Inari Medical (NARI 1.84%) went public in what should have been one of the most difficult times for a non-COVID related healthcare company ever -- May 2020. Yet it has ridden the success of its clot-removing devices -- the FlowTriever and ClotTriever -- to 124% gains since.
With earnings coming up, it's a good time to reflect on the past few quarters and determine what investors should be focusing on in its next report. Aside from revenue growth, which everyone obsesses over, the key questions for management center on what investors can expect in a post-COVID world.
1. The impact of COVID
Inari only had three quarters with a product on the market before the pandemic changed the healthcare world. Because of that, management is still trying to get a handle on what "normal" actually looks like. While the company has put up impressive growth numbers, it believes restrictions related to COVID-19 have held it back somewhat. On the first quarter earnings call, it pointed to sunnier skies ahead. That's hard to imagine after 113% year-over-year growth in the first quarter of 2021.
That said, hospitals full of patients who had delayed care and staff shortages may offset the tailwind the reduction in cases should provide. After all, it wasn't necessarily the COVID cases themselves that got in the way, it was the lack of access to the pulmonologists, hospitalists, intensivists, and ER doctors that represent potential customers. If they are still too busy to focus on new treatment approaches, the headwinds may persist. Investors should listen for indications that salespeople are able to connect with the potential users of Inari's products. The recent increase in cases and hospitalizations in certain geographies may also prove to be a valuable topic for gauging growth the rest of this year.
2. Expansion of the sales force
Speaking of salespeople. One item management pointed to as a key to its impressive first quarter growth was the expansion of its salesforce. It is also consistently listed as one of its five levers of growth for the future. CEO William Hoffman believes the salesforce will eventually rival the largest interventionally focused sales organization in the market.
To achieve that, Inari will need to hire people. And that's something almost every organization has been struggling to do lately. Management reports a good proxy for that hiring -- sales territories -- each quarter. It started the first quarter of 2021 with 130 and added 20 over the subsequent three months. After previously guiding to only 10 additional territories per quarter, Inari now believes it can have 180 to 200 up and running by the end of the year. Given the tight labor force, specialized knowledge, and lag between hiring a salesperson and getting trained doctors to use the products, it will be important for the company to show it is on pace to achieve its aggressive target. If it can't, Wall Street will be quick to assume the previous revenue guidance of $240 million to $250 million is in jeopardy.
3. Adjacent market opportunities
Finally, a less quantifiable update I'll be excited for is on adjacent markets. Inari has been coy about where it might go next. Admittedly, there is still plenty of opportunity for FlowTriever and ClotTriever. Management believes it treats less than 5% of patients who might benefit from its devices. Still, they have said they are actively working to address unmet needs beyond their core products and plan to discuss them in future calls. I'm excited to hear about them, but I expect I'll have to wait.
Hoffman learned a painful lesson in last year's third quarter earnings call after projecting a launch date for its FlowSaver device. That's a simple contraption that lets doctors return extracted blood back into the patient. Unfortunately, the Food and Drug Administration didn't have the same timeline as the company.
In late-July, Inari did receive notification from the agency that the FlowSaver is considered substantially equivalent to previously approved devices. It's a positive step. That might give management the go ahead to shed a little more light on its timing and potential. The company is likely to play any other opportunities close to the vest, but the language used could give some indication as to where it might focus next and when it may share more information. While the stock may rise or fall on short-term revenue results, long-term investors will be more impacted by how well the company can build out the organization and align its expertise with unmet needs in patient care.