Accendra Health (ACH) Q3 2026 Earnings Call: Guidance Cut and Turnaround Plan

Key Takeaways

• Third-quarter 2026 revenue was just under $602 million. Excluding the terminated large commercial payer contract and a noncore asset sale, revenue declined 1% year over year.
• Adjusted EBITDA was $47.8 million, reflecting weaker collections, unfavorable business mix and insufficient cost reductions following the payer contract loss.
• Sleep revenue grew more than 4%, led by sleep supplies. Diabetes declined nearly 3%, respiratory fell approximately 6.5% and wound revenue decreased about 6%.
• Management now expects full-year net revenue at the bottom of its previous $2.45 billion to $2.55 billion range. Adjusted EBITDA could be as much as 30% below the prior guidance midpoint of $310 million.
• Accendra Health reported nearly $300 million of available liquidity. Net debt was $1.73 billion, and the company remained in compliance with its quarterly debt covenants.
• New CEO Kenneth Gardner-Smith outlined a turnaround focused on winning referrals, improving patient retention, strengthening revenue cycle management and reducing branch and back-office costs.

Key Financial Data

Business and Operating Performance

Sleep was the strongest major category. Revenue increased more than 4%, primarily because of growth in sleep supplies. However, management said Accendra has lost share in sleep and respiratory despite growth in those markets.

Diabetes revenue declined nearly 3%. Continued growth in pumps was insufficient to offset lower continuous glucose monitoring and other diabetes supply revenue. Respiratory and wound revenue fell approximately 6.5% and 6%, respectively.

The soft-goods categories of ostomy, urology and incontinence grew, but at a slower rate than earlier in 2026.

Management identified several operational constraints: low adoption of digital referral management, order rework, slow intake-to-shipment timelines and inconsistent sales execution. In sleep, patient attrition before the 90-day compliance threshold and weak resupply retention have limited sustained census growth.

The company has placed commercial operations and contracting under its new Chief Commercial Officer. CEO Gardner-Smith has also assumed direct oversight of branch and back-office operations. Accendra plans to launch the first version of revamped operations, simplified processes and automated activities in Q1 2027.

Management Guidance

Management expects full-year 2026 net revenue at the bottom of the previous $2.45 billion to $2.55 billion range.

Full-year adjusted EBITDA could be as much as 30% below the $310 million midpoint of the prior guidance. The company expects fourth-quarter adjusted EBITDA to be comparable with Q3’s $47.8 million.

Accendra expects 2027 patient service equipment CapEx to be substantially lower than in 2026. Of year-to-date 2026 patient service equipment CapEx, $35 million related to the former large commercial payer contracts.

The company plans to provide its 2027 outlook and more detail on the financial impact and timing of its turnaround plan in early 2027.

Risks and Areas to Watch

Collections remain below management’s expectations, although contractual allowance trends improved compared with the first two quarters of 2026. The lower collection rate and category mix following the payer loss contributed to the 280-basis-point increase in cost of net revenue.

SG&A remains elevated because Accendra has not removed enough costs to offset lost revenue. Higher business insurance claims also increased expenses during 2026.

The turnaround depends on improving referral conversion, patient compliance and retention, collections, automation and administrative productivity. Management said some initiatives will require testing and time before their expected financial benefits are achieved.

Accendra has $1.73 billion of net debt, with its first maturity in early 2029. Management believes the company’s liquidity, balance-sheet actions and recurring revenue provide sufficient runway to execute the turnaround.

Analyst Q&A Highlights

JPMorgan analyst Rishi Parekh asked whether commercial payer prepayment audits would affect 2027. CFO Jonathan Leon said the issue was largely resolved after the company passed sampled audits and began receiving delayed cash. He expects the remaining work to conclude in Q4 2026, with no impact carrying into 2027.

Parekh also questioned the timing, cost and liquidity requirements of the turnaround. Management said commercial and organizational changes are already underway but did not provide a timetable for achieving the expected financial benefits.

Leon said Accendra does not expect to draw significantly more from its liquidity facilities. He pointed to working-capital management, the absence of 2026’s substantial one-time cash outflows and potential EBITDA improvement as factors supporting future cash flow.

The company also extended its $150 million accounts receivable securitization facility through October 2029. Separately, it is working to close the sale of a small noncore asset expected to generate approximately $14 million in proceeds without affecting revenue or adjusted EBITDA.

Full Earnings Call Transcript

Complete Earnings Call Transcript

Management Remarks

Operator

Good evening, and thank you for standing by. Welcome to Accendra Health's Third Quarter 2026 Earnings Conference Call. Please be advised that today's conference call is being recorded. [Operator Instructions]

I would now like to hand the conference call over to your first speaker today, Will Parrish, Vice President, Corporate Development and Investor Relations.

Will Parrish

Thank you, operator, and good evening, everyone. I'd like to welcome you to Accendra Health's third quarter earnings call. Our comments on the call will be focused on the financial results of the third quarter of 2026, all of which are included in today's press release. The press release, along with the third quarter 2026 supplemental slides to which we will refer during the call, are posted on the Investor Relations section of our website.

Please note that during this call, we will make forward-looking statements that reflect the current views of Accendra Health about our business, financial performance and future events. Matters addressed in these statements are subject to risks and uncertainties, which could cause actual results to differ materially from those projected or implied here today. Our expectations, beliefs and projections are expressed in good faith, and we believe there is a reasonable basis for them. However, there can be no assurance that our expectations, beliefs and projections will result or be achieved. Please refer to our SEC filings for a full description of these risks and uncertainties, including the Risk Factors section of our annual report on Form 10-K and quarterly reports on Form 10-Q. Any forward-looking statements that we make on this call, in our earnings press release or in our supplemental slides are as of today, and we undertake no obligation to update these statements as a result of new information or future events, except to the extent required by applicable law.

In our discussion today, we will refer to non-GAAP financial measures and believe they might help investors to better understand our performance or business trends. Information about these measures and reconciliations to the most comparable GAAP financial measures are included in our press release.

Today, I am joined by Kenny Gardner-Smith, Accendra Health's President and Chief Executive Officer; Jon Leon, the company's Chief Financial Officer; and Scott Lloyd, the company's Chief Commercial Officer. I will now turn the call over to Kenny. Kenny?

Kenneth Gardner-Smith

Thank you, Will, and good evening to everyone joining us. It is a pleasure to be speaking with you for the first time as CEO. Accendra is home to leading brands that serve important segments of the home DME market. I've had the privilege of serving on the Board for the past several years, which gave me a deep appreciation for the clinical importance of what we do and the strength of our brands and footprint.

When the opportunity arose to step into the CEO role, I took it because I believe these assets, combined with a more disciplined operating system, can deliver meaningfully better outcomes for patients, referral sources and shareholders. My background in growing, optimizing and scaling specialty healthcare operations and leading turnarounds gives me conviction that most of the issues we face are fixable and largely within our control. I am excited to be here and optimistic about our future.

Prior to my official start, I worked closely with the management team and the Board on a forward-looking value creation plan. Over the past month, I've spent time digging into the business, listening to leaders and frontline teammates, connecting with key partners and speaking with our investors.

Those conversations, together with the strategy work and the value creation plan, have given myself and the team a clear view of where we stand and what must change. We will not be in a period of prolonged diagnosis. Rather, we are already in the midst of active execution focused on speed to value.

I want to acknowledge that in spite of that optimism about our future, we have significantly underperformed expectations in 2026. Before I share my perspective on what has caused the deterioration in performance in 2026 and how we will address it, I will turn it over to Jon to walk through our Q3 results and balance sheet positioning in more detail.

Jonathan Leon

Thanks, Kenny, and good evening. Turning right to the financial results. The quarter was extremely disappointing as most of the near-term profit improvement efforts over the last few months did not yield the expected results. On a positive side, we have continued to effectively manage cash flow and expect to have plenty of liquidity for the foreseeable future.

Before getting into the specifics of the quarter, please note that any discussion about the financial results and outlook for the company will cover predominantly non-GAAP financial measures. You can find GAAP to non-GAAP financial reconciliations in the press release filed a short time ago and residing on our website at accendrahealth.com.

First, as shown on Slide 6, third quarter revenue was just under $602 million and was down 1% from the prior year, excluding the impact of the large commercial payer loss earlier this year and the third quarter sale of a noncore asset. This was the first quarter in 2026 in which revenue was down versus the prior year, excluding the impact of a large commercial payer, and the entire organization is focused on reversing this as quickly as possible.

Despite attractive year-over-year growth in the very important sleep category, it was not enough to offset ongoing declines in the CGM, respiratory and wound categories. The soft goods group of ostomy, urology and incontinence showed growth, although at a much slower rate than they have been growing earlier in the year.

Breaking it down further, excluding the impacts of the terminated contract with a large commercial payer and the sale of a noncore asset, sleep grew over 4%, primarily driven by growth in sleep supplies. However, diabetes declined by nearly 3% as the continuing year-long growth in pumps could not offset drops in CGMs and other diabetes supplies. Also, we did not see enough pickup in respiratory and wound as they fell about 6.5% and 6% respectively, continuing to run well below expectations.

Clearly, our efforts to win referrals and maintain patients on therapy are not where they need to be. And as you'll hear from Kenny, this is a major focus of our efforts going forward with actions already underway. Contractual allowances, which are an adjustment to gross revenue driven by the long-term collection rate, were again higher than prior year and have not improved to the extent previously expected. However, there has been improvement.

Year-over-year, the third quarter contractual allowance impact was about $4 million smaller than the previous 2 quarters, coming in at $6 million favorable versus the prior year, better than the approximately $10 million we cited in the first and second quarters, but collections clearly are still disappointing.

The cost of net revenue was 56.6% of net revenue, 280 basis points higher than last year's third quarter due largely to an almost even split between the category mix change resulting from the first quarter loss of the large commercial payer and the lower collection rate. However, at 56.6% of net revenue, these costs have remained within 1 percentage point all year and is worth noting to hopefully alleviate concern about significant supplier price increases.

SG&A costs were 41.5% of net revenue, up from 38.1% from the third quarter of 2025 and 180 basis points higher than the second quarter of 2026. The year-over-year change is again largely due to the previously discussed Q1 commercial payer loss and the challenges we continue to face to take out enough costs to offset the lost revenue.

Also throughout the year, we have experienced an increase in business insurance claims driving up SG&A. These issues are all addressable, and we intend to reverse these trends in the months ahead. All of this resulted in adjusted EBITDA of $47.8 million in the quarter. Adjusted EBITDA plus noncash convert to sale write-off expense, less patient service equipment CapEx, was just under $17 million.

The details of key drivers are shown on Slide 8. A very important detail is shown on that slide. You'll see that we have footnoted that $35 million of the year-to-date 2026 patient service equipment CapEx is related to the former large commercial payer contracts. As we have said in the past, the CapEx related to that former contract was disproportionately large relative to the adjusted EBITDA generated.

Also, payment terms on much of that equipment are such that the final cash outlays continued into the third quarter of this year. So when looking ahead, adjusted EBITDA, less CapEx, will benefit meaningfully and future CapEx will be quite a bit lower in 2027 than 2026.

Now turning to the balance sheet. Net debt of $1.73 billion was down $40 million versus December 31, but was higher by $18 million or 1% from the end of June. Total debt for the year is down $295 million due to the application of the net proceeds from the year-end '25 divestiture and the balance sheet optimization transaction that closed in June. And we are in compliance with our quarterly debt covenants.

Moving to the cash flow statement. Recognizing that the year has seen significant onetime cash items on Slide 9, we have included a detailed bridge from adjusted EBITDA to cash flow from operations, which illustrates these onetime items as well as ordinary course items to help reconcile between the 2 figures. As you can see, there has been approximately $94 million of onetime cash expenses within cash flow for operations for the 9 months ended September 30 and an additional $21 million of onetime cash expenses and cash flow used for our financing activities.

Thanks to prudent actions taken earlier in the year, coupled with effective working capital management, our liquidity position remains strong with $27 million of cash and only $35 million drawn on our revolving credit facility as of September 30, giving us nearly $300 million of available liquidity sources.

Demonstrating well-managed working capital, and as you can see on the statements of cash flows, changes in receivables, payables and inventory provided approximately $24 million in cash flow in the third quarter and $7 million for the 9 months ended September 30. And as expected, the payer audits mentioned last quarter are largely behind us, and we began to receive the cash that we have been expecting during the third quarter.

Also, we were very pleased to have extended our accounts receivable securitization program a few days ago. Working with our banking partner, we were able to extend the facility for 2 years beyond the last maturity date. The facility is now available until October of 2029. The facility size remains unchanged at $150 million, further ensuring plenty of liquidity and is evidenced at the high quality and generally effective management of our receivables.

And as a reminder, we are still working toward closing the sale of a small very noncore asset, which will generate about $14 million in proceeds. The sale will have no impact on revenue or adjusted EBITDA, and we're hoping that for the fourth quarter close of that transaction.

In a moment, Kenny will discuss his early observations with turnaround steps already underway and the plan to put the company back on the path to higher growth and profitability. As the process that Kenny will outlay develops, it will inform our outlook for 2027, which we plan to share early next year.

For the remainder of 2026, acknowledging the missed guidance and significant underperformance throughout the year, we now believe full year net revenue will be at the bottom of our previous guidance range of $2.45 billion to $2.55 billion, and that adjusted EBITDA could be as much as 30% lower than the $310 million midpoint of the last adjusted EBITDA guidance provided. Meaning adjusted EBITDA for Q4 is expected to be comparable to the third quarter.

Finally, as we move through the fourth quarter and into 2027, we will be enhancing our reporting shared with the investment community in an effort to improve transparency, align stakeholders with the same metrics management uses and simplify the investment thesis so that investors can quickly regain confidence in our story.

With that, I'll turn the call back to Kenny. Kenny?

Kenneth Gardner-Smith

Thank you, Jon. Our Q3 results were very disappointing, and it is clear we need to quickly and fundamentally change both elements of our strategy and most importantly, the consistency of our execution. Through the strategy work and the subsequent value creation plan we have developed, a clear picture of the issues has emerged. The shortfalls are not primarily a market or brand problem. In fact, we have great brands and attractive end markets.

It has become clear to me that, in particular, in sleep and respiratory, 2 of our most attractive businesses, we have lost share while the markets grew. We have identified that our current operating model suffers from high friction for customers, slower and more costly order intake than necessary and inconsistent sales execution, all of which have constrained new patient starts, revenue and collections.

Our adoption of e-prescribe, which is digital referral management, sits well below industry peers. Too many orders require rework and the time from intake to shipment and ultimately to collections is longer than it needs to be.

On the patient retention side, material portions of new sleep patients lapse before the 90-day compliance window and a meaningful number of those who do reach compliance do not return for resupply. Weak early engagement relative to competitors, limited adoption of digital tools and a lack of clear accountability and structure for our patient-facing sleep resources have all contributed to our lack of sustained census growth.

Similar gaps show up in respiratory conversion programs, which exist but have not been executed properly. Over my first few weeks, I've heard these same themes regarding friction at intake, inconsistent early patient support and excess administrative burden in the branches and central functions repeated firsthand by our sales, clinical and operations professionals. That alignment gives me high confidence that we are focused on the right problems.

Our vision for the path forward is both clear and simple. We need to be the most trusted partner across the clinical conditions we serve so that every referral is easy to send, patients comply with and remain on therapy, and we timely collect the dollars that we earn. To execute on that vision, we will focus on 4 key areas that directly address the gaps identified.

First, winning referrals. We need to improve both our go-to-market approach and our intake process, particularly in respiratory and sleep. We must make the referral process easier and faster, so the decision to refer is straightforward for referral sources.

Second, supporting and maintaining patients over the life of their therapy. Therapy compliance within the first 90 days has material room to improve. Supporting and maintaining patients after setup will become a North Star objective and KPI for our teams, ensuring therapy compliance for patients aligns with our mission, bringing care to life.

Third, optimizing our revenue cycle management to ensure we collect timely and completely. Improvements here do not require a new referral, a new branch or a new product. They require for us clean orders, on-time filing, fewer reasons for denials and faster rework. Every 1 percentage point of improvement can generate meaningful operating cash flow tailwinds and help reduce our reserves.

Finally, rebuilding our back office and branch operating system to accelerate speed to serve while materially reducing cost to serve. Our goal is to shift branches towards patient service and clinical hubs, not administrative warehouses. We believe we can further consolidate key administrative functions while increasing productivity through automation and process simplification.

From my personal experience and what I have seen thus far at Accendra, as we execute on these key areas and tighten underlying operations, returning to market-leading growth rates is very achievable. We fully believe our problems are fixable. Most of what we need to do is in our control. And the work to improve is already underway. Some things will take time as we test and learn, but we are moving quickly where we can. A few examples I'd like to share.

We are actively reorganizing the structure of all our commercial operations, including commercial contracting, and have consolidated this function under our new Chief Commercial Officer. I have the utmost confidence that this change will improve our go-to-market strategy and execution, and will allow us to more effectively manage our strategic relationships with commercial payers.

In addition, after decades of service, Perry Bernocchi, our Chief Operating Officer, has transitioned to an advisory role, and I now have direct oversight over our branch and back-office operations. We will continue our work on fully scaling our sleep center of excellence while accelerating adoption of end-to-end digital referral management.

In addition, in Q1, we will launch the first iteration of revamped branch and back-office operations, simplified processes and key automated activities. To support these efforts, we have launched a dedicated transformation function that will be focused 100% on execution of our multiyear value creation plan with quarterly hard dollar targets.

Lastly, I want to reemphasize an important point made by Jon. We believe the prior work on liquidity and the balance sheet and the recurring revenue nature of the business have given us the runway we need to make the necessary changes ahead of needing to refinance our first maturity in early 2029. We look forward to sharing further details, including our expectations on the financial impact of the changes I am previewing in Q1 of 2027.

I will now turn the call back over to the operator for Q&A. Operator?

Operator

[Operator Instructions] Your first question comes from the line of Rishi Parekh with JPMorgan.

Question-and-Answer Session

Rishi Parekh

Great. Can you just -- well, first on the commercial side, you said that you resolved the issues around it. We saw the $88 million and the $20 million hit on the commercial payers. I assume that's going to continue in the fourth quarter. Can you just walk us through what has been resolved? How should we think about the commercial side of it? And ultimately, what's going to leak into '27 as we think about the commercial payer side? And I have a follow-up.

Jonathan Leon

Rishi, are you referring to the prepay audit that we discussed last quarter and addressed again today?

Rishi Parekh

Yes, we do.

Jonathan Leon

Yes. Okay. On that issue, as I said, it's largely behind us. And frankly, I'm sure -- and we really -- it is not really relevant as to what led to it. It was, I think, a lot of a series of miscommunications and administrative matters, but it was a very odd set of circumstances that we got disproportionately number of prepaid audits from a couple of large commercial payers.

As I said, it's largely behind us. It's just a matter of cleaning up the work that needs to be done. We actually reached an agreement with the payers, at least one of the major payer, that allowed us to -- allowed them to take a sample of some of the prepaid audits that they were giving us, which, as we mentioned before, were unprecedented levels of audit requests. We passed those audits with flying colors, and that allowed the cash to begin to roll in.

So I think that wraps up in Q4. Nothing leaks into 2027, my estimation. And in dollars that we're behind now are measured by millions on fingers on one hand. So it's an immaterial amount of cash that we're still delayed in getting, but we expect to get that over the next several weeks and the issues will be completely done at that point.

Rishi Parekh

And then you highlighted a number of operational challenges, and you don't operate in a vacuum and your competitors are probably also on this call as well. You've noted that you need to make a number of changes within the sales organization. How long do you think it's going to take? And what are the costs to actually implement some of these strategies going through this year and into next year.

And it seems it sounds difficult that you're going to be able to really turn this business around immediately in '27, and you talked about liquidity being fine. I guess I'm having a really tough time trying to understand how that's going to be possible. Is it just your AR facility? Is it that you're going to borrow the entire amount on your revolver? What do you expect to do to bridge that liquidity gap that you plan on for '27?

Kenneth Gardner-Smith

Yes, Rishi, this is Kenny. I'll start with the commercial execution piece. Some of the changes that we intend to do are already underway. Some of it is organizational in nature. So bringing in a new Chief Commercial Officer, who's been in role now for a month, making changes across the team and really going back and reevaluating our go-to-market strategy to make sure that's adequate.

There are some things that we need to do that are related to the way we operate in the back end, which I talked about. So a framework that will be critical for us is speed to serve and cost to serve. Those have tentacles into our commercial execution. We feel good about the pace to be able to get those initiatives launched into 2027. We aren't really prepared today to talk about exactly when we expect to reach the dollar impact that we expect to achieve from the initiatives, but they're well underway.

And I'll let Jon give additional clarity on the liquidity point. But as we said in the call, we did a lot of work earlier in this year to set the company up for the liquidity necessary to execute on the changes, and we feel we have the runway to do that.

So Jon, any clarity you want to add to that?

Jonathan Leon

Yes. Rishi, I would just add, I mean, we're not going to have to certainly draw significantly on any of our facilities, and we'll continue to use those as we have been throughout the year. If you think about 2026, which obviously and admittedly in a terrible adjusted EBITDA performance year, and keeping in mind, we had $115 million to date through the third quarter of onetime cash outflows with just a little bit of improvement in our EBITDA.

We think we'll be in pretty good shape. But there's no need for us to draw really on any more than we have been in the past. Working capital will continue to be a go-forward benefit for us as it was this quarter. So I think you'll see decent cash flow from the business.

Operator

There are no further questions at this time. I will now turn the call back to Kenny for closing remarks.

Kenneth Gardner-Smith

Yes. Thank you, operator, and thank you, everyone, again, for joining us on the call and the continued interest in our organization. I'll just make a couple of really quick points.

Number one, as I said in the call, we are in the early stages of doing the critical work to revamp our company and to take advantage of our scale and brand. We have both scale and amazing brands out in the market, and we have critical work to do to unleash the full potential there.

And then lastly, the last point I'll make is we look forward to sharing the details of the impact of that plan into the next year. A lot of the work is underway. I highlighted a few of the changes in my remarks in the call. We continue to reaffirm and test our assumptions, but we will be prepared in early Q1 of next year to share greater details on our plan, including timing, and we look forward to unveiling that as early as possible.

So again, thank you, everyone, for your interest, and we look forward to communicating again. Thank you.

Operator

This concludes today's call. Thank you for attending. You may now disconnect.