Shares of customer relationship management (CRM) software company Salesforce (CRM -0.24%) are up 100% year to date in 2023, as of this writing. These returns have crushed the otherwise impressive 24% gain for the S&P 500. And the explanation for Salesforce's outperformance can be simplistic.

In the earnings call for the fiscal third quarter of 2024, co-founder and CEO Marc Benioff started his commentary liberally, using words like "unbelievable," "incredible," and "exciting." And he was largely referring to Salesforce's cash flow.

In Q3, Salesforce had an operating cash flow of $1.5 billion, up a stunning 389% year over year. And to be clear, the company's cash-flow growth isn't entirely recent. The trend has been ongoing for years and is a big reason Salesforce stock has been a winner, as the chart below shows.

CRM data by YCharts. TTM = trailing 12 months.

Could Salesforce's long-term cash-flow story continue in 2024 and beyond? Or will it come back down to earth? Well, the future is uncertain. But there are reasons to believe the company could keep gaining ground in the coming year. Here's why.

What's going right for Salesforce in fiscal 2024

In general, 2023 has been a difficult year for enterprise software companies. And Salesforce's revenue growth has admittedly slowed to an all-time low. But through the first three quarters of its 2024 fiscal year, the company's revenue is still up 11.3% from the comparable period of fiscal 2023, which isn't too shabby.

In latest years, Salesforce has acquired other software companies, including Slack and Tableau. The company's broader range of products is leading to more services being bundled and larger contract values with customers.

Accordingly, Salesforce's million-dollar deals were up 80% year over year in Q3. And with these bigger deals, the company's remaining performance obligations (future revenue from existing contracts) are also growing nicely. It ended Q3 with remaining performance obligations of $48.3 billion, up 21% year over year.

Give Salesforce's management a lot of credit. Some of its impressive cash-flow growth has been driven by exercising discipline on spending. Through the first three quarters of fiscal 2024, operating expenses were down 1.5% from the comparable period of fiscal 2023.

However, Salesforce's Q3 cash-flow performance was largely driven by higher-than-normal collections than what's customary during the third quarter. This is more of a timing issue than a material improvement to the business, which is something to be mindful of.

What's next for Salesforce?

Collections will vary from quarter to quarter, so this isn't a material part of the investment thesis for Salesforce. To grow cash flow, therefore, the company can grow revenue, cut expenses, or facilitate a combination of the two.

Looking at expenses, Salesforce is already putting up impressive numbers, so it feels greedy to expect it to do much more than it already is. Just look at the chart of the company's operating margin over the last decade.

CRM Operating Margin (TTM) data by YCharts. TTM = trailing 12 months.

Therefore, if it's going to grow cash flow, I believe it's more important for investors to think about Salesforce's revenue growth potential. And, as mentioned, there's reason for optimism.

Salesforce has been piloting new products built on its artificial intelligence (AI) software. But as of Dec. 14, it's making its AI generally available through a package called Unlimited Edition+ (UE+). UE+ plays on the current customer trend of bundling more Salesforce services into one contract.

According to management, Salesforce customers who switch to UE+ increase their spending by 70%. That is a huge revenue growth opportunity just within its current customer base.

In short, the trends regarding revenue growth in the coming year are in Salesforce's favor. The company's customers want to bundle more services, so it now offers UE+ to its entire base. And so far, customers switching to UE+ have spent significantly more money. If Salesforce's management can maintain financial discipline, it's very possible the company's cash flow will continue growing as it's done over the long term.

Currently trading at roughly 30 times its free cash flow, Salesforce stock isn't necessarily cheap in absolute terms. But the chart below does show that this is about the cheapest it's ever been.

CRM Price to Free Cash Flow data by YCharts.

In conclusion, it's unrealistic to expect Salesforce stock to double in value two years in a row. But on its current path, I believe it very well could deliver positive returns in the coming year and beyond, meaning its shareholders would do well to keep holding, even after the impressive gains in 2023.

• Salesforce has gone all in on a marketing push to brand its generative AI as trustworthy and safe.
• At Salesforce World Tour, executives spoke about bridging "the trust gap" between customers and AI. 
• Behind the marketing campaign, Salesforce is "lagging" on innovation, one analyst said.

As cloud companies race to cash in on the generative-AI boom, Salesforce has been busy spinning itself as the safest, most trustworthy avenue through which to test the nebulous new technology. There's just one problem: Its customers aren't buying it yet.

At its World Tour conference in New York last week, Salesforce introduced several product enhancements, including vector database support — a way to store unstructured data such as images and text — and AI search for its Einstein Copilot product, meant to make integrating generative AI into workflows easier for customers. Company executives underscored the product announcements with a recurring theme: trust and safety.

Still, Salesforce likely won't see sales from those announcements anytime soon. Salesforce has moved slowly on AI, RBC Capital Markets managing director Rishi Jaluria told Insider — at least that's what the company's partners and customers told him.

"Most customers are still in more of an exploration phase and actual implementations are a long ways away," Jaluria wrote in a research note this week.

Jaluria spoke with Salesforce partners at World Tour who noted that customers are still focused on optimization, or getting the most value out of what they've purchased. One said they were encouraging customers to start first with Einstein, the original AI product Salesforce launched in 2016, before adding new generative-AI services to their bills.

The 'trust gap'

At World Tour, Salesforce's new generative-AI offerings almost felt like an afterthought to its marketing campaign, which touts the company as a safe harbor in uncharted waters.

In a promotional video, actor Matthew McConaughey, dressed as a 19th-century cowboy, stared pensively at the camera and asked, "If AI is the Wild West … well, who's the sheriff around here?"

The question was the first of many moments during the conference when a Salesforce executive brought up trust and safety when talking about generative AI.

Patrick Stokes, Salesforce's head of product marketing, took to the stage to introduce the company's approach to AI. First, he said, before writing a single line of code, Salesforce developed a list of principles to guide its generative-AI work, based on the company's No. 1 value: trust.

"How do they make sure that all the large language models they need to generate things from aren't stealing all your data, aren't sucking it all up and answering questions about your business with one of your competitor's businesses?" Stokes asked the audience. "And how do they make sure they're not full of bias and toxicity? If you think about where a large language model is trained, it's basically the open internet, and the open internet is a weird place. There's definitely going to be bias and toxicity."

Executives spoke about the "trust gap" — the concerns Stokes listed above — and the "trust layer," or what Salesforce calls its guardrails for creating prompts on Einstein.

All the trust talk, however, could just be that: talk.

"Salesforce is lagging when it comes to AI," said Jaluria. "They market it really well. But that's typical Salesforce, right? Salesforce is a marketing machine."

Salesforce can't just buy innovation

Salesforce has long had a reputation as a company that "bought" innovation via acquisitions of other companies, rather than developing meaningful new products in-house. Salesforce likely isn't in the market to buy another company right now — at least that's what it signaled to Wall Street. Last year, under pressure from activist investors pushing Salesforce to Excellerate its profit margins after its $27.7 billion Slack acquisition, the company disbanded its M&A committee.

Despite that, Salesforce continues to invest in other companies via its venture arm, which includes a $500 million Generative AI fund. Through Salesforce Ventures, the company has invested in AI startups like Anthropic, Hugging Face, and Runway.

AI adoption isn't just a Salesforce problem. Analysts have said for months that customers are being cautious about generative-AI spending. Jaluria said that with the exception of Microsoft, he doesn't expect software companies to see meaningful revenue gains from generative AI until at least 2025.

That might come down to the trust gap, said John Somorjai, who runs Salesforce Ventures.

"McKinsey's put out these studies that show that generative AI will add $4 trillion to the GDP every year for the next 10 years," Somorjai said to a room of analysts and press at World Tour. "And for that to really happen, people need to feel comfortable with the technology. They need to trust it. And that's why we're so focused on this responsible development of AI. They know that if they do it right, that fear will be taken away."

Do you have information or insight to share about Salesforce? Contact Ellen Thomas at ethomas@insider.com or on the encrypted messaging app Signal at +1 (646) 847-9416. Reach out using a nonwork device.

In the age of "Dr. Google," it can be tempting to click your way to self-diagnosis — but an overload of health information can cause its own set of symptoms.

"Cyberchondria," a subset of health anxiety, is described as a condition in which an individual excessively searches for health information online. 

While cyberchrondria may not start as a physical disease, it can cause intense levels of anxiety and fear that can negatively impact a person's health, according to Dr. Maggie Williams, a family physician in Scottsdale, Arizona, and medical director for MDLIVE Virtual Primary Care.

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Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said he and his colleagues used to call the condition "medical students' disease."

"When you know a little, but not enough, you imagine you have everything and constantly worry," he told Fox News Digital.

Although cyberchondria is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a formal diagnosis, it’s thought to be closely related to hypochrondria, a more general heightened anxiety about one’s health.

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In 2014, two U.K. researchers, Eoin McElroy and Mark Shevlin, created a "cyberchrondria severity scale" that measures a person's score across eight areas: compulsion, distress, excessiveness, reassurance seeking and mistrust of medical professionals.

Growing prevalence of cyberchrondria

As Siegel pointed out, the condition is becoming more common over time. 

"The invention of the internet and then the perfection of search engines created a global hypochondria, where patients searched to find possible explanations for their symptoms," he said.

"It especially increased during the pandemic, when dogma abounded and everyone was suddenly an expert," Siegel added.

A study published in JIMR Formative Research last year found that COVID-19 caused a spike in the condition in spring 2020, as people experienced higher levels of "cyberchondria-related distress and compulsion during the pandemic."

"The invention of the internet and then the perfection of search engines created a global hypochondria, where patients searched to find possible explanations for their symptoms."

One user shared experiences with cyberchrondria on Reddit: "I thought that I might see something that will ease my mind, but … it makes it all worse and worse. Out of the 100 times I checked a symptom online, only 10 of them kinda made me feel safe."

Another user wrote, "I'm pretty sure I have this. The pandemic definitely made my health anxiety worse. Unfortunately, the pandemic also made it harder to get in to see a doctor in a timely manner and so the internet is the next logical place to look for answers."

In a small study by MDLIVE Virtual Primary Care, more than half of respondents said they searched online instead of going to the doctor, and more than two in five (42%) turned to social media to ask about their symptoms.

Another 22% said they rely on artificial intelligence for medical answers.

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Nearly half of the 518 respondents, who provided data in August 2023, said they have misdiagnosed or mistreated an issue based on information they found online.

As Siegel warned, online medical information "isn't often accurate, and it isn't filtered, and it lacks clinical judgment."

Telltale signs of cyberchondria

Several signs may indicate that people are experiencing cyberchondria, Williams said.

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"Most people may not recognize the symptoms before it’s too late, after they’ve invested hours, delayed access to the doctor and worsened their overall anxiety," she told Fox News Digital.

One warning sign is spending one to three hours or more at a time searching for symptoms online.

A quarter of the survey respondents said that when experiencing a health issue, they spend more than one hour searching for their symptoms online.

Obsessive medical searches may also get in the way of day-to-day activities, Williams noted.

In the MDLIVE study, 41% of respondents said that compulsively searching for symptoms has gotten in the way of their daily tasks.

"Most people may not recognize the symptoms before it’s too late, after they’ve invested hours, delayed access to the doctor and worsened their overall anxiety."

"You may feel a compulsion to search online constantly, often rechecking symptoms multiple times, despite having completed an exhaustive search," Williams said.

Another symptom of cyberchrondria is high levels of distress and anxiety when searching for symptoms online — an rather than easing of concerns.

Fifty-eight percent of the participants in MDLIVE’s study said that searching online for their symptoms made them more anxious. 

"You may also have a heightened fixation on a particularly serious disease or condition, despite any evidence that you are suffering from it," Williams added.

Addressing or preventing cyberchondria

If you think you may be experiencing symptoms of cyberchondria, Williams said it’s important to set boundaries on the time spent searching for health information online. 

"Resist the urge to check and recheck symptoms," she advised.

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She also recommends avoiding "deep diving" into online forums or threads where people share "worst-case scenarios." 

"These tend to be exceptions rather than the rule, which can unnecessarily increase your anxiety," she said.

It’s best to consult with a health care professional at the onset of any symptoms, Williams advised. 

"They can provide accurate information about your health concerns, potentially helping you to sidestep the slippery slope of cyberchondria," she said.

Siegel noted that as a physician, one of his jobs is to help patients sort through their fears and worries and put them in perspective of real risk and disease. 

"You may also have a heightened fixation on a particularly serious disease or condition, despite any evidence that you are suffering from it."

"This is even more the case with social media, where you end up searching through videos — especially TikTok — and become convinced you have a disease," he said. "This all increases anxiety and is bad for health."

For those who might have trouble physically getting to a doctor’s office, Williams suggested setting up a telehealth visit to address concerns in a timely manner, which will reduce the temptation to dive into online searching.

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It's important to address cyberchrondria seriously, just as you would with any other health issue, she said.

"If you're experiencing anxiety related to your health, you may find it helpful to speak with a mental health professional."

While there are some reputable sources of health information on the internet, not all online information is factual or trustworthy.

"I still rely on the Centers for Disease Control and Prevention (CDC), National Institutes for Health, Mayo Clinic, NYU Langone and CIDRAP (Center for Infectious Disease Research and Policy)," said Siegel.

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That said, he warned that even vetted medical websites can still sometimes be wrong.

For those suffering from cyberchondria, Siegel advised them to find a doctor they can trust who can help guide them, while at the same time pulling back from online sources.

For more Health articles, visit www.foxnews.com/health.