Q2 2022 Doximity Inc Earnings Call
I'm in nature, and we may or may not provide updates on those metrics in the future.
I would now like to turn the call over to our CEO and co founder Chuck Handy.
Thanks, Perry and thank you everyone for joining our second quarter earnings call. We will begin with a few highlights first our topline I am pleased to report that we delivered $79 $4 million in revenue for the second quarter of our fiscal 2022, an increase of 76% over the same quarter last year and 8% above the mid <unk>.
<unk> of our guidance.
We're also raising our annual guidance by 10% to a midpoint of $327 1 million for fiscal 2022, which translates to 58% growth year on year.
Turning to our bottom line, we posted an adjusted EBITDA margin of 41% last quarter or <unk> $32 $8 million, which was 22% above the midpoint of our guidance. Our vertical sales model continues to deliver strong incremental margins, allowing us to scale efficiently as a strong ROI, we deliver for our clients generate low friction.
Upsells more on this in a minute.
Last but not least our network continues to grow as hybrid home office work schedules become the new norm for many doctors, we're proud that our mobile workflow tools have been able to help our E signature and fax product usage continued at our Q1 record highs and we expanded our paid telehealth platform to an additional 50.
Physicians last quarter.
Our active telehealth users reached a record high with over 330000 unique physicians NPS and medical students completing a telehealth visit with us in the quarter.
Okay. Those are the highlights I'd like to take a few minutes now to do a deeper dive on the drivers and sustainability of our topline growth then I'll close with a couple of partnership spotlights from the quarter.
For the past decade, it's been our mission at Doximity to help physicians be more productive to provide the best care for their patients today over 80% of all U S. Physicians are members of our platform using it to video call their patients signed important paperwork remotely and keep up with medical news.
Our interactive platform allows top hospitals and pharmaceutical companies the best brands in medicine, the connect efficiently with the right physicians about new treatments clinical trials and patient referrals. We then measure our clients' return on investment or ROI using third party claims in prescription data.
At a high level there were two primary drivers of our growth this past quarter.
First is ROI fueled expansion with our existing clients. We completed 23 third party ROI studies last quarter, our pharma clients saw a median return of 17 to one while hospital. So a median of 14 to one Kirk medicine of the University of Southern California for example, netted in 18.
One ROI from increased new patient referrals, leveraging our peer connection and awareness modules.
Of note. This quarter's ROI results were up from our historical median of 10 to one for pharma and 13 to one for hospitals as reported in our S. One.
Our clients generally target of two to three times return on their marketing investment so they're pretty pleased with us at a 14% to 17 times return.
These existing clients, then reinvest with us by adding new brands modules audience months of coverage or all of the above this land and expand upsell motion grew our net revenue retention rate or an IRR to a record high 173% over the trailing 12 months that's up from 100.
67% in the prior quarter and 139% in the prior year period.
The second key driver of our growth is healthcare belated, but burgeoning shift to digital as a reminder, U S. Health care spent just 28% of its 2020 advertising budgets on digital channels for IDC, that's less than half the 63% share other U S industry spent on digital over the same period.
E marketer, so health care digital marketing could double and still be a laggard.
But that's changing.
A recent Accenture study only 10% of U S physicians want to return to the pre pandemic methods of marketing more and more they are closing their doors to sales reps, becoming an industry prolong say no see doctor back.
Back in 2008, roughly a quarter or 23% of all U S. Oncologists were no see today, that's grown to 79% or nearly four out of five oncologists as no see.
Just in colleges across all U S. Physicians three out of five are now no C. <unk> access monitor an industry report.
We believe digital will become the primary channel for industry dialogue, but you'd be amazed at how much is still spent on bail in magazines to these doctors today.
Finally, since a few of you have asked us about iOS 14, I'd like to clarify that zero percent of our revenue is or ever was based on cookie technologies as a physician's first company. We have always drawn a hard line when it comes to protecting our physicians privacy.
In terms of revenue sustainability, we believe we're in the early innings of a decade long secular shift to digital physicians have fundamentally changed the ways that they interact with industry and we're leading the way and digitizing. These workflows.
Okay, I'd like to close out with a couple of partners spotlights.
First U S news this quarter, we signed a six year extension and expansion of our U S News partnership.
After a statistical review of our coverage you assume has decided to end their traditional mail and voting. This year. So doximity as now the only place where physicians can verify and vote for the U S News best hospitals rankings.
We're proud to help patients and physicians alike make better decisions and seeking care.
Second we're pleased to announce a new partnership with press Ganey as many of you know press ganey is the market leader in measuring patient experience working with over 41000 health care facilities to complete over 26 million patient surveys so far this year.
Our collaboration began with us wanting to measure the patient impact of our new Telehealth features for example, we found that when doctors used our professional named badge in their video visits a bottom of screen overlay, which shows the doctor's name credentials specialty logo a bit like a television news anchor.
When their patient quality scores went up by on average have a star on our five star scale patients appreciated seeing the doctor's preferred name and Theyre doing a few days and for doctors and hospitals have star increase is a pretty meaningful result.
So hospitals need to conduct a minimum number of patients surveys to maintain their reimbursement levels. So they do lots of expensive phone calls and postal campaigns to get responses are real time surveys not only improve the quality and recency of the patient feedback, but also lowers the cost of collection.
As a company, we will continue to develop partnerships, which create win wins for our physicians and clients. We believe we have become the partner of choice for digital doctoring and that creates value for both our doctors and partners.
Alongside existing partners like up to date epic and U S News.
Pleased to add Presque any this quarter.
Okay. So I'd like to end by thanking the entire Doximity team worked incredibly hard to deliver a spectacular quarter and with that I'll hand, it over to our CFO at a pricing to discuss our financials and revised guidance Anna.
Thanks, Jeff and thanks to everyone on the call today, we continued to deliver strong results in our second fiscal quarter and are encouraged by the broad based strength in our business.
Second quarter revenue grew 76% year over year to $79 4 million solidly exceeding the high end of our guidance range.
<unk> result was driven primarily by expansion within our existing customers as they continue to deepen their digital partnerships with us.
Exemplified by strong upsell success quicker program launches throughout the quarter.
There are several core drivers underpinning this growth.
First we continue to see expansion in the average number of brands and modules per existing customer, which grew 19% and 18% respectively versus the prior year period.
Second these customers are also growing their spend through additional upsell factors, such as increasing audience sizes and extending their programs.
As a result of these factors our net revenue retention rate continued to decline in Q2, reaching a record 173% on a trailing 12 month basis. Another way to look at our growth through the lens of the number of customers spending six figures or more on our platform.
We ended the quarter with 235 customers contributing at least $100000 in subscription based revenue on a trailing 12 month basis.
83% increase from the 154 customers we had in this cohort a year ago.
Similar to last quarter. This increase was split fairly evenly between existing customers that we up sold and new customers to our platform.
Also of note for the first time ever the average spend per customer in the ESCO surpassed $1 million on a trailing 12 month basis.
While the majority of our top line growth came from expansion within existing customers. We are also encouraged by the new adoption of our solutions amongst longer tail pharmaceutical manufacturers and health systems and.
In addition, we are continuing to attract other customer types like medical device and diagnostic companies and notably added another seven figure customer in these newer markets in Q2.
Just as we have proven with our current customers. We anticipate we will be able to deliver significant value for these new customers over time, which will lead to future cross sell and upsell opportunities.
Turning to our profitability non-GAAP gross margin in the second quarter was 90% compared to 84% in the prior year period. This result was driven by our revenue outperformance going forward. We will continue to invest heavily in our customer success teams, which make up the largest line item in our cost of revenue.
Key facilitator of this top line strength.
Adjusted EBITDA for the second quarter was $32 8 million and adjusted EBITDA margin was 41% compared to $12 6 million and a 28% margin in the second quarter last year.
Our adjusted EBITDA exceeded the high end of our guidance range due entirely to our top line outperformance.
Turning to our balance sheet and cash flow. We ended the second quarter was $742 7 million of cash cash equivalents and marketable securities.
Free cash flow for the second quarter of $18 1 million compared to $11 3 million in the second quarter last year.
As you consider our free cash flow for this quarter. One thing to note is historically the summer months have been the slowest for us from a cash collection perspective, as our customers take time off and we saw that again. This year. However, as expected our collections have picked it back up to normal levels in October.
And now moving onto our outlook for the third fiscal quarter of 2022, we expect revenue in the range of $85 eight to $86 8 million, representing 47% growth at the midpoint and we expect adjusted EBITDA in the range of $32 million to $33 million, representing a 38% adjusted EBITDA margin.
For the full fiscal year 2022, we now expect revenue in the range of $326, one to $328 1 million, representing 58% growth at the midpoint. We now expect adjusted EBITDA in the range of $127 six to $129 6 million, representing a 39% adjusted EBITDA.
<unk>.
With regards to our revenue outlook, we are raising our guidance meaningfully due to several factors.
Despite some return to in person marketing activities the level at which our customers are spending on our high ROI digital platform remains elevated compared with what we initially anticipated at this point in the year.
In addition, our customers continue to launch new programs at a faster pace, while also adding onto existing programs, which is yielding quicker revenue conversion for us.
In summary, we're excited by the momentum in our business led by the rapid growth amongst our existing customer base. Although we have achieved success to date. There is still considerable white space for our offerings and we believe we're just scratching the surface of our market potential.
We look at our largest opportunity and take the top brands that are existing pharmaceutical customers. We estimate that we remain less than 5% penetrated into their U S medical professional marketing budgets and we believe we are uniquely advantage to gain market share as these budgets continue to ship digital over time.
With that I will turn it over to the operator for questions.
We will now open the line for questions.
Thank you Amy.
Our first question comes from Ryan Daniels with Baird. Your line is open.
Yes, thanks for taking the questions and congrats on the strong performance and outlook, Jeff maybe one for you I thought it was quite impressive the data on the ROI studies and the increasing ROI for both of your key customer basis. So can you dive into a little bit more detail. There on what you think is driving that uptick specifically with pharma which was.
Very significant uptick in the ROI from where <unk> been trending.
Okay.
Yes, thanks, Brian good to hear from you and yes, it's a great question.
I think so just to recap for folks.
Back in the Roadshow for our IPO a few months back we were very proud to have a 10 times return on investment for our pharmaceutical clients as a median.
And Thats grown to 17 X this past quarter.
And dozens of studies that we've done.
So we're pleased to see that going up I can tell you what it's not.
It's not us increasing the AD load or the amount of sponsorship on the network I can tell you that if you look at our various programs they monetize in different ways. So you could argue that having more.
Pharmaceutical clients in our sample closet to order samples is better or more appointments in our booking engine is better.
But when it comes to our new three we don't want to have too many of the cards be sponsored even though we write all the sponsored cards ourselves and so this trailing 12 months, it's still only at one in 14 of those cards that sponsored so we think we still have a lot of room to grow there before anything becomes noticeable or annoying or.
In any way.
Harms I'd say, the overall health of the network.
So I think our pharma clients are just seeing the doctors are paying more attention to us, especially in a world where they're getting together, maybe a fewer live conferences and dinners and.
This is the place where they're learning from their colleagues and staying up to date on the latest science, which is changing faster than ever.
Finally, I would just say that our engagement with our news feed has never been higher it's grown too.
Levels much much higher than our pre pandemic levels and so we're just really pleased to see that physicians are allowing us to stay up to date on the latest research and science.
Okay. That's great. Thank you and then one quick follow up if we think of maybe one mega trend. We're hearing from all our provider groups as we go across the earning season its workforce burn out its turnover its challenges in recruiting and it seems like your platform is well positioned to help with all of those whether it's workforce improvements in the productivity.
<unk> front.
Certainly you have a recruiting platform for hospitals and Im curious what youre doing as an organization and specifically provider centric organization to help with this kind of workforce burnout.
Turnover, we are seeing in the market. Thanks.
Yes, no great question, Ryan Yeah, I'll talk about burn at first but then a bit about recruiting so a burnout.
We have had a number of good discussions with health systems, and certainly as a physician centric organization, it's something we care a lot about.
We've asked these health care heroes to be heroes for a very long time, right now and it's it's difficult for everybody.
So we have some ideas we've got test out Mayo clinic has done some things we're just getting together with peers that you haven't seen for a while but maybe you were in the trenches with residents seem to have a nice dinner could be very.
<unk>.
Very reenergizing for docs. So we're looking at some I'd say somewhat simple, but hopefully powerful ways. There to help doctors would be charge. During this incredible pandemic period right.
Second with regard to recruiting I'm glad you asked about it.
You have asked about it a bit in the past as you recall about a year ago that start of the pandemic.
We decided to offer more of a white glove service to our clients and offer them not just our talent finder software tool, but also services to help them actually credential and schedule and actually bringing those physicians. So we acquired a firm in Dallas is called curative, it's our only non subscription revenue.
As a company. So it's revenue that we earn based on actually placing the doctors. So this will be in our 10-Q, which will come out in the next 12 hours or so and you'll see that that business grew 31% year on year. This past quarter, which is accelerating growth for us and we're actually quite excited about the prospects to go in further digitize.
What today is a very.
Very paper driven industry. So excited that one of the top cruise lines actually chose us to find their ship doctors as they are reopening. So it's interesting to think about it from a cruise perspective, but this is a business that has had to completely reboot right and as they reboot. They are realizing that they don't want to be getting sick Fedex packets of paper.
For work, they would rather be talking with us and doing their scheduling credentialing online directly with the doctors instead of with all of this back office that now seems.
Outdated. So we're excited to see speak to more of the growth there in coming quarters, but recruiting we think it's big big opportunity for us.
Great. Thanks, so much.
Your next question comes from Stephanie Davis with SBB Leerink.
Hey, guys. Thank you for taking my question and congrats on another good quarter.
No.
This first one might be best for Jeff.
I was hoping you could walk us through how you think about daily active users how often that comes up in your conversations with some customers.
They're factoring in for their internal ili population.
Yes, Thanks Stephanie.
So first I'll say, we don't talk about daily active users with our clients.
Really we're focused on delivering them return on investment and at the end of the day, we're a partner a marketing partner over these year long subscription programs to help them get lift.
Now, we do look a lot with them who their target audiences are and what modules. They are employing and the kind of engagement they see around those modules, but.
Yes.
It's really more of an impression kind of model and you'll keep in mind, we only will show a particular sponsor news card wants to an individual doctor.
And again, it's more about finding the referrals and the connections.
I know there had been some reports that have been circulating about our overall usage, which is an important long term metric.
Being flat from pre pandemic levels and I can just hit that head on and say our users and usage is way up mid double digit percentages from our pre pandemic levels and any third party data that suggests otherwise.
I was just wrong and believe me we've looked at this a bunch of different ways.
Internally, we split our three product teams across three different teams that we individually metric measure called news network and comms or communications.
So comms or telehealth has been our fastest percent grower over this pandemic.
Over three times, so from less than 100000 quarterly active physician callers pre pandemic to a record of 330000 physicians <unk> last quarter.
Focused on that metric because we've seen that actually heavy telehealth users also tend to be high prescribers and and refer or since they are hail from specialties like oncology endocrinology and cardiology, which are particularly good for doing telehealth quick follow up visits to help patients titrate their meds.
Heavy prescribing specialties also our heavy tele health specialties, and so we've chosen telehealth active doctors as our core metric and we'll report on it each quarter.
Telehealth is really a very competitive space right now it's a land grab we're proud to have added 50000, new physicians to our paid telehealth platform. This past quarter, and we're going to keep holding our feet to the fire to deliver to continue to grow our market share grow our footprint there of our telehealth platform, which again hit record highs this past quarter.
Very good work on that.
The subtext.
Now and I can't forget either.
I do want to call. It the guidance does imply a pretty meaningful slowdown as we look to the back half of the year.
I think we're being prudent about reopening assumptions I was hoping you give us more granularity about the puts and takes at the detail and let socket and whatnot.
Yes sure.
Your voice.
Start by saying that the shift to digital that we're seeing is certainly a fluid situation and the market landscape is constantly evolving and our guidance really reflects our best estimate.
At this time.
The shift to digital will really look like over the next few quarters now that said our pipeline remains robust and thats reflected in our second half guidance.
<unk> to 40% growth in the back half of the year after a year, where we saw an unprecedented revenue acceleration. So I'd say, we're really pleased with this momentum and then more importantly, what I would focus on and what I would turn your attention to is that we're focusing on building a company that yields long term sustainable growth and we think we can.
To achieve that just given how under penetrated we are into our customers' budgets and the high ROI that Jeff was just talking about.
Behalf of Gabelli.
Your next question comes from Alex Sklar with Raymond James.
Thanks, Jeff on your extension and expansion of <unk>.
Now that you're the only source of voting for physicians what are your expectations around kind of the health system spend as it relates to kind of improving their own standing within those rankings.
Yes. Thanks, Alex Good question. So I will say, we are pleased to be working with U S news as we have and expanding our partnership with them to help patients find the best care in a sub specialized way and they've really been expanding nicely. You may have noticed they used to just do sort of a national and then they started doing regional and <unk>.
Eight level now they're doing local level.
Rankings as well, so it's becoming more and more helpful for patients to find the best care, but the care Thats also local to them and of course that means a lot more hospitals and health systems care about them too. It's not just the top 20 across the country. It's the top several hundred now which is terrific.
In terms of working with them.
Say that certainly hospitals care a lot about what doctors think of them.
And we're proud that we've got the statistical coverage per their rigorous analysis to be able to be in effect the voting booths the polling booth for.
Covering every geography, and every specialty and pulling that together.
Health systems have been our fastest growing business as you look at just our overall internal revenue growth there and I think it's partnerships like this with that will allow that to continue.
Got it. Thank you and then one follow up just in terms of the pricing dynamics with some of your life sciences customers as you've kind of grown the total and active user base and then as you kind of mentioned about the pressure to the Macy and some of the legacy sales and marketing tactics. How much have you been able to grow unit pricing and is that the focus right now or.
Or is that just kind of a future we should think about that as a future lever longer term.
It's a great question and.
No see doctors I'm pleased to hear you, calling some of these tactics of the mainland magazines legacy I wish they were more legacy than they actually are.
When we look at how much is actually still spent there you'd be surprised.
We mainly look at our pricing through an ROI lens, it's our job to be your marketing partner to deliver your results not.
Not through other lenses.
That all said.
Prices are going up, but frankly modestly reasonably it's not the main lever we're pulling right now.
We're in this for the long haul we're playing the long game.
Our point of view. These are partnerships that we expect to have four for decades to come and we understand that.
Delivering good ROI means that they should be willing to pay us more but it's part of our ongoing partnership.
Okay, great. Thank you.
Your next question comes from Richard close with Canaccord Genuity.
Yes. Thanks for the question I was wondering Jeff can you go into the press Ganey partnership a little bit more in terms of how you are working with them is that a revenue generator for you guys in the future just just exactly how that relationship works would be helpful.
Well, thanks, Richard Yeah. So press Ganey I think as folks know works with almost every hospital in the country.
You're required to have a certain number of patient feedback surveys as part of reimbursement dynamics.
So we're pleased to be working with them. They have a footprint everywhere and I will tell you is we try to grow our telehealth platform. We're looking for for more partners right we need.
Places, where we have existing client relationships and press ganey has them again almost everywhere. So we're excited to cross sell frankly with <unk> access.
And get more.
More health systems moving onto our <unk> platform.
We're helping them up their tech came a little bit we've got a strong strong engineering and tech DNA in the company and making it very easy to take this process today that takes usually a couple of days for press ganey to call out to the patient and do a survey afterwards, sometimes a little longer and really make that real time right. After the telehealth visit.
Get a text message receipt right there on your screen and to have that be real time is obviously better quality input.
For for that health system, and also much lower cost than paying lots of people in our call Center.
Indiana to call all of these patients. So I think it's a win win we're bringing the tech side. They are bringing a lot of customer relationships and yes that will help us grow our health system footprint with our telehealth business now that all said our telehealth business is a small single digit percentage of our overall revenue right now so.
While we expect that can be much much larger in the future.
Felt like we're leaning on this press ganey partnership to deliver cross sales that we need to make our next quarter.
Okay. That's helpful. Thanks, and just maybe on the med device and diagnostics.
Yes, that's two quarters in a row, it's sort of been called out as a new initiative and making some progress. There can you can you go into a little bit more detail in terms of do you have a dedicated sales force towards.
Those customers just how are you thinking about expanding in that sub segment.
Sure I'll take that question Richard.
First I, just do want to start by saying and reiterating that our message here remains the same as last quarter. So we still believe our largest opportunity is the markets. We address today and I think the example, I gave where we remain less than 5% penetrated into our pharma customers medical professional marketing budget is really the perfect proof point for why now that said.
You just mentioned, there's also a shift to digital underway under under indexed industries, such as med device and diagnostics and we're encouraged by our ability to capitalize upon that.
With regards to your question specifically around a separate sales force out there right now we're able to really utilize our existing sales force and also our existing module, which I think is pretty unique to <unk>.
Cross sell to this new industry. So we're really talking about the traction we're seeing there, but I do want to just reemphasize. Once again, we don't really expect to hit our markets to represent more than a single digit percentage of our revenue and so in the near term we're much more focused on really penetrating our core pharma and health system clients.
Okay. Thank you I'll just add quickly Richard this is Jeff Yes, we are considering a separate sales force there.
I have to say I've been surprised at historically medical devices, and specifically have been incredibly salesforce focused and the marketing budget is relatively small in the digital marketing, even smaller still and to see them stepping up and paying seven figures and coming to us in some cases.
Its been gratifying, maybe it's a sign that this this IPO marketing bump really does exist.
But theyre thinking of us coming to us, but it's also a sign that things have really changed and how doctors communicate with industry.
We're excited to see that kind of momentum in our space that historically hasnt really done much in digital marketing.
Alright, thank you.
Your next question comes from Jackson Ader with Jpmorgan.
Okay. Thanks for taking my questions guys.
I actually just follow up on the just that 90 basis point that you just mentioned, Jeff do doctors have the same kind of purchasing decision power like do they have the same agency purchases of medical devices and diagnostics they do for prescription.
Short answer is yes, I mean, if you're a orthopedic surgeon and you're deciding what what devices you choose to use cninsure.
So short answer is yes, and whats interesting actually is that our surgeons.
I have always been among our more active users are actually the first one is again on the platform because they care about referrals right and.
They want to be connected in their local local markets to other physicians.
But in terms of having ways to monetize them, it's been a little harder because again the medical device firms werent really into digital marketing and now that they are I think that opens up a whole new a whole new avenue for us to leverage some of these surgeon relationships that we have that are among our strongest.
Okay, alright that makes sense.
And then as the as the author and some of the Spooky engagement reports.
I'm curious if the if the data from third party providers.
Erroneous unfounded.
Whatever.
And then where would you suggest investors or analysts ago.
To source some of the engagements.
Might not matter on a short term basis, but.
Certainly might matter in terms of the health of the network in the long term.
That's a great question and certainly report did lead to a lot of I think productive constructive discussion on R&D, obviously the biggest issue.
A lot of these third party trackers are based on three VPN software, which largely hospitals and doctors know end users I think the one you did use is based more on.
App tracking, which apples made really hard to track other apps.
So Android is a little friendlier, but doctors from our from our coverage and study and I think we would know as well as anyone doctors are 85% iOS or iPhone only about 15% Android so it doesn't cover that market very well.
If anything I would say looking at some of the data that we've seen out there. It's interesting it's picking up some of those health care workers that we opened up to at the start of the pandemic you may recall at the beginning of the pandemic, we offered a free year of telehealth to all health care workers in the U S. Because we just wanted to do our small part to help out.
And we're so pleased that so many of them were able to use it to call their patients and call their patients' families, but we have thousands of receptionists and back office hospital folks who adopted us.
And we have been phasing out that products, we're really focused on serving clinical users.
So that might be some of what those third party data sources are picking up.
As maybe those Android users.
And of course, Theyre missing all the web users, which is a big chunk of what we do too.
I honestly don't have a good answer for you on where to look on those reports I know inside.
The pharmaceutical industry. There are some reports that <unk> and others do put out.
Those are largely survey based but that's that's where our clients tend to use in addition to just our own actual reports that we provide back to clients after each program.
But there is.
Unfortunately, not not a good.
Sort of.
Yes.
Nielsen sort of this space.
Alright, Okay, alright, thank you very much.
Your next question comes from Ken Zerbe with Morgan Stanley.
Thank you Craig on for Ricky just follow up on the comments of 40% year on year growth in the back half.
<unk> for the March quarter is around 33%, which suggests it's getting closer to kind of your more normalized view of 30% net revenue retention.
Can you just talk about perhaps just the potential puts and takes around kind of the return to normal.
Sure Hi, Craig.
So here's what I'll say here around our Q4 growth. So when we talk about our net revenue retention I wanted to kind of think about that a little bit separately. Then we think about quarters year over year growth. So net revenue retention is a trailing 12 month metric. So it is a direct function of our trailing 12 month revenue growth. So if you think about the lenses. It was 85% this past.
Quarter now as our TTM growth rate normalizes, which we are predicting the future. Our net revenue retention rate will normalize as well, but I do want to add that we certainly anticipate existing customers will continue to lead our growth here for many reasons. So theres the deep relationships. We've built there is a high ROI that they've become accustomed to in our platform.
The multiple cross sell and upsell vectors that we have and then there is finally, the large budgets that they have that are very under indexed in digital.
So while we once again are kind of guiding towards the center.
This metric will be we do think it will track pretty closely with our overall trailing 12 month growth rate and in the medium term, we believe our baseline which is where we landed in the pre pandemic years in that range of 130% plus is likely what we'll see and once.
But again, that's still very strong NR, we're very very pleased with that.
Got it appreciate the color and then just a follow up in terms of the strong growth you're seeing given the tight labor market are you seeing any constraints in terms of looking for to reinvest in the business.
No not necessarily at all actually Theres, a tight labor market, but our hiring.
Remains robust here and I'll just add if you look at our quarter that we just had the EBITDA beat was entirely driven by our revenue outperformance. So we spent in our opex exactly what we said we'd spend so we're pretty on track for our hiring plan.
We're still continuing to invest very heavily in our R&D teams and our sales and marketing teams in order to keep growing our topline.
Thank you and then add this is Jeff.
Adding RF user recruiting package has been a big bonus.
Certainly made things a lot easier.
And yes, we have been doing well, we were three quarters remote or distributed as a company before the pandemic hit and I think we've.
Earned good stripes as just being a company that knows how to manage that hybrid.
Work.
Lifestyle, well and Thats allowed us to recoup from a pretty broad base.
Terrific.
Your next question comes from Sean <unk> with Barclays.
Hi, Thanks, so much.
So on the telehealth business, what can you share with us about any metrics on either utilization or.
Some details of monetization strategy and maybe even how much did that contribute in the quarter.
I'll start I think Ana can speak to the contribution which again I think the small three or 4% of our revenue, but again, it's ramping nicely and it's.
Subscription ramp.
In terms of the utilization.
Again, we had a record number of doctors trying us out I think really just spreading the word is spreading inside the enterprises that have adopted us and we're becoming the favorite to go to the the first place that they've got to go initiate that visit.
In terms of overall call volume is down of course I think the.
The time, a year ago was really the peak time for shutdown and everything else, but again our model is not based on number of visits in any way shape or form.
We're not a telehealth service provider, we're not providing a health care service were more like a zoom and we get paid per user per month. So from our point of view that ebb and flow will be good.
Just add Sean since I know you are a student of the game and of the industry here I think there's a really interesting debate that's going on inside telehealth right now around what is appropriate care for telehealth and I think there's a big debate that's happening around us it really appropriate for certain types of urgent care emergent care visits given that when the patient presents with a hole.
Host of things.
Are they getting the highest quality care if it is telehealth and I can't get a full sense of the patient.
So a lot of our clients are making the argument that having a pre existing client relationship is important I think for successful telehealth and again, but we see that it's been really successful and received high patient scores and doctor scores for those follow up visits with the diabetic patient who.
It would have otherwise had to travel for an hour and a half in an hour and a half back and sit in a waiting room for a half hour all to have a 10 minute visit to ask how it's going and titrate. Their meds I think telehealth is exceptionally good at that sort of a quick follow up visit cadence and I think our product is actually well built for that use case as well.
Yeah.
Hi, Sean this is Nate I'll touch on monetization.
The enterprise business that we have today and telehealth is growing nicely again, we expanded the Paypal offering by 50000 physician licenses in the last quarter and the primary driver.
Purchasing decisions as a combination of remain the favorite among physicians for ease of use I think as evidenced by our user metrics among clinicians over 330000 in the last quarter and also being a leader in the class I T department ratings to be able to integrate easily reduce no shows.
Great network effect here with the rest of our platform such as checking the news feed between minutes is that we want to keep the price of the basic offering competitive as we seek to gain share and leverage those engagement benefits in the long run we believe that we can upsell additional capabilities here over time, but when we do that a win win for US is something that helped.
Doctors be more efficient and there is a lot of adjacencies that fit that mold and I think you can see some good examples.
In terms of helping improve the sales specialists or just the.
The progress that we've already made but I am encouraged by in optimizing the post telehealth call experiences with those trusted brands update press ganey.
Thanks very much.
That concludes the Q&A session I will now turn it over to Jeff <unk> for closing remarks.
Alright, well. Thank you everybody for joining us today, we really appreciate it and again I'd like to thank the entire doximity team for their incredible dedication and results. This past quarter. Thank you for joining.
This concludes today's conference call. Thank you for joining us.
Correct.
[music].
Okay.
Sure.
[music].
No.