Health Catalyst (HCAT) Q3 2026 Earnings Call: Guidance Reaffirmed as Retention Takes Priority

Health Catalyst (NASDAQ: HCAT) reported third-quarter 2026 revenue and adjusted EBITDA above the high end of its own guidance ranges. Management reaffirmed its full-year outlook while identifying client retention, cost alignment, portfolio simplification and execution as its main priorities.

Key Takeaways

• Q3 2026 revenue was $56.3 million, above the company’s guidance range of $55 million to $56 million.
• Adjusted EBITDA reached $779,000, exceeding management’s guidance of breakeven to $500,000.
• Adjusted gross margin fell to 44.3% from 52.6% a year earlier. Professional services margin declined to 1.7% as revenue fell faster than delivery costs and medical claims increased benefits expense.
• Health Catalyst reaffirmed full-year 2026 guidance for $246 million to $249 million in revenue and $18 million to $18.5 million in adjusted EBITDA.
• The company now expects 2026 bookings to exceed the high end of its previous $22 million to $26 million target, although churn continues to offset bookings growth in reported results.
• Management said migration-related churn should largely persist through the end of 2027. Retention is the new CEO’s most immediate operating priority.

Key Financial Data

Q3 results included one full month of Vitalware before the divestiture closed on July 31. Health Catalyst subsequently retired its credit facility, leaving the company debt-free.

Higher-than-expected medical claims increased internal benefits costs by approximately $1.6 million during the quarter. About half was recorded in cost of revenue and half in operating expenses. Project Nexus cost savings remained on track, but workforce investments and benefits expenses offset part of the year-over-year expense reduction.

Business and Operating Performance

Management is focusing on converting bookings into revenue more quickly. One client deployed an embedded product approximately 75 days after signing. According to the company, the client reported that 86% of prescriptions were completed within 24 hours and call volume declined 8% in the latest week.

New CEO Simeon Kohl outlined four priorities: improving client retention, aligning costs with the current revenue base, reducing organizational and product complexity, and delivering more consistent execution.

Retention is the immediate focus because churn has remained above management’s preferred level. Health Catalyst plans to engage clients earlier in the renewal cycle, support existing technologies including DOS, and offer more flexible deployment options.

The company also intends to simplify how it presents and integrates its technology, data and healthcare capabilities. Management said easier deployment alongside clients’ existing systems could lower adoption barriers and expand the addressable market.

Health Catalyst is also terminating an unprofitable interoperability relationship with a large health information exchange client at the end of 2026. Management characterized the decision as part of its focus on durable, profitable revenue.

Management Guidance

The full-year guidance implies a Q4 adjusted EBITDA loss of $1.3 million to $1.8 million. Management said Q4 will be the first full quarter without Vitalware and will reflect ongoing churn as well as seasonally higher medical claims expense. The full removal of Vitalware is expected to account for most of the sequential decline in adjusted EBITDA.

Cash is expected to decrease modestly in Q4, primarily because of vendor-payment timing and a large hosting-infrastructure prepayment. Client billings that typically benefit the fourth and first quarters should partially offset those outflows.

Risks and Watch Items

Migration-related churn remains the main revenue headwind. Management expects the company to be generally through this pressure by the end of 2027, but noted that churn is currently offsetting positive bookings activity.

Professional services profitability is another key concern. Q3 adjusted margin was only 1.7% because services revenue contracted faster than delivery costs. Health Catalyst has begun aligning delivery expenses with its current contract base.

Additional uncertainties include elevated medical claims costs, the Q4 earnings impact from the Vitalware divestiture and the execution required to improve retention while reducing costs and simplifying the business.

Full Earnings Call Transcript

Complete Earnings Call Transcript

Management Remarks

Unknown Speaker

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Operator

Welcome to the Health Catalyst Third Quarter 2026 Earnings Conference Call.

[Operator Instructions]

I would now like to turn the call over to Stephanie St. Clair, Senior Vice President of Finance and Investor Relations.

Stephanie St Clair

Good afternoon and welcome to Health Catalyst Earnings Call for the Third Quarter of 2026. I'm Stephanie St. Clair, Senior Vice President of Finance and Investor Relations. With me today are Simeon Kohl, our President and Chief Executive Officer, and Jason Alger, our Chief Financial Officer. Complete disclosure of our results can be found in our press release issued today and 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. A replay of this call will be available afterward.

Today's call includes forward-looking statements pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995, including about our financial outlook, expectations for the fourth quarter and full year 2026, client migrations and client retention, future growth and strategic priorities, our ability to strengthen our foundation, our ability to achieve profitable revenue growth and deliver returns to shareholders, long-term opportunities, retention, bookings, the impact of the Vitalware divestiture, and the general anticipated performance of our business. These forward-looking statements reflect management's views 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 statement or outlook. Actual results may materially differ. Please see the risk factors in our 2025 Form 10-K filed March 12, 2026 and our third quarter Form 10-Q filed today. We will also discuss non-GAAP measures. Reconciliations to the most comparable GAAP measures are in our press release. Non-GAAP financial information is presented for supplemental purposes only, 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. We will provide forward-looking guidance for certain non-GAAP measures in this earnings call, not for the most directly comparable GAAP guidance measures or reconciliations because some items are not within our control or cannot be reasonably forecasted. Simeon joined us as President and CEO on September 14.

With that, I'll turn the call over to him.

Simeon Kohl

Thank you, Stephanie, and good afternoon, everyone. Earlier this afternoon, we reported third quarter revenue of $56.3 million and adjusted EBITDA of $779,000, both above the high end of our guidance ranges of $55 million to $56 million and $0 to $500,000, respectively. Given our performance year-to-date, and with Project Nexus cost reductions on track, we are reaffirming our full-year revenue and adjusted EBITDA outlook. As a reminder, Project Nexus is our strategic initiative designed to fundamentally transform our operating model and deliberately reposition our business. Before turning the call over to Jason for details on our financial performance and outlook, I'd like to share my initial perspectives on Health Catalyst, what attracted me to this opportunity, and the priorities that will guide our decisions and actions. As Stephanie mentioned, I joined in mid-September, and over these first several weeks, I've spent considerable time connecting with our leaders, team members, clients, and many of you. Those conversations have reinforced many of the reasons I was excited to join Health Catalyst.

Health Catalyst has deep healthcare expertise, longstanding client relationships, and proven measurable outcomes. Data and analytics technology, together with solutions in clinical quality, financial performance, interoperability, and consumer engagement, helps healthcare organizations connect complex data and turn it into actionable insights that address some of healthcare's most pressing challenges. But equally important, we have a team deeply committed to improving healthcare. Their expertise and dedication are fundamental strengths of this business and will be essential as we build on the results we've currently delivered to clients. We also have a stronger financial foundation following the Vitalware divestiture and the retirement of our credit facility. We are debt-free with approximately $79 million in cash, giving us increased flexibility as we move forward. So my view is straightforward. I believe Health Catalyst has meaningful assets and a compelling long-term opportunity, and our immediate priority is to strengthen the foundation of the business.

At the same time, there are areas where we can do better and client retention is the most immediate focus. Churn has been higher than we would like and strengthening our ability to retain and grow existing client relationships is a top priority. We are approaching it with urgency and a focus on sustained improvement. My experience at Performant gave me the opportunity to build and lead a healthcare business through considerable challenges and difficult decisions, which ultimately supported Performant's journey towards increased profitable growth. Along the way, we made deliberate choices about where to invest, how to differentiate, and how to create sustainable value for clients and shareholders. The circumstances here are different, but many of those same principles apply and they inform my four priorities. The first is retention. We must do more to preserve our client relationships and the revenue they represent.

That starts with gaining a better understanding of what clients need, addressing where we fall short, and continuing to deliver value as their needs evolve. Health systems have invested heavily in technology, and many, understandably, want to get more from those investments without adding complexity. Our role is to meet clients where they are by continuing to support the technology they use today, including DOS, offering greater flexibility in how they deploy our solutions, and aligning our modernization and optimization efforts with their priorities. Ultimately, we want clients to choose Health Catalyst for the value we deliver with technology and deployment options that work best for them. We're focused on building stronger relationships with our clients, staying close to their priorities, and working across the organization to deliver the value they expect from us. Retention is foundational to everything else we want to accomplish. It's difficult to build sustainable, profitable growth when we're continually replacing lost revenue. As we've said before, we expect to be generally through the migration-related churn headwinds by the end of 2027.

Second, greater cost alignment. We intend to grow Health Catalyst, and our focus is on building durable, profitable revenue that creates lasting value for our clients and attractive returns for our shareholders. This requires aligning our cost base with the revenue we can support today and investing with discipline in opportunities for future growth. We're sharpening our understanding of the economics across the business to identify where we generate attractive returns, where performance needs to improve, and where investment can create the most value. That insight will guide how we allocate resources, improve efficiency, and strengthen our financial foundation to support future growth. We will act with both urgency and care.

Third, less complexity. We've become more complex than we need to be, and we're focused on simplifying how we operate and how we present our capabilities to clients and prospects. Over the years, Health Catalyst has developed and acquired a broad portfolio of technology, data, and healthcare expertise. We have an opportunity to bring those strengths together more effectively, making it easier for clients to understand the value we offer, adopt our solutions, and expand their relationships with us. As healthcare organizations work to improve clinical outcomes, lower costs, and deliver a better consumer experience, I believe our combined capabilities position us well to help them achieve those goals.

Our immediate opportunity is to make better use of what we already have by simplifying how we present our solutions, improving integration across the portfolio, and helping clients realize more value from our capabilities. Making our solutions easier to deploy alongside clients' existing technology can also reduce barriers to adoption and broaden our market.

Fourth, more consistent execution. We have talented people throughout Health Catalyst, and we need to translate that talent into more consistent results. That requires clear priorities, shared accountability, stronger coordination across functions, and reliable information to guide our decisions. We're establishing a more disciplined operating cadence and bringing our product, engineering, and client-facing teams into closer alignment so we can execute as one Health Catalyst.

Stepping back, these priorities reinforce one another. Stronger retention can make our revenue more predictable and durable. Greater cost alignment can strengthen profitability and our ability to invest in products that meet clients' evolving needs. A simpler, more integrated approach can help clients get more value from our product partnership, and more consistent execution helps to drive a more reliable, high-quality delivery. Together, we believe these priorities lay the foundation for a more profitable, predictable business positioned for sustainable growth.

We're also realistic about where we stand today and the work required to improve our performance. We see opportunities to strengthen the economics of the business, improve commercial effectiveness, and unlock more value from the capabilities we already have. We're making disciplined decisions grounded in those opportunities with growth and investment tied to where we believe we can create clear client value and generate attractive returns.

I also want to be clear about what you should expect from me and our leadership team: transparency about our progress and our challenges, discipline in how we invest, and accountability for the commitments we make. Financial results will ultimately be the most important measure of our success, and we want to give you better visibility into what drives them. We're evaluating a focused set of measures to help you assess our progress, and we'll share more of that as work advances.

We also benefit from a board with deep experience of healthcare delivery, technology, and business transformation, further strengthened by the recent additions of Steve Nelson and Tami Reller. I appreciate the perspective and active engagement of our entire board as we move these priorities forward.

Let me close with this. I'm still early in my tenure, and we have important decisions ahead. We won't have every answer immediately, and meaningful improvement will require sustained execution, but I'm encouraged by our combination of healthcare expertise, technology and data assets, and trusted relationships with organizations tackling the most difficult challenges in healthcare. Our responsibility is to bring those strengths together with greater discipline and accountability, and to earn your confidence through results.

With that, I'll turn the call over to Jason.

Jason Alger

Thank you, Simeon. As Simeon noted, third quarter revenue and adjusted EBITDA both came in above the high end of our guided ranges. One item to keep in mind, third quarter results include 1 full month of Vitalware in July before the divestiture closed on July 31.

Let me walk through the details on the third quarter. Total revenue was $56.3 million, against our guided range of $55 million to $56 million. Technology revenue was $40.7 million, and professional services revenue was $15.6 million. We continue to make progress on bookings with a focus on converting those wins into revenue as quickly as possible. Clients achieve value sooner when implementations move fast, and we benefit from quicker revenue recognition. One client went live on our embedded product in about 75 days after signing, and they've reported that 86% of prescriptions are now completed within 24 hours, with call volume down 8% in the most recent week.

Adjusted gross margin was 44.3% compared to 52.6% in the prior year period. Adjusted technology gross margin was 60.6%, consistent with the trend we discussed last quarter. The adjusted professional services gross margin was 1.7% because services revenue declined faster than our delivery costs, and elevated internal benefits costs related to medical claims created an additional headwind. We anticipated the professional services margin pressure in the second half and have begun aligning delivery costs with our current contracts.

Adjusted operating expenses were $24.1 million, or 43% of revenue, compared to $28.1 million, or 37% of revenue in the prior year period. Project Nexus savings are tracking to plan, but investments in our team and higher than anticipated internal benefits costs offset part of the year-over-year reduction. The internal benefits costs related to medical claims were approximately $1.6 million greater than expectation across the business this quarter, with about half in cost of revenue and half in operating expenses.

Adjusted EBITDA was $779,000, above our guided range of breakeven to $500,000. Adjusted net loss per share was negative $0.03 on a weighted average share count of 75.4 million. We ended the quarter with approximately $79 million in cash, cash equivalents, and short-term investments, and no debt. We expect cash to decline modestly in the fourth quarter, mainly from the timing of vendor payments, including a large prepayment for hosting infrastructure, partly offset by client billings that typically benefit the fourth and first quarters.

Turning to guidance, we're reaffirming our full year 2026 revenue and adjusted EBITDA outlook. We expect total revenue of $246 million to $249 million and adjusted EBITDA of $18 million to $18.5 million. That implies an adjusted EBITDA loss in the fourth quarter of negative $1.8 million to negative $1.3 million, consistent with the full-year range we provided last quarter. The fourth quarter is our first full quarter without Vitalware, and it reflects the churn dynamics we discussed this year, as well as seasonally higher medical claims expense. The full removal of Vitalware in Q4 versus 1 month in Q3 drives the majority of the adjusted EBITDA decrease quarter over quarter.

For the full year, we continue to expect overall adjusted gross margin below 50%, with adjusted technology gross margin in the low 60s and adjusted professional services gross margin in the low-to-mid teens. As we said last quarter, we continue to see migration-related churn pressure that is generally in line with the framework we previously disclosed. We are listening closely to clients and focusing on the outcomes they need rather than the infrastructure decisions they face. We are engaging well ahead of renewal to identify and address potential risks.

We believe continued innovation in our technology, designed around how clients operate, is the most durable way to strengthen those relationships. We continue to see new bookings and expansion within our existing client base, and we now expect to exceed the high end of our $22 million to $26 million bookings target for the year. The churn pressure offsets that positive bookings result in our reported figures. Consistent with our focus on durable, profitable revenue, we're being deliberate about the revenue we pursue. For example, an interoperability relationship with a large health information exchange client that was not profitable terminates at the end of 2026. Decisions aren't taken lightly, but they're necessary in focusing on durable, profitable relationships. We're managing the business with urgency and cash discipline, with close scrutiny of every dollar we spend.

We know confidence is earned through execution, and we're focused on delivering. With that, operator, open the call for questions.

Operator

[Operator Instructions]

At this time, I'm showing no questions in queue. I will now turn the meeting back to Simeon Kohl for additional or closing remarks.

Simeon Kohl

Thank you, operator. No questions. Before we close here, I just want to thank our team members for their Herculean effort and certainly our clients and shareholders for their continued support. There's no doubt a lot of work ahead of us, but I believe we're taking the right steps to build a much stronger Health Catalyst for the future. So thanks all for joining us today, and we look forward to sharing our progress on the next Q4 call.

Operator

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

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