Trellus Health (LSE:TRLS) — Full Year Results

0:01 Good afternoon, and welcome to the TRELLUS HEALTH PLC full year results investor presentation. Throughout this recorded presentation, investors will be in listen only mode. Questions are encouraged and can be dismissed at any time by the q and a tab situated in the right hand corner of your screen. Just simply type in your questions and press send. The company may not be in a position to answer every question received through the meeting itself. However, the company can review all questions submitted today and publish responses where it's appropriate to do so. Before we begin, I'd like to submit the following poll. I'd now like to hand you over to doctor Marla Dubinsky, CEO. Good afternoon to you. Good afternoon. Thank you. Good afternoon, everybody. Good

0:33 afternoon. I'm Joy I'm Marla Dubinsky, cofounder and CEO, and I'm joined today by Joe Joy Besinger, CFO and strategy lead. And we're excited to be presenting today, on, Trellis Health and our innovation for whole person health, our annual results. Here's our disclaimer. So, just wanted to refocus on our company overview and focus on some key elements of our value based, innovative solutions that we're offering to, for comprehensive management of chronic conditions. There's three main sort of key constructs around our our product, which is it's patient centered, it's outcomes focused, and value based. We're gonna get a little bit more into, the terminology around value based and where health care in general is going, particularly in The US. Just remind you about the two key elements of the method that we licensed from Mount Sinai and focus first on our ability to apply a scientifically validated metric or measure of an individual's resilience, which has been able to identify, stratify, and predict individuals who are at risk of high cost, low resilient, behaviors in a population of inflammatory bowel disease patients, which includes patients with Crohn's disease and ulcerative colitis.

1:57 We're also the first company to take, an understanding of an individual's behavior and be able to actually target and focus personalized support that is based in condition management resiliency, and being able to prove that it's able to modify health behavior, meaning an individual's behaviors that they're exhibiting, and also improve psychological resilience and health outcomes, which mentions comes in the value base, which is reducing the cost of care. So not only are we elevating the outcomes of individuals who gain resilience, but also reducing the health care costs that are associated with these low resilient behaviors. We're deploying Trellis Elevate, which is really the whole entirety of the program, which includes the platform or the engagement platform where individuals who are enrolled in the Trellis Elevate program interact with the learnings, the teachings, the education, and the team, all, delivered digitally to be able to, change behavior, and these interventions are supported, and recommendations are solely driven by an expert trained support team. So this concept where we're technology facing, but really this hybrid model where we have a team of trained individuals that are focused on customizing and designing the program to meet the individual needs of that, member who has joined the program based on their initial assessment of where they are in their spectrum of resiliency.

3:26 And also note that because we are focused on resiliency of an individual who is, suffering from a chronic condition that allows us to really deliver value by actually partnering with the member, making these members more active participants in controlling their condition and also actively engaging in their in their overall care, which allows us really to align, and we'll show you a little bit more as we discuss some of our opportunities and our partners really where we align in this value based ecosystem. Because everyone really in health care is interested in saving money and improving individual outcomes. But at the end of the day, the cornerstone is really being able to actually help individuals become empowered and take more control over their health. And that's really the construct under which our programs have been focused and designed and developed.

4:20 So just to highlight the 2023 highlights as a reminder, so new leadership, Dan Mahoney came in as chairman of the board. Julian Baines went and was our previous chairman and is now, with EKF. And similarly, Steve Young, who was serving as interim CFO, has joined Julian and EKF, and we were able to, be fortunate enough to have Joy Besinger come on as our full time CFO and as noted earlier, leading the strategy. A couple of key highlights also, we developed, the irritable bowel syndrome program. So we already have a program that is ready to go, and that's built for our clients who want to expand their offering beyond inflammatory bowel disease who also want to encompass other chronic GI conditions. So because they're similar in nature in terms of the type of resiliency training, it allowed us to easily sort of customize an IBS program.

5:16 We launched our early b to b pilot programs in inflammatory bowel disease, and we'll get to that in just a moment. We did complete our direct to consumer model, and transition them to a community testing program and what our DTC model, which we've talked, before in the last two, both the in interims in October and also our annuals last year, was really to talk about that we needed to ensure that the model worked outside of Mount Sinai, which is really in person analog, programming to be able to make sure that the program is something that is needed across the country, not just in a region, not just in one hospital health system, and be able to ensure that we're evolving with the needs of the individuals that would be, using the platform.

6:02 We had positive data that and real world evidence that supported the TRLS elevate model based on our direct to consumer, model. And we actually showed that unlike at Sinai where we actually saw it took about eight to nine months to really notice behavior change, what we saw is we can get there faster when you actually go to where the patient is living and be able to have it digitally delivered. So they're not needing to come to a provider's office, but it's actually being delivered where and when they need that support, at that time. Also, we, in 2023, we finalized the scope of work for national, health insurance plan. We've now launched. We'll get to that in just one moment. We also had talked about last time that we built we really were ready and built to scale and built an enterprise level platform, which accounts for many things, reporting metrics. Mhmm. It also accounts for privacy, our ability to have certification, which is really the industry standard around privacy and security controls and compliance when you're dealing with personalized health information from our health plan partners and attain the operational scalability while maintaining a cash runway into mid, 2025.

7:16 So now let's get to the post period highlights. We're here, we're April 2024. So we're, happy to note that we executed indeed on our contract with large US health plan, which is UnitedHealthcare. We not only executed, but also launched TRELLUS HEALTH PLC. Mhmm. We completed our early pilots, and we'll talk a little bit about what we learned from that. We also I mentioned the psych SOC two type two certification, which as noted was really meeting industry standards for system security and reliability. We signed two licensing agreements with pharma for one for our proprietary resilience assessment to look at how individuals who enter into clinical trials, what is their overall resilience portfolio, and can their resilience in any way impact outcomes and data seen in a clinical trial setting. And the other one was for content.

8:10 You know, we have a whole person sort of support content and wellness, and lifestyle content that one of our pharma partners who they themselves have an app and wanna deliver more holistic, support for individuals who with ulcerative colitis who are either on their personal their drug that they're marketing or just having UC alone, being able to offer something beyond just a therapeutic, but actually the whole person, approach. So they've licensed some of our content for some of our modules, which are called jump start modules, which are in the moment sort of health behavior, how to manage pain, how to, manage your mood, how to manage stress, worry, all in the moment. So these are short exercise and videos that our pharma partner will be offering on their, application.

8:58 And continued scalability and operational scalability while maintaining cash runway into mid twenty twenty five. You'll see the theme, and then Joy will update us on the financials, and we'll get back to that a little bit about where we are. Mhmm. So just, taking back taking us back to where our role is and how we offer value and what our business model is, it really is about understanding that the totality of Trellis Elevate and the program and the platform by focusing on individuals and getting them to have an active role really is a cornerstone to value based care. Now there are many companies in this value based space. Right? Because the value quotient is if you improve outcomes of individuals and do it at lower cost, meaning our health plan partners or health systems save money doing that, that means you've met the definition of sort of enabling or providing value or being part of an enabler of value based care no matter who is trying to deliver that. Now there are key components to be able to do that, and I'll just highlight what we do and why it is considered patient engagement and really focusing on, individual self management and activating is because patient engagement, it really is a cornerstone of value based care, and a lot, as noted, companies are focused on the provider, changing provider behavior, working ways to improve billing efficiency or our electronic medical record or maybe referral pathways to

10:28 get people in the door sooner, trying to reduce the ED utilization, trying to reduce hospitalizations, trying to really avoid unnecessary care, and trying to connect individuals to take more control of their health and relying less on the emergency room or the urgent care. So, essentially, there are really two main components at a very simple sort of simplistic way is, one, you have to identify and assess individuals at most risk of using the emergency room, having more surgeries, not adhering to their medication because that's really where cost accrues. But it's one thing to identify that individual, but it is another to go in and engage them and personalize and drive behavior change.

11:16 So I think those two and that's why I started at the beginning talking about really the the two components of the method, and that really is the visibility and the ability to predict that someone is gonna use their health care system unnecessarily, but also intervene and fix it and really deliver at a customized tailored way to the individual and not just everybody does the same program. I think when we talk to our our our partners, the key things that they wanna know is, one, you could actually tell who the reason why someone may be engaging in low value care. Yes. Because we have visibility into their resilience. We go to their home. We understand what are the what are the drivers of high cost care or high, low value behaviors.

12:02 And we also personalize their management or their support based on where they are in their journey and specific to their behaviors and sort of this concept of, assessing and engaging leads to improved outcomes. And that's really the green box really is what value based care is. You actually improve the clinical outcomes and fiscally responsibly and be able to lower the cost all while improving and the health of individuals, both mind and body, this concept of whole person. And that's really, again, the cornerstone of value based care, and we've got that solution. That's how we partner with our clients. So, also, just to go back and understand what does it mean to be a company or a solution that offers value or enables our partners to deliver value based care or sustain this value based model. So we're enabling our clients. Right?

12:59 We have addressing both the physical and emotional aspects of having a chronic health condition. We offer personalized support, activating lifestyle and behavior change. We use technology to be able to improve efficiency and customization to our to a user. We use understanding education and empower the one to actually better self manage, not rely on, as noted, the emergency room or the constant in basket message to providers who have their own pressures to be able to deliver, their financial responsibility to the system. So there's a lot of a lot of work to be done to really keep patients out of the d ED in the hospital, and part of it is being able to actually empower the patient to start, activating their self management.

13:46 All of that results in the end game of cost savings. Right? So we do the all of that. Right? That's our presentation to our our shareholders. That's the presentation to our clients. That is our story. And we've had this story from day one, but we thought maybe to just remind, all of you where where the integration of what we do and why it matters and why this is an important, moment for TRLS because we're able to take what we did at Sinai, which just that just as a reminder, what we did at the Mount Sinai Health System is we showed that when you measure someone's resilience and deploy a program that is personalized to build someone's resilience, when resilience goes up, health care utilization goes down, and outcomes improve.

14:33 That is at a very large health system with a very high prevalence of inflammatory bowel disease, patients who have complex disease. And the fact that we were able to do that in a very complex, patient population because we're a tertiary. We're, like, fifth opinion, seventh opinion on occasion. Patients have had long standing disability and sort of long standing both mental and physical disability and the fact that we were able to teach someone resiliency and lower the cost of care through the patient. Right? Going directly to the individual, not trying to change me as a provider behavior, but really focusing on what we know changes cost, and that is the individual. So that you know, knowing that and knowing the importance of what we already did really allowed us to have very high level discussions.

15:23 We talked about on '23 and now launching. So we thought we would tell you at a high level summary. As you can see, we just recently launched with UnitedHealthcare. This is the terms around the current agreement, sort of the first phase of our partnership. The region that we're focusing on delivering Elevate to or TRELLUS Elevate is in the New York and Connecticut region specifically. The term of the, contract, the initial term is twenty one months. That includes a six month enrollment period. And every single individual from day one of the enrollment period until literally the final day of the enrollment of that six month, everybody has access to at least twelve months on the program, free access to the members. There's no cost to the provider as well for their member for their patient to be on the program.

16:11 So those are the terms around the initial contract. As noted here, resilience scores are a key outcome metric. Why are we emphasizing that is because on the Sinai slide, what I showed you, it is very well known that when you raise someone's resilience, even at four months or six months, it predicts that you will have better health care outcomes. So the point of this is that resilience scores is really an early indicator that we are moving forward in terms of providing what we said we're gonna provide to our to our partner, and that is a predictor of lower health care costs. So it's important to note that the initial assessment of our value to our partner is really our ability to change resilience in these members early, and they saw that at Mount Sinai, we're able to do that. And then in our early direct to consumer data, that data was very important because it actually showed that we can do that within that six month time frame because that means that long term, there will be health care savings. So there's really the fact that we can do that early and we don't need to wait until twelve months to show that someone's health behavior change is an important metric for us to share with you.

17:28 Another, sort of highlight that we wanna talk about when we talk about the program in general is really the commitment of our, of our partnership here is that we are in real time weekly having steering committee calls, allows us to review where we are, ensure that the messaging is aligned, ensure that together we are continuing to get, members to have access and know about the program. And that's really been instrumental in us problem solving if there are things that we need to change, if they need to change, if their outreach needs to be different, or the messaging needs to be different, we are sharing in that knowledge and lived experience in real time. Also, just a reminder of the business model for a pricing model for this particular program, it's a monthly fee per engaged member per individual member of the program, but we also had a onetime in in implementation fee in the initial, term. But also highlighting just to let you know how sort of it works is that an individual a member eligible member is made aware of the program.

18:35 They then, go to the website, which starts their, their engagement. They fill out their resilience assessment and their disease complexity assessment, and then they have a call where first human touch with a TRELLUS team member, which is the resilience navigator. At that time, the navigator is reviewing the scores and the results of their online assessment, determining whether they qualify for the program. So being eligible means

19:04 it's offered to you at no cost to, from your health plan, but then making sure that we're engaging with the right individuals, those who have very high disease complexity, those with low resilience, for members who happen to have very, very low disease complexity sorry, not high disease complexity, but have low disease complexity and have high resilience, those members are already reached the outcome for which TRELLUS was built. So at that moment, we do, screen them. We let them know that at this moment, they have their high resilience score and give them a tip sheet of when to come back. So that way, we are actually reimbursed for that screening fee, for those who actually don't go into the monthly. But at any time during the opening of the contract during the term of the contract, they are able to come back and reengage because our partner knows that life changes.

19:59 IBD constantly changes. So the ability to have a place like TRLS, if things change in their disease, if they've had surgery or there's other life events or challenges that have rendered them needing a little bit more of a toolkit, then they are, going to be reassessed and reengaged in the program. Another sort of concept that we've learned, is the importance of a cobranded customized launch site. So individuals will be, given their material, which is the marketing material, the outreach material by both us at TRLS and our digital marketing campaign, but specifically from the health plan where there are emails and there are actually, mail campaign with trifolds and brochures that come in the mail with a QR code as well as every month that someone becomes a new member with the health plan, they actually get told about this opportunity. So there's this constant sort of funnel of new people every month who are have, now a new health plan, for example, during the six month enrollment.

21:06 Additionally, those that are already members will also have reminders and outreaches directly from UHC. There's also a provider campaign because what is known is that patients often rely on their providers to sort of endorse that there are programs out there that would work along their treatment plan and don't want to intermediate or do something that their provider wouldn't approve. But the good news is, as, some of you may have heard me say this before, TRELLUS HEALTH was built for providers as well because us as providers, IBD is very complex. It's hard to monitor our patients outside of the office, and TRLS really provides us connected continuous support. And my provider friends know that if it's driven by something that worked at Mount Sinai, their patients now have access to something that is considered gold standard nationwide.

22:00 So I think this really allows us for them to be reminded, providers that this program is available. And, also, TRLS has engaged, and we show a screenshot here of miss Sydney who is talking about her experience with TRELLUS and sort of that holistic, approach and sort of that three sixty integration of mind and body, physical, mental, and emotional. And we've got a whole marketing campaign, Instagram, Facebook, LinkedIn, etcetera, for our bill our ability to really get into, the ecosystem of how people are searching for health care solutions these days and be present when they're getting this material from their health plan. They know what TRLS is. They see a face of someone who has experienced TRLS. So that's been really important.

22:46 And the final point is the fact that it's, located in Connecticut and New York, which is where I am located physically. It allows me to have some direct honest conversations with my colleagues who have always wanted to have sort of the methods somewhere and send our their patients to us at Mount Sinai just for their program. But because we have to only see patients who are followed by us, it's not something we offer to, patients outside of Mount Sinai health system. This was really an opportunity for now their patients to get access again to what is considered gold standard whole person support. So it's set up really for success, and, hopefully, you hear the tone around our partnership and our and our, relationship with, the team that's been working with us to launch this program.

23:33 Just to update you, we noted in, post post period highlights that we've closed down. We've concluded, actually, the pilots that we initially started with Mount Sinai, because those programs weren't based on cost savings. Meaning, our KPI or outcome was not to

23:50 save money. It was really to ensure that individuals at Mount Sinai or those who seek care for IBD at the Mount Sinai health system have broader access than just those that may only see me and Lori at the IBD center as an example. So these were a couple of different ways that people can have more access. We saw again that through the, program that individuals met their outcomes of increased resilience. And a couple of things we also learned is that it is really important that the health plan is driving the messaging and reminding them at no cost that this is available. And that was sort of a learnings that we learned outside of Mount Sinai is that this needs to also go beyond Mount Sinai and that being able to get a broader reach of members who are at other health care systems really is the way that TRLS moves forward. But, also, another aspect is we have a set limited team member. We have a set budget for technology. We have a set you know, we have resources that we needed to ensure are available for UHC. Right? It was very important that now that we have our sort of a contract that is focused on cost, real metrics around resiliency, and its association with total cost of care, we wanted to just focus all of our research allocation to this contract.

25:11 And so that's why we've concluded these, and one of them, the, managed care health plan, will be concluding at the end of May. So that's where we are with that. We really field tested our method, our technology. We improved actually our technology because of some of the feedback. And what we really also learned is all around engagement. It was really important. So we've really focused on ensuring we develop the right UI or user interface and u UX, the experience, and the and now we're really also focused on engagement because we're able to get this early field testing to say, this is what keeps people on the program. And because we're paid per engaged member per month, part of it is, one, getting people on, but also ensuring that they engage over time. And that's really been the focus and joy we'll talk about the financial, financials now. Yeah. Thanks, Marla. So we ended the year with a cash of 12,200,000, versus 19,000,000, the same period last year. Our adjusted EBITDA loss was 5.8 versus 8.1 in the same period last year. So you can see that even though we've made a lot of investment this year and got getting really ready to scale for United, we were still able to really bring down our costs and be very careful managers of the investment. We've spent about 9,000,000 in capital investment to date since our founding on our tech and our software.

26:33 We expect that to start going down starting this year, and I'm gonna talk about that a little bit more as we go forward. So we're looking to focus on bringing in more partners, large to midsized partners. We are able to continue to develop and scale with what we have on hand. Our cash resources are sufficient to get us into mid twenty twenty five. That's with assuming conservative revenues and actually understanding that we can start bringing down our incremental capital investment. And I think I I'll actually talk. Thank you. I'll actually talk about this more as we talk about traction. So in addition to revenue growth, improving our cash flow, which are obviously very important, the health plan, the licensing agreements we signed earlier this year are important. We're gonna expand our active members.

27:20 We're gonna be able to bring in new clients. We can do this at lower cost because now we have a playbook for how we approach this. Now we have the metrics in place for reporting, for our content and what we can offer, what we can how we can tailor. We're very we're able to be very nimble. We've been able to improve our technology. We're gonna be able to lower our cost to deliver at scale. We're already doing that with United, and we're gonna focus on expanding the TRLSLEVATE to meet market demands. And we're again, we're seeing this as when we announced United, we already saw some a sense of FOMO perhaps in other insurers. So they are actually starting to pick up their pace of conversations. I think just to touch back on the other point about the capital investment, we're in a unique position as a company at our smaller size at our at our stage of development.

28:12 We actually can now we have built an enterprise level solution. We are ready to to cater to the Uniteds of the world. And I think it's important to to note that we're able to do this while we can now stop start moderating how much we spend on capital investment, how much we spend on our platform. And going forward, we are able to tell partners if you want something especially bespoke, we will build that for you.

28:38 It will be included in implementation fee, and it won't start being built until the contract is is fully signed. And I think that that's an advantage we have over other companies our size. Yep. Thank you. So then just to end, you know, sort of thinking about the summary of what we've discussed today, but also what's what's happening for us in in the rest of the year. It's really you know, obviously, we began to deliver commercialization at scale. We're expanding the the platform, to engage more active members with our existing partner, but also as we build out new partners. Obviously, the agreement with UHC does kick start a shift to more commercial scale and facilitates discussions specifically focused on the cost saving model and that value based enabling solution that we are. Obviously, talked about the cash on hand to execute for our current partner and secure additional. I think that was really important concept that we really wanna make sure we've gotten across is that we built it for large scale. Right? So we invested early, and you noted that

29:39 towards the second half of this year, we'll be able to really get to a level where it's more of a maintenance for for the capital investment. I think that's important because even though more people will come on, it doesn't mean more cost. And I think the fact that we've built it for such, an important partner allows us to bring individuals on without incrementally increasing the cost, ongoing discussions, with other large and mid sized, b to b partners. And I think probably the most important messaging across is the systems playbooks and insights that we've really taken, over this journey that we've had getting to where we are today, highlighting what we understand to be our goals for traction, revalidating that we're in the business of value based care, and we get paid when we save others money. And we know that our method saves money. And I think now being able to, with confidence, be able to take all of our learnings and execute our current contract, but also execute the additional contracts that, we're gonna be progressing and the goal will be to progress too. Of course, that's our growth opportunity that we now have a playbook to discuss.

30:48 And I think that has been clear and have, has allowed us to be where we are today. So thank you so much for for your time, and we'll open it up for, questions. Thank you. Perfect. Marla, Joy, thank you very much for your presentation. Ladies and gentlemen, please do continue to submit your questions just by using the q and a tab, which is situated on the top right hand corner of your screen. But just for the company to take a few moments for you, those questions have been submitted today. I'd like to remind you that recording of this presentation along with a copy of the slides and the published q and a can be accessed via your investor dashboard. As you can see, we have received questions throughout today's presentation. And if I could perhaps hand back to you at this point just to run through the q and a, I'll pick up from you both at the end. Sure. So I'll start with how does TRLS help measure and evaluate member engagement with the platform? Great question, actually, because you saw it's per engaged, member per month. So that we actually have a number of ways that individuals can engage, and we've set up the platform, whether it's just a direct message, whether it's login, whether it's tracking your medications, whether it's tracking your vaccination, whether it's, having a telehealth visit with your coach, whether it's filling in out your resilience assessment.

31:58 So we've got sort of a composite. We've got so many ways and push notifications. So someone gets a push notification if there's a new assignment. We also have emails. So someone will get an email that their team sent them a new assignment. They can click right on that email and get back into the platform. So as long as they engage in the program through multiple modalities, that defines engagement. So we've built it to be able to win on the engagement strategy. So thank you for asking, that question. In terms of KPIs for effectiveness, so as noted, the real key KPI is the resilience score in the short term, And we actually measure that at day 90. So we will already know sort of ninety days in. It's a standard. We measure it at baseline ninety, one eighty, and then, again, three fifty for those that are still extension beyond the, one eighty days because not everybody is able to, rally and get their resilience back to high resilience in just six months. If you the lower you are on your resilience assessment when you join the program, the longer it takes.

33:08 That's a lot of work that patients are willing to put in, obviously, members. But, you know, if you have the disease for twenty years and you have depression and anxiety and you've had three surgeries, it's gonna take a while to get through sort of the complexity. But we did it. We did at Mount Sinai meeting, we know that this is actually possible. And so it's really about the metric of resiliency. And, of course, as everyone approaches their twelve months, looking at the total cost of care, because that is still our business model, right, is that we still need to show, value from a cost. But it's remember, the quotient for value is both increased outcomes, which means higher resilience as well as lower cost. So it's not just the cost base. So there's this balance between outcomes and and cost, but thank you for, for asking. So, beyond the current agreement, obviously, our goal is to continue to expand discussions with health systems, other either regional, or national health plans, as well as, continue to build out some of our pharma, discussions actually. Because as I said at the beginning, what's interesting is the common denominator for everybody in health care is the patient.

34:24 So everybody has their own ways of helping themselves improve their value because they're gonna be held accountable, but nobody actually has the patient in mind. And so I think what's what you'll see, our diversification, over you know, the goal is for the rest of the year is really to show that we do live in different lanes because we are helping patient center. Right? So it's at the center is the member itself, and that's who are who are users. Right? Our end user is the member or the patient. So I think that's what you're gonna see, and that's our goal is that we're continuing right after sort of the signature happened. Joy and I were obviously already saying, what are we gonna you know, this is where we're going next and evolving those discussions faster because we had made you know, we had gotten been able to progress with executing and and signing the contract. So we look forward to updating you on the pipeline when we are here again on the phone.

35:23 Yeah. One question on regulatory because I think that's a a great question. And for those who have been with TRLS since minute one, you know that we actually initiated in 2021 as building provider offices across the country and getting, psychologists and nurses to deliver it and try and copy and paste exactly what happens at Mount Sinai. And in spring of twenty twenty two, when there was thoughts around the fact is, is this gonna cost more money to set up professional corps across The US and get people credentialed and hire providers? The answer was yes. Yes. Yes. And there was a strategic decision at that moment in spring of twenty two to actually switch to a coaching model where we're not delivering care, we're not diagnosing, we're not treating with a drug, we're not using any regulatory hurdles to deliver it. And I think once we became condition management through health behavior change, there is, in FDA guidance from 2019, there is all around this wellness concept. And within the wellness products falls, behavior change strategies, lifestyle, companies that are focused on behavior change for category one is general population.

36:43 Category two is lifestyle and behavior change specific to chronic conditions. So that allowed us to, live in that environment. And as noted, there are clear criteria what what deems you a device, and we do not meet criteria of a device, and we are not delivering, care in the traditional sense or prescribing. And those were really important, important components. So thank you for, the the discussion or the question around it. So maybe, Joy, you wanna take the Sure. I'll let cash. Actually, I feel like we we talk about this a little bit, but I'm happy to to highlight it again. So the question is despite the decrease in net cash position, the extension of the expected cash runway until midyear twenty five as mentioned. Could you provide more details on how the company plans to manage its cash resources, particularly considering the ongoing commercial traction? So I do think that that probably in the near term, the most important thing that we can discuss is to just reinforce that we expect we are in an unusual position at a company at our stage of development and at our size, that we built an enterprise level solution, which United is now on, which has room for more people to come on as it is right now. We were ready for this. It's already at commercial scale.

38:02 So we are able to continue to not just be keep a good eye on our spend, but also more importantly, we're not gonna be able we're not sorry. We're not gonna have to make further really big capital investment as we have been up to date. We're gonna start seeing that drop off. It's already come down a bit. It'll drop off in the second half when we go into maintenance mode where we're maintaining the tech, updating it, making sure we keep up with the times, but we're in a really good position, and I think that was done, deliberately. Yeah. Thank you for the question. Yeah. And thanks, everybody. There's no other no further questions. So, one, we just wanna thank everybody. Hopefully, this update sort of gave you the information you need to understand where we've come and how we're gonna be gaining some traction.

38:51 I think when we come back in October, there's gonna be some interesting data that we're gonna share as well as update you on our further discussions with other clients. So thank you so much. Thank you, everyone. Perfect. Marla, Joy, thank you for updating investors today. Could I please ask investors not to close this session? I should now be automatically redirected to provide your feedback in order the management team can better understand your views and expectations. This will only take a few moments to complete, but I'm sure it'll be greatly valued by the company. On behalf of the management team of TRELLUS HEALTH PLC, we'd like to thank you for attending today's presentation, and good afternoon to you all.