Quest Diagnostics Inc Q1 FY2022 Earnings Call

Welcome to the Quest Diagnostics First Quarter 2022 Conference Call. At the request of the company, this call is being recorded. The entire contents of this call, including the presentation, and the question-and-answer session that will follow, are copyrighted property of Quest Diagnostics, with all rights reserved. Any redistribution, retransmission, or rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited. Now, I'd like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Go ahead, please.

Thank you and good morning. I'm joined by Steve Rusckowski, our Chairman and Chief Executive Officer and President; Jim Davis, CEO-Elect; and Mark Guinan, our Chief Financial Officer. During this call, we may make forward-looking statements and we'll discuss non-GAAP measures. We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables to our earnings press release. Actual results may differ materially from those projected. Risks and uncertainties, including the impact of the COVID-19 pandemic that may affect Quest Diagnostics' future results include, but are not limited to those described in our most recent annual report on Form 10-K and subsequently filed quarterly reports on Form 10-Q, and current reports on Form 8-K. The company continues to believe that the impact of the COVID-19 pandemic on future operating results, cash flows, and/or its financial condition will be primarily driven by the pandemic's severity and duration, health care insurer, government, and client payer reimbursement rates for COVID-19 molecular tests, the pandemic's impact on the U.S. health care system and the U.S. economy, and the timing, scope and effectiveness of federal, state, and local governmental responses to the pandemic, including the impact of vaccination efforts, which are factors beyond the company's knowledge and control. For this call, references to reported EPS refer to reported diluted EPS, and references to adjusted EPS refer to adjusted diluted EPS. Any references to base business, testing, revenues or volumes refer to the performance of our business, excluding COVID-19 testing. Growth rates associated with our long-term outlook projections, including total revenue growth, revenue growth from acquisitions, organic revenue growth, and adjusted earnings growth, are compound annual growth rates. Finally, revenue growth rates from acquisitions will be measured against our base business.

Thanks, Shawn and thanks everyone for joining us today. We’re off to a good start in 2022. We drove strong year-over-year growth in our base business, which excludes COVID-19 testing. COVID-19 volumes remain strong early in the quarter and decreased in February and March, in line with the market. We continue to make investments to further accelerate growth in the base business, and our efforts to improve productivity are helping us to offset inflationary pressures. So, based on the strength of our business, we’re raising our 2022 guidance. This morning, I’ll discuss our performance for the first quarter of 2022 and then Mark will provide more detail on the financial results and talk about our updated financial outlook for 2022. But first, I like to ask Jim Davis to give us an update on our leadership transition. Jim?

Yeah, thank you Steve. We are making very good progress on the transition. Yesterday, we announced a series of organizational changes and leadership appointments of seasoned executives designed to help us accelerate growth and drive operational excellence. First category is a Senior Vice President of the regional businesses. Kathy has deep knowledge of our business gained through three decades of leadership at Quest. She will oversee the regional and enterprise operations, the commercial organization, and marketing. She will also be responsible for driving operational excellence, including the company’s quality and productivity initiatives. Next, Carrie Eglinton Manner is taking on an expanded role as Senior Vice President, Advanced and General Diagnostics Clinical Solutions. For more than five years, Carrie has been responsible for bringing innovative solutions to the market through Quest clinical franchises. Before joining Quest, Carrie had nearly two decades of leadership experience in healthcare and medical technologies. Patrick Plewman, who has led our West region and has been with Quest Diagnostics for more than nine years, is named Senior Vice President, Diagnostics Services, which is a portfolio of data-driven analytics and services businesses, enabling employers, providers, pharma companies, and others to deliver healthcare more effectively and efficiently. This portfolio includes employer population health, employer solutions, ExamOne, Healthcare Analytics Solutions, and Quest HealthConnect. Mark Delaney has joined Quest as Senior Vice President and Chief Commercial Officer. Mark has responsibility for the commercial team, including sales and sales operations. Previously, he held senior sales and marketing leadership roles over his 30-year career at GE Healthcare and Hillrom. Finally, Richard Adams has joined Quest as Vice President and General Manager of our Consumer Initiated Testing Business, a new role. Richard has two decades of varied leadership experience in e-commerce, digital marketing, and customer experience, and will lead our rapidly growing direct-to-consumer testing business. These appointments demonstrate the strength of our management team and we're really excited about the leadership and expertise that both Mark and Richard Adams will bring to us. Additionally, we're making very good progress on our CFO selection process and are on track to name a leader in the next several months. The management transition is going very well and the changes we've announced are an important step in positioning us for the future. Steve, I'll now turn it back to you.

Thanks, Jim. I agree the transition is going well. Now, turning to our results, our base business continued its strong recovery, up more than 6% from the prior year. Total revenues were $2.6 billion; earnings per share was $2.92 on a reported basis, and $3.22 on an adjusted basis. Cash provided by operations was $480 million. COVID-19 testing revenues were approximately $600 million in the first quarter, which is down approximately 28% from 2021. Nearly 60% of the COVID-19 revenues came from the Omicron peak in January. We project demand for PCR testing through the end of the year and into 2023, albeit at lower levels. The public health emergency was extended into July, maintaining our current level of reimbursement. Based on these factors, we raised our COVID-19 revenue guidance for the full year of 2022 to between $850 million to $1 billion. Turning to our base business, in the first quarter, we continued to make progress executing our two-point strategy to accelerate growth and drive operational excellence. Here are some highlights from the quarter. We continued to make in-roads with our health plans, gaining share and increasing revenues faster than the market. Our health plan revenues without COVID-19 grew faster than our overall base business did in the quarter. We also deepened relationships with payers through value-based contracting. Currently, about 30% of our health plan revenues are tied to value-based elements. This includes patient health outcomes, quality, or shared savings. We believe we could grow this by about 50% over the next few years. We also think that these value-based contracts are achieving better alignment with health plans, which we believe will allow us to gain shares. We're also working with our hospital health system leaders to help them execute their strategies. Partnerships with Hackensack Meridian Health in New Jersey, Memorial Hermann in Texas, and others are performing well. Hospitals look to us for help with laboratory design, staffing, and management, which allows them to monetize outreach lab assets that help free up needed capital. We have continued to make important investments to strengthen our advanced diagnostics capabilities and are already seeing results. We continue to invest to accelerate growth in oncology, hematology, hereditary genetics, genomic sequencing services, and digital health solutions. Since ramping up our investments in our advanced diagnostics portfolio, we have already accelerated growth by several hundred basis points and expect to deliver the 8% growth earlier than 2024, which we committed to at our 2021 Investor Day. We remain excited about the opportunities we see in the direct-to-consumer testing market. As you know, we're ramping up investments in our consumer business and it’s having an impact. In the quarter, our direct-to-consumer revenues more than doubled compared to the prior year, driven by strong growth in both our COVID-19 testing operations as well as our base business testing. We’re seeing solid demand for comprehensive metabolic panels and complete blood counts. Also, our new and approved digital experience is on track to launch later this year. Finally, we've been expanding our diagnostics services portfolio. We are collaborating with a small digital software firm to deliver diabetic retinal imaging services through designated Quest Diagnostic patient service centers across the United States. This will aid in the screening of patients as part of the diabetes management program. The second part of our strategy is to drive operational excellence. We remain focused on improving our operational quality, service, and costs, thereby driving productivity gains. We are not immune to the current inflationary environment, but we're tightly managing our operations and are expecting another good year of productivity improvements to help offset these pressures. For example, our procurement team continues to work with our strategic suppliers to mitigate potential price increases and improve productivity through our long-term relationships. The team has effectively managed challenges in our global supply chain. We also look to our suppliers to deliver innovation to help us lower the overall cost of testing and improve quality. The most recent example is the rollout of our new automation technology being deployed across our laboratory network. Our new lab in Clifton, New Jersey, has been operational for about a year, and we are seeing incremental productivity gains from the investment we’ve made in automation and artificial intelligence. Our new appointment system encourages patients to make appointments, allowing us to better manage demand and productivity while enhancing the patient experience. The system has been successfully deployed to over 700 patient service centers. Our continued investment in operations is producing results. We are on track to achieve our targeted productivity gains of 3% of our cost structure in 2022. Now, Mark will provide more details on our performance and share more insights into our updated guidance for the remainder of 2022. Mark?

Thanks, Steve. In the first quarter, consolidated revenues were $2.61 billion, down 4% versus the prior year. Base business revenues grew 6.3% to more than $2 billion, while COVID-19 testing revenues declined 27.6% to approximately $600 million. Revenues for Diagnostic Information Services declined 3.9% compared to the prior year, reflecting lower revenue from COVID-19 testing services versus the first quarter of 2021, partially offset by strong growth in our base testing revenue. Total volume measured by the number of requisitions increased 1.3% versus the prior year and was roughly flat on an organic basis. Total base testing volumes increased more than 6% compared to the prior year. Excluding acquisitions, total base testing volumes grew nearly 5%. We experienced some modest softening of base testing volumes in January during the peak of the Omicron surge. The volume has rebounded in February and March. COVID-19 testing volumes surged during the spread of the Omicron variant during the winter and volumes peaked in January, but declined through February and into March. Together with our JV partners, we performed approximately 7.2 million molecular tests. Quest performed roughly 6.3 million molecular tests, down approximately 2 million tests year-over-year in the fourth quarter respectively. We also performed nearly 450,000 serology tests in the first quarter. Our COVID-19 molecular volumes have generally stabilized at an average of roughly 30,000 tests per day over the last four weeks, excluding similar requests. Revenue per acquisition declined 5.2% versus the prior year, driven primarily by lower COVID-19 molecular volume. Base business revenue per rep was up modestly. Importantly, we continue to see an improving price environment. Unit price reimbursement pressure was less than 100 basis points in the quarter. Reported operating income in the first quarter was $513 million or 19.7% of revenues compared to $660 million or 24.3% of revenues last year. On an adjusted basis, operating income was $554 million or 21.2% of revenues, compared to $708 million or 26% of revenues last year. The year-over-year decline in adjusted operating income was primarily related to lower COVID-19 testing volumes, a higher portion of COVID-19 molecular testing volume from non-traditional channels, which carry additional expenses or logistics costs, investments to accelerate growth in our base business, and lower average reimbursements for COVID-19 molecular tests. These factors were partially offset by strong growth in our base business. As many of you have heard, the health resource and services administration or HRSA stopped accepting claims to pay and treat uninsured patients on March 22 due to insufficient funding. This program provides funding for COVID-19 testing, vaccination, and treatment for uninsured patients. Approximately 14% of our COVID-19 molecular testing volume has come from uninsured patients, which is much higher than the 1% to 2% we typically see in our base business. As a result, we were unable to bill HRSA for over $20 million in COVID-19 testing work that was performed just prior to the March 23 HRSA cut-off date. Moving forward, we are now billing uninsured patients for COVID-19 testing directly upfront. We saw a decline in our uninsured COVID-19 molecular testing volumes in late March and into April, reflected in the trends I shared earlier. Reported EPS was $2.92 in the quarter, compared to $3.46 a year ago. Adjusted EPS was $3.22, compared to $3.76 last year. Cash provided by operations was $480 million in Q1 versus $731 million in the prior year period. We repurchased $350 million of stock during the first quarter. Now, turning to our updated guidance. Revenues are now expected to be between $9.2 billion and $9.5 billion, a decline of approximately 12% to 15% versus the prior year. Base business revenues are expected to be between $8.35 billion and $8.5 billion, an increase of approximately 4% to 6%. COVID-19 testing revenues are expected to be between $850 million and $1 billion, a decline of approximately 64% to 69%. Reported EPS is expected to be in a range of $7.88 and $8.38, and adjusted EPS to be in a range of $9 and $9.50. Cash provided by operations is expected to be at least $1.6 billion and capital expenditures are expected to be approximately $400 million. Before concluding, I'll touch on some assumptions embedded in our updated 2022 guidance, as well as some additional considerations. Our guidance assumes COVID-19 molecular volumes to average approximately 10,000 to 20,000 tests per day for the rest of the year. This reflects modest continued declines in Q2 from the roughly 30,000 tests per day we are seeing in April, and some degree of stabilization during the second half of the year. As we look toward 2023, our expectation for COVID-19 molecular and serology testing volumes assumes that the COVID-19 testing run rates in the second half of 2022 continue into next year. Last week, the public health emergency was again extended another 90 days through mid-July. We assume average reimbursements of COVID-19 molecular testing to hold relatively steady through this period, while the public health emergency renewal beyond July, additional extensions are not captured in our guidance. We remain prepared for additional future surges collecting COVID-19 testing volume from a range of customers. While the PHE is in effect, we continue to incur incremental costs from non-traditional channels for supplies, special logistics, and channel expenses for this volume, which can represent roughly $30 in incremental cost per test. Therefore, you should not assume that the higher reimbursement due to the PHE extension drops right to the bottom line. As Steve noted earlier, we're already seeing returns on our investments to accelerate growth, particularly in the areas of advanced diagnostics and direct-to-consumer testing, and would expect a margin tailwind on these investments in 2023. As a reminder, we are planning to spend approximately $160 million on these investments this year. We spent approximately $30 million in the first quarter and are looking for these investments to ramp up in Q2 to support the launch of our new consumer site later this year. A portion of these standup IP costs are temporary, but variable marketing costs will increase with the launch of the new site. We’ll also be adding additional headcount this year to support our consumer offering, as well as bioinformatics capabilities within advanced diagnostics. Finally, we know there's a lot of focus on expectations for 2023. While it’s clearly too early to provide specific guidance for next year based on everything we know and see today, we expect to deliver top-line and earnings consistent with our long-term outlook that we provided at our 2021 Investor Day. I’ll now turn it back to Steve.

Thanks Mark. Well, to summarize, we're off to a good start in 2022 driving strong year-over-year growth in the base business. We continue to make important investments to accelerate growth and we are seeing the results. Based on the strength of our base business, we've raised our outlook for the remainder of the year. Now we'd be happy to take your questions. Operator?

Thank you. Our first question comes from Ricky Goldwasser from Morgan Stanley. Your line is open.

Good morning. So, a really nice job in the quarter managing costs and improving margins. So how has the performance in Q1 compared to your expectations? And how should we think about the margin expansion opportunity for the rest of the year from 1Q level? If we look at that as a baseline?

Yes. Ricky, thanks for the question. As you look at the way the quarter played out, Omicron was more severe than we had anticipated, which drove higher COVID revenues, but we also saw the base business impacted by that. So, definitely in January as we mentioned, the base business was softer, so relative to our expectations in Q1, more COVID, less base business. But as we exited the quarter, and certainly as we talked about in February and March, the base business bounced back to our expectations. So, while we're very pleased with where we see the base business growth for the year, it would have been even higher had it not been for Omicron. And the margin is really what we were expecting. We walked through in the last call how some of the margin impacts in Q4 were really temporary around the annual incentive plan and some costs related to some special things that we needed to do for COVID testing in that quarter. Look, once we got past the Omicron peak those costs generally did go away and we anticipate further reductions in some of the special expenses related to COVID safety and protection for employees as we continue to manage the transition into the endemic phase. So, I'd say other than the higher COVID revenue and a little lower base in January, generally what we expected, and that's why we're comfortable raising the bottom and upper end of our guidance at the midpoint.

I'd like to reiterate what Mark said about the base business. Just underscore that we're pleased with what we saw in Q1. It would have been better, if it didn't have the softness that Mark talked about in January. We remind everyone that we posted about 6.3% growth in our base business, with only about 100 days’ worth of acquisitions. So, the organic growth was around five. And again, if January was stronger, it would have been stronger than that. So, we feel good about that as the start of the year, which gives us confidence for the full-year. So, to feel good about the start of the year for our base business. And that gave us the confidence to raise guidance for the full-year beyond COVID.

One additional comment on that. When you look at the comps, the easiest compare on the basis was Q1. So, to Steve's point, we've credited that even better. We would have done it better than the 6.3% had January not been impacted by Omicron, but as we go through the balance of the year, the compares get a little tougher because a lot of the recovery from the pandemic occurred late in 2020 and early in 2021. So, the growth going forward is more going to be driven by share and less about utilization and the market recovery.

So, can I just quickly follow-up on that? You talked about the improvement in margins with more difficult comps. So, how is demand shaping up in April to date?

Yes. The business continues to perform at a high level as it was happening in Q1. So, it wouldn't be updated in our guidance if we weren't confident that what we saw in terms of the performance early is continuing. So, we’re more focused on overall growth as opposed to the percentage year-over-year because obviously the comparison makes it complicated. So, we're very happy as we get into April and we see the performance of our base business. And as we mentioned, COVID is kind of stabilized. We're not sure how long that will continue. We certainly took a little bit of a volume hit from the change in HRSA. And because there's been a little bit of a spike, I'd say some of that was partially offset by the market growing a little bit recently. So that's probably the way you get to a reasonably flat level of COVID testing over the last month.

Thank you.

Our next question comes from Patrick Donnelly from Citi. Your line is open.

Good morning, Patrick.

Hey, good morning. Thank you guys for taking the questions. Maybe just another one on the margins. You touched on a little bit there in the first question. Can you just talk about your thoughts as we work our way through this year and into 2023? Obviously, the PHE extension should help on that front in terms of the margin side. So, when we look at the earnings raise, how should we think about the base margin piece again ex-ASP as we work our way through this year and again into 2023?

Yes. As Mark indicated in his prepared remarks, we expect changing dynamics that are business with investments in the second quarter and then less COVID in the back half of the year. What we indicated is that we'll be coming out of the year in the back half with a reasonable amount of COVID testing. There's a good level to think about in 2023. We also expect to continue to get the investment returns that we expect in advanced diagnostics and in consumer testing starting in the back half, and again, as Mark indicated in his prepared remarks, we believe that investment return will be a tailwind for us in 2023. So, this is a transitional year with those investments and transitional year for COVID. Mark, would you like to give a little perspective on Q2 and then the back half?

Yes. And I’ll try to answer your questions, Patrick. So, on inflation, we talked about building in an extra 100 basis points or so in our wages costs. That was in our original guidance. Through 3.5 months of the year, we haven't seen anything that suggests that wasn't a reasonable assumption. So, basically, inflation was about where we were expecting. And I'd say our non-wage items, such as materials and supplies, and so on, surely fuel costs have been bouncing around, but nothing has deviated significantly from our critical assumptions coming into the year around inflation. The PHE is significant revenue support, and from a dollar margin perspective, it certainly is helpful, but from a percentage margin perspective, I want to be clear that it's not significantly higher than the post-PHE world because those costs are about $30. So, while people focus on percentage margins, the base is not a big change in terms of what you will see. And I guess the important thing is that as the base volume grows, we've always shared that incremental organic growth in the base business has a very high level of drop-through. So, the other margin consideration, as we grow as we expected and as we've signaled in our guidance, will help drive margin expansion. Finally, just a reminder that we are in a much better place in price than we've been historically. Therefore, a lot of the productivity savings that in the past helped pay for inflation, while inflation is a little bit worse, certainly the pricing environment is better. There’s more of that to cover inflation and also to drive bottom line margin expansion.

So remember too, as you think about, as we transition for the year, and Ricky asked about April, we have higher level testing in April going on. We do periodically update you on that. That number we expect in our guidance to come down. As we indicated, as we come out of 2022, we'll be running around 10,000 to 15,000 tests per day. We're assuming the PHE will expire because we don’t have anything beyond what we've heard so far, which will be sometime in July.

Okay. That's helpful. And then maybe just on the balance sheet, cash flow obviously has been pretty strong for the past few quarters here, capital allocation is in focus for investors, can you just talk about your priorities there? What the M&A pipeline looks like, what the funnel looks like? And then maybe compare that to kind of the share repo opportunities?

Sure. Our capital priorities haven't changed. We have that commitment to return the majority of free cash flow as we shared. You know, in normal times, we get pretty close with the dividend, and we do some share repurchases to offset dilution. Obviously, with the COVID cash generation and we've had the inability to deploy more cash. We always preferred to do M&A because we've got very high standards around the deals that we executed. That would always be the preference, but at any given point in time, with our strong cash from the balance sheet and our ability to generate cash, we're not going to sit on it. The $350 million in the first quarter is more a reflection of how much cash we had at year-end and the fact that we didn’t do a transaction in Q1 as opposed to any change in priorities. Steve, would you want to comment on the pipeline?

Yes. We feel good about again, our commitment of 2% growth through acquisitions. As you know, we've delivered that consistently. We feel good about our ability to – on a routine basis deliver the consolidation strategy we've been executing against. We've got a few steps we are working on and we still feel that we will be able to get close to that 2% in 2022. As I have said in the first quarter, we're lighter than that. This is lumpy, but we do expect that we'll be moving on a few in the second quarter and into the third quarter to deliver what we expect.

Great. Thank you.

Operator, next question.

Our next question comes from A.J. Rice from Credit Suisse. Your line is open.

Good morning, A.J.

Hi, everybody. Obviously, the value-based arrangements are becoming more significant as you described in your prepared remarks. I wondered if we could step back and talk about a few key features of these arrangements and discuss how they allow Quest to do better economically? It sounds like you think you can do better economically under these types of arrangements. And I know you referred to pricing being better. We used to think of managed care pricing as a 1% to 2% negative headwind each year; has that dynamic changed, and is it mainly because of these value-based arrangements?

Yes. Let me start and then I'll ask Mark and Jim to add to this. As we have said in our strategy here, and health plan access has changed, there is a big opportunity for us. Number one. Number two is, we do plan that gaining share. And number three, we are gaining shares. So our health plan revenues are growing faster than overall revenues, and we believe growing faster in the markets. So we are making progress. In that regard, the second question is the environment has gotten better. We've indicated in prior calls and quarters, and it's proven to be true as we go throughout this year. As we get into renegotiations with the plans, we believe we have a stronger position to negotiate and in some cases, modest price increases because we're delivering more and more value. Our quality is improving, service performance is better, and we have an opportunity to help them narrow the network and the number of providers they have with the number of these programs. So it has gotten better, and we indicated that price pressure is less than 100 basis points overall. I'll remind you that when we talk about price, there's a lot of focus around the plans, but we have price pressures in the hospital business and our client build business, but at least on the health plan side, it has gotten better, and we have received modest increases for some contract renewals that we've had.

Yes. A.J., personally, when we think about value-based care and arrangements, we look at our relationship with United Healthcare, and many of these value-based care incentives come to us through performance on leakage agreements where they provide us a list of physicians that are using our services, and we work to connect with them for better patient care. We proactively work with both payers on moving work out of extensive health system laboratories. This includes a selective list of physicians that are using those labs and we go after it. Finally, we work hand in hand with both of those plans and others on approaching employers and getting employers to see the benefits of steering their employees to independent labs like Quest Diagnostics.

The only thing I'll add, A.J., is there are elements in those contracts, as Jim just described. The one I'll add is also when we do an acquisition of hospital outreach, instead of the rates immediately dropping to our rates, there's a step-down that a majority of our large contracts right now. We kind of share the value of network movement through acquisitions, which aligns our incentives. The greatest value is that it moves the conversation away from price being the way they create value and more towards quality, tools, and experience for physicians and patients. There’s a lot beyond price that determines value, and that's where we've been successful in moving the conversation. Yes, then within the contracts themselves, there will be shared savings and these other value-driven parameters that can get us a better price or more value as we demonstrate to them where we’re creating value for them as well.

Alright, great. Thanks a lot.

Our next question comes from Pito Chickering from Deutsche Bank. Your line is open.

Good morning, Pito.

Very good morning, guys. My question is back to the guidance question. Previously, it didn't assume any share repurchases besides offsetting dilution; what does your current guidance assume? Back into net income guidance, you know from the previous guidance using 124 million diluted shares in the fourth quarter, versus the current guidance at 121 million shares backing into the midpoint range and net income, essentially flat despite revenues up $200 million at the low end. So, it's got us into a margin compression of about 10 basis points. So, a long way of saying, is margin guidance down today versus previous guidance and any response?

Yes. At this point, share repurchases have essentially offset our equity programs. So, there's not a huge decline in waste as based on what we've done. In terms of going forward, it will depend on M&A opportunities versus buybacks. Therefore, there's no material change in our waste so contemplated in our guidance. As you see in our results, we ended Q1 with about $700 million worth of cash. We're going to put that to use in a good way. We're looking at acquisitions, as we talked about, and we'll handle that in due course throughout the remainder of the year.

I think just as you drill into that, you know backing into previous guidance as your current guidance with the share counts you had before versus current share counts, I get to a net income of about $1.1 billion for both the current Quest, the current guidance versus previous guidance, despite revenues going up. Is that the right math? Does that imply margin compression about 10 basis points?

Yes. So, I would not want to take away an implication of margin compression, Pito. And remember that we don't do point estimates. We do ranges. So, there's a lot of moving parts, everything from top line mix, clinical mix, exactly how much COVID testing we get going forward, and share, obviously, the deployment of cash. So that's why we give a range. We feel very good about the margins. We would expect that the margins would improve on the base business going forward. Certainly, the COVID elements and everything from the PHE to the volume we have could impact margins as well. I’ll give you one example: if you're looking at income margin, certainly some of the JVs where specifically some of our Quest where they have done a lot of COVID testing, we have no revenue, but we get their earnings contribution from that. So, there's a lot of things that can skew margins, but I think what people really want to understand is the base business. What’s going to happen going into 2023? We're very comfortable with the base business—we’ll be at or above pre-pandemic levels, and we'll have a larger base business in 2023 with some levels of COVID testing in the margin performance that you saw in Q1—so we're not expecting it to erode, even despite the factor we did talk about raising up some of our CIT investments in Q2. So, it's also being contemplated. It’s all in that range of guidance, and so it’s kind of hard to pin down specific margins at this point, but it's not bad news.

Great. Thanks so much.

Our next question comes from Kevin Caliendo from UBS. Your line is open.

Good morning, Kevin.

Good morning. I want to follow-up on the guidance question just a little bit, so you beat in the quarter by roughly $0.25 and you raised your COVID revenues by $150 million, which depending on what margin you use could almost equate to that same sort of $0.25. Was the guidance range raise related to the first quarter beat; was it related to the COVID increases? Were there overlaps there? How should we think about that?

So, the guidance range was related to the totality of the business. If you look at Q1 as we shared, the base business was extremely well. We didn’t do as well as we expected when we entered the year because of Omicron. Some of the raises in COVID for the year and the performance in Q1 were really offsetting a slightly softer base business. Now, the good news is that the base business came back. So, that softness in the base business was temporary. The other dynamic is that, we do have the PHE being extended, and we also have this change in HRSA, which is not insignificant. So we mentioned there was over $20 million of loss opportunity that we won't get paid for the uninsured from more than we did in late March. So, there are a lot of moving pieces here, and it's really hard to parse precisely what is driving the raise. It's really our greater confidence in the business performance for the year in totality with all of those pieces. While many people focus, as they rightly should, on the midpoint, I'd say just in general business is in better shape than we would have expected 90 days ago, and that's why we're comfortable raising both the top line and the bottom line.

As we enter the year, we indicated for COVID is around $700 million to $1 billion, and obviously we're delivering $600 million in the first quarter. We have more certainty around what is left within that initial guidance. Obviously, going into the year, there's a lot of uncertainty about what would happen next, how fast the decline would occur, and how each testing would go on in the back half of the first quarter. So, the timing of raising guidance is hit by this, as Mark indicated there's puts and takes in terms of the impact on our bottom line. But I'll just reiterate, we feel good about our start with our base business, and we're tracking well for a strong year based on our initial guidance.

Okay. Just a quick follow-up on the $160 million in investments. You said part of it would be temporary, part of it would be permanent. I think one of the things we're all trying to figure out here is what the base margins look like in a non-COVID or a COVID flat year-over-year, or whatever, which seems like we're moving into now, what the base margins normalize would look like? So, if we think about how much might linger, any help on that? And maybe the question would be, what do you think base margins look like in 2023 or exiting when COVID becomes endemic versus where they were in 2019? Is it possible that those base margins are higher going forward? That you guys have figured out a way to be more productive?

Remember, we're investing $160 million, because we have a strong business case to get the returns. We’ve indicated we are ahead of our plan to get the returns in advanced diagnostics, and we feel positive about the opportunities of the consumer business. We've had good results on both fronts and will continue to see results in the back half of the year. What we also said is that as we come out of 2022 into 2023, when you think about a year-on-year comparison, the returns we expect from Advanced Diagnostics and the returns we expect from the consumer will provide a net tailwind for our margins in 2023.

So just a reminder that we shared a view that we could grow to the consumer business to $250 million by 2025. And remember, especially if you strip out the COVID testing revenue, this was a business that was smaller millions not that long ago. So, we think that very significant growth is projected in this business, and we’re still very comfortable and confident about that. We talked about the performance this past quarter, and we don't have our new customer experience IT capability that we think is really going to make a difference in terms of the ease and use of that site. As Steve said, creating tailwinds because we'll be investing less relative to the revenue. But in terms of the margin, what I'd say is, on the business ex-consumer, the margins will be as good or better than you’re used to talking about pre-pandemic. However, we will have a sizable consumer business that is still in investment mode, because we're still looking to grow. So, the overall enterprise margin you should not expect to be expanded. The good news is we would expect stronger growth. As for some reason that consumer business doesn't deliver, we can turn off the marketing expense. It’s not as if we’re adding tons of people or infrastructure or costs. We’re very confident in our ability to grow that business. We want to invest to optimize that growth for a period of time; this is going to improve its bottom line next year relative to this year, and then certainly over the years beyond that, we would expect to have a nice healthy margin on that business as well. And it will be quite sizable.

As Mark said, as we go through thinking about what we indicated in our Investor Day, and we're not going to give you 2023 guidance, but Mark indicated is when we think about 2023, we're still believing we're comfortably in the range we would expect in 2023 in terms of EPS growth. The second half sets itself up nicely and what we've implied in our guidance for the full-year supports this, so we would be able to deliver what Mark indicated in 2023 and a view that we indicated in our Investor Day in spring of 2021. We're consistent and we believe we're on track to deliver in line with what we expect in 2022 and 2023.

Thank you for all that detail.

Thanks.

Our next question comes from Jack Meehan from Nephron Research. Your line is open.

Hey, Jack.

Hey, Jack.

Hello, and happy to say, Nephron Research. So, Steve, on 2023, I know it’s still premature to give a specific number, but at the Analyst Day, you talked about 7% to 9% earnings growth kind of off of an $8 number you were gearing us to at that point? Now, talking about some tail of COVID here too. Can you just like make sure we're doing the math right? Can we take 8%, grow it, add some COVID on top? There's obviously some other moving parts, but is that the right way to think about it, or where am I wrong?

We're going to refresh all of your memories of what we said in 2021. Yes, we talked about $7.40 to $8, and then 7% to 9% CAGR from 2022 and beyond. As we got further along past Investor Day, we started to signal that we would expect it would be closer to the $8 or on the upper end of the range. Because 2022 has more COVID revenue, I would just remind everybody that the growth rate in 2023 is going to be below that CAGR, but the absolute number we're saying should still align with what you'd calculated back in March of 2021. It just happens that the pandemic has hung around a little bit longer. I also mentioned at Investor Day that we did not assume COVID would go away. So, in that outlook, I had a level of sustained COVID testing, and we expect that COVID testing will be around part of our portfolio. Certainly, none near the levels of 2020 and 2021, or even what we're projecting this year, but not insignificant. I did not take COVID as upside for that. We certainly have some COVID built into that outlook.

Yes, what we said, remember this was in the spring of 2021. We expected 2022 to be able to grow as indicated both topline and bottom line, but we also said, and it continues to this day, we expect that COVID will continue to be part of our portfolio of tests going forward. So, that was 2021, thinking about 2022, the same is true for 2022 going into 2023. We’re coming out of 2022 with some COVID testing. You see the volumes we indicate, which is about 10,000 to 15,000 per day. Obviously, we're assuming right now the lower price. We will continue to have COVID testing in 2023, and we’ve always assumed in our outlook going forward for growth in the topline and bottom line will be COVID testing as part of our portfolio. We think it’s a good opportunity. Because if you go through the math, even at lower price points, this is a sizable market, and we have a good size share right now. We think there’s dynamics to the marketplace, and we're working on plans to actually gain share in the COVID testing marketplace that could be with us for the foreseeable future.

Great. As a follow-up, I wanted to ask you about the consumer-directed testing. You talked about the growth rate; how much revenue did that area generate in the quarter? And can you also talk about interest beyond COVID? Is there any specific areas of the menu that you're targeting or you think are resonating and where that investment is getting directed?

First of all, Jack, we like to give you specific numbers for the quarter. What we share with you is, it grew nicely double-digits on both the base business as well as on COVID. Jim, why don’t you talk about the portfolio and what we're seeing growth in?

Yes. Jack, we've talked in the past; there are various segments in the consumer-initiated testing business. I'll touch on two. One is, we call them watchful warriors—people that have chronic conditions like diabetes, like cancer, but their insurance company will only pay for, let's just say, two A1c tests a year and these people worry about the disease, so they may come in once in a while to get testing done. It just makes more sense for them to do it through us directly rather than having to go to a physician's office and pay an expensive bill just to get an A1c test. So, there's a lot of demand from these types of patients. The second is, we’ve talked about people who don’t want their insurance company to know they are getting tested; they may not want their doctor to know, they may not want their spouse, or they may not want their mother or father. Some of this is in relation to STD testing, so it is a big segment for people that value privacy. Finally, there's a generation, a much younger generation, that may not want to go to the doctor. They don't have a doctor, but they may want to get lab testing done once a year just to check the underlying health of their body. So, call it the 20 to 26-year-old segment that they don't have primary care physicians, but they are concerned about their health and they come in and get these once-a-year comprehensive tests for overall health.

Jack, we've talked about this previously. We moved this, what we call a blueprint for wellness, which was an offering we gave to employers. It is a battery of diagnostic testing that gives you a good blueprint for how your health is tracking across various important metrics. We're actually offering that now on a consumer basis, and people really find that interesting. So, it's an opportunity to get a full run of diagnostic testing like people have gotten through employers. We do it for our own employee base, and we can find it to be very valuable. And then, obviously, if there's anything that’s out of range, we direct them to the doctor instead of going to the doctor first to get the script.

As Mark said, it's a small business, particularly on the base business, and that number is growing strong double-digits. We've said we're committed to building this business to about $250 million in size by 2025. Needless to say, with the investment we're making, the new leadership we've brought in—and that Jim indicated—and really a very focused organizational model that we have in place, we’re getting good traction. We believe you're going to start to see acceleration of the revenues we get from it, which should be a net tailwind for our growth overall as we go into 2023 and beyond. When you consider the numbers, they get much more substantial year-on-year to give us a nice lift in our growth rate going forward.

Operator, next question.

Our next question comes from Brian Tanquilut from Jefferies. Your line is open.

Hey, good morning, guys. Good morning. Just one question. Mark, I know you don't give quarterly guidance and you've given us some color for the guidance for the year, but just any considerations we need to be thinking about as it relates to Q2? And then maybe just on that $30 cost you mentioned that goes away related – as COVID volumes go down per test? How quickly does that go away? I'm guessing some of that's payroll and headcount. So, just curious how that structure functions over the course of the year—in terms of eliminating that $30 number?

Yes. So, the payroll is actually a fee we pay to a partner, and that relationship we have is only permissible during the PHE. So, there's absolutely a guarantee that when PHE goes away, that payment goes away. It’s directly 100% correlated to that in addition to some other costs I mentioned, like logistics and so on. Obviously, if we stop the relationship and stop the payment, we don't have the logistics cost as well because we're not making those special runs to areas that normally we wouldn't go to pick up specimens. So, I think you probably have other pieces, Brian, to go through. We talked about a level of testing that’s been averaging about 30,000 here early in the quarter; we talked about a lower level in the second half. So that's one consideration for COVID. You know, the PHE is due to provide full revenue impact this quarter, and then we’ll have more of a revenue impact and dollar margin versus percentage margin shift as we see a change from Q2 to the back half of the year. And importantly, we're back to growth mode. Every week, every quarter gives us an opportunity to go out and do what we were doing before the pandemic, win over more work, and grow organically, and all of that will benefit the back half relative to where we were in Q1 and certainly expect to be in Q2. So yes, COVID rent is likely to decrease, and the base business will continue to grow. The PHE is part of our guidance, but we also expect those incremental costs with COVID testing will go away with the PHE ending.

And then just to remind you, what we’ve told you is this $160 million that we’re investing. We’ve spent about $30 million so far, and what we’ve said is in Q2, we've got some investments we're making, particularly with our new platform. Think about that as somewhat of this is period expense and some of it is one-off, but some of this is repeatable that we will see in the back half of the year. So, there will be some headwinds in the second quarter, but we think we have a real great opportunity for us to grow long-term, so consider that as well as when we think about the timing of what will happen throughout the remainder of the year.

Appreciate that. Thank you, guys.

Our next question comes from Derik de Bruin from Bank of America. Your line is open.

Thank you and good morning. I want a couple of questions on advanced diagnostic testing. First of all, one of the other public labs that does oncology testing talked about weaker volumes, as we're coming out of the pandemic. Could you talk about what you've sort of seen in oncology testing through that market, and are you gaining share there? As a follow-up to that, your other main competitor has been doing a number of acquisitions and things like biopsy and the others, how are you sort of thinking about building out your pipeline for the advanced market? Are you looking at potential acquisitions in that area?

Absolutely. We shared with you strategically what we're doing. Last year, we indicated that our business, and our definition of advanced diagnostics is entirely defined around genetics and molecular. Excluding COVID, it was about $1.3 billion in size last year. What we have done is focused on four areas that we've already mentioned in my prepared remarks, where we're putting additional investments, and those investment dollars are made throughout the entire value chain. It's investment upfront in the test, in organic traction. It’s also in our experience that we work with our physicians and the patients they serve, and that's also around the services that we provide, along with our sales force to be able to have better reach within the markets we serve. We’ve been aiming for 3% to 4% growth in that business, but we’ve planned at our 2021 Investor Day to accelerate growth to high single digits. We indicated today that we're making good progress toward that—it's about 8%. Majority of that assumption is we’re doing that organically with the investments we're making. However, we’ve previously made some selective acquisitions, particularly Blueprint Genetics, which gives us some bioinformatics capability that enhances our capability around genetics. What we indicated last year is that strategy is working. Those areas of growth are growing strong double-digits in 2021 versus 2020, and also in 2021 versus 2019 at pre-pandemic levels. So we feel our organic strategy of investing is working, and we feel good about our position here.

Yes, Derik, you asked about our oncology performance. When we think about our oncology business, it includes solid tumors, pathology work that then folds into needed requirements for testing. That business is doing well and has recovered from 2019 levels. Our core hematology business, which has always been a real strength of Quest Diagnostics, continues to expand. So our oncology portfolio is in good shape. You mentioned liquid biopsy; there's a market opportunity here as well. We're working on assays that are also commercially available from our suppliers, and we're considering both—pre-cancer or cancer screening assays are something we watch closely. As you know, there are many start-up companies in the liquid biopsy space; we're certainly keeping an eye on that market as well.

Our next question comes from Ann Hynes from Mizuho Securities. Your line is open.

Good morning, Ann.

Hi, good morning. So, one more margin question. I think the issue is, maybe we're overestimating the margins on COVID backed into your big base business, and you referred to your partner, which I'm assuming is CVS, that you have to pay that $30 fee. Can you tell us what percentage of your tests is CVS? So, just to make sure that we are estimating, just kind of the consolidated margin for COVID quickly?

So, when we talk about non-traditional channels, it's not limited to one partner. What I can share is that it grew before the pandemic, and it was nearly up to half of our volume that was coming from the non-traditional channels, and a higher proportion of the traditional volumes were uninsured. Since the uninsured volumes have dropped off, that proportion has dropped off as well as we go, but it’s still significant. I would not want to comment specifically on any partner, and certainly the one you mentioned is not our only partner.

Yes, and the percentage of our volume that comes through these retail partners varies. During surges, I would say it reduces because we start to then get a lot of specimens from physician offices, urgent care centers, and hospitals. When COVID subsides, then that becomes a slightly larger percentage of our mix.

Right. We can do less cooling, and we can take a little bit of a hit on turnaround time, $25 that is in a lot of the contracts, and certainly in CMS’ payments. There are a lot of dynamics that can offset each other. That’s why we really focus people that we can make a reasonable margin on the CMS reimbursement grade for COVID going forward, and it's not the price change that will all drop to the bottom line.

Going back to what's in our numbers and what’s based and what's COVID, I'll reiterate. We took advantage of the opportunity we had in 2020 and 2021 to invest in accelerating growth. Those investments take time and they’re ahead of schedule, and that's going to help us next year, year-on-year. So, think about that as it moves through the plan for this year into next.

Our final question comes from Rachel Vatnsdal from J.P. Morgan. Your line is open.

Hi, thanks for taking the questions. Could you just elaborate on the POS contract momentum that you've been seeing, especially returning to normal? How should we think about the cadence of those wins and revenue contributions for this year?

Yes, I mentioned in our prepared remarks that we've announced and that our relationships are strong and beginning to demonstrate that we can bring real value to these healthcare delivery systems. Remind you all, what it is, is we help them run their labs, and we see that they can save money while we perform our services. Healthcare systems are struggling, and they have fixed reimbursements. Hospital systems are having difficulty offsetting inflationary pressures that have been tougher through these recent times. When we have our relationships, our advanced diagnostics business and our overall sophisticated testing business, which we call reference testing with hospitals, also serve as opportunities. We bring in a larger share of that work with hospitals. We have partnerships that continue to yield good value that help sort of the acquisition target, but also help us because eventually they are accretive since we know the systems quite well. So it has worked well, and going forward, the funnel continues to build. We have a dedicated team, and we've invested in that as well. Jim and I are very much engaged together, working a large number of these accounts. We personally do a fair amount of travel and spend time with management teams to engage on these opportunities. So, we believe it continues to yield a nice opportunity going forward to continue to accelerate growth. So, Jim, anything you’d like to add to that?

I would say that the funnel is full of opportunities over time and negotiation. Obviously, having someone help system laboratory is something that helps us when trying to operate. Now that COVID is subsiding, that helps us serve patients, and I think you'll see the deal pick up.

Okay, great. Thanks again for joining our call. We appreciate your continued support, and you all have a great day.

Thank you for participating in the Quest Diagnostics first quarter 2022 conference call. A transcript of prepared remarks on this call will be posted later today on Quest Diagnostics website at www.QuestDiagnostics.com. A replay of the call may be accessed online at www.QuestDiagnostics.com/investor or by phone at 800-583-8095 for domestic callers or 203-369-3815 for international callers. Telephone replays will be available from approximately 10:30 A.M. Eastern time on April 21, 2022 until midnight Eastern Time. Goodbye.