Sometimes the best medicine is a short, sharp shock; that's why Medtronic's products reside in its customers' hearts and minds (among other places). A leading maker of implantable biomedical devices, the company makes defibrillators and pacemakers that issue electrical impulses or shocks to keep hearts beating normally. Its Cardiac and Vascular Group also produces catheters, stents, valves, balloons, and surgical ablation technologies used to treat vascular and heart disease. The company's Restorative Therapies Group makes nerve and brain stimulation devices, implantable drug delivery systems, products used to manage diabetes, and surgical devices for ear, nose, and throat (ENT) and spinal conditions.
Medtronic got its start treating heart disease -- it was a leader in the development of pacemakers in the 1950s -- and a majority of its revenue still comes from sales of products used to treat heart or vascular conditions. However, it has expanded its reach into the rest of the human body, and the rest of the world, by offering products that treat neurological, musculoskeletal, and metabolic conditions as well.
Within the Cardiac and Vascular Group, which accounts for about half of revenue, reside its Cardiac Rhythm & Heart Failure Disease Management (CRHF), Coronary & Structural Heart Disease Management (CSH), and Aortic & Peripheral Vascular Disease Management divisions. CRHF is Medtronic's largest single unit, accounting for about 25% of sales; the unit makes pacemakers, defibrillators, heart monitors, and other products used to keep the heart beating properly. The remaining Cardiac and Vascular units focus on minimally invasive technologies including drug-eluting stents to prevent reclogging of arteries (Coronary division) and aortic heart valves (Structural Heart), as well as stents, grafts, and balloon systems for non-heart vascular procedures (Endovascular).
Under the Restorative Therapies Group is Medtronic's Spine unit (housing its Sofamor Danek and Kryphon businesses), which accounts for around 35% of sales and manufactures spinal devices and implants, as well as surgical instruments and bone grafting tissue. Other units within the Restorative Therapies Group include the Neuromodulation division, which makes electrical stimulation devices and drug delivery systems for conditions including chronic pain, tremors, and urinary incontinence.
The Diabetes Group consists of three divisions: Intensive Insulin Management, Non-Intensive Diabetes Therapies, and Diabetes Serves & Solutions. They develop, make, and market integrated diabetes management solutions including insulin pump therapy, continuous glucose monitoring systems, and therapy management software.
Finanally, the Minimally Invasive Therapies Group -- which includes the majority of Covidien's former operations -- includes Surgical Solutions and Patient Monitoring & Recovery (PMR). Surgical Solutions specializes in products that treat diseases that are typically addressed by surgeons, while PMR's focus is enabling complication-free recovery. The Group accounts for more than 10% of revenues.
Medtronic markets its products in more than 160 countries around the globe. Some 60% of revenues come from the Americas; the company's largest international markets include Western Europe and Japan.
The company operates some 350 locations worldwide, including some 70 manufacturing plants in the US and another 275 in about 70 other countries. It has manufacturing or research facilities in Brazil, Canada, China, Costa Rica, Denmark, the Dominican Republic, France, Germany, India, Ireland, Israel, Italy, Japan, Malaysia, Mexico, the Netherlands, Puerto Rico, Singapore, South Korea, Switzerland, Thailand, Turkey, the UK, the US, and Vietnam.
Medtronic also has some 70 sales and administrative offices in the US and another 275 locations in 67 other countries.
Sales and Marketing
Medtronic sells through direct representatives in the US, while using a combination of independent distributors and direct marketing methods in overseas markets. Its products are marketed to customers including hospitals, clinics, physicians, and wholesalers, as well as government health plans and group purchasing organizations.
Medtronic has reporting steadily rising revenues over the past few years, including sales growth of 19% in fiscal 2015 (ended April) to some $20.2 billion, which was attributed to strong product sales increases in all divisions. The inclusion of the Minimally Invasive Therapies Group revenue following the acquisition of Covidien also contributed to the rise. Within the Cardiac and Vascular Group, growth came from nearly every sector, led by Cardiac Rhythm & Heart Failure and Aortic & Peripheral Vascular. Likewise, the Restorative Therapies Group reported growth in all divisions except the Spine unit. The Diabetes Group saw a 9% increase that year.
The US grew 6% on a comparable basis in fiscal 2015, driven by strong new product launches across nearly all businesses. The Non-US Developed Markets grew 3% -- new products did very well in Australia in Zealand -- while Western Europe benefited from Cath Lab Managed Services. Emerging Markets grew 12% that year (just short of its goal of mid-teens growth).
Net income, which has been declining since 2013, dropped again in fiscal 2015 by 12% to about $2.7 billion, as the company had higher expenses and acquisition-related costs. Cash flow from operations decreased 1% to $4.9 billion that year.
Strategically, the company maintains a steady stream of new product introductions through a mixture of internal research and development and acquisitions to fuel its growth. Medtronic spends about $1.6 billion (or about 8% of sales) on R&D programs each year, with the goal of producing new technologies that enhance existing products or fulfill unmet medical needs. The company also widens its offerings through partnerships, licensing agreements, and acquisitions. In 2014 it released an insertable cardiac monitor dubbed Reveal LINQ.
Medtronic is also focusing on expanding its international business, which has increased to account for 40% of company sales. Medtronic has an especially keen eye on the emerging markets of Brazil, China, India, and Russia. It has laid plans to increase sales in those markets to eventually account for some 20% of company sales.
The company also works to increase efficiency for its customers. In 2013 it began managing cath labs for customers in Europe, which effectively led to lab upgrades for many. It increased efficiency for itself by purchasing Biostar, its Turkish distributor. In select international markets, it has more recently launched the MiniMed 649G System, which features continuous glucose monitoring and SmartGuard technology that can suspend insulin delivery when necessary.
Other new launches include the CD HORIZON SOLERA VOYAGER Spinal System and the CoreValva Evolut(TM) R System, both in 2015.
Mergers and Acquisitions
In 2013 the company purchased Cardiocom and its remote-monitoring and telehealth services and software for about $193 million. The following year Medtronic made progress towards its goal of growing in international markets when it acquired device manufacturer China Kanghui for approximately $816 million in cash. The purchase added direct distribution operations in the Chinese market, as well as a product portfolio and R&D pipeline containing spinal, trauma, and joint reconstruction devices.
Infections from implanted pacemakers and defibrillators are relatively rare but Medtronic cut the odds for its patients even further in early 2014 when it purchased Tyrx for about $160 million. The company makes implant devices that treat infections associated with surgeries and implanted devices. Other 2014 deals included an Italian hospital manager, an American maker of MRI-guided laser systems, and a Dutch company that makes brain stimulation tools. It followed those up with the purchases of Given Imaging, Visualase, Reverse Medical Corporation, and Sapiens Steering Brain Stimulation.
In early 2015 Medtronic paid $43 billion for fellow medical device maker Covidien. In addition to expanding Medtronic's global footprint and delivering what the company hopes will be $850 million in synergistic savings by 2018, the move also let Medtronic easily move its headquarters to Covidien's home in tax-friendly Ireland.
Also in 2015, Medtronic acquired Advanced Uro-Solutions, which develops neurostimulation products for those suffering from overactive bladder. In a move to to boost its ENT offerings, it also bought Sophono, a developer and manufacturer of magnetic hearing implants. It then acquired private medical device firm Aptus Endosystems, which is focused on advanced technology for endovascular aneurysm repair and thoracic endovascular aneurysm repair, for some $110 million. More deals followed with the $93 million purchase of CardioInsight Technologies, which has developed a novel approach to improve mapping of electrical disorders of the heart, and the planned $458 million acquisition of Twelve Inc., maker of a heart valve replacement device.
The company in 2016 agreed to buy HeartWare, which is developing the HVAD line of implantable heart pumps and other technologies to treat end-stage heart failure, for $1.1 billion. That deal will strengthen Medtronic's cardiac and vascular operations; Medtronic will utilize its size and experience to help bring HeartWare's devices to the market.