The first quarter 2024 earnings call for Exact Sciences was a whirlwind of information. We heard about Cologuard’s continued dominance, Oncotype DX’s international surge, and a tantalizing pipeline brimming with potential game-changers. But hidden within the flurry of details, a single, seemingly innocuous statement stands out, one with the potential to completely redefine the company's growth trajectory.

Remember the saga of the sales force pause? After a decade of relentless expansion, Exact Sciences made the surprising decision to slow down its sales force growth, a move that left many analysts scratching their heads. While leadership defended the move as a measured approach to prioritize profitability, the market wasn't entirely convinced. Doubts lingered, fueled by the whispers of rising competition in the blood-based colon cancer screening arena.

But in the Q1 2024 call, Kevin Conroy, Chairman and CEO, dropped a bombshell. He confirmed that not only was the sales force expansion back on track, but it was already yielding results. "We have seen accelerated growth in Q2," he declared, attributing this early success to increased marketing investments. Now, couple this statement with the planned influx of new sales reps hitting the field, and the implications are staggering.

Exact Sciences isn't just re-embracing growth; they're doubling down on it. Conroy hinted at a potential shift in strategy, a recognition that perhaps the company had been a tad too cautious in the face of a market opportunity so vast. Remember, 16 million Americans remain woefully behind on their colon cancer screening. That's a colossal untapped market, and Exact Sciences appears to be realizing the urgency of seizing it.

But here's where that tiny, seemingly insignificant detail comes into play. Conroy revealed that Cologuard orders per office visit have skyrocketed, a whopping 50% higher than just two years ago. This isn't just a testament to the product's growing acceptance; it speaks volumes about the efficiency and effectiveness of the company's sales approach.

Think about it: the more Cologuard tests are ordered per visit, the less time and resources it takes to drive revenue growth. This enhanced productivity, coupled with a larger sales force, sets the stage for an explosive growth scenario. Add to the mix the growing demand for Cologuard in payer and health system-run care gap programs, which are projected to have a "significant" impact in the second half of the year, and we're looking at a potent cocktail for success.

Cologuard Orders per Office Visit

The chart below illustrates the hypothetical growth in Cologuard orders per office visit over the past two years.

Let’s play with some numbers. If Cologuard orders per visit are indeed 50% higher than two years ago, and Exact Sciences successfully deploys a significantly larger sales force, we could be looking at a potential revenue boost in the range of 20% to 30% from this factor alone. This doesn't even factor in the potential upside from rescreens, the 45 to 49 age group, or the anticipated momentum in international Oncotype DX sales.

The market, understandably fixated on the looming threat of blood-based competition, seems to have overlooked this critical element: the power of a well-oiled, highly productive sales machine. While the blood-based screening landscape remains uncertain, Exact Sciences is quietly building a growth engine capable of generating substantial revenue regardless of how that battle unfolds.

"Assuming a conservative 10% increase in sales force size for 2024, and a 50% increase in Cologuard orders per visit compared to two years ago, we can project a potential 15% to 20% boost in Cologuard revenue from sales force productivity alone. This excludes other growth drivers, including rescreens, the 45-49 age group, and international Oncotype DX sales."

While the allure of new technologies and the competitive pressures of blood-based screening are undeniable, Exact Sciences is strategically positioning itself to thrive in any scenario. By focusing on enhancing sales force productivity and re-engaging in aggressive sales force expansion, the company is poised to unlock a new level of growth, one that could exceed even the most optimistic market expectations.

"Fun Fact: Did you know that Exact Sciences was founded in a basement? That's right, this company, poised to become a global leader in the fight against cancer, started with humble beginnings. Perhaps that's why they have an innate understanding of the importance of building a strong foundation, one that can support ambitious growth and a mission as vital as eradicating cancer."