WAY — Waystar Holding Corp.

Summary of Waystar Q1 2026 Earnings Call

1. Key Financial Results and Metrics

• Revenue: $314 million, up 22% year-over-year; organic revenue growth at 11%.
• Adjusted EBITDA: $135 million, a 26% increase year-over-year, with an adjusted EBITDA margin of 43%.
• Net Revenue Retention: 111%, slightly above the historical range of 108%-110%.
• Client Growth: Added 42 new clients with over $100,000 in trailing 12-month revenue, totaling 1,433 clients, a 15% increase year-over-year.
• Subscription Revenue: $172 million, up 38% year-over-year, representing 55% of total revenue.
• Volume-Based Revenue: $139 million, increased 7% year-over-year but faced some headwinds.

2. Strategic Updates and Business Highlights

• Waystar continues to position itself as a leader in the healthcare revenue cycle management space, emphasizing its AI-powered solutions.
• The integration of Iodine is ahead of schedule, enhancing capabilities in mid-cycle clinical intelligence.
• AI-driven solutions accounted for approximately 40% of new bookings, reflecting strong traction in the market.
• The company is focusing on embedding AI deeper into workflows, with a goal of transitioning towards an autonomous revenue cycle platform.
• Waystar's sales pipeline is reported to be the largest in its history, indicating strong demand and future growth potential.

3. Forward Guidance and Outlook

• Revenue Guidance: Reaffirmed for the full year at $1.274 billion to $1.294 billion, suggesting 17% year-over-year growth.
• Adjusted EBITDA Guidance: Expected to be between $530 million and $540 million.
• Anticipates a flat to 1% sequential growth in Q2, with a return to 1% to 3% growth in Q3.
• The company expects continued strong demand and bookings activity, particularly in the second half of 2025, which could provide upside for late 2026 and beyond.

4. Bad News, Challenges, or Points of Concern

• Volume-Based Revenue Headwinds: Notable pressure on patient payment volumes due to macroeconomic factors and a shift from print to digital statements, which may affect revenue in the short term.
• Patient Utilization Decline: Changes in healthcare coverage and weather-related impacts have contributed to lower patient interactions, affecting volume-based revenue.
• Longer Sales Cycles: Larger contracts typically take 6 to 18 months to realize revenue, which could delay financial benefits despite strong bookings.

5. Notable Q&A Insights

• Management acknowledged that the shift from print to digital statements is a long-term positive transformation but has temporarily impacted revenue.
• There is excitement around AI capabilities, with management indicating that AI will significantly expand the total addressable market.
• The company is actively engaging with both providers and payers to enhance collaboration and efficiency in the revenue cycle.
• Management noted that while sales cycles remain stable, elevated win rates indicate strong competitive positioning in the market.

Overall, Waystar's Q1 2026 results reflect solid growth and strategic positioning, particularly in AI and integrated solutions, despite facing some near-term challenges in volume-based revenue. The outlook remains positive with reaffirmed guidance and a strong sales pipeline.