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All right. I think that's everybody. So good morning. Thank you for joining Volpara's Q4 FY '22 Update Call. Joining us today is Group CEO, Ralph Highnam; Jill Spear, Executive Vice President of Sales and Marketing; Chief Financial Officer, Craig Hadfield; and Teri Thomas, Strategic Adviser. [Operator Instructions] I would also like to remind you that today's call is being recorded.
So I'll now hand over to Group CEO, Ralph Highnam.
Thanks, [ Lauren ]. Hello, and thank you for your taking the time this morning to hear about our busy and commercially strong Q4 FY 2022, which ended the 31st of March 2022.
Volpara's mission is to save families from cancer by providing an integrated software platform for the delivery of personalized breast care. We're proud that our software is now contracted to be used in over 35% of the U.S. breast cancer screenings. That software is helping ensure that patient experience is personalized, safe, comfortable and effective with cancer as being caught as early as possible. We're making a major impact on thousands of lives each and every day.
Now as per the ASIC salesmen that went out earlier today, we're very pleased with how Q4 has landed despite the continuing disruption from COVID and ever-increasing security requirements in our space. And today, we're going to cover the traditional 4C cash numbers, which show record cash receipts and very close to our first $8 million a quarter. The SaaS-based metrics showing solid growth over the quarter and operational and strategic news.
As [ Lauren ] said, I'm joined today by Craig, our CFO, based here in Wellington; our EVP, Sales and Marketing for the U.S., Jill, based on South Carolina; and Teri Thomas, a long-term strategic advisers to the company based in New Zealand. Both veteran in the U.S. electronic health record market. [Operator Instructions] Okay. And I'm not sure, [ Lauren ], if you can bring up the PowerPoint we prepared. Or Craig, if you want to do that, but there you go. All right.
Let's review then the 4C cash metrics posted up earlier this morning onto the ASX. I would like to say that during Q4, we had our strongest quarter ever for cash receipts from customers with receipts of about $8 million, up 50% compared to last year. Those cash receipts almost being all from subscription sales. I'd like to go on record and thank our CFO, Craig, and his team who did their work in collecting those receipts not just in this quarter but throughout the year, which where we ended up collecting $28.5 million of cash receipts over the year, up 45% compared to the previous year.
During the quarter, we had net operating and investing cash outflow of $2.9 million, down 20% from Q3 as we continue to see cost synergies come into play post the various acquisitions that we've done.
Optimizing the productivity in the car company has been a feature of the last year as we look to become ever more scalable. That will continue to be an even bigger focus of the company over FY '23 as we look to leverage the team products and partnerships we have to move more aggressively towards cash flow breakeven.
Cash on hand in Q4 was a little over $18 million, leaving us with continuing strong bank balance in approximately in 7 quarters on cash on hand at our current run rate. And that includes any earnout considerations. The company continues to have no debt on the balance sheet.
Turning now to our SaaS or recurring revenue metrics. Let me remind you almost all our new quotes are subscription-based, although there are still a few historical capital deals coming over the line. This focus on SaaS continues to be a key differentiator for Volpara and one that we continue to see more and more companies in the medical engine space trying to adopt but failing basically because they struggle due to their legacy capital sales business structures.
During Q4, despite continued COVID disruption and uncertainty due to the war in Ukraine and continued news about some security breach in the U.S., we added over USD 700,000 of net new ARR driven mostly by upsells. It shows the power of the installed base that we have, especially as we already have the IT security documentation in place with those customers. The overall number would have been even higher, but for a number of deals at new sites were delayed due to those extra IT security forms, which we continue to see become even more strict.
Now just as we've changed the SaaS, IT security is a particular area that's strong due to our cloud shift in 2016. That strength is also then becoming a key differentiator for us and a real barrier to entry to new companies coming into this space.
We're now at USD 22.2 million of annual recurring revenue, which means over the full year, we added USD 3.6 million of net new ARR, nearly 40% higher than our previous record in FY '21.
The ARPU across the installed base is now running at USD 1.51 with deals in the quarter averaging $3.15, but the range of ARPU being from $1 for a single product up to $7.50 per site who brought Analytics, Patient Hub risk and Transpara.
Net churn of SaaS ARR remains low, 3% or less, and we now have our products contracted to help over 35.5% of all U.S. women, which is a fantastic achievement. That means we now have over 1 in 3 women being helped by our software in the U.S. This provides us with an ever-expanding opportunities to upsell, which we're seeing more and more as noted above. And that will be a key feature again of FY Q3.
In short, Q4 is commercially strong despite the ongoing pandemic, and that's a testament to the sales and marketing team we have under Jill in the U.S. and the momentum they've generated. As a reminder, she's online and happy to take questions at the end.
Now let's first talk about a few of the kind of more operational highlights for the quarter. As within the 4C that went out earlier today, we signed a deal to work with leading Italian x-ray vendor Giotto to supply VolparaScorecard, which is our density product to a number of leading Italian sites. That gives us a major footprint in Italy, which ties in well with the EUSOBI announcement. All women in Europe should be told their breast density. Europe screens some 18 million women a year. We're also then working with Fuji Middle East to supply VolparaScorecard to sites across the region, with the first one being Cleveland Clinic in Abu Dhabi.
We're also growing our 99th and 100th patent cementing again our leadership position in the quantification of breast images. And we remain well on track to hit our revenue guidance for the year of over $25 million subject to final audit. We're reporting that out as part of our annual report announcement at the end of May.
Finally, we just hit the 60 million images mark in the cloud from over 5 million individual women. That is a phenomenal amount of data, especially as it's the key raw x-ray data that comes off the machine, and therefore, it's much more quantitative than the images that get stored in packs. You can access the talk I gave about that data on the link in the 4C. This is a major talk that went out onto many, received a lot of views. And I think that really indicates the interest people have in that quantitative raw data that Volpara is really unique in storing. We remain convinced that data is key to the next wave of innovation to come from Volpara for a range of administrative and clinical uses, which we discussed over the last 9 months or so.
Now before we open the questions -- the floor to question, I'd like to introduce Teri a bit more to you. She worked, I think, for 20 years, reporting directly to the CEO for most of -- she's based in New Zealand has been working with us for the last 18 months, helping us refine, I think, about electronic health record companies and how Epic grew to be so profitable? So Teri, if you want to say a few words?
Thank you very much, Ralph. Very nice to meet you all virtually. Yes, Epic was a remarkable story of starting small. When I started, I think it was half the size of Volpara. And now it's a multibillion dollar company, very profitable. And I learned a lot in my time at Epic. A number of those key areas of focus on how to make sure you're maximizing resources and doing more with less or elements that I'm driving into how we're making decisions together with Jill and with Ralph and having Volpara in a way that will become profitable and strong. So as you see in some of our numbers with 4C and elsewhere, for example, taking advantage of the benefits of COVID and people wanting to be able to connect virtually, driving down some of our sales costs and new customer acquisition costs.
Another example area is using the big EHR playbook, looking for the biggest customers and tailored approaches to win larger overall deals. So Jill and I are working closely with the rest of the sales team, accelerating the adoption of risk pathways as an underlying component of a broader EHR deployment. And you'll see more of those pieces coming up in the future. Delightful to work with Volpara.
With your experience and having access to your knowledge and expertise this last 18 months, I'm looking forward to continuing to work closely with you to drive the company towards profitability with growth. And we're also launching new ways of innovation to help save more families from cancer.
With that, I'd like to open the floor to questions either to Teri, Jill, Craig or myself.
Okay. We have a question from Scott Power. Scott, I will allow you to speak. Hopefully this works.
Congratulations. That's a terrific result. Teri, I was just interested in your comments you were just making there about targeting those large customers. So perhaps between yourself and Jill, could you sort of describe now your ideal customer and how you see that customer moving forward with Volpara over the next number of years?
And Ralph, just a second question, if I can just sort of get you to perhaps summarize some of the key comments you made in that presentation the other day in terms of the value of that data? I think that's really useful for everyone to understand that.
Yes. Great question, Scott, and I'll speak a little bit on the ideal customer now before I turn it over to Teri and Jill. We've talked over the last year in particular about ideal customers. It's kind of, I think, it's common stage of us as a SaaS company to really hone down what we do and really focus on those ideal customers, and that helps drive down customer acquisition costs. So that question is music to all our ears because it's one of the things we've really been talking a lot about internally. So Teri, Jill, do you want to pick up on that?
Why don't I take a few moments and Jill, you can add some color. So when -- and it is nice. We have been talking about the ideal customer. And when you look at the dynamics about consolidation of health care, you've got some monster big integrated delivery networks that have a desire to provide some consistency across all of their locations, even virtually integrated networks. And I think historically, a lot of how we engage with these customers was on a site-by-site basis. However, the ideal customer for us now is engaging with a large integrated delivery network with multiple hospitals and looking for the opportunities to improve their ability to save lives with all of our components of software.
So looking at the entire life cycle, starting with understanding a women's risk and providing them with the ability to provide a personalized approach that brings more women in their doors, makes them feel known and cared about through the best quality mammogram experience, using all of our software to ensure that they're providing the strongest, best use of our science all the way through to triaging even to the point of genetic testing. So we've got customers that can do that across scale. And that's how I see our ideal customer. What would you like to add, Jill?
I think what's interesting is the larger you get, the more you need to be objective and not subjective. So you can't say -- you're going to have variation. You're going to have variation in your stack performance. You're going to have variation in the how you call breast density. You have variation in the pathway. And the more you can standardize and the more you can streamline that workflow, not only does it make it a better clinical outcome for the patient, it makes it better for the staff. Like everyone knows that's the protocol and that's what they're working towards. And so they're better aligned to deliver it.
So I think while we do bring incredible value to smaller customers, the larger the customer, the bigger the challenge and the more likely you are to really understand the value that we bring.
Thanks, Jill. Thanks, Teri. So the other question we got there was about the data. So we -- I've got the presentation to Morgans, Scott, that some time ago talking about the data, which I think is available online, which I urge you to have a look at. But we've got 60 million -- an x-ray machine generates raw x-ray images. Those images are quantitative in their raw format. By the time the image gets the radiologist to look at for detection of cancer, they've been heavily processed in many, many different ways and then they become very nonquantitative. So it's critical that we've got that raw quantitative data. And we are extremely excited about the opportunities that, that brings for AI and deep learning.
And the way we're looking at it is in many ways, it's kind of short-term wins, medium-term wins and long-term wins. So just picking up on the theme down of ideal customers, I mean all that data flows up into the cloud. If you've only got breast density at all at the moment, then we can plow through that data, we can spot the sites that have got quality issues, where we might want to go in and sell Volpara Analytics, for example. So it's really going to help us spot ideal customers.
Today -- or even today it's helping us improve our algorithms. Our latest release of the algorithm which was out about a year ago now was built on 10 million, 20 million images, which is just a phenomenal amount of data. And that really helped us take that algorithm to a new level of robustness. And we did that because, for example, whereas before we have 1 or 2 images of a shoulder appearing in the breast image with the amount of data we have in the cloud. Now we've got 200 or 300 shoulders appearing with breast images. That means we can train algorithms to detect and remove them from our analysis.
But then one of the things that really kind of keeps me getting out of bed in the morning is think about where we go with that data in the future. And really, breast cancer screening, like a lot of medicines, is becoming much more personalized. And really, that personalization is being done by risk assessment and so on, as Teri touched on there. But in most risk models today are done on 10,000, 20,000 women, we've actually got an opportunity now to do a risk assessment based on hundreds of thousands, if not millions of women. And that will take it to a whole another level of accuracy. And that's kind of actually what you need to really make personalization work at the scale needed.
As those women go on to personalized care pathways, whether that's increased imaging or so on, there's also going to be preventative strategies like certain drugs like Tamoxifen, for example, that might get offered. And then we're going to enter a whole world of monitoring breast change over time so in which Volpara is going to be uniquely placed to be able to do because we've got access to the raw data access to the previous data. And we've got access in the cloud, the compute and power that we need to really work out if it's good change or bad change over time. So incredibly exciting kind of future for us in that space.
So we've talked about this before, we're moving to a world to predict, monitoring, detect and empowering women. And that data really gives us the ability to do all of those things very uniquely in the world and all backed up, of course, by those patents, which we've just announced our 100th one.
Great. If I'm able to ask one more question. I might just flip across to Craig. Craig, what was noted that you had a very strong quarter, but there were a couple of things that perhaps are flowing into the next quarter. So I was just wondering if you could perhaps give a little bit more color around that. And just noticed the range between $1 and $7.50. Again, just perhaps some color around that in terms of was the $1 a higher-volume client? Or were they just buying single products? And obviously, the $7.50 is getting much closer to the $10 ARPU that we talk about. So I mean how much more do we need to do to sort of get towards that client that buys the $10 or has an ARPU of $10?
Yes. Thanks, Scott. I might answer that first one and then hand it over to Jill. So if you can give a bit more color on that the deals that pushed. But we certainly had a number of deals in the pipeline. This was a bit of a strength, I would say. But for example, one large customer or potential customer, IT security was the reason why it pushed. It's not a lost customer. It's purely in Q1 as opposed to Q4. And sometimes that's how these quarters roll. Q2 is traditionally our large quarter, yet Q2 for us this year was by far our largest quarter. So sometimes the quarters don't necessarily go according to plan. But nevertheless, I think, USD 700,000 ARR is still very good performance. Jill, do you want to add a bit more color on maybe 1 or 2 of those deals and what Q1 maybe looks like?
The question was around like the $1 ARPU or the $1 per patient piece of, it. And that's really just when they buy 1 product. And there were a couple of those this quarter -- or actually, this quarter was more people adding on to existing installed base. So in my opinion, that's kind of like our superpower is we typically do like 60% of break-in new customers. That's what we've done historically in the last couple of years. And this quarter, we didn't do that, but we sold it up in our own installed base.
And so people that buy Volpara products, in my mind, have kind of become a candidate for more Volpara products because we do a great job of delivering our product suite and training the customers on how to use them. And they're very relevant in the marketplace.
So people, it's why I joined. I mean I've known Volpara for 10 years, and I came running over here because of what we're doing. So I think it's a really credible group of people that work with our customers. So I think -- this quarter, we sold a lot into our installed base. But when you look at that range of price point, I think that was, Scott, we really do sell 1 product to a customer and then some customers we sell 5 or 4 products to them. So that's just the range of the suite.
And getting to the $10, I think what we really see ourselves being able to do is also layering in professional services, helping them achieve what they want to achieve with our solutions because, right now, people are short-staffed and they need the easy button. They want somebody to come in and say, "Oh, yes, I build a genetic high-risk program. Let me show you how to do it." "Oh, yes, and layered in genetic labs, we do all the ordering and the radiologists are going to do 1 extra click. Can you show me how to do that?" And I think that will become our solutions. And I think adding in genetic testing will be another one of our solutions. I think we'll keep growing.
Thanks, Jill.
Thanks, Scott. There's been a question that come through just so we're talking about customers and say, ideal partners. And Teri, this might be another one for you, noting your strong relationships with 3G and GE. So there's a question around can you please describe Volpara's ideal partners such as GE and, of course, how the relationships are developing?
Now the relationships are developing well. We've got a couple of meetings scheduled next month with Cerner and Epic, including sitting down with Epic CEO.
It's fascinating when you look at these big vendors out there that are taking care of patients broadly like electronic medical record vendors or Fuji that are doing all radiology, they don't have the capability to develop that deep vertical expertise that we have to be able to really tackle personalized breast care. And so the ideal relationship to me is one in which we help them win better with what they do. So we have that knowledge. We have that focus. And by integrating ourselves into their workflows, they can make their radiologists, their mammographers and their patients a lot happier by having us underneath the covers.
So even the approach with Epic and talking with my former colleagues over there, areas that are a source of frustration to some of their customers, epic is never going to be able to take on the depth of knowledge of breast that we have. So for us, being an integrated part of their workflow, that somebody can sign an Epic contract and just chuck this in at the checkout counter, that's the ideal relationship and that's what we're working towards. Did that make sense to the anonymous?
I hope that answers the question. If we need a little bit more detail, feel free to put that back in the chat. We also have a question from [ Andrew ].
Actually [ Kevin Bennett ] here. Congratulations, Ralph, good result. Just can we give a little bit of color about Q1 or I suppose this year at the cash burn. Clearly, you expect volumes to pick up as the U.S. economy opens up. But what's going to happen on the cost side? What's your sort of profile you're looking at?
Yes, it's a good question, [ Kevin. ] And obviously, we are living in a strange world. I want to ask Craig to come in. But as a company, right, we're very focused towards moving towards profitability. And we're very focused on keeping those costs contained whilst still getting the growth. So yes, that's our general outlook. We are going through the budgeting process now with the Board. It's progressing, and we're about to get sign off, but the general gist is aim towards profitability. And we're still getting that good growth. Craig, do you want to add anything else to that?
I think a couple of things, [ Kevin. ] One, I think we're in a fortunate position where -- fortunate or unfortunate, but I think in our case, fortunate in that our revenue lags our ARR. And that's a common theme in this industry because it takes a while to get installed. So our revenue will continue to grow, and what we have seen this year, particularly under some recent cash flow, it has not suffered at all in terms of cash inflows. This was by far our strongest year for cash inflow over nearly 50% up on last year. And yes, some of that was CRA, but there was a lot of organic growth in there as well. So our cash inflow will continue to be strong. I think everyone on this call will understand that inflation is running rampant at the moment. A lot of our employee base is in New Zealand and the rest in the U.S. And there are a lot of pressures on staffing in both countries, especially in the IT or engineering space. So our focus is on keeping our employees, rewarding them appropriately, but also at the same time, finding where we can find some cost savings, synergies, et cetera. And I think we've done a very, very good job over the last couple of years and really focusing on the costs that we can control, to a large extent, like Microsoft, for example.
We've done a lot of multi-tenanting and all the back-end work that has saved us significant amounts and will do for the future. We've got a new release coming out soon, which will further improve that.
And so I think there's multiple different answers to that question. But I think overall, we are very focused on prudently managing our cash as well as continuing to really drive cash inflows. And our goal, obviously, over time is to continue to see a reduction in our net cash outflow. Over the last 12 months, we have seen that reduce over time. We had a couple of peak months of more quarters. But overall, that's been a material reduction on FY '20 and '21. And I think FY '23, the goal is the same to continue to see that dropping. And currently, we still have $18 million cash in the bank. So I think we're in a decent position right now.
Great. And just one more, if I can. For Ralph, what's the biggest bottleneck to your growth at the moment? What would you sort of size your major restricting factor?
So a good question. Kevin, I'll let Jill perhaps come in on that. But certainly, one thing, we've got an outstanding sales team over there, but we are seeing, like we talked about staff shortages and IT security forms and so on, which really are pushing out growth. But if we can get -- and I actually believe all those things are IT security is going to be a key differentiator for us in the future, and it really is going to be a barrier to entry to new companies coming in, so it's going to play out positively in the medium term. Yes, those staff shortages, the IT security forms, but then launching a new -- kind of around the back launching a new wave of innovation. We've talked around the data, finding those ideal customers, getting more focus and priority, they are all going to help really fuel growth and drive us through some of the questions that we get.
Can I add something on that?
Sure.
I think we've got a really solid sales team. Jill is doing a fantastic job orienting the entire team on cross-selling and upselling and leveraging who we have, getting stability across in charge of which regions. So I think we're poised to really take off and do well in that area next year.
But we have to step back and still recognize that as a company, we really are still 3 companies coming together. We acquired MRS a few years ago. We acquired CRA. And so we've got a little bit of work to continue to do to pull those companies together, make sure that we've got the foundation in place for consistent customer engagement processes, customer success development. And as Jill mentioned earlier, customers want the easy button. They want the ability for us to take them by the hand and lead them to successful outcomes. And that's a big area of focus for us. Once we have this really strong and in place delivered in a SaaS sort of way, we'll really be poised for growth
So a couple of questions have come through in the Q&A as well. So just off the back of the operating and investing cash flow. There's a question here from [ Claude Walker ]. So we'll stay on theme and I'll work through these. So question, I suspect predominantly for you, Craig, is operating and investing cash outflow decrease between Q3 and Q4 last year before increasing again in Q1 and Q2 of this year. Are you expecting another increase in cash burn either in the next quarter or the one after that? And when can Volpara commit to consistent reduction rather than fluctuation?
Thanks, [ Lauren ]. Thanks, [ Claude ]. So Q1 is generally our most expensive quarter or our most cash outflows for various reasons, but we do have larger costs in Q1. We generally also have larger cash inflows in Q1 as well.
I think one of the difficulties and one of the complexities of operating in the U.S., specifically, and one that's particularly pertinent to our business is we have 750 customers, so that's not a small amount of customers. And 80% to 85% of our U.S. customers pay us by check, okay? And the difference between a very good quarter and a not-so-good quarter could be the difference of 1 day in terms of how long it took the mailman to get the check to the post office. And I don't say that sarcastically. I think it is quite important to understand that nuance that we are dealing with. For example, at the end of Q4, we had a large check come in on the last day of the year. That could have easily come in on the first half of the year.
So at our level of cash burn, that can also be the difference between average cash burn for the quarter or extremely good or extremely bad. So I think that is one nuance to just take into account.
However, having said that, I think the overall theme of the business is one of consistent overall -- over the course of the year, if we look at a year overall, those differences are enough quarter-on-quarter. And what we are focusing on is a continued annual decrease in our overall cash burn. And that is the plan for FY '23. And the plan for FY '24 and onwards is to continue to decrease that on a consistent basis. But I do urge you to look at our cash burn over a year, not quarter-on-quarter for those nuances that I've referred to earlier. Hopefully, that answers your question, [ Claude ]. Happy to take e-mails from you as well, if that helps.
Thanks, Craig. A question then around head count and current sales efficiency amongst the sales team. How do you prepare to grow the sales team and drive sales efficiency further up?
I'll let Teri and Jill come in on that one, [ Lauren ]. But I want to note that Jill's been onboard for a year now. It's been fantastic to have her onboard for a year. And one of the things Craig and I recognize as soon as she's come on was how particular she is in recruiting her sales staff. You have to be extremely good to work for Volpara and -- but equally, one of the things Craig and I have also learned over the last few years is that whenever a salesperson comes on, it always takes some 6 or 9 months to generate up to speed. And so those outstanding new people that did join last year to bring the team up to full speed or to full numbers are now on that way to full productivity, albeit speeding up is always a good move. Jill, do you want to talk to that one?
I agree. We've hired great people, and we had an amazing foundation, so I don't want to diminish that at all. I think it's a good question. So when you think about our sales deployment, it's really 2 different -- we have 2 different organizations touching our customer. One is the sales directors and the sales team that support them. And they're designed to really grow and expand, sell to new customers. And like we talked about earlier, we're looking at some of those large IDNs.
Likewise, we have a customer success team that works with our installed base, and so many of our installed base customers, I think it's something like 15% have everything that we sell. But there's another 85% that only have 1 or 2 of our products. So we really have an opportunity to grow in both places. And so we're working to ensure this group is really successful and wants to look at how they can layer in additional functionality. And this group is introducing customers to the influence and what we can bring in terms of value.
So I really think about it as both sides of that equation. And if you look at that, we're just at the same size we were before COVID but focused in different areas. So I think that's going to be the key to our successful long term is making sure everybody that uses us wants to add functionality. And the groups that we haven't really been used by, pair up that we can create new opportunities with them.
And this year, we took this solution set. Again, Teri mentioned, we have just brought in the risk pathway team to CRA. We just brought in the MRS team. We went to ASBS NCBC, RSNA, and we're really seeing that every different group we touch from surgeons to oncology and cancer solutions to radiology, each one of these groups, this message resonates with them. So we're seeing a lot of engagement across all the different clinical teams that we touch.
I see Jill also really leading the sales team to be more strategic from more of a product-oriented sale to more of a solution multiple products in it, which will also drive up our ARPU. So we're using the same size of a team but using them more strategically in how they engage with the market, aligned with the connectivity between our products that continues to grow over time and provide more value.
Thanks for that. This is probably another one for you, Jill and Teri, and it is around customer conversion and cybersecurity and what Volpara might need to do from a cybersecurity perspective to get customers across the line or whether it's more at the customers end that they would need to improve their own cybersecurity infrastructure.
I think what's limiting us today -- so first of all, this is a strength for us. I mean we're -- just in the past quarter, 4 different customers have told us our responses to their cybersecurity questionnaires are best in class. Like really, we do a great job with this. I think what is slowing us down is, first, the IT teams are strapped for time. So we -- they have to do the rigor every time. And we want them to do that rigor, but it just takes a little bit longer.
I think the second thing is that we are seeing some requests for different and unique solutions like CrowdStrike and things like that. And so we're flexible, and we're working through those types of requests to make sure that we meet the customer needs. So I think in the end, it's always a positive thing. And again, I believe we really bring a unique set of tools here and our team is fabulous in this area. So I don't know, Teri, any comments on that?
I think that about covered it. I think our team is good. We've built some redundancy, but largely, it's on the customer's end, unfortunately.
I'd just build on that slightly. What is your customer retention? Craig, do you want to speak to the percent, the numbers?
Yes, I'll take that one. Thanks, Lauren. Overall, our churn rate is about 3%. We have different -- obviously, there are multiple different products along that line that we track, and we track them by product. So some are close to no churn and some are slightly more, but on average, about 3% per annum is on churn rate, which for an enterprise sales business or enterprise deals, that is a good trend, right.
Thank you. Now this is an interesting question from [ Philip Reichman ]. Do you have a 25-year plan? And is there any plan to, say, look at buying other health companies so that in the next 25 years, you could be, Volpara could be the next CSL?
That's a great question. I'm not sure, Craig, if we've got forecast out 25 years. But certainly, one of our manages internally, right, is -- and you've had us talk a lot more about profitability and so on is we want to be strong and independent. There's a huge amount of innovation that we want to bring out. And we really believe we've got a lot of very unique AI and really unique ways of helping women around the world. Certainly, we're kind of a long-term vision on that. And we see strong independent being a key way of keeping innovation flowing out there to help people.
Obviously, we're very focused on breast. And we talked last year about lung. When we get breast kind of narrowed down completely, obviously, there's long and there's a whole range of other kind of screening workflows after that where the benefits of good patient tracking along with AI kind of with the unique core of insights that Volpara brings, will show us whole new areas to grow into.
So yes, we're very focused, strong and independent being very innovative. We would love to be the next CSL, but I'm not sure yet we're ready to give a 25-year forecast, but I'll talk to Craig about it afterwards.
It's always good to dream big. Speaking of and a tone shift into the U.S. legislation, I'm wanting to get an understanding of how that impacts Volpara and whether we will see any direct impact soon.
Yes. So great question. And as per the 4C, there's a couple of other things. There's just a huge amount of tailwinds in general around what we do at the moment. Lots of American organizations coming out and saying we should be doing a risk assessment. We should be doing genetics on all women in particular. So just to remember those tailwinds have been building for the last few years. And then you also have Biden, coming out in February this year, talking about the Cancer Moonshot and reiterating their desire to halve cancer deaths over the next decade or so.
And the way that they can see doing that is by predicting who's going to get cancer in general much better. Again, that's a huge tailwind to us, and they talk about breast density and risk assessment and the need for really good IT solutions. So again, a lot of kind of tailwinds already in the U.S. And then we have EUSOBI, which is European breast engine coming out saying that all women in Europe should be told their breast density and should be offered Breast MRI every 2 or 4 years if they're extremely dense. So we've not talked a lot about Europe. We do see these tailwinds now starting to develop in Europe.
And then going back to the U.S., obviously, we are watching intently for signs of the FDA coming out with a standardized law around density report and wording. We've not heard anything about that now for the last few months, but we've heard no indication as well that's not being worked on. And certainly, some of the patient advocacy groups like DenseBreast-info and so on are doing a huge amount of lobbying at the moment, of the FDA, to try and get them to do what they started looking at to offer years ago and start to pull that law out. But key thing is that all would be important to us, but there's a lot of tailwinds already going on globally, which are really playing into what we do.
Thank you. And then in Australia, the recent federal government budget ahead of the election has included a financial commitment to improving women's cancer screening services. What does that mean for Volpara in Australia?
Yes. Good question, Lauren. We -- so there's also interesting things going in Australia. We've got some more private sales, private imaging sales during Q4, which is good to see. Obviously, we also went live in Queensland with our Volpara Analytics project. And in South Australia, we have the density pilot continuing. So a lot of activity in Australia private and public screening levels. And we have been freeing up budget and there is a sort of financial commitment in there to help, in particular, catch up screening post-COVID. So obviously, during COVID, there was a couple of months where women weren't screened, and that ends up resulting in lots of late-stage cancers coming through, very sadly.
So it's been a commitment now by the federal government in Australia to do catch up and so on, but there was also a renewed emphasis on breast MRI and, therefore, high-risk women, which, obviously, plays into Volpara's role in particularly in the U.S., where we are the tool of choice for measuring density. That density then flows into a risk model. And those risk models tell the U.S. people who to go and get or who to offer breast MRI to. So there certainly is a positive benefit from that budget for us. but we are yet to see where it actually plays out in clinical reality but looks positive at this stage.
Thanks, Ralph. Craig, I have a follow-up question for you from [ Claude ]. Claude, I'll allow you to speak, if you'd like to ask your follow-up directly.
Look, I was just wondering, like I understood from -- I just want to clarify, I understood from your previous answer that, yes, there is a possibility essentially that Q1 and Q2 will once again see a bit of an increase in cash burn. I just want to check if that's correct understanding.
And then secondly, I remember, I think it was in Q2 last year, there was a big insurance payment that impacted cash burn then? Is that going to repeat in Q2 this year?
Yes. So I think the important thing, [ Claude ], and maybe I wasn't necessarily as clear earlier. Our costs are relatively consistent quarter-on-quarter as they have been in the prior year, so, and our costs are predictable. To a large degree, we know when our cash outflows are going to go out. What is uncertain is our cash inflows. So we know we're going to have good cash inflow and that's going to go up. But I think the important thing is we could have one very large check on the day before the year-end or the day after.
And I think the other important thing to note is when I mentioned earlier we have 750-odd customers, I think one of the benefits to Volpara is that we don't have any sort of customer concentration risk. If 1 customer leaves us, it's not the end of the world. But equally, we don't necessarily have 1 customer who's going to pay us $1 million at this point. Hopefully, in the future. But for example, the check I mentioned earlier, $280,000, that's a material amount at this point. So 1 or 2 of those checks in the quarter and all of a sudden Q1 and Q2 don't necessarily have an increase in cash burn, but equally, if we don't get those and they push into Q2 or Q3 or Q4, then maybe we have a slight increase. So our cash burn is going to be lumpy over a full year. But like I mentioned, if you look at a 12-month period, the overall reduction should be to the positive side.
Yes, I think I get what you're saying.
Yes, the insurance payments is a Q2 expense and that will be relevant in Q2 again this year.
Thank you. So that's all the questions that we have currently. [Operator Instructions] Otherwise, if there are no more questions, I'll hand over to Ralph for some closing remarks.
Thanks, [ Lauren ]. Look, thanks again for your time today. As you can tell, we're remarkably resilient business, helping millions of women each year.
Thank you for your continued belief in our mission to save families from cancer, and we look forward to presenting our full year results at the end of May. So thank you all.
Thank you.