將其中一些 CMA 測試作為未來外顯子組的墊腳石或種子。由於商業團隊已經開始執行，我們新增了 MSL 團隊來參與對話。

I think what we've seen is that we should expect a more moderate conversion ramp from CMA into exome than a massive bolus of conversion or inflection point, really anchored on a few things. One, physician -- long-standing physician behavior. We are just encountering docs who have been practicing genetics for the same way for quite a long period of time. And we have education to do with respect to misperceptions in the marketplace with respect to these tests that they take months and not weeks.

我認為我們所看到的是，我們應該期望從 CMA 到外顯子組的轉換坡度比大量的轉換或拐點更溫和，這實際上取決於一些事情。一、醫師－長期存在的醫師行為。我們只是遇到了很長一段時間以來一直以同樣的方式實踐遺傳學的醫生。我們需要教育人們糾正市場對這些測試的誤解，認為這些測試需要幾個月而不是幾週的時間。

We've got our rapid exome product down to a verbal report in three days. And so, all perceptions around turnaround times, all perceptions around pricing, and the noise that might be in a report with respect to variants of unknown significance are all things that we're seeing in trench behaviors and mindset among physicians. And we've seen a flattening of that conversion ramp versus previous expectations.

我們的快速外顯子組產品在三天內就得到了口頭報告。因此，所有關於週轉時間的看法、所有關於定價的看法，以及報告中可能出現的關於未知意義變異的噪音，都是我們在醫生的行為和心態中看到的。我們發現，與先前的預期相比，轉換率趨於平緩。

So it's primary driver. That said, the exome portfolio has grown rapidly, and we'd expect pretty similar growth rates going forward. So the go-forward guide for the fourth quarter, we just posted a plus $5 million revenue quarter from Q2 to Q3, and we'd expect something similar in the fourth quarter. As we're starting to see a normalization of what we can expect in terms of that CMA tax on conversion.

所以它是主要驅動力。也就是說，外顯子組組合成長迅速，我們預期未來的成長率將非常相似。因此，在第四季的展望指南中，我們剛剛公佈了從第二季到第三季營收增加 500 萬美元的季度收入，我們預計第四季也會出現類似的情況。隨著我們開始看到 CMA 轉換稅的預期正常化。

Okay. That is helpful. So it looks like the midpoint of your guide would imply about 10% or 11% revenue growth for the full year. Recognizing that you are picking up a higher mix from exomes, is it reasonable as we think about our models for 2020 for that greater than 10% should be readily achievable? But any other granularity or commentary about the levers of growth in '24 would be helpful.

好的。這很有幫助。因此，您的指南的中點似乎意味著全年營收成長約 10% 或 11%。認識到您從外顯子組中獲得了更高的組合，當我們考慮 2020 年的模型時，超過 10% 應該很容易實現，這是否合理？但有關 24 年成長槓桿的任何其他粒度或評論都會有所幫助。

Yeah, so we're not providing a full-year '24 guidance. We'll do that in early January, but just try to outline for you, in my prepared remarks and there's a page in our earnings materials as a deck we posted to our website, really to sketch out what we believe is an illustration of the path to profitability and believe firmly we can get there to breakeven and beyond even if you assume the year-over-year revenue growth of around 20%.

是的，所以我們不會提供 24 小時全年指導。我們將在 1 月初這樣做，但只是嘗試在我準備好的評論中為您概述，並且我們的收益材料中有一頁作為我們發佈到我們網站上的平台，真正勾勒出我們認為的說明盈利之路，並堅信即使您假設收入同比增長20% 左右，我們也能實現盈虧平衡甚至超越。

And if you think about the go-forward base, all of our growth is really going to come from the exome portfolio, which just grew well in excess of that mark. And so, really believe that you should expect similar exome growth year over year moving forward. If you recall, this year was impacted earlier from some price concessions we offered to the marketplace at the end of next year.

如果你考慮未來的基礎，我們所有的成長實際上都將來自外顯子組組合，它的成長遠遠超過了這個目標。因此，我真的相信您應該預期未來的外顯子組將逐年增長。如果你還記得的話，今年早些時候受到了我們在明年底向市場提供的一些價格優惠的影響。

So that played with the year-over-year growth rate some and that's all worked through the system and believe at this point, you should expect on exome, only sequential ASP improvements moving forward. So we might expect a greater growth rate year over year from '23 to '24 than what we posted this year.

因此，這在一定程度上影響了同比增長率，這一切都是透過系統實現的，並且相信在這一點上，您應該期望在外顯子組上，只有連續的 ASP 改進向前推進。因此，我們預計 23 年至 24 年的年成長率將高於我們今年發布的數據。

Okay. That's helpful. And if I can sneak one last one, the adjusted gross margin from continuing ops of 48%, that was strong and well above our modeling. Do you think that's perhaps a level that you can build off of from here? Or were there any one-timers in Q3?

好的。這很有幫助。如果我能偷看最後一項的話，持續營運的調整後毛利率為 48%，這非常強勁，遠高於我們的模型。您認為這也許是您可以在此基礎上進一步發展的水平嗎？還是第三季有沒有一次性的？

Yeah, we do think it's a new level or base to work off of. There were no meaningful one-time items in that number, either in terms of ASPs, revenue, or COGS. To your point, we are seeing some efficiency initiatives take hold and provide results ahead of schedule. I tried to call out a few in my opening remarks. But yeah, we've outperformed in the cost per test, in particular cost per test around exome and think that those efficiency gains are here to stay.

是的，我們確實認為這是一個新的水平或工作基礎。無論是在平均售價、收入或銷貨成本方面，該數字中都沒有有意義的一次性項目。就您的觀點而言，我們看到一些效率舉措得到落實並提前取得成果。我試著在開場白中指出一些內容。但是，是的，我們在每次測試成本方面表現出色，特別是圍繞外顯子組的每次測試成本，並且認為這些效率收益將持續下去。

Okay. That's it for me. Thank you.

好的。對我來說就是這樣。謝謝。

(Operator Instructions) Brandon Couillard, Jefferies.

（操作員說明）Brandon Couillard，Jefferies。

This is Matt on for Brandon. Maybe sticking with gross margin, and I appreciate all the color, Kevin, in terms of the three buckets you spiked out for the sequential improvement in gross margin, should we think about each one of those kind of having a similar contribution? Or is there one in there that was an outsized driver to the improvement that we saw in 3Q?

這是布蘭登的馬特。也許堅持毛利率，我很欣賞所有的顏色，凱文，就你為毛利率的連續改善而列出的三個桶而言，我們是否應該考慮每一個都有類似的貢獻？或者其中是否有一個因素對我們在第三季度看到的改善起到了巨大的推動作用？

It's really the -- I would say, take them in the relative order that I outlined with cost per test leading the way there. And those are coming from a number of areas, both in the wet and dry side of the laboratory, some are process related, some are technology related. The new machinery from Illumina is paying off as expected.

我想說的是，按照我概述的相對順序進行排序，每次測試的成本領先。這些來自實驗室的濕側和乾側的多個領域，有些與製程相關，有些與技術相關。 Illumina 的新機器正在取得預期的回報。

I think what gives us the most comfort and conviction moving forward is we've got a large roadmap going forward of additional efficiency items that are near-term line of sight and can be relied on. And so, we're only just getting started in driving down cost per test of exomes. That one probably leads the way and you can take them into ranked order in which I outlined.

我認為，最讓我們感到安心和堅定前進的信念是，我們已經制定了一個關於其他效率項目的大型路線圖，這些項目是近期的視線範圍內並且可以信賴。因此，我們才剛開始降低每次外顯子組測試的成本。那一個可能會帶路，你可以將它們按照我概述的排名順序排列。

That's helpful. And then I appreciate all the color on the cost-outs. I just wanted to ask so $40 million of further cost-outs reiterated your profitability target for 2025. So not pulling it forward on those or anything.

這很有幫助。然後我很欣賞成本支出上的所有色彩。我只是想問一下，4000 萬美元的進一步成本支出重申了你們 2025 年的盈利目標。所以不要在這些或任何事情上推進它。

I mean, are we supposed to think about that when that profitability question comes, it could be more meaningful given the additional $40 million that's coming out today, or just trying to get hands around meeting the profitability target, not playing it forward, but taking another $40 million out of the cost structure? Thanks.

我的意思是，當盈利能力問題出現時，我們是否應該考慮一下，考慮到今天將額外發放4000 萬美元，這可能更有意義，或者只是試圖實現盈利目標，而不是向前推進，而是採取行動成本結構中還要再削減 4,000 萬美元嗎？謝謝。

Yeah, I think the marker of 2025 acknowledges that the revenue base came in a bit lower than expected for this full year. The $40 million really meant to ensure we meet the commitment we made, which was to turn this company profitable by the end of 2025. We're more convicted today in our ability to do that.

是的，我認為 2025 年的標誌承認全年的收入基礎略低於預期。 4000 萬美元的真正目的是確保我們履行我們所做的承諾，即到 2025 年底使該公司實現盈利。今天，我們更加確信我們有能力做到這一點。

Frankly, we found more efficiencies as part of a recent review than we thought we might on the outset of that analysis. I think any upside to be able to pull profitability into 2024 would come from outsized revenue growth, which, of course, we're aiming to achieve, but wanted to be careful not to over-promise.

坦白說，我們在最近的審查中發現效率比我們在分析開始時想像的要高。我認為，能夠在 2024 年實現盈利的任何好處都將來自於收入的大幅增長，當然，我們的目標是實現這一目標，但希望小心不要做出過度承諾。

And then, I guess, last one maybe for Katherine. You had made a lot of changes on the commercial side, work in new territories, new outreach programs, things like that. Maybe just talk a little bit about what the recent hire for your Chief Growth Officer, should we expect any kind of change or additional things there in the commercial side or more just kind of a continuation of some of the moves you guys have made so far this year? Thanks.

然後，我想，最後一個可能是給凱瑟琳的。你在商業方面做了很多改變，在新的領域工作，新的外展項目，諸如此類。也許只是談談你們最近聘請的首席成長官，我們是否應該期待商業方面的任何變化或額外的事情，或者更多的是你們迄今為止所採取的一些舉措的延續今年？謝謝。

Katherine Stueland Certainly, so just added Melanie Duquette, who joined in September, to lead the overall commercial strategy and she's working off of a strong foundation that we have in place. I think to take us to kind of the 2.0 version of where we want to go in terms of commercial efficiencies. So really what we expect is I would say the cross-functional teams that our focusing on growth and on account profitability to be really working more efficiently together.

Katherine Stueland 當然可以，因此剛剛添加了 9 月加入的 Melanie Duquette 來領導整體商業策略，她正在我們現有的堅實基礎上開展工作。我認為，在商業效率方面，我們將進入 2.0 版本。因此，我們真正期望的是，我想說的是，我們專注於成長和客戶獲利能力的跨職能團隊能夠真正更有效地合作。

So I would say she has done a tremendous job when she was at her prior company, really shifting the focus from volume to keeping the team focused on volume, on revenue, on ASPs, and overall account profitability. So I would say that's what we're looking for in terms of the shift moving forward and just some continued improvement on overall efficiency and ensuring that those teams that we're working with are working in a more singular way and support of account growth.

所以我想說，她在之前的公司工作時做得非常出色，真正將重點從數量轉移到讓團隊專注於數量、收入、平均售價和整體帳戶盈利能力。因此，我想說，這就是我們正在尋求的轉變，以及整體效率的持續改進，並確保與我們合作的團隊以更單一的方式工作並支持客戶成長。

So continued focus on opening up markets, but doing it in a way that will align with our P&L and will continue to focus on delivering on good patient care.

因此，我們將繼續專注於開放市場，但這樣做的方式將與我們的損益表保持一致，並將繼續專注於提供良好的患者護理。

Matthew Sykes, Goldman Sachs.

馬修賽克斯，高盛。

Hey, guys, this is Prashant Kota on from Matt. What split do you see between inpatient and outpatient exam testing? And do you see that evolving over time?

嘿，夥計們，這是來自 Matt 的 Prashant Kota。您認為住院考試和門診考試有什麼區別？您認為這種情況會隨著時間的推移而演變嗎？

Hi, Prashant. Yes. So the vast majority, I think, 97%, 98% is in the outpatient setting today, really predominantly focused on exome versus genome in the outpatient setting. I would say, though that the rapid setting in the inpatient, which is primarily a utilization of our rapid genome product, that is growing quickly. It's just a very small portion of the business.

嗨，普拉尚特。是的。因此，我認為絕大多數人，97%、98% 現在都在門診，實際上主要關注門診中的外顯子組與基因組。我想說的是，儘管住院患者的快速設定（主要是利用我們的快速基因組產品）正在快速成長。這只是業務的一小部分。

I think that's going to fall into the category of longer-term market building. There is a lot of fundamental dynamics that we have to continue to work through in order to drive utilization. That being said, we just had a really nice win in a health system in Florida where we've been able to get institutional contracts set up to be able to drive utilization of our rapid genome in the NICU.

我認為這將屬於長期市場建設的範疇。為了提高利用率，我們必須繼續解決許多基本問題。話雖這麼說，我們剛剛在佛羅裡達州的衛生系統中取得了非常好的勝利，我們在那裡建立了機構合同，以便能夠推動 NICU 中我們的快速基因組的利用。

So I'm encouraged by some wins like that that ensure that product is being utilized. The vast majority of the inpatient is institutional pay. So that's obviously one barrier that we have removed both for utilization and also for us. We get paid 100% of the time on those. So we really appreciate that business.

因此，我對此類確保產品得到利用的勝利感到鼓舞。絕大多數住院病人都是機構付費。因此，這顯然是我們為利用和我們自己消除的一個障礙。我們在這些方面 100% 都能得到報酬。所以我們非常感謝這項業務。

But we continue to view that as being a longer pole in terms of driving utilization, that's going to take some more time. So as we think about the breakdown over the next several years, we're still going to see it predominantly in that outpatient setting.

但我們仍然認為，就駕駛利用率而言，這是一根較長的桿，這將需要更多時間。因此，當我們考慮未來幾年的崩盤時，我們仍然會主要在門診環境中看到它。

Got it. And then can you just talk about your progress in reducing claim denials? And specifically, what percent of claims are not approved, if you have that number, and roughly how long is the appeals process?

知道了。那麼您能談談您在減少索賠被拒方面取得的進展嗎？具體來說，有多少百分比的索賠未獲批准（如果您有這個數字），以及上訴過程大約需要多長時間？

Yeah. So as we talked about, we did bring in a bunch of new folks, really to take a look at our end-to-end processes, in particular on the front end of claim submission. So a lot of work is ongoing. And we did see an uptick in ASPs, that all driven by a slight reduction in the denial rate this quarter.

是的。正如我們所討論的，我們確實引入了一群新人，真正來看看我們的端到端流程，特別是在索賠提交的前端。因此，大量工作正在進行中。我們確實看到平均售價有所上升，這一切都是由於本季拒絕率略有下降所致。

So pleased with the initial finding, certainly a long way to go there. I think it was just important to get pressurized on our processes and we really feel confident that much of the denials are addressable. To your question, north of 60%, so low 60s is our denial rate today on the exome portfolio. That hasn't changed in a while, although we did improve about one percentage point in the third quarter versus the second, and that's what drove the incremental uptick in average ASPs.

對最初的發現非常滿意，當然還有很長的路要走。我認為對我們的流程施加壓力非常重要，而且我們非常有信心許多否認的問題都是可以解決的。對於你的問題，我們今天對外顯子組投資組合的拒絕率超過 60%，如此低的 60 多歲。儘管我們在第三季確實比第二季提高了約一個百分點，但這種情況已經有一段時間沒有改變了，這就是推動平均 ASP 增量上升的原因。

I think, longer term, you should expect us to take incremental bites out of that denial rate with each passing quarter as the effects of the ongoing work begins to take hold. The appeal process themselves -- itself is lengthy with really us going back to payers to re-adjudicate claims based on the medical necessity and unique circumstances of patients.

我認為，從長遠來看，隨著正在進行的工作的效果開始顯現，您應該期望我們每個季度都會逐步降低拒絕率。上訴過程本身很漫長，我們實際上會根據患者的醫療必要性和獨特情況，返回付款人重新裁定索賠。

We have an appeal process stood up today, but I think more important to driving down denials and improving ASPs and, therefore, revenue comes from avoiding denied claims. And that's where all of our effort is focused at the moment.

今天我們建立了上訴程序，但我認為對於減少拒絕索賠和提高平均售價更重要，因此，收入來自於避免拒絕索賠。這就是我們目前所有努力的重點。

Got it. That makes sense. And if I could squeeze one last one in, how are you thinking about capital allocation given the new capital you've raised with the debt agreement?

知道了。這就說得通了。如果我可以擠進去最後一筆，鑑於您透過債務協議籌集的新資本，您如何考慮資本分配？

Yeah, I think the way we look at the new debt agreement is to couple it with the cost reduction actions that we took today, which, as I mentioned, the reductions really placing an emphasis on three main priorities for the company. How do we drive exome growth? How do we improve exome reimbursement by reducing denials? And then how do we find cost efficiency and reduce cost elsewhere to improve the financial health of GeneDx to meet that commitment to become profitable sustainably in 2025 and beyond?

是的，我認為我們看待新債務協議的方式是將其與我們今天採取的成本削減行動結合起來，正如我所提到的，成本削減確實強調了公司​​的三個主要優先事項。我們如何推動外顯子組的生長？我們如何透過減少拒絕來改善外顯子組報銷？那麼我們如何找到成本效率並降低其他方面的成本，以改善 GeneDx 的財務狀況，以履行在 2025 年及以後實現可持續盈利的承諾？

And so, all of our available capital is allocated to supporting those three pursuits with any capital allocated to R&D and product and technology to find ways to help the company get more efficient to drive down exome cost.

因此，我們所有的可用資本都被分配來支持這三個目標，而任何資本都被分配給研發、產品和技術，以找到幫助公司更有效地降低外顯子組成本的方法。

Great. Thank you.

偉大的。謝謝。

Thank you. And now to include Q&A for today. I would now like to turn the conference back to Katherine Stueland for any closing remarks.

謝謝。現在包括今天的問答。現在我想請凱瑟琳·斯圖蘭（Katherine Stueland）發表閉幕詞。

Great. Thank you. We have a strong and growing business, a commitment from the management team to continue to do it as efficiently as possible. And we are grateful for the continued support of our shareholders and look forward to seeing many of you at an upcoming conference. Thank you.

偉大的。謝謝。我們擁有強大且不斷成長的業務，管理團隊承諾繼續盡可能有效率地開展業務。我們感謝股東的持續支持，並期待在即將舉行的會議上見到你們。謝謝。

And this concludes today's conference call. Thank you for participating. You may now disconnect. Everyone have a great day.

今天的電話會議到此結束。感謝您的參與。您現在可以斷開連線。每個人都度過了愉快的一天。