Align Technology's Management Present at Morgan Stanley Global Healthcare Conference (Transcript)

Sep.11.12 | About: Align Technology, (ALGN)

Align Technology, Inc (NASDAQ:ALGN)

Morgan Stanley Global Healthcare Conference

September 11, 2012 08:00 AM ET

Executives

Kenneth Arola - Vice President, Finance and Chief Financial Officer

Analysts

Steve Beuchaw - Morgan Stanley

Steve Beuchaw - Morgan Stanley

Good morning everyone. Thank you for joining us. I am Steve Beuchaw from the Morgan Stanley Medtech team. It is my pleasure to have you all here and to introduce Align Technology. We have Ken Arola, CFO of the company.

Before we begin though, please do note that all important disclosures including all personal holdings disclosures and Morgan Stanley disclosures, appear on the Morgan Stanley public website at morganstanley.com/researchdisclosures. It’s a riveting read. So Ken, I would like to open the floor to you for any opening remarks.

Kenneth Arola

Sure. I just like to thank everybody for being this morning at Morgan Stanley Conference, just a little bit of Align Technology for those of you who don’t know. We have been in business for about 12 to 13 years as a public company. We’ve helped about 2 million patients get treatment and generated over about $2 billion in revenue over that time period along the way was delivering about 75 to 80 million individual class II medical devices which we call aligners.

Our strategy for the company really focuses around four key areas. One of them being clinical innovation giving doctors what they want to treat the patient effectively and get the results that they are looking for and I am sure we’ll get some questions on that at this morning. The other one is the driving consumer demand and educating patients so they can walk into doctor’s offices understanding the capabilities of what Align – Invisalign can do for them and should basically challenge a doctor if that something they want as a formal treatment.

The third one is on customer experience making sure that we are doing business as effectively can with the doctors making it easier for them to do their ClinCheck approvals, to get their cases going etc., and the fourth lever that we are pushing on for the Invisalign business is really around the international expansion of business in core Europe as well as in China. We opened up some offices about a year ago, in four major cities over there and then about a year ago we acquired a company called Cadent Inc. They provide scanners to the market place and are strategic to look at the Cadent business was to increase the placement of scanners in the market place over time and at the same time driving Invisalign revenues up of those scanners as doctors can submit cases directly to us versus taking impression. So, with that I’ll stop and turn it over to you Steve.

Steve Beuchaw - Morgan Stanley

Thanks Ken. So, Align is interesting in a number of ways. One of them is that the company has been growing very fast now since let’s call it early part of 2010, most businesses go through ebbs and flows and we’ve seen some companies that grew very fast in 2011, slow a little bit with the macro pressure this year and Align is frankly just powering right through it. What is your secret? What are you doing differently? What are you doing differently than what you did in 2009 when even a very fast growing Align saw a little bit of pressure from the economy.

Kenneth Arola

Sure. So, I think back to 2008 actually was a year we came out with some products to address areas of the market where we were not effectively competing in and one of them was the Teen product, we came out with in the middle of 2008 and then towards the end of the year we came out with the a product called Assist, which is really to help newly trained doctors get comfortable with Invisalign.

In 2009, with the economy we thought we are going to be down pretty significantly in our business. We had about a 3% growth in 2009, difference between then and now is really the fact that we have a lot of new technology in the product like I said Teen and the Assist product and over the past couple of years we’ve also added additional technologies and features into the product. Features that we called Invisalign 1.5[ph] back in 2009, then in 2010 we followed up with what we called G3 and in G4 in 2011 and those are the features that are across all of our products whether it is full Teen Assist etc. giving doctors better control to get their results that they want whether it is (inaudible) procedures, optimize attachments, precision cuts in the aligners.

So, what is more effectively allowing doctors to get the outcome that they want as they report back to us. They were very pleased with the results that we are getting in the practice, they’ve actually reported that. They are more confident now and when they look at the ClinCheck, they are going to get the results at the end of the case that they were expecting to get and they are more likely to recommend Invisalign. So, contrast that back to 2009 coming into 2009, Orthos and GPs both kind of hunker down, the Orthos themselves never really had to sell as much as they have to pay and when patients were walking into the office asking for Invisalign. They were more hesitant when GPs, they didn’t want to push Invisalign back in early 2009 time frame and now it is because of her $5000 procedure, they got the whole family in their practice and in our reality they did not want to practice to walkway because they got upset that the doctor is trying to push him on a $5000 procedure. So, couple of different things in the marketplace probably the biggest driver though is technology that we are adding to the products over the past several years.

Steve Beuchaw - Morgan Stanley

Can you speak a little bit more to your customer service approach and how that has changed not so much how you think about treating patients differently, but how you make the experience for an orthodontist or a dentist working with your sales rep or with you as a company. How you make it that smoother?

Kenneth Arola

Sure. I certainly have to make a lot of improvements over that over the past several years. So, I am back -- back 5 years ago, we weren’t so great at that. We made a lot of improvements. We’ve changed some of our coverage and models with our sales force over the past couple of years. We used to have a team of highly experienced sales reps dealing with all doctors GPs and Orthos at all levels in the business, whether they are doing one or two cases a quarter or whether they are doing 50 or 100 cases a quarter. We’ve deployed a new model of the past couple of years. It has been more effective for us (inaudible) territory specialist. They are more entry level and intermediate level sales people and we basically assign them to the newly trained doctors and doctors that deal a few cases a quarter, trying to get those doctors motivated and moving. It is a more effective cost model for us and then as those doctors bring more cases over time they will pass that doctor op to a highly experienced sales reps, that seems to have worked very well for us.

We have employed about 700 people, and we’ve grown there from 500 people few years ago of technical support and customer care people in Costa Rica. To work with the doctors when they have issues on their cases and those types of things. So, that is from a sales perspective and then from a marketing perspective when we look at it we’ve got more effective in our consumer demand creation as well.

Several years ago we were mostly on television, maybe not in greatest spots in the evenings or in late at night and we’ve been more effective on the types of shows run, lifestyle kind of programs and in addition to that we broadened out into various PR campaigns like Disney is next big thing tour. We’ve been at the U.S. surfing contest back at California for several years and that is really to broaden the awareness of Invisalign over time and educate patients or perspective patients on the value proposition of Invisalign as they walk into the doctor’s offices.

I want to reflect on one particular product and that has the new 5-trade system. You launched that early this year and this has been helpful for the company and that it gives you more about suit-to-nut offering. You can do just about anything some of you would want to do in clear aligners were before. We didn’t do some of those very early stage or very simply cases. How big a driver has that been – is that really been the key for share gain as it seems like you’ve taken probably 300 to 500 basis points of market share this year.

I think share gain started with that and I think that is coming across our entire product line. Teen has done very well for us over the past few years growing at 20+% a year 20 or 25% a year on an annualized basis. Our full product continues to be the mainstay product in our product line. Assist growing very nicely over the past couple of years as we’ve got doctors and we trained doctors to use that product more frequently and as you mentioned Steve, we came out with a Invisalign expressed bi-product at the beginning of this year. The product has been well, has met her expectations, it is a smaller base of the overall business today and we expect that to continue grow over the next several years. It goes after a part of the market that we weren’t competing in before the V stage aligner system looking for simple crowding or spacing issue. As patient may not want a full comprehensive treatment and it was one of the key drivers last quarter on a sub-conscious growth quarter-over-quarter as well as the other products. We haven’t really specifically disclosed the volumes that we were doing in that particular business, but to your point, it doesn’t make that it much more effective competitor on the low end for their V and X stage aligner systems for simple cases. We are at the 1/3 progress mark. So, with that I’ll open it up for questions.

I am sorry, if you wouldn’t mind just waiting for a microphone.

Question-and-Answer Session

Unidentified Analyst

Ken, just a quick question on that V trade[ph] system, how do you make sure that, that took and cannibalize the existing business whether it is Assist or Teen.

Kenneth Arola

So, it is Assist and Teen, those are full comprehensive products for some of the needs, treatment that is going to take probably a year to year and a half where a V-stage system is 5 sets of aligners to change every two weeks. So again very very minor crowding so it really isn’t any cannibalization that I would point to relation to teen or a full a case or an Assist case. There may be some marginal amounts on the expressed bi-product (inaudible) aligner system as well, but I think more than anything it expands the market for us because we weren’t competing at their 5 stage aligner system like some of our competitors are. And the difference between 5-stage aligner system is, it has all the features that I was mentioning G3, G4 that you can get in any one of our other products to ask customize manufacturing factory in Vorres[ph]. You can use optimized attachments, which other competitors don’t have the capability today to use optimized attachments and enforce a treatment. So, I think it gives the patients a really good option who are looking for something very simple to do some minor crowding issues or spacing issues at a very reasonable price.

Steve Beuchaw

I wonder Ken, if you could speak to how the company built the composition of expectations for growth for the second half of the year. You are looking for about 20% of revenue growth in the third quarter – I am sorry, 20% case growth in the third quarter. Revenue growth, that’s a little below that. Can you walk us through the decomposition? How much of the difference between unit growth and revenue growth is, price, how much is currency, promotions? Are there any other points that you would point out, just to help us understand the organic growth of the business?

Kenneth Arola

Sure. Well, I guess I would first start by saying the organic growth of the business as we look at it is the case volume growth that we see quarter-over-quarter, which has been net 20% range and looking at 20% growth in quarter three roughly, given the range of guidance that we gave. When you step back from that organic growth of case volume and you look at what’s impacting overall revenues, it’s ASP. Our pricing to the customers have been very consistent over the past many years here. And what we have seen is some impact to ASP in relation to some programs we run.

So, we have had for several years in our mix and advantage rebate program, so as doctors do more significant volumes for us, we allow them to attain certain discounts, and we have seen more doctors moving up in the cheerings of the program both on the GP and ortho side and attaining higher levels of rebates. From our perspective, it’s a good return on investment for us, giving a few dollars back in price for them, we don’t spend a lot of time with those doctors from a clinical point of view as we are treating the case.

So, the ROI is very, very positive on that, given a few dollars back to them and it drives incremental volumes. As far as ASP impacts, that was probably the – I am not going to break out specific dollars, but that was probably one of the more significant drivers of ASP last quarter. Next beyond that is probably the Teen/Vivera promotion that we ran. We ran a promotion to bundle our Vivera Retainer system when a patient finishes their treatment, they can purchase that retainer. It’s a one-year subscription to pull their teeth after they finish the treatment.

We bundle that with the Teen product for two reasons. One, it gives doctors an experience, the Teen summer rush right now, as we go through the summer – orthodontists treating more teenagers during the summer than any other time in the year. So, having them with an offer that says, if you buy a Teen product from us today, into the quarter, you can get a free Vivera Retainer system to use on any patients in your practice. They can retain that or receive that Vivera Retainer from us any time between now (inaudible) same program last year. It was a successful program for us.

It allowed doctors to do more teen products and we are motivated to do (inaudible) Vivera. So, they got trial with Teen, they got increased trial with Vivera. They have kept their volumes up on the Teen and the Vivera side, you see the business both growing, on both of those sides. We started the program a little earlier this year, and we are anticipating that we will run that through the end of September here. Hope, we will see the same results we saw last year if not better.

That was probably the second level of impact on ASPs and then the third one we talked about, we did put some numbers around that of about $0.5 million impact or so related FX euro to the dollar exchange rates on a quarter-over-quarter basis.

Steve Beuchaw

I wonder if you could speak to the operating environment in the US. And what would you do is, let’s say, Teen? That case gets done year-in, year-out. Part of what you do though is more discretionary. So, I wonder in that piece of the business that’s more discretionary, can you talk about how the consumer thinking is changing overtime? How is it this summer relative to last summer? How is the third quarter looking relative to the second quarter? Where are things headed there?

Kenneth Arola

Sure. Our direct-to-consumer advertising, like I said, we have gotten much more efficient and what we are doing there and educating patients and driving them into the doctor’s offices. We have continued to push on that this year. Probably a little bit harder even in the second quarter. We advertise more heavily in the second quarter than we did the previous year. So, changing the pace of that to get ahead of the teen season during the summer months, making sure that the moms and dads and the kids are aware that (inaudible) is a good option for them. So, we will see how that plays out during the summer months here. As far as the doctor’s practice systems sells, from an economic metric, economic point of view, our feeling is we probably are the best one to be looking after that. We are so underpenetrated in the marketplace. We look at things like patient flow in the doctor’s offices, are the doctors engaged in their practice, are there point of books and those types of things. And when we start coming into the quarter where they were very consistently seeing patients, the flow of patients in the practice were very steady, and again, where we are put at on that at the end of the quarter.

Steve Beuchaw

Same question, but across the pond. You guys have had interestingly a fair amount of success. You called out Spain in the last year as a real area of growth . I don’t know if any other company could claim that. Can you speak to how things are evolving there, Spain, the UK, a couple of works influx there? How is Europe looking, how is Germany looking?

Kenneth Arola

Sure, yes. Europe is still our fastest growing area around the world, faster than North America, it’s coming off of a smaller base, of course. We are less penetrated in Europe, which I think plays into some of that growth that you are referring to. As far as country by country, Germany has been very solid for us. In Spain and Italy, a while back, saw some down quarters in the southern region. And the last couple of quarters came back a little bit of surprise, but Spain nearly doing very well for us. In the UK, back last summer, we had some issues with some country management and some of the austerity programs going in the UK. So, we saw our business fall off last quarter three, which we were not really anticipating.

Coming into the next couple of quarters, we have changed out the management in the UK. We changed our approach in the UK to reach out. We are mostly in core London, dealing with most of the doctors in that region. We have expanded on to the other regions of the country. It’s moving in the right direction now. Actually, UK last quarter was our strongest growth area in the European area. So, and again, I think it mostly goes back to the fact that we are so underpenetrated in Europe. We are not getting effective as much as some of the other larger companies possibly.

Steve Beuchaw

One such on Cadent. It’s been helpful for the aligner business, but the Cadent business is a standalone, hasn’t grown at least as fast as we thought it would. Why is Cadent not growing faster and is there a case to reaccelerate that business into next year?

Kenneth Arola

Sure. So, actually in the North America region, we are actually doing better than we anticipated after the acquisition. We are placing more units, we are taking advantage of 150 sales reps across North America for the Invisalign side of the business and leverage that with the Cadent sales team. We have added to their sales team. They had, I believe, 10 reps when we bought the company, and we have now 24. We have a rep in each region where we have Invisalign territories. So, the cross fertilization of sales team has gone very well. We utilized the events that were at, whether the trade show events AAO/ADA, or whether it’s the only event we have put on forums, and the business has gone very well there in getting scanners placed.

We have had some customer service issues in relation to the cases. Doctors were turning in from a restorative point of view, which we think we work mostly through over the last couple of quarters. That’s slowed down from the service business. I think that’s really started moving again as we have gotten most of the issues behind us, I think we have got beefed up our resources on a customer care side of things, and things are moving in the right direction now.

In Europe, we have our partner in Europe we have been working with and capital equipment sales have been slow in Europe. Certainly not up to our expectations, if there’s any part of the business that’s not meeting our expectations as Europe, we are working very diligently with our partner over there to make sure we can get things back on track. And from an Invisalign point of view, we have delivered interoperability for the scanners. So, doctors can now – we have a scanner in our Invisalign certified, can submit cases to us. As they have submitted cases to us before and after they bought a scanner as we have tracked it, we have seen them after they bought a scanner submitting more cases than beforehand, and that’s because it’s easier for them to get the patients sold. They can take the scan immediately, send it in to us and get the case started versus the patient potentially walking out of the office and having to come back.

We are working on other applications for the scanner and outcome simulator – we are doing a before and after picture of the patient sitting right there as an additional tool to sell the patient. We have had it on pilot, it’s been very successful and we are looking at coming out with that on a commercial available basis towards the end of this year. So, overall, I would say the scanning business has been better in North America.

To sum it up, service side of the business had a little bit of a solace for a couple of quarters, but we have got more physicians behind us, and international, we are working really hard to get that back on track.

Steve Beuchaw

Over the next year, the Cadent business or let’s call it the scanner business in general, it’s going to become more competitive. You could think of that as a challenge, you could think of it as an opportunity because the penetration of scanners probably goes up even faster overtime. Is there a case in that kind of situation to become more of an open source player where the aligners can be more integrated with other company scanners?

Kenneth Arola

Sure. We do have an open system. We haven’t changed our approach though. We have been trying to work with all the scanning companies out there, you know all the names of them, over the last 5 or 6 years. The reason we looked at Cadent pretty hard was that Cadent had the capability to capture the digital data that we needed in a fashion that we could actually do a full large scan with the scanner, capture all the inner proximal spaces, gingival spaces. We you look at manufacturing aligner that fit the patient appropriately. The other scanning companies have not been able to get to that point. We have been open to them. We have continued communications with them in relation to qualifying their scanners. Where they are good at I think right now is in like a quadrant, they can take a quadrant to do a crown or a bridge, but getting that full large scan, again the resolution we need for Invisalign, they haven’t quite got there yet. But we have been continuing to engage in conversations with them. We think that’s an opportunity for us.

Steve Beuchaw - Morgan Stanley

Down to a few minutes left, I want to open it up one more time for questions from the audience.

Unidentified Analyst

Can you help us understand your supply chain? You are moving into a new manufacturing facility and why did you chose Juarez and how many different facilities do you have? Is that the only one that’s producing your aligners, I am just trying to understand the logistics behind that.

Kenneth Arola

Sure. So, from a manufacturing perspective we have a factory down in Costa Rica, and what they do is the 3D visual manufacturing part of equilibrium, the ClinCheck working with the doctors. Once that digital images are created with the doctor, that ClinCheck, it sends over to a factory we have in Juarez, Mexico, where we manufacture the aligners. Now, we have been in Juarez, Mexico for many years, probably 10 years now, and manufacturing product there. What we have done is past year has actually moved in – we are in the process of moving into a new facility we procured, where we expanded the footprint of the facility about 2x of what we had prior to that. We are in the process of moving our Invisalign business into that factory, we are part way through that at this point in time, that will continue as we move through this year and into early next year. I would hope that we would be pretty much out of the old facility by call it mid to later part of the year in 2013. We also had a manufacturing facility related to the Cadent business in New Jersey. We started to consolidate that effort down into Juarez and Costa Rica facility as appropriate last September, October timeframe. We are essentially complete with that now. We have hired all the people we need in Costa Rica and Juarez to do the production of the services business that we have there. We still have to wind down facility cost and those types of things in New Jersey, but we are making some good progress. So, what we have in Juarez now is the aligner business from a manufacturing point of view, manufacturing specific aligners, and the services side of the business for the scanners, and then we will have the continue with – got ClinCheck, our team down in Costa Rica.

Unidentified Analyst

(inaudible) Costa Rica going forward, once you move to Juarez, the Costa Rica –

Kenneth Arola

We are not planning on manufacturing the aligner that sell in Costa Rica. We will continue with the 3D modeling that they do down there for the doctors to get the ClinCheck setups done and continue adding resources for doing that overtime as we continue to increase volumes. We will look at manufacturing aligners in our Juarez facility. We have plenty of capacity for the near term here, I will say, doubling the footprint of the facility we can go for a while here before we need to look at additional expansion.

Unidentified Analyst

Talk about depreciation and amortization going forward?

Kenneth Arola

Depreciation and amortization, yes. In our old facility we are pretty much fully depreciated in our equipment. So, going forward we have to add new equipment into our new factory to handle the transition and the capacity. That equipment gets depreciated over a number of years, so we are taking our new depreciation starting -- actually at the beginning of this year it started. It’s like 10 years of depreciation, we haven’t estimated most of these equipment. But that will be an additional drag on overhead in the factory until we continue to fill it out with volumes.

Unidentified Analyst

Ken, could you comment on the genetics, what drives your desire to promote – to drive this promotional skills, now you are in a semi monopolistic situation. So why do you need to drive the growth? Could you also talk about the competitive landscape over the next couple of years? Thanks.

Kenneth Arola

Sure. So, why are we driving promotions? Driving the team promotion I think is very important thing to do to continue to get trial and adoption in the ortho market, in particular, in relation to teenage case starts. We have been starting to slowly move down in the age range of cases that we are competing for. Prior to having the Teen product in the marketplace we are treating mostly older teens, 17, 18, 19 years old. The team partly allows us to treat patients anywhere from 11 to 15, 16 years old as they have mature orientation, they are sharing some of their (inaudible) etcetera. So, for us to continue to get trial and adoption of the teen product in the summer, meaning bundling it was a very successful thing to do. It’s a point promotion, it’s been very successful for us. We have seen volumes moving last summer and doctors continuing to keep up with that team going as they move through the year. Other than that, our advantage program, we have been running for years. It’s a very consistent program and doctors are just doing more and more cases and then moving up in the peers. We evaluate that every year and see what kind of modifications we want to make to that.

As far as competition, from our perspective it hasn’t changed much. Our biggest competition is trying to get share away from (inaudible) players. As far as clear aligner therapy, we have heard all the things you guys have heard about, Dentsply with their MTM product. We are seeing a little bit in Canada and not much in North America. I understand they are still trying to get some approvals with the Onco [ph] product. They have come out with a Clear guide product of different stages of aligners. They had just Simpli 5 or Red White & Blue systems. From our perspective, the Clear guide system is may be competitive on the margin with our Express cases and the reason I say that is the way they are delivering the product is those send 5 set of aligners to the doctor then after the 5th aligner they will have the patient take a heat and bite impression send that in before they manufacture their second set of aligners to make sure it’s tracking. So, effectively, they are delivering two simplified cases to the doctor for higher price point. Again, it’s more of a manual based process, it doesn’t have all the same technology we have in our products for an Express product, the various features, G3 and G4 features and the mass customized manufacturing we can do with the product.

Steve Beuchaw - Morgan Stanley

Ken, one question on cash flow. So, operating income in the first half of the year was up by $20 million. Operating cash flow though was down nominally. Part of that is inventory build related to the manufacturing transition. Can you walk us through how we get back to operating cash flow growth and then what have been the drivers of the drag back?

Kenneth Arola

Sure. So, operating cash flow was impacted actually this past quarter by one specific item and it’s an accounting literature that we had to follow. We had excess benefits from stock-based compensation from prior years that we utilized some NOLs to minimize some tax payments. The accounting literature says you have to show that as a reduction of your operating cash flow and then it gets offset in financing activities. So, net the total cash flow is netted out but it degrades you from an appearance point of you it degrades your operating cash flow, that’s about $17 million last quarter. If we take that out, our operating cash flow last quarter was relatively comparable, a little bit down based on the capital of purchases that you were just referring to. I would expect that it’s starts returning to that $20 million or $30 million range of operating cash on a quarterly basis as we go forward relatively quickly.

Steve Beuchaw - Morgan Stanley

And then quickly on the medtech tax, how should we think about that in the model for next year?

Kenneth Arola

Sure. As we have analyzed medtech tax, from our perspective it’s going to apply to our aligners and it’s going to apply to the scanners in the Cadent business. We don’t think it’s going to apply the service side of the business. As far as how we are going to deal with it, we are still evaluating that, we are going through our planning processes right now, whether we are going to absorb it, whether we are going and try to pass it along as a tax, or whether they are going to try to pass it onto through pricing, we are evaluating on the alternatives right now. We are also polling some of our physicians and trying to understand what other companies out there trying to do as well.

Steve Beuchaw - Morgan Stanley

Okay. Thanks everyone. Thank you Ken.

Kenneth Arola

Alright. Thank you, Steve.

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