Amwell (AMWL) Telefonkonferenz zu den Quartalszahlen für Q3 2026: EBITDA-Breakeven-Ziel für Q4

Wichtigste Erkenntnisse

• Amwell erzielte im 3. Quartal des Geschäftsjahres 2026 einen Umsatz von 49 Mio. US-Dollar. Dies entspricht einem Rückgang von 12,9 % gegenüber dem Vorjahr, liegt jedoch um 1 Mio. US-Dollar über dem oberen Ende der eigenen Prognosespanne.
• Das bereinigte EBITDA verbesserte sich von einem Verlust von 12,7 Mio. US-Dollar im 3. Quartal 2025 auf einen Verlust von 3,6 Mio. US-Dollar. Der operative Verlust verringerte sich um rund 60 % auf 11,7 Mio. US-Dollar.
• Der Umsatz der Amwell Medical Group stieg im Jahresvergleich um 11,7 % auf 23,7 Mio. US-Dollar. Der Umsatz pro Behandlungsfall erhöhte sich um 11 % auf etwa 79 US-Dollar, während die virtuellen primärärztlichen Konsultationen um rund 41 % zulegten.
• Das Management erwartet für das 4. Quartal 2026 ein bereinigtes EBITDA zwischen der Gewinnschwelle und plus 1 Mio. US-Dollar und bekräftigte das Ziel, in diesem Quartal einen positiven operativen Cashflow zu erwirtschaften.
• Die Umsatzprognose für das Gesamtjahr wurde auf 204 Mio. bis 206 Mio. US-Dollar angehoben, während sich der prognostizierte Verlust beim bereinigten EBITDA auf 6,9 Mio. bis 7,9 Mio. US-Dollar verbesserte.
• Das US-Kriegsveteranenministerium (Department of Veterans Affairs) hat eine unverbindliche Absichtserklärung zur Nutzung der Amwell-Plattform abgegeben. Die Vertragsbedingungen und der Zeitplan für die Einführung hängen weiterhin von den Verhandlungen und den bundesstaatlichen Beschaffungsbestimmungen ab.

Wichtigste Finanzdaten

Geschäftliche und operative Entwicklung

Das Umsatzwachstum von AMG wurde durch eine günstige Preis- und Volumenentwicklung in der Akutversorgung sowie durch eine Verschiebung hin zu höherwertigen klinischen Programmen unterstützt. Die virtuellen primärärztlichen Konsultationen stiegen im Jahresvergleich um rund 41 %.

Der Abonnementsumsatz blieb durch den zuvor bekannt gegebenen Kundenabgang belastet. Das Management rechnet künftig mit deutlich weniger Abgängen im Bereich der Krankenversicherungen, wenngleich in Geschäftsbereichen, die Amwell weniger priorisiert, weiterhin eine gewissse natürliche Fluktuation auftreten kann.

Laut Amwell führen seine dauerhaft aktiven Mitglieder-Engagement-Tools zu einer mehr als dreimal höheren Plattformnutzung im Vergleich zu Phasen, in denen diese Tools deaktiviert sind. Das Unternehmen reduzierte zudem den Ablauf für wiederkehrende Mitglieder von 12 Bildschirmen auf drei, wobei die Mitglieder die Behandlungen mit 4,9 von 5 Punkten bewerteten. Das Management gab an, dass die Einführung erst vor Kurzem erfolgte, sodass sich die finanziellen Auswirkungen in den ausgewiesenen Ergebnissen noch nicht wesentlich widerspiegeln.

Das Unternehmen positioniert seine Plattform als zentrale Integrationslösung für Krankenversicherer und Arbeitgeber zur Verwaltung von Amwell-Diensten sowie klinischen Programmen von Drittanbietern. Amwell betreut derzeit Kunden, die mehr als 90 Millionen versicherte Personen repräsentieren.

Im staatlichen Gesundheitswesen betreibt Amwell weiterhin seine Plattform für das Military Health System, das 9,6 Millionen Begünstigte abdeckt. Das Unternehmen verhandelt über eine direkte, längerfristige Vereinbarung mit der Defense Health Agency und gab an, dass das derzeitige System weiterhin im vollen Betrieb läuft.

Das US-Kriegsveteranenministerium (VA) hat eine Absichtserklärung für eine unternehmensweite Einführung abgegeben. Das VA betreut mehr als 9 Millionen Veteranen, aber Amwell betonte, dass die Absichtserklärung kein bindender Vertrag ist. Bislang hat das Unternehmen keine Umsätze mit dem VA erzielt.

Prognose des Managements

Der Ausblick für Q4 geht von einem normalen saisonalen Anstieg der Behandlungszahlen im Winter und einer weiterhin stabilen Abonnentenbasis aus. Zudem erwartet das Management für Q4 einen positiven operativen Cashflow sowie einen Kassenbestand von rund 180 Mio. US-Dollar zum Jahresende.

Amwell hat keine Prognose für 2027 vorgelegt. Laut Management werden das Wachstum und die Profitabilität im Jahr 2027 teilweise vom Zeitpunkt und den Bedingungen potenzieller Verträge mit dem VA und der DHA abhängen. Die Prognose für das Gesamtjahr 2027 wird bei der nächsten Telefonkonferenz zu den Quartalszahlen erwartet.

Risiken und wichtige Beobachtungspunkte

• Die Absichtserklärung des VA ist unverbindlich; eine endgültige Vereinbarung muss gemäß den bundesstaatlichen Beschaffungsvorschriften noch ausgehandelt und unterzeichnet werden.
• Zeitplan und Umfang der Einführung beim VA sind noch nicht finalisiert. Das Management rechnet nach Erzielung einer Vereinbarung mit einem detaillierten Implementierungsprozess.
• Die Vertragsverhandlungen mit der DHA dauern an, was zu Unsicherheiten hinsichtlich des Zeitplans und des finanziellen Beitrags im Jahr 2027 führt.
• Der Abonnementsumsatz blieb im Jahresvergleich stark rückläufig, und das Management erwartet eine gewisse natürliche Fluktuation bei weniger priorisierten Geschäftsbereichen.
• Es wird erwartet, dass neue Aufträge der öffentlichen Hand erst im Laufe des Jahres 2027 anlaufen und somit nicht das gesamte Kalenderjahr über einen Beitrag leisten werden.
• Eine ergebnisbasierte Preisgestaltung könnte das Umsatzpotenzial durch die Nutzung erhöhen, verlagert jedoch auch mehr Leistungsrisiko auf Amwell.

Wichtigste Punkte aus der Analysten-Fragerunde

Zeitplan für VA und DHA: Das Management erklärte, dass die Verhandlungen mit dem VA fortgeschritten seien, lehnte es jedoch ab, ein konkretes Datum für die Unterzeichnung oder den Start zu nennen. Der Direktvertrag mit der DHA sei bereits weiter fortgeschritten und stehe möglicherweise vor dem Abschluss, während die bestehende Plattform weiterhin betriebsbereit bleibe.

Wachstumsvisibilität für 2027: Das Management gab an, dass Amwell über die bislang stärkste Pipeline verfüge, der Zeitpunkt des Beginns neuer Verträge jedoch bedeute, dass potenzielle Umsätze aus der öffentlichen Hand möglicherweise nicht das gesamte Jahr 2027 betreffen. Jegliche Umsätze mit dem VA wären zusätzlich, da Amwell zuvor keine Umsätze mit dem VA erzielt hat.

Kostenstruktur: Amwell geht nicht davon aus, dass große Verträge einen erheblichen Anstieg der Mitarbeiterzahl erfordern werden. Das Management plant, Implementierungen durch spezialisierte Teams zu unterstützen und gleichzeitig die Arbeitsabläufe weiter zu vereinfachen sowie Ausgaben in weniger priorisierten Bereichen zu senken.

Organisches Wachstum: Das Management sieht Wachstumschancen durch eine höhere Mitgliederaktivierung, ein breiteres Angebot an klinischen Dienstleistungen und die verstärkte Nutzung von Programmen von Drittanbietern. In weiten Teilen des vom Unternehmen adressierten Marktes liegt das Engagement weiterhin im einstelligen Prozentbereich, womit ein erheblicher Teil der versicherten Mitglieder inaktiv bleibt.

Psychische Gesundheit: Die Expansion von SilverCloud stellt einen potenziellen Wachstumsbereich dar. Dienstleistungen im Bereich der psychischen Gesundheit für die DHA werden jedoch als separate Chance auf Zusatzumsätze und nicht als Teil der aktuellen Verhandlungen über den Direktvertrag betrachtet.

Vollständiges Transkript der Telefonkonferenz

Vollständiges Transkript der Telefonkonferenz

Ausführungen des Managements

Operator

Hello, everyone, and welcome to Amwell's Conference Call to discuss their Third Fiscal Quarter of 2026. Joining us on the call today are Amwell's Chairman and CEO, Dr. Ido Schoenberg, and Mark Hirschhorn, Amwell's CFO and Chief Operating Officer. Earlier today, a press release was distributed detailing their announcement. The earnings report is posted on the Amwell website at investors.amwell.com and is also available through normal news sources. This conference call is being webcast live on the IR page of the website, where the replay will be archived.

Before they begin prepared remarks, I'd like to take this opportunity to remind you that during the call, we will make forward-looking statements regarding projected operating results and anticipated market opportunities. This forward-looking information is subject to the risks and uncertainties described in the filings with the SEC. Actual results or events may differ materially. Except as required by law, we undertake no obligation to update or revise these forward-looking statements.

On this call, we'll refer to both the GAAP and non-GAAP financial measures. A reconciliation of GAAP and non-GAAP financial measures is provided in the earnings release.

With that, I would like to turn the call over to Ido.

Ido Schoenberg

Good evening, and thank you for joining our third quarter earnings call. This was another quarter of steady progress. We set a goal at the start of the year: reach positive cash flow from operations and positive adjusted EBITDA in the fourth quarter and build from there. We beat our guidance for the quarter on both revenue and adjusted EBITDA. That makes 9 quarters in a row of delivering our commitments to you. We are pleased with the quarter and with our progress across the business, and we have good visibility to that fourth quarter goal. Mark will take you through the numbers.

Before he does, let me cover our market, our product, and recent developments in our company. Let me start with our customers, because their reality shapes everything we do. Health plans and employers face their largest cost increases in about 2 decades. Costs are projected to rise another 8% to 11% in 2027. Last month, UnitedHealth said costs remain stubbornly high across the entire health care landscape. Premiums are not keeping pace. The easy fixes are gone. Technology-enabled care is one of the few levers left, but only if it comes with proof. That pressure is changing how health plans and employers buy. They no longer buy access. They buy engagement and outcomes. Most now tie digital health fees to performance. Nearly half of them say the programs they buy enroll fewer than 1 in 4 eligible members. Poor engagement is now the top reason they switch vendors.

Health plans and employers face 3 major challenges in digital health today. The first is vendor sprawl, dozens of point solutions, each with its own front door, costly to connect, and hard to compare. The second is member confusion. A member who does not know where to start does not start. The third is the lack of proof. It is hard to see which programs work and harder still to replace one without disrupting members. That sprawl is accelerating. AI has made it faster and cheaper to build a clinical program. Investors have backed hundreds of new digital health companies this year, many of them built on AI. Our customers feel pressure to offer these programs, but each one brings its own cost, its own integration, and its own front door. The opportunity is real. So is the complexity.

More and more, a member's journey to care begins in a conversation with an AI assistant. Three in 10 adults now use AI tools for health information at least once a month, up from about 1 in 6 2 years ago. The question for our customers is where that conversation ends. It can end with a guess. It can end with care that is wrong for the member and wasteful for the plan, or it can end with a covered in-network service that fits the member's need and has proven clinical and financial outcomes. This is the problem Amwell is determined to solve for our customers. We help them improve clinical and financial outcomes. We do it through activation, getting more of their members into technology-enabled care in place of conventional care that often costs more. We give our customers 1 platform under their brand with 1 integration. It provides reliable, scalable rails to bring in a program, exchange data with it, and tests whether it works. The member's experience stays consistent, simple, and engaging. A common data structure proves the outcomes and improves performance over time.

As AI begins to transform health care, this platform becomes even more necessary. We are not selling an AI feature. We are the trusted platform where AI-powered care runs with clinicians in the loop. We extend our clients. We never compete with them. That is why large and sophisticated organizations trust us with their members. Our customers together represent more than 90 million covered lives. We serve the 9.6 million beneficiaries of the Military Health System, and the Department of Veterans Affairs has signaled its intent to do the same. Two recent recognitions point the same way. In September, Frost & Sullivan recognized Amwell for technology innovation leadership. It cited our ability to address health care fragmentation through a unified platform. Time magazine named Amwell to its list of the world's top health tech companies of 2026.

Let me be specific about where we are focused for our customers today. There are 6 areas, and all 6 run on the platform I just described. Three are about the member, getting members in, what they see, and keeping them. Two are about the programs, our partners and our own.

The last is the data that proves what works. For each, I will describe the problem and what we do about it today. First, activation. A customer gets value only when its members use the care it has bought. Most of the health plans we talk to still see engagement in the single digits. We address that with always-on engagement, outreach to members through our customers' own channels within the rules they set. When a customer switches it fully on, members use the platform at more than three times the rate we see when it's off. Activation is where value begins. Without it, nothing else happens. With it, members get care, our customers get results, and we grow.

Second, the member experience. This quarter, we shipped a dramatically improved experience to most of our key customers. Returning members now see 3 screens instead of 12. Members rate their visits 4.9 out of 5. Behind that experience are the clinicians of the Amwell Medical Group. They provide urgent care, virtual primary care, and behavioral health, as well as nutrition and lactation programs. They are also empathetic guides through a confusing system. They help the member decide where to go next, and they are a steady source of confidence, simplicity, and a personal connection to a clinician. That is the experience we deliver.

Third, the member's ongoing relationship with a clinician. Today, most virtual care ends when the visit ends. We invest in what happens before and after the visit, so the relationship is durable and the member has a reason to come back. That matters to our customers because the clinician the member trusts is an effective referral point into the programs the customer has chosen. That is how activation compounds.

Fourth, choice. This is where the programs come in. The member should get the right program, not just the available one. Our standard process brings a partner program live in weeks. One sign-on, one eligibility file, one data connection, one report under the customer's brand. Our customers can add a program or replace one without disrupting members. That is choice without the sprawl.

Fifth, behavioral health, where demand keeps rising and supply keeps falling short. SilverCloud is our behavioral health module on the Amwell platform. It automates the delivery of evidence-based care, and it gives members a path to our own therapists and psychiatrists on the same platform. The evidence is building. Last month, we published a case study with Discovery Health, one of South Africa's largest health plans. In its first 12 months, the program activated 22,000 members. 90% of surveyed users were satisfied. Among members with moderate to severe depression, 60% to 78% showed clinically significant improvement. And in the year after use, members' hospital costs related to mental health were 6% lower after adjusting for other factors. Activation first, with measured outcomes behind it. We prove, we do not claim.

Sixth and last, data. A common data structure runs under everything I have described. It sends a member into a program with the right information. It collects outcomes back, and it reports value in the customer's own terms, whether that customer is a health plan or an employer that the plan serves. That is how a program proves its return on investment and how it gets better over time. Six areas, 1 platform. Together, they answer the 3 challenges I started with: vendor sprawl, member confusion, and the lack of proof. That is where we are focused for our customers today and where we will keep investing.

Let me turn to our government business, starting with the Department of Veterans Affairs. In September, we announced the department issued a letter of intent for us to deploy the Amwell platform across its enterprise. The department serves more than 9 million veterans. I want to be precise about what this is. The letter is not a binding contract. A definitive agreement still has to be negotiated and executed under federal procurement rules, and that work is underway. The letter followed a comprehensive evaluation. It cited scalable video consultations, interoperability, cybersecurity compliance, and support for integrated care delivery. In plain terms, the capabilities the Department evaluated are the ones we already run at scale for the Military Health System, and the Department's own scale is considerable. In fiscal 2025, more than 2.9 million veterans used its telehealth services, and it delivered more than 11.7 million video visits to the home. We are honored by that trust, and we are preparing for this work deliberately. With the Defense Health Agency, we continue to serve the Military Health System without interruption. We are negotiating the direct, longer-term contract that the agency signaled its intent to award in June.

Before I close, 2 principles guide how we run the company. The first is discipline. We are determined to keep improving efficiency and effectiveness across the business. We hold ourselves to the same standard we offer our customers. We measure results before we claim them. The second is focus. We are simplifying our efforts around a single differentiated Amwell platform. One platform is more reliable for our customers, faster to extend, and less expensive to run. It is what makes everything I described possible.

To sum up, the market is moving towards what we've built. AI is multiplying the programs our customers can offer. Our platform is the reliable way to bring those programs to members and to prove which ones work. Virtual care for the Military Health System runs on it. The Department of Veterans Affairs has signaled its intent to follow, and we are doing all of this with discipline. We have good visibility to positive cash flow from operations and positive adjusted EBITDA in the fourth quarter.

With that, I will turn the call over to Mark, who will walk you through our operational and financial results. Mark?

Mark Hirschhorn

Thanks, Ido, and good afternoon, everyone. On today's call, I'll start with the highlights from the third quarter, walk through our financial results in detail, and close with our outlook for the fourth quarter and the full year. In the third quarter, we delivered revenue above the high end of our guidance range and adjusted EBITDA toward the high end of our range. The outperformance was driven primarily by stronger-than-expected visit volumes and continued cost discipline. These results keep us on track toward our goal of generating positive cash flow from operations in the fourth quarter of this year.

Total revenue for the third quarter was $49 million, down approximately 12.9% year-over-year, although $1 million above the high end of our guidance range. Subscription revenue was $23.9 million, down approximately 22.5% year-over-year and down approximately 6.8% sequentially. The year-over-year decline continues to reflect the previously disclosed churn we've discussed on prior earnings calls. Amwell Medical Group, or AMG, visit revenue was $23.7 million, up approximately 11.7% year over year and down approximately 3.1% sequentially, reflecting normal seasonality in visit volumes. AMG paid visits totaled approximately 301,000 visits, essentially flat year over year, with revenue per visit of approximately $79 per visit, up approximately $8 per visit, or 11% from the third quarter of last year. That increase reflects favorable pricing and volume in urgent care, along with the continued shift in our visit mix toward higher value clinical programs. Virtual primary care visits were up approximately 41% year over year, continuing its strong growth trajectory. Total platform visits were approximately 760,000 visits, down approximately 30.5% year over year, which is consistent with the portfolio changes we've discussed previously.

Gross profit was $26 million, with a gross margin of 53%, up approximately 57 basis points year over year from the 52.4% in the third quarter of 2025. The year-over-year improvement was driven by cost containment and higher clinical program revenue. As we've noted, our existing revenue mix is likely to produce a margin profile consistent with recent quarters, and we continue to expect our mix to shift toward higher margin SaaS offerings over time.

Total operating expenses, including depreciation and amortization, were $37.6 million, down approximately 36.1% year over year and up approximately 1.3% sequentially. As a percentage of revenue, operating expenses improved to 76.8% compared to 104.5% in the third quarter of last year and 71.3% last quarter. The year-over-year improvement reflects the benefit of our transformation actions, lower litigation costs, and continued cost discipline across the business.

Adjusted EBITDA for the third quarter was a loss of $3.6 million compared to a loss of $12.7 million in the third quarter of 2025. That's a $9.1 million improvement.

Operating loss was $11.7 million compared to a $29.3 million operating loss in the third quarter of 2025, an improvement of approximately 60%.

Amwell's balance sheet continues to be very well positioned. We ended the quarter with approximately $181 million in cash and investments and zero debt. We expect to be in a very similar position at year-end.

Now turning to guidance. For the fourth quarter of 2026, we expect revenue in the range of $48 million-$50 million and adjusted EBITDA in the range of breakeven to a positive $1 million. This outlook reflects the typical seasonal pickup in visit volumes as we move into the winter months, along with continued stability in our subscription base. For the full year, we are raising our guidance. We now expect full-year 2026 revenue in the range of $204 million-$206 million, compared to our prior range of $195 million to $205 million. We also now expect full-year adjusted EBITDA to be a loss in the range of $6.9 million to $7.9 million, a meaningful improvement from our prior range of a loss of $12 million to $16 million. We continue to expect full-year AMG visits at the high end of our previously communicated range of 1.32 million to 1.37 million visits. Our fourth quarter outlook reflects breakeven to positive adjusted EBITDA, consistent with our previously stated goals.

In summary, during the third quarter, we exceeded our revenue guidance with stronger visit volumes, a stable subscription base, and a leaner cost structure that positions us to finish the year on a strong note. I want to thank all of my colleagues, for they are by far the most valuable of Amwell's assets, for their continued hard work and dedication.

With that, I'll turn it back to Ido.

Ido Schoenberg

Thank you, Mark. Before we take your questions, let me leave you with the key points. 2026 brought clarity, focus, and urgency to solving our customers' unmet needs. Our customers face their largest cost increases in two decades. They no longer buy access. They buy engagement and outcomes. AI is multiplying the programs they can offer. It brings real opportunity and real complexity. Amwell gives them one platform under their brand with one integration. We bring members in. We give them a simple, consistent experience. We connect them to the right program, and we prove what works. We are not selling an AI feature. We are the trusted platform where AI-powered care runs with clinicians in the loop. We extend our clients. We never compete with them.

Virtual care for the Military Health System runs on our platform. The Department of Veterans Affairs has signaled its intent to follow. We run the company with discipline and focus. We beat our guidance this quarter. That is nine quarters in a row of delivering on our commitments, and we have good visibility to positive cash flow from operations and positive adjusted EBITDA in the fourth quarter. I am proud of our team and grateful for the way they rose to this challenge with agility and passion. We are more strategically and operationally focused on our mission than ever before. We have accomplished much. We have significant work ahead, and we are committed to the path we are on and to increasing shareholder value.

Now we will open the call for your questions. Operator, please go ahead.

Operator

[Operator Instructions] Our first question today is from Stan Berenshteyn with Wells Fargo Securities.

Fragen und Antworten

Stanislav Berenshteyn

First, on the VA, can you just walk us through, what is the process of these negotiations? What are kind of the next milestones, and how should we think about this over the course of this year or maybe next year? Do you expect any sort of contract terms this year, next year? How should we think about this?

Ido Schoenberg

These are very detailed discussions following a very long process that resulted in the letter of intent that we have received and published. It's equally detailed to move this general direction into a full contract and work plan, but we are very optimistic that we are going to get there. I'm not going to second guess the timeline, but we don't think it's going to take too long. We covered a lot of ground already, and very importantly, the VA is very pleased to see that our platform is proven to work in an environment that has a lot of similarity to its own.

We are fairly optimistic that you're not going to wait too long for this project, and then we definitely plan to go through a fairly detailed implementation at the beginning of next year, and its duration and go-live really depends on specifications that are not fully determined at this point.

Stanislav Berenshteyn

On the DHA, obviously, there's a potential new contract that's coming down the line here. I guess a two-parter here. The first is, before you maybe sign the new contract, what happens with the existing contract? Is there any runoff or any type of contingency that the preexisting contract continues to run through? Can you just help us bridge the outgoing contract and the potential new contract and how we should think about that?

Ido Schoenberg

Sure. We are in full production universally with the DHA. The system is operating very well since it went live without any issues, at least ones that we are aware of, and our dialogue with the customer, I think, reflects that right now. We fully expect, as Mark suggested in different opportunities before, to convert the current agreement into a different one, a longer-term agreement that may be a direct agreement per the preference of the DHA with Amwell. And of course, when that happens, we are going to share it with everyone.

Operator

Our next question is from Craig Hettenbach with Morgan Stanley.

Craig Hettenbach

On the commercial side of the business, as your focus has shifted toward payers, what is resonating most with these customers today, and what type of expansion opportunities do you see going forward?

Ido Schoenberg

You are absolutely correct that most of our significant opportunity is in this space between commercial payers and also government, that in many ways is like a payer, where risk is very, very important. Today, as I mentioned in my prepared remarks, people are very focused on clinical and financial outcomes, and that requires activation, it requires reducing the operational costs related to vendor sprawl and its translation into lack of outcomes or the fact that it could hurt outcomes. I think that it is very clear to us that when we talk to customers, existing ones and new ones, the fact that we have one platform that requires one integration, generates one simple engaging experience with great degree of flexibility to add any program and to measure whether it works or not is very, very compelling. We hear that time and time again.

As you probably know, a lot of the infrastructure of payers is now limited because of budget constraints. Vendor sprawl is big as ever. The demand from employers and others to increase programs is big, but the ability to execute it without a platform is very compromised. We fit right in into this environment.

Our growth opportunities are really twofold. One, and it is very, very significant, is sales growth. We are not scratching the surface. We are, all of us, the entire industry, in the single digits of activation, and there are so many people that could benefit from the service that is already covered for them and very available. We know they love it when they use it. They just are not aware of it and not active for various reasons. That is an area where we are seeing a lot of opportunity. The fact that our own marketing, for example, is able to produce 3x on traditional alternative options is again very, very encouraging. We fully expect to see growth in the number of members that are using our platform.

Very importantly, because of the way that the platform works with different investment, the level of sophistication and breadth and the parts of the continuum of care that we can offer is likely to grow a lot. Mark shared earlier that our virtual primary care alone, which is much broader than urgent care, traditional urgent care, rose more than 40%. This, we think, is a trend, and we think the value per member, in addition to the number of members, are very exciting growth opportunities for the company.

In addition to that, of course, we have still quite a few payers and significant number of sizable government agencies that are not a part of our client base today, where we definitely see a nice growth in pipeline and growing level of interest. These 2 combine, by the way, because as our existing customers report better outcomes and reduce costs and overall high satisfaction of members, that immediately translate into the sales cycle and level of appetite of their peers. That is really how we see it.

Craig Hettenbach

Then just as a follow-up, as you begin the budgeting process for 2027, can you just touch on the visibility into your growth at this time of year versus a year ago, and any other key areas of investment or efficiencies that you expect to drive?

Ido Schoenberg

Stating the obvious, we made some serious investments in the government sectors, and the results depend on factors that are in play right now, that we are optimistic about them concluding very, very well. We are confident that the quality of revenue is increasing in the company and the pipeline is increasing. Of course, we are not providing next year's guidance. We are probably going to do it in the next earnings call, and I think that's the right time to share more color on the exact dynamics of next year.

Operator

Our next question is from David Larsen with BTIG.

David Larsen

Congratulations on a good quarter. Can you comment around EBITDA expectations for the fourth quarter? It looks like you're guiding to almost break even. Do you expect that trend to continue into 2027?

Mark Hirschhorn

Dave, thanks for the kind words. We do in fact have good visibility into this current fourth quarter's EBITDA. We are confident that we will achieve our now longstanding goal of being EBITDA break-even. We will likely be on that positive side, on the upward side of that range that we provided. There is a significant amount of impact that will clearly determine if we continue on a break-even pace throughout the respective quarters of 2027 based on the timing and receipt of a, hopefully, of a VA new contract and the impact of any extension of a standalone direct contract with the DHA. As Ido noted, on February 16, we will give guidance for the full year 2027. But as of now, we are executing towards and feel extremely confident about ending the year with EBITDA positive results for the quarter and a cash balance right around $180 million.

David Larsen

I'm sorry if I missed this, but what sort of incremental revenue do you expect from 2026 to 2027 for the VA and/or the DHA, and what are the components of that incremental increase, if any?

Mark Hirschhorn

Right. We did not give any details around that increase. Obviously, anything with the VA is going to be additive since we have not generated any revenue from the VA in the past, and the DHA contract is in the final throes of being completed most likely this quarter.

David Larsen

Is the VA starts 1/1/2027?

Mark Hirschhorn

No, that's not known yet. We are continuing the negotiations with the VA. We're far further along with the DHA, but we're hopeful that we'll obviously sign something with the VA over the next couple of months.

David Larsen

Congratulations on the progress you're making. Nice work.

Operator

Our next question is from Jailendra Singh with Truist Securities.

Jailendra Singh

Congrats on the good quarter and the VA LOI as well. I want to ask about, last quarter you talked about supporting a return to growth without a meaningful increase in headcount. Would that still hold if the VA opportunity comes through? I am trying to figure out how much can you leverage the current federal infrastructure you already have versus needing to invest ahead of deployment? Maybe just give some color there.

Ido Schoenberg

Jailendra, there are a number of factors that contribute to our profitability. As you can see with our numbers, we went a very long way to focus the company on the Amwell platform, to define what is important and not important, and divest or de-emphasize anything else. We also dramatically changed the workflows and processes in the company, with and without AI, to deliver great efficiency and effectiveness. This trend is continuing, and we fully expect to continue this process going forward. We are very much restructuring the company.

To answer your question directly, we do not expect any significant growth, even with the large contracts, beyond something that is not material or dramatic, because of the efficiencies. That does not mean that we are not going to give these new contracts our full attention. We absolutely will. We have dedicated teams. We have plans to serve it and continue to serve it well. But efficiencies from other things that we stopped doing and things that we are now doing much more efficiently are going to continue a very disciplined cost structure for the company.

Jailendra Singh

That makes sense. My quick follow-up on the more subscription revenue, after declining what, 7% in Q3, now Mark, you are talking about stability in Q4. Does this suggest that we have effectively reached the bottom in subscription revenue, and now we should probably I am not looking for 2027 guidance, but I mean, can you just say that directionally we should probably start seeing sequential growth going forward as all that churn is probably hopefully behind us?

Mark Hirschhorn

Jailendra, I think the churn that we have been experiencing has been probably the components of the churn. You will start seeing far less churn from any health plan impact, but the other businesses that we have determined that we are no longer focused on and we have de-emphasized, I'm assuming we will still have some degree of natural churn.

As far as the big swings that may have been experienced in 2025 and 2024, you are certainly correct. We do not anticipate any more of that activity going forward.

Operator

Our next question is from Charles Rhyee with TD Cowen.

Charles Rhyee

Congrats on the progress, guys. Maybe if I could follow-up from some of the earlier questions. Mark, I think you gave sort of a target last quarter, sort of all the opportunities in the pipeline kind of pan out. We can think of maybe mid-teens as a reasonable growth target for next year. Given the progress that you're making right now, is that still sort of the framework we should be thinking about? If not, how should we think about next year in that sense?

Mark Hirschhorn

Yes. Charles, when we spoke last time, we were confident that we were making great progress on some of the larger opportunities. We are now closing in on the end of the year, and the commencement dates for those new opportunities are therefore pushed into 2027 as opposed to starting on Jan 1 of 2027. While we're confident we're going to be seeing some of that growth, we know that it's not going to be impacting the entire calendar year. We still have, and we remain in the best position pipeline-wise than we've ever been. We just need to see these contract start dates begin as early as possible.

Charles Rhyee

Can you talk about what you gave a bunch of examples earlier of how patient experience has improved, outcomes are improving. That obviously helps with the sales pipeline for other customers to see those results and then come to Amwell. Does this also drive sort of organic, sort of same-store sales? Maybe can you talk about how the results that you're delivering has generated sort of organic sales at existing customers? How much growth perhaps this year has maybe been from that, and how much could we think about that as part of building towards next year and future revenue growth?

Ido Schoenberg

Charles, you're absolutely correct. Some of the investments we made are beginning to show very clearly in the numbers, and each has a lot of potential growth with it. I'll give you a few specific examples. This year, we dramatically improved our engagement capabilities, and I said that before, but it's still a very nice number. We know that when we execute that, we get 3x better engagement, which is very good. In addition to that, we just launched a new experience for members, and we saw NPS and ratings jump, as they said earlier, to 4.9 out of five. I think it's one of the highest, if not the highest, we've seen before, and that too has direct relationship with engagement. We are now with an infrastructure that is able to add a partner within short weeks, versus many months before, and we are shooting for days. That's really important because it allows our customers to really test a lot of new programs, associate them with different accounts. It's good for the relationship with the different national accounts and other employers, but it's also very good in order to optimize the outcomes. That also, together with our investment in data, allows us to make results much more transparent and easy to understand for people.

So, if you think about it, today, engagement is in the single digits. Saying it less optimistically, over 90%, sometimes 97%, 98% of the population, the addressable population, does not benefit from technology-enabled care. I'm not only talking about urgent care, I'm talking about the entire gamut. We're not talking only about AMG, which is becoming so much better and so important in navigation and trust, in relationship with the patients. I'm talking about all those many programs they can refer to. So there is a world of opportunity with 90 million covered lives. I'm not even talking about the potential growth in the government, and that's very important. I'm not going to second-guess the pace of that, but it's apparent that the upside is very, very significant.

As I said earlier, we're going to probably, almost likely, very likely, add significant new clients into the mix, and that will even grow the addressable population. I believe that the pricing mechanism will morph and change from the traditional SaaS recurring more and more into an outcome base, which is directly related to traction. The changes we made provide us an opportunity to share more of the risk with our customers, but when we perform more, it also provides a much bigger upside to take a fair share from the MLR through the savings that we generate.

Overall, I think the company today is very focused on a very clear value proposition. This value proposition resonates. It provides a path for multi-year growth that is significant. To be clear, the exact dynamics in this part, in the next few months and so on, is something we are going to talk about in the next call.

Charles Rhyee

And maybe just to clarify, understanding that AMG is a volume-driven part of your business, but in the rest of your business, as engagement increases, so more of the covered lives are engaging with Amwell, does that generate more revenue for the company, or have customers are paying for sort of a fixed amount of usage?

Ido Schoenberg

Absolutely. Essentially, I believe that when you fast-forward into multi-years from now, most of our activity will be related to clinical services that win and deliver the outcomes. The SaaS component, although may not necessarily shrink significantly, but in proportion to the clinical revenue, the clinical services that deliver the outcome will become smaller. We believe that a lot of the upside is in utilization, where we share the results with our customers.

Operator

Our next question is from Ryan MacDonald with Needham & Company.

Matthew Shea

This is Matt Shea on for Ryan. Maybe piggybacking off of Charles' question, it seemed like member experience and the upgrade you shipped this quarter was a meaningful call-out and could be a key upgrade to drive member engagement. But curious, when did that go live at most clients? Was that earlier in the quarter versus later? And sounds like qualitative feedback has been strong, but any quantitative evidence yet, like visits per member or repeat visit rates, or what would be the best metrics to track going forward, I guess, to gauge success of the member experience overhaul?

Ido Schoenberg

Matt, the upgrade was fairly recent, and although you saw quite a few of our investments pan out in the numbers that Mark shared, definitely what we see is early days with very encouraging results. You do not still see a lot of this impact in the numbers today.

Matthew Shea

And best metrics you expect to track going forward to kind of gauge success?

Ido Schoenberg

Yes. Thank you for reminding me. Clinical revenue sometimes is through direct utilization of different AMG services, virtual primary care. We are very, very bullish about behavioral health. We talked about SilverCloud. We did so well internationally in way of outcomes. We are now investing in bringing it in fully into the United States with significant investments, and we have high hopes for that. AMG services are going to become much more efficient and much more attractive. In addition to that, partners, third-party clinical programs utilization that generates a nice margin where we generate, basically bring the traffic to them together with information, collect information, and present it back to the payer in a unified way. That part of the revenue is likely to be a very meaningful growth driver going forward, in our opinion. Both are going to, in our opinion, grow much faster than the SaaS recurring revenue in a world where our customers are very, very focused on the outcomes.

Matthew Shea

On the DHA contract, I think you had previously sized the behavioral health opportunity as 15%-20% or more of platform value, with next year being the earliest on activation with that. Is reinstatement part of the current direct contract negotiation, or should we think of that as a separate procurement opportunity afterwards? Just trying to think about how that layers into your 2027 opportunity set.

Ido Schoenberg

At this point, we are focused on the current infrastructure that is in play and works really well. You are absolutely correct that we proved in this environment that our behavioral services deliver very good results, but that's a full upside opportunity that we believe is separate from the current dialogue.

Operator

I am showing no further questions at this time. I'd now like to turn it back to Ido for closing remarks.

Ido Schoenberg

Thank you, Trace, and thank you, everyone. We appreciate your support for Amwell, and thank you for joining us this evening.

Operator

This does conclude the program. You may now disconnect.