Earnings Call Transcript - HCAT Q1 2026

Operator, Operator

Welcome to the Health Catalyst First Quarter 2026 Earnings Conference Call. I would now like to turn the call over to Stephanie St. Clair, Senior Vice President of Finance and Investor Relations.

Stephanie St. Clair, Senior Vice President, Finance and Investor Relations

Good afternoon, and welcome to Health Catalyst's earnings call for the first quarter of 2026, which ended March 31, 2026. My name is Stephanie St. Clair, Finance and Investor Relations Senior Vice President. With me on the call today are Ben Albert, our Chief Executive Officer; and Jason Alger, our Chief Financial Officer. A complete disclosure of our results can be found in our press release issued today as well as in our related Form 8-K furnished to the SEC, both of which are available on the Investor Relations section of our website at ir.healthcatalyst.com. As a reminder, today's call is being recorded, and a replay will be available following the conclusion of the call. During today's call, we will make forward-looking statements pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 regarding our future growth, financial outlook for the second quarter and full year 2026, market conditions, AI initiatives, bookings, retention, operational priorities, strategic and restructuring initiatives, client migrations and the general anticipated performance of our business. These forward-looking statements are based on management's current views and expectations as of today and should not be relied upon as representing our views as of any subsequent date. We disclaim any obligation to update any forward-looking statements or outlook. Actual results may materially differ. Please refer to the risk factors in our most recent Form 10-K for the full year 2025 filed with the SEC on March 12, 2026, and our Form 10-Q for the first quarter of 2026 filed today. We will also refer to certain non-GAAP financial measures to provide additional information to investors. Non-GAAP financial information is presented for supplemental purposes only and has limitations as an analytical tool and should not be considered in isolation or as a substitute for financial information presented in accordance with GAAP. A reconciliation of our non-GAAP financial measures to their most comparable GAAP measures is provided in our press release. We will provide forward-looking guidance for certain non-GAAP financial measures in this earnings call and are not providing forward-looking guidance for the most directly comparable GAAP measures and therefore have not provided reconciliations because they are items that may impact the comparable GAAP measures that are not within our control or cannot be reliably forecasted. With that, I'll turn the call over to Ben.

Benjamin Albert, Chief Executive Officer

Thank you, Stephanie, and thank you to everyone for joining us today. We are pleased to report a strong first quarter with solid bookings and results that exceeded expectations on both revenue and adjusted EBITDA. We ended the quarter in a strong cash position and, combined with the cost savings from streamlining our operations, we are making progress as we position the company for durable and efficient growth. We are also introducing a new performance metric that we believe provides a clear benchmark of success and issuing full year guidance as promised. Jason will detail our performance and outlook in his remarks. But first, I'd like to spend a few minutes sharing learnings from our initial assessment and the actions we've taken and will continue to take with urgency to transform the company's operating model, simplify our organizational structure and align resources around our highest conviction technology opportunities. Over the last few months, we have begun examining every dimension of the business, from our cost structure and our product portfolio to our go-to-market approach, organizational design, leadership, technology infrastructure and how we deliver value to clients. This review has reinforced the strength of our foundation and the need to operate differently. One of the most significant findings from that review was the direct connection between our previous migration strategy and the revenue pressure we are managing this year. Setting a rigid timeline for migration efforts over the last two years has created a churn dynamic, which is heavily impacting 2026. It is the area we've addressed most aggressively, prioritizing client success and retention to build a more durable revenue base. As we shared in our March earnings call, we stopped managing the migration as a one-size-fits-all program and conducted a line-by-line review of every remaining client. We developed a tailored plan for each client's specific situation and have strengthened the teams dedicated to taking clients through this process, including options where clients stay on DAS for an extended period of time. The initial review is now complete and gives us a new level of visibility into a path forward. As we look at our business holistically, we believe that Health Catalyst has exceptional core assets including 18 years of proprietary health care improvement data, deep client relationships, proven outcomes and a team that genuinely cares about improving health care. However, these assets were hampered by a fragmented and cumbersome business structure that created friction and lacked focus for clients and teammates. While this accumulated complexity will take time to unwind and will create short-term revenue pressure, we are focused and confident in our plan of action. Ultimately, we believe this short-term impact is necessary to achieve more profitable growth long term. Importantly, we are building a leadership team that is equipped and eager to execute this plan. We've added significant experience across nearly every function, bringing in operators with vision, executional discipline and a track record of results. We also recently promoted our new Chief Marketing Officer, who is already transforming our messaging, product positioning, and how we take our solutions to market, and our new Chief Growth Officer, who is bringing her excitement and data-driven leadership to our growth function. At the Board level, we've also made significant changes. We recently welcomed Steve Nelson, who currently serves as the President of Aetna and brings deep health care expertise and public company leadership experience. He previously served as Chief Executive Officer of UnitedHealthcare, GenMed and Duly Health in Care, building and scaling delivery models where health outcomes, provider experience, cost discipline, clinical performance and consumer engagement operated as a single integrated strategy. Out of our seven current Board members, he is one of four Board members who have joined us in the last year, including a new Chair. The Board refresh brings fresh perspective, outside expertise and strategic insight. Moving forward, our focus is being a technology business that wins in the market, operating with efficiency and discipline and investing in our AI intelligence that differentiates our solutions. Two weeks ago, we announced a comprehensive operational and business restructuring we're calling Project NEXUS. It is a strategic initiative designed to fundamentally transform our operating model, improve our cost structure and advance each of these priorities. This initiative is expected to generate annual run rate cost savings of approximately $30 million and accelerate the progress we've already made to integrate our core functions and consolidate our operations under one company with one commercial approach, one client-facing team and one set of standards. On the engineering side, we piloted a new development model, utilizing highly efficient pods and proprietary AI development agents. In initial pilots, development teams increased story points delivered by as much as 100% per developer, allowing us to simultaneously reshape our cost structure and accelerate product innovation. Finally, we are introducing total bookings as a simplified operating metric. We consider investor feedback carefully and believe it is one of the most direct indicators of whether our commercial engine is working. Combined with our guidance and continued focus on adjusted technology gross margin and cash generation, we believe our metrics will give you a clear and consistent framework to track the success of this transformation. Now let me tell you how the work we are doing positions us for the opportunity ahead and why I took this job. Health care is at an inflection point. The financial pressure on health systems, narrowing margins, shifting payer mix and rising labor costs is structural, not cyclical. In this environment, organizations are looking for more than incrementally better tools. They are looking for a partner who can help them reduce costs, improve clinical quality and grow consumer relationships while delivering meaningful outcomes. That is the market we are built for, and AI strengthens our ability to scale. Health care data infrastructure has increasingly commoditized. Durable advantage lies in the intelligence built on top of it. And our advantage is something no one else has: our wealth of improvement data, the link between an intervention, its cost and its measured outcome. Eighteen years and thousands of improvement engagements later, our proprietary data set compounds, building our competitive advantage. A new entrant cannot manufacture this data set retrospectively. These engagements include an evidence base that tells us what reduces cost, improves clinical quality and grows consumer engagement and then can be calibrated to each system's case mix, cost structure, workforce and starting point. The result is a prescriptive roadmap that identifies opportunities sized in dollars and interventions ranked by impact, sequenced, and with foundations in place before the harder work begins. That is the foundation of our AI strategy. We are building a growing suite of generative AI models across cost management, clinical quality, consumer experience and ambulatory growth embedded in our domain-specific application. These improvement agents will combine multiple layers of machine learning models and LLMs to surface the right opportunities for each health system, quantify the impact and guide execution. We are building a moat by combining our depth of improvement data with purpose-built AI agents at scale. Both activities that once required months of consulting services and manual effort are being embedded in our technology solutions, and they will recalculate daily as conditions change, improving with every outcome delivered. I want to add something more personal. I believe that a thriving health system is foundational, as essential as education and central to the fabric of the community. For the communities they serve, health systems provide care, employment and resilience. When they struggle, communities feel it in ways that go far beyond health care. That reality is under threat today, and many communities do not yet see it coming. Health Catalyst exists to help health systems sustain and strengthen that role. Our improvement data is the foundation and AI will allow us to make that expertise efficient, scalable and accessible to every system that needs it. That is the company we are building. In conclusion, we asked for time and we used it to conduct a thorough assessment of the business. We are acting on what we found. We are transforming the company's operating model by simplifying our organizational structure and aligning resources around our highest conviction technology opportunities. We have increased visibility into the DAS to Ignite migration impact, and we expect that the majority of that revenue pressure will be absorbed in 2026. These changes to our operating model position us to enter 2027 with a more efficient organization and a commercial engine that will be aligned to where we believe we will win. With that, I'll turn it over to Jason.

Jason Alger, Chief Financial Officer

Thanks, Ben. I want to start by putting the Q1 results in context. Ben described the transformation we are undertaking and the framework we are using to measure it. The financials this quarter reflect the very early stages of that work. We exceeded our guidance on both revenue and adjusted EBITDA. We are reporting strong Q1 bookings, which gives us confidence our commercial simplification work is gaining traction, and our cost discipline continues to show up in the numbers. Let me walk through the details. For the first quarter of 2026, total revenue was $70.8 million, exceeding the high end of our guided range of $68 million to $70 million. Technology revenue was $49.5 million, and professional services revenue was $21.3 million. On the top line, I would point to a few things. Our revenue trajectory is beginning to show some of the revenue pressure that Ben discussed that was partially offset by milestone delivery-based revenue and new client revenue. Professional services revenue continues to decline as expected, as we shift toward a more technology-led model, which is by design. Adjusted gross margin for the first quarter was 51.5%, compared to 49.2% in the prior year period. Adjusted technology gross margin was 55.3%, and adjusted professional services gross margin was 19.4%. Adjusted technology gross margin reflects duplicate hosting costs as we migrate clients to Ignite and heavy data loading costs associated with HIE client deployments before revenue can be recognized. We are laser focused on margin expansion as part of the transformation to streamline delivery and optimize our cost structure. We expect that the operational changes that Ben described, which include certain head count and non-headcount changes that impact cost of revenue, will begin to show up in Q2 results and will become more evident in the second half of 2026. Adjusted operating expenses in Q1 were $27.3 million, representing 39% of revenue compared to $32.8 million or 41% of revenue in Q1 2025. We have been disciplined about cost management while protecting investments in areas that directly support the transformation. Adjusted EBITDA for the first quarter was $9.1 million, exceeding the high end of our guided range of $7 million to $8 million compared to $6.3 million in Q1 2025. Adjusted net income per share was $0.02, with a weighted average share count of $72.6 million. Turning to the balance sheet, we ended the quarter with approximately $108.8 million of cash, cash equivalents and short-term investments. As Ben noted, cash generation is a central focus. This Q1 cash, cash equivalents and short-term investments value reflects a $13.1 million increase compared to December 31, 2025. Although we don't anticipate this level of cash generation every quarter, we are managing liquidity carefully, and we expect the restructuring actions we are taking will meaningfully improve our ability to generate cash. Let me walk to the math of Project NEXUS because I think it is important for investors to see how these actions connect to the financial trajectory we are targeting. We expect total second quarter restructuring charges of approximately $4 million. This program spans workforce actions, infrastructure consolidation, and go-to-market realignment. We expect the majority of these charges to be incurred in Q2 with the restructuring substantially complete by year-end. Project NEXUS is expected to generate annualized run rate savings of approximately $30 million, inclusive of direct savings of approximately $22 million from the 9% reduction in head count and reductions in non-head count spend, such as infrastructure, subscriptions and contractors, and indirect savings of approximately $8 million from the closing of open head count and cancellation of other previously planned expenses. It is important to note that these savings are annualized, so not all of the benefit will be seen in 2026. As we think about 2026, we expect our quarterly adjusted operating expenses to decrease by $3 million to $4 million compared to Q1. We also expect our quarterly adjusted cost of revenue to decrease by $1 million to $2 million. These quarterly impacts will start to take effect in Q2 and will ramp throughout the year. We are making meaningful structural changes to how this company operates and what it costs to run. Today, we are providing full year 2026 guidance. I want to walk through not just the numbers, but how we expect the year to unfold because the shape of the year matters as much as the totals. For full year 2026, we currently expect total revenue of $260 million to $265 million, adjusted EBITDA of $30 million to $33 million. For Q2 2026, we currently expect total revenue of $68 million to $70 million, adjusted EBITDA of $9 million to $10 million. Our full year revenue guidance reflects the weight of short-term revenue pressure related to the previous migration strategy as well as TAMs and professional services-related revenue reductions and the assessment that Ben described. The churn that we are working through today is largely the result of prior decisions that forced clients into an accelerated decision point on the migration before we had the right retention program and client-facing structure in place. On our previous earnings call, we shared certain data points related to the DAS to Ignite migration, including the $12.5 million of ARR notified downselling churn and approximately $52 million of potentially at-risk ARR. Following the client-by-client review, we anticipate retaining at least $22 million of the previously identified $52 million of at-risk ARR; this leaves approximately $30 million of at-risk ARR, which we are focused on retaining through dedicated account plans tailored to each client's needs. The current expected impact will be approximately $20 million in 2026 and $10 million in 2027. For simplicity, we've provided this detail in a chart in our earnings release. We would note that a number of clients will continue to use our application solutions going forward even after transitioning to their own infrastructure. As we previously noted, the migration impact is temporary; we expect it to be generally through the end of 2027. This does not mean every migration is complete as we are extending the availability of DAS, but it means we will transition each client when the time is right and on the products that make sense. Additionally, the changes we have put in place are helping us to build a more durable revenue base exiting 2027. As we prioritize a mix shift to higher-margin technology revenue, we continue to work with clients on the right services approach. In certain cases, it makes sense for clients to in-source team members, which aligns with our technology-led strategy and improves our margin profile. Our best estimate today is that exiting 2026, our Services segment will be between $55 million and $65 million in revenue annually. Our Q1 bookings were strong, and our pipeline supports moderate bookings in Q2 and positive bookings momentum in the second half. Over the course of 2026, we expect $22 million to $26 million in new bookings, which includes all ARR and non-recurring revenue. We use new bookings as an operating metric and define it further in our Form 10-Q filed today. We will report results for this new metric on an annual basis; we aim to turn bookings into revenue promptly for the advantage of our clients and our business. From an adjusted gross margin standpoint, we expect adjusted technology gross margin to fluctuate modestly quarter-to-quarter and to finish the year in the mid-60s. Technology margin expansion is a key focus area of our business moving forward, but it will take time to realize improvement in our financials given duplicate costs from the Ignite migrations and heavy data loading costs associated with HIE client deployments. We anticipate that our adjusted professional services gross margin will decline over the course of the year, as we continue to work through the migrations with a full year margin expectation in the mid- to low-teens. We are targeting adjusted EBITDA that reflects changes to the operating model taking hold. This is the financial case for why the short-term migration-related revenue pain is worth it. We believe our new structure will allow us to lean into high-priority opportunities and realize improving leverage and growth returns. We are managing this business for durable value creation and believe the actions we are taking in 2026 are laying the foundation for that. With that, I'll turn the call back to Ben.

Benjamin Albert, Chief Executive Officer

Thanks, Jason. In closing, I want to thank our clients for their continued partnership and our team members for their commitment during this period of progress and transition. We are energized by the transformation underway and our Board and management team are fully aligned on driving shareholder value. We have a clear plan and are executing with urgency and discipline. We remain confident in the direction of the business and in our ability to create long-term value for our clients and shareholders. Operator, we are now ready to take questions.

Operator, Operator

Our first question is coming from Stan Berenshteyn with Wells Fargo.

Stanislav Berenshteyn, Analyst, Wells Fargo

On the prepared remarks, you mentioned a bigger focus on the technology business. Are there any value-added services that are still part of this vision or is the expectation here that services is going to shrink as a mix of total revenue?

Benjamin Albert, Chief Executive Officer

Thank you for the question. The expectation is that services will shrink as we go forward in terms of percentage of revenue as we invest in technology-driven opportunities for the company overall. But we certainly see—and we'll continue to see—areas of opportunity for our services in the business. An area of example is chart abstraction. And while we might infuse more AI into the process of our chart abstraction work, we will still have wraparound services to support that because our intention is to meet our clients where they are. Sometimes that will require utilizing some services in the business. But we will see a mix shift as we go forward, especially with the AI strategy we're unfolding and how we're really taking advantage of the highest technology opportunities the business has.

Operator, Operator

We'll now move on to John Pinney with Canaccord Genuity.

John Pinney, Analyst, Canaccord Genuity

I guess I just wanted to get greater detail on—you said the shift from DAS to Ignite was kind of a sticking point trying to force that shift on people. I guess what is the hesitation of people shifting? Is it just the flux that it would create during that shift? Is there something about DAS that they want to stick with that Ignite doesn't have?

Benjamin Albert, Chief Executive Officer

Thanks for the question. There are a couple of things we can answer that with. DAS provides a lot of value to our clients and our clients have invested a lot in DAS over time. Taking on that transition to a new platform, whether it be Ignite or another, is just a lot of work and it requires a tremendous amount of effort. They get tremendous value from DAS today, so for many clients they're comfortable staying on DAS. Over time, they may move to Ignite, and we want to meet them where they are and support them through that transition as we go forward. So DAS does provide a lot of value, and I think that's what we're seeing. Now as it relates to the second part of the question, the data platform layer has been commoditized a bit. The value really is in the intelligence that sits on top of the data platform. We have this 18 years of proprietary improvement data that sits on top of the data platform, and this is on top of Ignite, of course. We're enabling these AI capabilities off of that across three critical areas: helping our clients manage cost, helping them improve consumer engagement and ambulatory growth, and driving clinical quality. As we invest in AI and use that improvement layer that sits on top of the data platform, we will see more and more clients take advantage of what Ignite has to offer.

Operator, Operator

Thank you. We'll move on now to Jeff Garro with Stephens.

Jeffrey Garro, Analyst, Stephens

Yes. I want to ask about feedback so far on Ignite Intelligence. Curious, what are you hearing from customers in terms of overall budgeting for AI and then feedback on your offering versus efforts or investigations they might have into building it themselves or buying from someone else?

Benjamin Albert, Chief Executive Officer

Sure. Thanks, Jeff. The feedback has been very positive as it relates to the initial rollout of our AI capabilities, particularly on the cost management side of the equation, which is very early innings there. The feedback has been excellent, and we continue to invest more and more in that work to unearth these capabilities that we can provide and to show how it drives measurable improvement for our clients. That's really all about that 18 years of proprietary intelligence that we have on top of the data—what we call our improvement data—and 18 years of projects, thousands of projects to help improve our clients across how they better manage their costs, how they better manage labor, how they better manage clinical quality and how they better manage their consumer experience. We have that data, and we can enable our clients to utilize that in our AI agents that really make our solutions much more robust and help them manage the changes going forward. There's a lot of excitement, and we believe that will be a huge component of our future growth.

Operator, Operator

We will now move on to Jessica Tassan with Piper Sandler.

Jessica Tassan, Analyst, Piper Sandler

I appreciate you reinstating the guide. Kind of a multipart question. Are you able to disclose how many DAS and Ignite customers you have today? And what is the average ARR for DAS customers in '26 versus Ignite customers in '26? And then when you say data infrastructure is commoditized, when did that occur? Who are the competitors on the data infrastructure side—and how much of the DAS or Ignite ARR would you ascribe to data infrastructure versus the intelligence layer?

Jason Alger, Chief Financial Officer

I really appreciate the question. What we have provided in the prepared remarks as well as in the earnings release document is full detail around what we expect from a downsell and churn perspective. We don't have a logo count that we'll be disclosing at this point in time, but we'll keep everyone apprised of how we're projecting there. It does continue to be less common for an enterprise client to exit entirely. What we are saying is that clients are generally continuing—even if we do see a downsell or churn on the data infrastructure side—we are continuing to maintain those application relationships with us. Regarding when the data platform became commoditized, we've discussed this on prior calls: players like Databricks and Snowflake and cross-industry tech vendors have helped enable that data platform layer. They lack the domain-specific intelligence that sits on top, which is where our improvement data and our applications add differentiated value. So while the infrastructure options have expanded, our intelligence layer is the defensible moat.

Benjamin Albert, Chief Executive Officer

I'd just add that we can still do the whole thing for clients who need that. Ultimately, what we do now is we have that intelligence layer that can sit on top of that data platform. So Ignite Intelligence can enable our clients and future clients with a much greater improvement opportunity through the intelligence we provide.

Operator, Operator

We'll now move on to Eden Conniff with Stifel.

Eden Conniff, Analyst, Stifel

I have a two-parter. First, in the $30 million of anticipated churn and downsell, is that entirely the data infrastructure layer? And then secondly, thanks for providing the bookings metrics. How quickly are you expecting those to convert to revenue?

Jason Alger, Chief Financial Officer

I appreciate the question. Yes, related to the $30 million in anticipated churn or downsell, I would say it's heavily focused on the data infrastructure side. It's not 100% data infrastructure; we are seeing some of that churn come out of the application side as well, but it's primarily focused more on data infrastructure. And then to the second part of that question—could you repeat that second part?

Eden Conniff, Analyst, Stifel

Yes. In terms of the bookings you guys provided, how are you thinking about those converting to revenue in terms of the time frame we should expect?

Jason Alger, Chief Financial Officer

Got it. So we would expect bookings to convert into revenue typically within about three to six months. It really does depend on the project or on the technology that we're deploying, but three to six months would be most common.

Operator, Operator

Thank you. We'll move on to Daniel Grosslight with Citi.

Daniel Grosslight, Analyst, Citi

I know you mentioned earlier that your pipeline supports moderate bookings in Q2 and positive momentum. Does this positive momentum represent a change in behavior among the DAS clients relative to your initial expectations? Or could you characterize that—are purchasers overall stable or is there still a bit of tightening in the market?

Benjamin Albert, Chief Executive Officer

I think it can be attributed to our approach. We recently added a new Head of Marketing and a new Chief Growth Officer, and we're really focused on how we are taking our platform and our capabilities to market and how we're messaging those solutions. Health systems are still making purchases today, but the bar is definitely higher. The ROI threshold is higher. They don't want just one solution; they want a partner who can provide multiple solutions like we can across cost intelligence, labor intelligence, clinical intelligence and consumer intelligence. When you can come to them with a message of how well we understand them—18 years in health care with tremendous improvement data that sits on top of it—and then the ability to convert that data into meaningful outcomes and measurable improvement across multiple areas of their business, that capability is truly unique and differentiated in the market. We do anticipate that driving the back half of the year.

Operator, Operator

We'll move next to Ryan Daniels with William Blair.

Ryan Daniels, Analyst, William Blair

One for you. I just wanted to dig into the details related to ARR churn and potential downsell. Can you talk a little bit more about the $52 million? What actually delineates the $22 million you anticipate to retain versus the $30 million? What are the characteristics defining your ability to retain some of that ARR versus the potential risk? And then what are you guys doing to mitigate that risk going forward? Or is it likely gone at this point given some of the conversion structure is already in place?

Jason Alger, Chief Financial Officer

Thanks for the question. We are working hard to retain as much of that as we can. As we did our assessment over the last few months, we went line by line against every DAS to Ignite migration account and put a plan together to support them. We're not going to lose them all. Some will downsell as opposed to full churn, obviously. But ultimately, we do have an approach, and we are hopeful to make some inroads there. We want to make sure we're communicating clearly, building credibility and setting the right expectations in the market. We do have a plan to go and try and retain as much of that revenue as we can through those account-by-account approaches.

Operator, Operator

Thank you. There are no further questions at this time. I'm happy to turn the floor back over to Ben Albert for additional or closing remarks.

Benjamin Albert, Chief Executive Officer

I'd like to thank everybody for joining us today. We are excited about what Health Catalyst can become as we go forward. We're very focused right now on the fundamentals, the launch of Project NEXUS to transform our operating model and drive our company forward. We're investing in the areas that we believe will drive growth for our organization. We're trying to provide as much transparency as we possibly can so you can all really understand where our business is and where our business is going. We recognize that our performance hasn't been where we want it, and that we're going to be judged by the performance that we create here, and we're very focused on executing against that. So thank you all very much for joining us today. Appreciate it.

Operator, Operator

This concludes today's Health Catalyst First Quarter 2026 Earnings Conference Call. Please disconnect your line at this time, and have a wonderful day.