LifeStance Health Group, Inc. (LFST) September 2026 Conference Transcript

Awesome. All right. We'll keep this thing rolling. Next up, we've got LifeStance Health Group, and we're pleased to have Ryan McCordy, CFO, here with us today. Ryan, thanks for coming.

Thanks for having me.

Maybe to jump right in, you know, Q2, obviously, you get the report last month, maybe just walking through sort of State of the Union, all the happenings for LifeStance right now.

Yeah, absolutely. I'd be happy to do that. So first, Jack, thank you for hosting us and Jeffries. This is a great conference. I love this conference because it's my hometown. So got to wake up in my own bed this morning, which is always important when you're on the conference circuit. So in reference to Q2, so really strong momentum when you think about the first half of the year and in Q2. So a couple of highlights, Q2 specifically. So our overall revenue grew 26% year over year, and our adjusted EBITDA grew 94%. So really strong quarter overall. And so the strength of the quarter and the momentum that we're seeing allowed us to raise our full year revenue by another $45 million in the quarter. So from a cumulative basis, that's $70 million on a year-to-date basis, and also adjusted EBITDA by another $15 million. So on a cumulative basis, we've increased our guidance on adjusted EBITDA by $30 million. So really strong momentum coming out of the quarter.

Awesome. And it's a good way to team me up here. I mean, I think it may be taking two sides of it, right? Because you've had great momentum in the business. You have some targets heading to 28 to talk about it. And if we disaggregate between maybe top line and then pulling at the margin story a little differently. But to start with top line, you know, the growth has been really solid. You've seen efficiency gains that are helping aid things. But if I take a step back and look at, because the question I'll get sometimes is, you know, the runway as we think about this on a very long-term basis. 2Q, I think you guys dropped a little Easter egg of like where you think you are from a penetration standpoint. But the pitch has always been this is a really big market. as you think about TAM for sort of the core therapy offering? Like, how do you approach that question? Where are we at this point? We'd love to hear.

Yeah, no, absolutely. So we believe we are operating in a marketplace that has an extremely high TAM. So you can think of a TAM, and again, it's always hard to kind of get really good reference points on this, but we believe the TAM to be over $50 billion. So when you think about us in the midpoint of our guide, at 1.7 billion. So obviously, we're the largest kind of in the outpatient behavioral space. But that's really low single digits from an overall TAM perspective. And when you think about our 8,500 clinicians, again, very large, but it's still very small in relation to the amount of clinicians that are out there in the US. So you've got that as kind of like the overall market, you also have 60 million Americans that need access to mental health, right? And you've got a marketplace that's not only growing in unit demand, but you also have folks converting over from cash pay to using their insurance card. So we feel like we're really well positioned as it relates to kind of continue to take advantage of our place within the market, and then also a tremendous amount of upside room and jack you referenced like the breadcrumb that we put out in our q2 call which was really related to hey look in roughly 50 we're only in roughly 50 percent or half of the top 150 markets in the u.s so we have a tremendous amount of opportunity to not only go deeper within geographies but to expand out our geographic footprint so we're real excited by that okay and maybe as i think about it because i think this is another question that comes up a

little more recently just given the the power of the growth vector there's a bit of a question around competition you guys it's sort of a late developing i'm going to call it an mso type model right and to your point cash pay versus insurance pay is a key dynamic there um we're maybe starting to see some i'll call them you know my words copycat business models how do you think about the competitive landscape and and sort of how that weaves in when you contextualize it against the the broader tam yeah it's interesting from a competitive landscape perspective we like to we say a lot that the folks who we really compete with day in and day out are really the mom and pops out within the market so obviously you've got some movement and some folks you know like

copycat whatever kind of moving more towards the affordability angle in terms of taking insurance but i go back to the primary differentiators of us stance really is our national scale we have over 8 500 clinicians we service over a million patients we do over 10 million visits per year. We have what is not easily replicate is our overall hybrid model. So we do 30% of our visits in the 575 plus centers that we have are done in person. And then the residual being 70% being the virtual setting. And again, it's important to kind of think of this as we meet the patient where they're at and so we've got patients and clinicians that both kind of flex within that model so when you're going to you know initiate care you may go and want to establish a relationship with the clinician live and that better suits your life when you get to your you know second third plus visit to do it virtually and you look at the breadth of services that we have so both from a therapy from a psychiatric and then also I know Jack you've written a lot about specialty right and so we also have specialty as it relates to neuropsych testing and then also for solutions for treatment resistant depression and then again like I mentioned this once already but we also come through the door since our founding around affordability and affordability to us means taking insurance and so you see some of the the folks now kind of migrating to that but that is part of our dna and part of how we were founded was to take insurance and so obviously we've got established practices and relationships with the payers to be able to do that okay super helpful so as we as we piece that together you know there's there's that 28 framework that includes you know the same sort of mid-teens as gross you've talked about on the

top line margin expansion getting you know to you know within spitting distance or within the lower end of of that bottom end of the long-term range you've talked about at 15 to 20 percent EBITDA maybe just looking at at the margin side now and and thinking about you know how you get there and where it comes from efficiency gains have really helped on the the care margin front operating levers is another piece. How do you think about the building blocks, you know, as you build towards that?

Yeah. And Jack, I appreciate the question. I know we want to kind of go through the margin door. You've kind of framed out just the overall kind of growth algorithm from revenue. I always think it's helpful to start at the top. So, and it's always good to ground on what we've done just as a business. So when you take the midpoint of our guide and take the four-year compounded annual growth rate, we've grown revenue at 19%, right? When you flow that down to adjusted EBITDA during the same period, we're at 44% in terms of compounded annual growth on adjusted EBITDA. So we are a business that has grown and has proven the ability to grow at really high rates. And really, for the most part, that's all organic. And so really strong growth. When you look forward, our growth algorithm you know we call for mid-teens revenue growth and why I start here is because I always think it's important to kind of ground that that would be in low double digit visit volumes and then low to mid single digits from a rate perspective and then as you kind of go down the P&L to what we call center margins our long-term guide for center margins is in the mid-30s range and so you get some benefit from leverages of occupancy costs plus you have the contribution from specialty right which we expect to grow at a higher rate and a higher and an ultimate mature margin perspective at a higher margin on a mature basis so you get some center margin expansion from those dynamics and then you get into jack where you went with the last part of your question is around operating leverage so if you look at like 26 over 25 we are able to you know if you take the midpoint of the guide expand margins north of 200 bits on adjusted ebitda perspective with 165 bips of that coming through center margin as we go forward we expect more of the margin expansion to come through the gna line through operating leverage just based off of the investments that we've made in AI technology, AI and technology, being able to get scaled growth overall. So we do think you'll get some contribution from center margin, again, to the mid-30s, but get more from the G&A line. And, you know, we dimensioned in our Q4 call when we set 26 guidance that, you know, in, you know, our long-term, our long-term margin profile is 15 to 20% unadjusted EBITDA base in that Q4 call, we further dimension that from a timing perspective to say by full year 28, we get to mid-teens margins. And so it's helpful just to be able to kind of think through the modeling in terms of how it looks.

Totally. No, super, super helpful. And then maybe, I mean, you made reference to specialty. I think, you know, it's a key topic for a lot of folks. I've written about a bunch, pretty excited.

I guess to level set for everyone here in the room can you maybe just talk a little bit about what that growth pathway is and then probably more specific to to the trd treatments but um what that growth pathway is how you guys are approaching it and what the deployment looks like yeah so we're real excited about specialty overall so if you like just to do some framing for the folks uh in the room so specialty last year contributed about $50 million of our total revenue and is expected to grow this year to $70 million. So that's 40% growth. Specialty for us has the big chunk of 25 revenue is really around neuropsych testing. We believe us to be the biggest neuropsych tester in the U.S., where a lot of the growth kind of going forward is from where Jack went around the treatment resistant depression solution. So between TMS and Spravato. And so that's where we're seeing a meaningful amount of our growth on a go forward basis. And we're real excited about the ability to have those solutions. And so if I can just take a moment, kind of elaborate on how we put the solutions into our clinics so typically we organize ourselves in practice groups so you can think of a practice group as being three to five individual centers and again i kind of referenced earlier that we have 575 plus total centers so what we'll do is we'll put a chair into a center right within that practice group or a spravato clinic and so it's really super capital efficient because what we do is we reutilize some of the space that may have been for a group therapy room where you don't need it in that individual center because you still have it within the practice group. And so the capital build-out is really small. And then you already have the referral patterns coming in through your clinicians, right? So the cost of acquisition is de minimis because there already are patients that are seeing either a therapist or a psychiatrist. So overall, the setup is good.

Okay. And as I look at that from like a pacing standpoint, right? And I think you guys are being pretty, you've got a really good thing going in the core business and I think a pretty measured approach to it.

But as you look at layering into that ultimate sort of end state of those practice groups and having the capability within each one, what does that pacing look like over the next couple of years? yeah and so like i kind of go to the pacing because we're being very deliberate about the growth in the rate and pace right so if you look at you know through you know mid-year of this year we have 32 tms clinics kind of sitting within our portfolio and then from a spravato perspective we have 21 and if you look at what we grew we grew tms in the first half seven seven clinics and then Spravato 8 in the first half. That's kind of like the pacing that we're on right now. And the limiters, like if you want to kind of go to like potentially like, we're just being very deliberate around the growth. And so it's the being deliberate and then also having the context of you don't need to have it in every center, which is what I already set up, right? Just based off of how the practices are actually organized and run, you know feel like we're in good shape to be able to you know first and foremost do what's right for the patient because when folks are presenting with treatment resistant depression it's like the worst possible outcome you can be where you're not responsive to drugs right your depression level hasn't like remediated to be able to have these world-class solutions that actually impacts people's lives is really meaningful for us as a practice okay and that's you know a little bit of a like preempting the next question i had here but as i think about because the deliberate approach makes sense and maybe one of the things that you could be solving for is what's the reaction from patients what's the reaction from clinicians etc when you think about payers even the reaction on all three of those key fronts for your business as you're rolling it up what is the what is the back been as it's as it's been deployed it's it's really strong so if you go like start off with the patient so we produced our first outcome study and so we'll isolate here uh tms for a moment outcomes based off of a population that we serve and you know that the study is out there on our website so i recommend anybody go take a look at it but overall some of the key highlights are meaningfully clinical reduction in depression-type symptoms and also a reduction in suicidal ideation, so super important for this population. So we're really pleased with the outcomes from a patient. And I got Lisa Miller here, who is our COO with us, in our last town hall, which was last week. she just went through like testimonials from patients that are super powerful and really kind of resonate and hit you in your heart just in terms of how people's lives are being changed through these solutions and so it kind of feeds off so you go to the next the clinician level you know depending on when clinicians were trained and how comfortable they are you know there's a progression in terms of like oh this is a viable solution that really works and so we're seeing more and more referrals coming in depending on you know like what the clinician background is exposure to it so we spend a lot of time kind of making sure that the education is there like overall so like we're really pleased and then the last one back that you mentioned is payers payers are really interested because we've started to you know as a company one thing we didn't do prior to this year was really publish outcome studies and i use the tms study as an example of a really powerful study but we've also looked at studies as it relates to you know depression without a trp solution and then you go through the anxiety and this is really meaningful to the payers that having an impact on their population okay and then last one here obviously committing a lot of time to it.

And I think it may be worthwhile given the investor focus. But as I think about the sort of frontier expansion in this general area or this general concept, psychedelics are getting a lot of attention. Lily, you know, Lily's purchase of a tie, some updates coming, you know, they're positive out of Compass, et cetera.

As you think about what you're building with the capability and specialty services now, does it feel like that becomes then a platform where as the clinical, you know, sort of frontier moves forward in this space that that you can you know address things through more of these therapies or other pathways yeah jack excellent question and really good point that's why we really love the structure of our practice is to be able to as things come down the proverbial pipe we're situated and ready if we so choose to be able to bring that into our practice you know so for further psychodelics beyond bravado and you and i were briefly chatting about this prior still has to go through the fda approval and then for us the next gate is around that payers reimburse fairly for it uh and reimburse but like we are structured and set up from a clinician or clinical oversight and the ability to deploy that type of solutions just based off of our footprint and our expertise And then we also look at specialty a little broader, right? So we've got the neuropsych testing, TRD. But there are other areas that we always are evaluating that, you know, near adjacencies where you've got the right to win, large TAM, you like the margin profile. And obviously, we're not ready to kind of go out publicly with what potentially that could be. But at the end of the day, the space in which we play with the adjacencies that we have a right to win are pretty meaningful for us as a company okay one other piece and you mentioned you know the step up you have in the guidance thus far this year that's been really impressive part of that has been some of the efficiency initiatives you have in terms of getting clinicians schedules more full um you know maybe the current rate's not what extends all the way forward but if you can talk about what you've been doing there and sort of why it's been so successful yeah so from a what we term is productivity um spent a lot of time you know last year kind of conditioning the market to kind of look at us both the lens of net clinician ads but then how we utilize the time for the clinicians through productivity and the key point for us is productivity is not like this push down kind of strategy it's more being responsive to our clinicians as it relates to filling their schedules better, right? And so a lot of what we do from a pure practice management perspective is really spending time on, okay, when a new clinician comes in, how do we think about optimizing their schedule? How do we make sure we get the match right from matching a patient to a clinician that there's a nice therapeutic alliance of the the higher probability of that relationship enduring through the second and third visit how do we think about overall incentives so last year we realigned our incentive program to a cash-based program that was implemented that had very successful as it relates to aligning incentives i use these as examples not an exhaustive list of things that we've done to make sure that we're optimizing the productivity and again all in response to what our clinician needs are if you go to the second part of your question when you look at that in relation to the overall productivity we had meaningful productivity for the last 12 months right so it's seven percent in q2 we expect productivity from this point forward to be complementary to the net clinician ads so that we won't you won't see the step function type change in productivity, but it'll be a contributing factor, just more like in a more normalized range.

Okay. That makes a lot of sense. And maybe not the exact same front, but you gave more than enough notice to the market that you're planning a new EHR implementation that's going to kick off next year. Maybe just thoughts around how you're preparing for that, what that does for your business.

How does that sort of complement the other efforts you have on the productivity that are already underway yeah so on the EHR front is we're being very thoughtful in both our planning stage and our implementation so if you go back to we are in the planning stage right now and this will be a phased rollout and so we brought in expertise externally also we've brought in talent internally in terms of folks that, sorry about my mic, folks that keeps going out, folks that have expertise in terms of implementing EHRs. And so we'll go through a model office for our first phase and rollout, which will be a total of five phases for the full year 27. And so we like to say we've got, you know, off ramps through the process to make sure that we get this right. But we couldn't be more excited to bring in a top tier vendor for our EHR solution and be able to use this as the platform for foundational growth kind of going forward. So we believe it's got a ton of benefits and upside as it relates to our operating model, the patient experience, the clinician experience, be able to provide more clinician kind of support through the technology, more interoperability across the whole healthcare ecosystem. I could keep going on and on about the benefits of deploying, you know, a top-tier vendor into the HR. And so there's a lot of excitement internally around this.

But I also just want to always make sure anytime I'm talking publicly, this has been a really, really thoughtful approach around how to execute an implementation so that you mitigate, you know, any potential, any of the potential downsides of implementing new technology at this point. scale okay that makes sense and so as i think about now the gains you've had on the productivity front recruitment looks good it seems like you have a little more control around how much you bring on right um and maybe tying that into the retention question as well as like what are you looking at from recruitment and retention standpoint right now um in retention i think it had been a hot button topic for the stock long predating your time it seems like it's been more stable but maybe just talking through those dynamics and how those two things look yeah so Absolutely.

When we think about clinician recruiting, we feel we've got a very strong value prop for the clinicians overall. Jack, you referenced this in the questions. We could be hiring more clinicians than we actually do just based off of the thoughtful geographic approach we have to both the existing clinicians in the geography and then also the new clinicians that we look to add when you think about it from an overall retention so it has been stable so we haven't reported retention numbers out to the street in multiple years with the commitment being that if it was meaningfully different both positive or negative that we would kind of come out to the market and give an update but so it has been stable but we're actually when you look at it and you dissect retention we really like what we're seeing from a momentum perspective on retention so i use examples of you know the clinician incentive program we retain that population at a higher rate than what the average is and when we look at folks who are highly you know productive we're meaningfully more favorable on that population as a whole and typically that population, you know, lines into the top tier of the incentive program. Where we have opportunities is around, you know, the first six, 12 months with new clinicians and making sure that we continue to further optimize their schedule so that, you know, we're a W-2 fee-for-service so that they make the income around their expectations to be able to retain that population.

But we're really pleased with some of what we've seen come out of retention even though it has been stable from a headline kind of metric perspective okay and you touched on it a little bit earlier as it related to sort of what's a sustainable rate of growth for the business that rate contribution you know low to mid singles there's a lot of you know recent updates coming out for next year and what we're going to see from premium increases some chatter around this you know every employer seems to be saying this is untenable to commercial plans before they sign another 8% to 9% contract. I guess the question here is, looking at the value prop you have, that low to mid-single you've committed to, right, or that seems to be the viewpoint, but what makes you feel good about that being the rate at which rate can grow in the broader context of what's happening in commercial market?

Yeah, I think it's a great question as well. And so, again, we feel that our dialogue with the payers is very constructive. So we have a relationship with the payers at the executive level, at the clinical level, the operations level, and obviously at the payer level. So we make more of the relationship not always just about the rate component to it, about how do we collaborate and do right for our patients, their members. The backdrop, you know, I come 20-plus years on the payer side at one point in my career. The backdrop is always, you know, negotiations are always challenging, right? But at the same time, when you think about the constructive nature of our relationships, we provide a very valuable service. And so you can think of us as the primary care of behavioral health. And it's a gateway to a whole bunch of other things that has a potential to reduce costs for them, whether you're talking about people presenting to the ed talk about you know further need to make the connection between the mind and body like in totality so these are constructive conversations that we have for them and honestly the market's so fragmented they don't have a lot other providers like us that they can actually talk to and so when we think about the strength of trpv for this year you know updating our guidance from low to mid single digits to mid single digits we feel a reasonable expectation for this business is low to mid single digits in totality kind of going out in our longer term growth algo okay makes sense a little over 90

seconds left there's obviously a lot that investors are appreciating about the story given the run of the stock but if you if you take a step back and say what's one thing about life stance that one or two things about life stance that you think investors don't appreciate right now that they could could come to appreciate in the next you know one or two years what do you think Yeah, so I think that's a great question as well.

And again, there is a lot of energy around our business right now. And so I think there's a tremendous amount of appreciation for who we are and why we're different, all the way from our national scale, hybrid model, affordability, and breadth of services. so I think there's a lot of really strong recognition there I also think the market has moved past the productivity productivity being a question mark which is where a lot of the inquiries were right like historically to more around like how do I think about the ceiling on productivity versus if do I think it's a real concept so I think that's really kind of moved through i think there's a tremendous amount of interest rightly so in specialty lines right overall and so i think there's a lot of collective learning that the marketplace is looking for from us and plus through biotech etc trying to triangulate back to like where could this all go so i think so i'm not really answering your question directly because i think that we've got a lot of good alignment like with investors right now and like the end of the day and i know I've got 12 seconds left. I think there's just a lot of pure understanding about the strength of the flywheel that we've built in our business from low acquisition costs to bringing in new patients, converting them, and having them seen through the full course of treatment that I think is really exciting for us and I think obviously for investors as well.

Awesome. Ryan, thank you so much. Really appreciate it.

Thanks for having me.