WAY — Waystar Holding Corp.

Summary of Waystar Q1 2026 Earnings Call

1. Key Financial Results and Metrics

• Revenue: $314 million, a 22% year-over-year increase.
• Organic Revenue Growth: 11% year-over-year.
• Adjusted EBITDA: $135 million, a 26% increase year-over-year, with an adjusted EBITDA margin of 43%.
• Net Revenue Retention Rate: 111%, slightly above historical averages (108%-110%).
• Client Growth: Added 42 new clients with over $100,000 in trailing 12-month revenue, totaling 1,433 clients, a 15% year-over-year increase.
• Cash Position: Ended the quarter with $159 million in cash and equivalents, and $1.5 billion in gross debt.

2. Strategic Updates and Business Highlights

• AI Integration: AI-powered capabilities accounted for approximately 40% of new bookings in Q1, with a focus on enhancing operational efficiency and accuracy in revenue cycle management.
• Acquisition of Iodine: Integration is ahead of schedule, enhancing Waystar's capabilities in clinical intelligence and revenue cycle management.
• Product Development: New AI solutions, such as prebill anomaly detection and recruitment solutions, are expected to significantly improve revenue recovery and operational efficiency for clients.
• Market Positioning: Waystar aims to transition towards an autonomous revenue cycle platform, expanding its total addressable market from $20 billion to approximately $100 billion.

3. Forward Guidance and Outlook

• Revenue Guidance: Reaffirmed for the full year at $1.274 billion to $1.294 billion, representing a 17% year-over-year growth.
• Adjusted EBITDA Guidance: Expected range of $530 million to $540 million.
• Growth Expectations: Anticipates continued strong demand and bookings, with a large qualified sales pipeline supporting visibility into 2027.

4. Bad News, Challenges, or Points of Concern

• Volume-Based Revenue Decline: Patient payment solutions, representing about 25% of revenue, faced headwinds due to accelerated conversion from print to digital statements and lower patient utilization, leading to a slower growth forecast for Q2.
• Seasonality Effects: Expected tighter variability in first half vs. second half revenue, with Q2 growth anticipated to be flat to 1%.
• Competitive Pressures: While AI integration is a strength, there are concerns regarding how payers are deploying AI to manage claims, which may affect provider negotiations.

5. Notable Q&A Insights

• AI's Impact on TAM: Management emphasized that AI capabilities are expected to significantly expand the total addressable market and drive future revenue growth.
• Sales Cycle Dynamics: Despite the introduction of more complex SKUs, sales cycles remain stable, with elevated win rates indicating strong demand for the integrated platform approach.
• Client Feedback: Providers are increasingly looking for comprehensive solutions rather than point solutions, validating Waystar's platform strategy.
• Market Conditions: Management noted that while hospitals face financing challenges, Waystar's mission-critical solutions remain prioritized by clients, indicating resilience in demand.

This summary encapsulates the key financial metrics, strategic initiatives, future outlook, challenges, and insights from the Q&A, providing a comprehensive overview of Waystar's performance and direction in Q1 2026.