Would now like to turn the call over to Stephanie St. Clair, Senior Vice President of Finance and Investor Relations.
Good afternoon, welcome to Health Catalyst earnings call for the first quarter of 2026, which ended March 31, 2026. My name is Stephanie St. Clair, Finance and Investor Relations Senior Vice President. With me on the call today are Ben Albert, our Chief Executive Officer, and Jason Alger, our Chief Financial Officer. A complete disclosure of our results can be found in our press release issued today, as well as in 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. As a reminder, today's call is being recorded and a replay will be available following the conclusion of the call.
During today's call, we will make forward-looking statements pursuant to the Safe Harbor Provisions of the Private Securities Litigation Reform Act of 1995 regarding our future growth, financial outlook for the second quarter and full year 2026, market conditions, AI initiatives, bookings, retention, operational priorities, strategic and restructuring initiatives, client migrations, and the general anticipated performance of our business. These forward-looking statements are based on management's current views and expectations 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 statements or outlook. Actual results may materially differ. Please refer to the risk factors in our most recent Form 10-K for the full year 2025 filed with the SEC on March 12, 2026, and our Form 10-Q for the first quarter of 2026 filed today.
We will also refer to certain non-GAAP financial measures to provide additional information to investors. 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. A reconciliation of our non-GAAP financial measures to their most comparable GAAP measures is provided in our press release. We will provide forward-looking guidance for certain non-GAAP financial measures in this earnings call and are not providing the comparable GAAP measures and therefore have not provided reconciliations because there are items that may impact the comparable GAAP measures that are not within our control. With that, I'll turn the call over to Ben.
Thank you, Stephanie, thank you to everyone for joining us today. We are pleased to report a strong first quarter with solid bookings and results that exceeded expectations on both revenue and adjusted EBITDA. We ended the quarter in a strong cash position and combined with the cost savings from streamlining our operations, we are making progress as we position the company for durable and efficient growth. We are also introducing a new performance metric that we believe provides a clear benchmark of success and issuing full-year guidance as promised. Jason will detail our performance and outlook in his remarks. First, I'd like to spend a few minutes sharing learnings from our initial assessment and the actions we've taken and will continue to take with urgency to transform the company's operating model, simplify our organizational structure, and align resources around our highest conviction technology opportunities.
Over the last few months, we have begun examining every dimension of the business, from our cost structure and our product portfolio to our go-to-market approach, organizational design, leadership, technology infrastructure, and how we deliver value to clients. This review has reinforced both the strength of our foundation and the need to operate differently. One of the most significant findings from that review was the direct connection between our previous migration strategy and the revenue pressure we are managing this year. Setting a rigid timeline for DOS to Ignite migration efforts over the last two years has created a churn dynamic, which is heavily impacting 2026. It is the area we have addressed most aggressively, prioritizing client success and retention to build a more durable revenue base.
As we shared in our March earnings call, we stopped managing the migrations as a one-size-fits-all program and conducted a line-by-line review of every remaining client. We developed a tailored plan for each client's specific situation and have strengthened the teams dedicated to taking clients through this process, including options where clients stay on DOS for an extended period of time. The initial review is now complete and gives us a new level of visibility into a path forward. As we look at our business holistically, we believe that Health Catalyst has exceptional core assets, including 18 years of proprietary healthcare improvement data, deep client relationships, proven outcomes, and a team that genuinely cares about improving healthcare. However, these assets were hampered by a fragmented and cumbersome business structure that created friction and lacked focus for clients and teammates.
While this accumulated complexity will take time to unwind and will create short-term revenue pressure, we are focused and confident in our plan of action. Ultimately, we believe this short-term impact is necessary to achieve more profitable growth long term. Importantly, we are building a leadership team that is equipped and eager to execute this plan. We've added significant experience across nearly every function, bringing in operators with vision, executional discipline, and a track record of results. We also recently promoted our new Chief Marketing Officer, who is already transforming our messaging, product positioning, and how to take our solutions to market. Our new Chief Growth Officer, who is bringing her excitement and data-driven leadership to our growth function. At the board level, we've also made significant changes.
We recently welcomed Steve Nelson, who currently serves as the President of Aetna and brings deep healthcare expertise and public company leadership experience. He previously served as Chief Executive Officer of UnitedHealthcare, ChenMed, and Duly Health and Care, building and scaling delivery models where health outcomes, provider experience, cost discipline, clinical performance, and consumer engagement operate as a single integrated strategy. Out of our seven current board members, he is one of four board members who have joined in the last year, including a new chair. The board refresh brings fresh perspective, outside expertise, and strategic insight. Moving forward, our focus is building a technology business that wins in the market, operating with efficiency and discipline and investing in our Ignite Intelligence that differentiates our solutions. Two weeks ago, we announced a comprehensive operational and business restructuring we're calling Project Nexus.
It is a strategic initiative designed to fundamentally transform our operating model, improve our cost structure, and advance each of these priorities. This initiative is expected to generate annual run rate cost savings of approximately $30 million and accelerate the progress we've already made to integrate our core functions and consolidate our operations under one company with one commercial approach, one client-facing team, and one set of standards. On the engineering side, we piloted a new development model utilizing highly efficient pods and proprietary AI development agents. In initial pilots, development teams increased story points delivered by as much as 100% per developer, allowing us to simultaneously reshape our cost structure and accelerate product innovation. Finally, we are introducing total bookings as a simplified operating metric. We consider investor feedback carefully and believe it is one of the most direct indicators of whether our commercial engine is working.
Combined with our guidance and continued to focus on adjusted technology gross margin and cash generation, we believe our metrics will give you a clear and consistent framework to track the success of this transformation. Now let me tell you how the work we are doing positions us for the opportunity ahead and why I took this job. Healthcare is at an inflection point. The finance margins, shifting payer mix, rising labor costs is structural, not cyclical. In this environment, organizations are looking for more than incrementally better tools. They are looking for a partner who can help them reduce costs, improve clinical quality, and grow consumer relationships while delivering meaningful outcomes. That is the market we are built for, and AI strengthens our ability to serve it. Healthcare data infrastructure has increasingly commoditized.
Durable advantage lives in the intelligence built on top of it, and our advantage rests on something no one else has: our wealth of improvement data, the link between an intervention, its cost, and its measured outcome. 18 years and thousands of improvement engagements later, our proprietary data set compounds, building our competitive advantage. A new entrant cannot manufacture this data set retrospectively. These engagements include an evidence base that tells us what reduces costs, improves clinical quality, and grows consumer engagement, and then can be calibrated to each system's case mix, cost structure, workforce, and starting point. The result is a prescriptive roadmap that identifies opportunities sized in dollars and interventions ranked by impact, sequenced so the foundations are in place before the harder work begins. That is the foundation of our AI strategy.
We are building a growing suite of agentic AI models across cost management, clinical quality, consumer experience, and ambulatory growth embedded in our domain-specific applications. These improvement agents will combine multiple layers of machine learning models and LLMs to surface the right opportunities for each health system, quantify the impact, and guide execution. We are building a moat by combining our depth of improvement data with purpose-built AI agents at scale. Work that once required months of consulting services and manual effort is being embedded in our technology solution and recalculates daily as conditions change, improving with every outcome delivered. I want to add something more personal. I believe that a thriving health system is foundational, as essential as education, as central to the fabric of community as any institution we have. For the communities they serve, health systems provide care, they provide employment, and they provide resilience.
When they struggle, communities feel it in ways that go far beyond healthcare. That reality is under threat today, and many communities do not yet see it coming. Health Catalyst exists to help health systems sustain and strengthen that role. Our improvement data is the foundation, and AI will allow us to make that expertise efficient, scalable, and accessible to every system that needs it. That is the company we are building. In conclusion, we asked for time, and we used it to conduct a thorough assessment of the business. We are acting on what we found. We are transforming the company's operating model by simplifying our organizational structure and aligning resources around our highest conviction technology opportunities. We have increased visibility into the DOS to Ignite migration impact, and we expect that the majority of that revenue pressure will be absorbed in 2026.
These changes to our operating model position us better 2027 with a more efficient organization and a commercial engine that will be aligned to where we believe we will win. With that, I'll turn it over to Jason.
Thanks, Ben. I wanna start by putting the Q1 results in context, then describe the transformation we are undertaking and the framework we are using to measure it. The financials this quarter reflect the very early stages of that work. We exceeded our guidance on both revenue and adjusted EBITDA. We're reporting strong Q1 bookings, which gives us confidence our commercial simplification work is gaining traction, and our cost discipline continues to show up in the numbers. Let me walk through the details. For the first quarter of 2026, total revenue was $70.8 million, exceeding the high end of our guided range of $68 million-$70 million. Technology revenue was $49.5 million, and professional services revenue was $21.3 million. On the top line, I would point to a few things.
Our revenue trajectory is beginning to show some of the revenue pressure that Ben discussed. It was partially offset by milestone delivery-based revenue and new client revenue. Professional services revenue continues to decline as expected as we shift toward a more technology-led model, which is by design. Adjusted gross margin for the first quarter was 51.5% compared to 49.2% in the prior year period. Adjusted technology gross margin was 65.3%, and adjusted professional services gross margin was 19.4%. Adjusted technology gross margin reflects duplicate hosting costs as we migrate clients to Ignite and heavy data loading costs associated with HIE client deployments before revenue can be recognized. We are laser-focused on margin expansion as part of the transformation to streamline delivery and optimize our cost structure.
We expect that the operational changes that Ben described, which includes certain headcount and non-headcount changes that impact cost of revenue, will begin to show up in Q2 results and will become more evident in the second half of 2026. Adjusted operating expenses in Q1 were $27.3 million, representing 39% of revenue, compared to $32.8 million or 41% of revenue in Q1 2025. We have been disciplined about cost management while protecting investments in areas that directly support the transformation. Adjusted EBITDA for the first quarter was $9.1 million, exceeding the high end of our guided range of $7 million-$8 million, compared to $6.3 million in Q1 2025. Adjusted net income per share was $0.02, with a weighted average share count of 72.6 million.
Turning to the balance sheet, we ended the quarter with approximately $108.8 million of cash equivalents, and short-term investments. As Ben noted, cash generation is a central focus. This Q1 cash equivalents, and short-term investments value reflects a $13.1 million increase compared to December 31, 2025. Although we don't anticipate this level of cash generation every quarter, we are managing liquidity carefully, and we expect the restructuring actions we are taking will meaningfully improve our ability to generate cash. Let me walk through the math of Project Nexus, because I think it is important for investors to see how these actions connect to the financial trajectory we are targeting. We expect total second quarter restructuring charges of approximately $4 million. This program spans workforce actions, infrastructure consolidation, and go-to-market realignment.
We expect the majority of these charges to be incurred in Q2, with the restructuring substantially complete by year-end. Project Nexus is expected to generate annualized run rate savings of approximately $30 million, inclusive of direct savings of approximately $22 million from the 9% reduction in headcount and reductions in non-headcount spend, such as infrastructure, subscriptions, and contractors, and indirect savings of approximately $8 million from the closing of open headcount and cancellation of other previously planned expenses. It is important to note that these savings are annualized, so not all of the benefit will be seen in 2026. As we think about 2026, we expect our quarterly adjusted operating expenses to decrease by $3 million-$4 million compared to Q1. We also expect our quarterly adjusted cost of revenue to decrease by $1 million-$2 million.
These quarterly impacts will start to take effect in Q2 and will ramp throughout the year. We are making meaningful structural changes to how this company operates and what it costs to run. Today, we are providing full year 2026 guidance. I wanna walk through not just the numbers, but how we expect the year to unfold, because the shape of the year matters as much as the totals. The full year 2026, we currently expect total revenue of $260 million-$265 million, adjusted EBITDA of $30 million-$33 million. For Q2 2026, we currently expect total revenue of $68 million-$70 million, adjusted EBITDA of $9 million-$10 million.
Our full year revenue guidance reflects the weight of short-term revenue pressure related to the previous migration strategy, as well as the TAMS and professional services related revenue reductions and the assessment that Ben described. The churn that we are working through today is largely the result of prior decisions that force clients into an accelerated decision point on the migration before we had the right retention program and client-facing structure in place. On our previous earnings call, we shared certain data points related to the DOS to Ignite migration, including the $12.5 million of ARR notified down sell churn and approximately $52 million of potentially at-risk ARR. Following the client-by-client review, we anticipate retaining at least $22 million of the previously identified $52 million of at-risk ARR.
This leaves approximately $30 million of at-risk ARR, which we are focused on retaining through dedicated account plans tailored to each client's needs. The current expected impact will be approximately $20 million in 2026 and $10 million in 2027. For simplicity, we've provided this detail in a chart in our earnings release. We would note that a number of clients will continue to use our application solutions going forward, even after transitioning to their own infrastructure. As we previously noted, the migration impact is temporary, and we expect to be generally through the strains of the migration at the end of 2027. This does not mean every migration is complete as we are extending the availability of DOS, but it means we will transition each client when the time is right on what products make sense.
Additionally, the changes we have put in place are helping us to build a more durable revenue base exiting 2027. As we prioritize a mix shift to higher margin technology revenue, we continue to work with clients on the right services approach. In certain cases, it makes sense for clients to insource team members, which aligns with our technology-led strategy and improves our margin profile. Our best estimate today is that exiting 2026, our services segment will be between $55 million-$65 million in revenue annually. Our Q1 bookings were strong and our pipeline supports moderate bookings in Q2 and positive bookings momentum in the second half. Over the course of 2026, we expect $22 million-$26 million in new bookings, which includes all ARR and non-recurring revenue.
We use new bookings as an operating metric and define it further in our Form 10-Q filed today. We will report results for this new metric on an annual basis. We aim to turn bookings into revenue promptly for the advantage of our clients and our business. From an adjusted gross margin standpoint, we expect adjusted technology gross margin to fluctuate modestly quarter to quarter and to finish the year in the mid-60s. Technology margin expansion is a key focus area of our business moving forward, but it will take time to realize improvement in our financials given duplicate costs from the Ignite migrations and heavy data loading costs associated with HIE client deployments.
We anticipate that our adjusted professional services gross margin will decline over the course of the year as we continue to work through the migrations with a full year margin expectation in the mid to low teens. We are targeting adjusted EBITDA that reflects changes to the operating model taking hold. This is the financial case for why the short term migration-related revenue pain is worth it. We believe our new structure will allow us to lean into high priority opportunities and realize improving leverage when growth returns. We are managing this business for durable value creation and believe the actions we are taking in 2026 are laying the foundation for that. With that, I'll turn the call back to Ben.
Thanks, Jason. In closing, I wanna thank our clients for their continued partnership and our team members for their commitment during this period of progress and transition. We are energized by the transformation underway, and our board and management team are fully aligned on driving shareholder value. We have a clear plan and are executing with urgency and discipline. We remain confident in the direction of the business and in our ability to create long-term value for our clients and shareholders. Operator, we are now ready to take questions.
The floor is now open for questions. At this time, if you have a question or comment, press star one on your telephone keypad. If at any point your question is answered, you may remove yourself from the queue by pressing star two. Again, we kindly ask that you limit yourself to one question and that you pick up your handset when posing your questions to provide optimal sound quality. Thank you. Our first question is coming from Stan Berenshteyn with Wells Fargo. Please go ahead. Your line is open.
Hi. Thanks for taking my questions. On the prepared remarks, you mentioned a bigger focus on the technology business. Are there any value-added services that are still part of this vision, or is the expectation here that services is going to shrink as a mix of total revenue? Thank you.
Thank you for the question. The expectation is that services will shrink as we go forward as in terms of as a percentage of revenue as we invest in technology-driven opportunities for the company overall. We certainly see and will continue to see areas of opportunity for our services in the business. An area of example is a chart abstraction. While we might infuse more AI into the process of our chart abstraction work, we will still have wraparound services to meet our clients where they are. Sometimes that will require utilizing some services in the business, but we will see a mix shift as we go forward, especially with the AI strategy we're unfolding and how we're really taking advantage of the highest technology opportunities the business has.
Great. Thank you.
Thank you. We'll now move on to John Pinney with Canaccord Genuity. Please go ahead. Your line is open.
Hi. Yeah, John Pinney on for Richard Close. Thanks for the questions. I guess I just wanted to get greater detail on. You said, like, the shift from DOS to Ignite was kind of a sticking point, is trying to force that shift onto people. I guess, like, what is the hesitation of people shifting? Is it just, like, the flux that it would create during that shift? Is there something about DOS that they wanna stick with that Ignite doesn't have?
Thanks for the question. There are a couple things we can answer that with, DOS provides a lot of value to our clients, and our clients have invested a lot in DOS over time. Taking on that transition to a new platform, whether it be Ignite or other, is just a lot of work, and it requires a tremendous amount of effort. They get tremendous value from DOS today. For many clients, they're excited to stay on DOS, and over time, they may move over to Ignite. We wanna just be able to meet them where they are and support them through that transition as we go forward. DOS does provide a lot of value, and I think that's what we're seeing.
Now, as it relates to the second part of the question, you know, the data platform level has been commoditized a bit, and the value really is in the intelligence that sits on top of the data platform. We've got this 18 years of proprietary improvement data that sits on top of the data platform, and this is on top of Ignite, of course, that we're enabling these AI capabilities off of across these three really critical areas of helping our clients manage costs, helping them improve the consumer engagement and growth from the ambulatory side of the business, and also driving clinical quality. As we invest in AI and use that improvement layer that sits on top of the data platform, we will see more and more take advantage of what Ignite has to offer.
Thank you. We'll move on now to Jeff Garro with Stephens. Your line is open.
Yeah, good afternoon. Thanks for taking the question. Wanna ask about feedback so far on Ignite Intelligence. Curious, what are you hearing from customers in terms of kind of overall budgeting for AI? Feedback on your offering versus efforts or investigations they might have into building it themselves or buying from someone else. Thanks.
Sure. Thanks, Jeff. The feedback has been really positive as it relates to the initial rollout of our AI capabilities, particular in the cost management side of the equation. We're just very early innings there, the feedback has been excellent, we continue to invest more and more in that work to unearth these capabilities that we can provide. As we talk about what differentiates us and how it really drives measurable improvement for our clients, that's really all about that 18 years of proprietary intelligence that we have on top of the data. That improvement data is what we call it.
18 years of projects, thousands of projects to help improve our clients across their how they better manage their costs, how they better manage their labor, how they better manage their clinical quality, and how they better manage their consumer experience. We have that data, and we can enable our clients to utilize that with our AI agents that really will make our solutions much more robust and help them manage the changes going forward. There's a lot of excitement, and we believe that will be a huge component of our future growth.
Thank you. We'll now move on to Jessica Tassan with Piper Sandler. Your line is open. Please go ahead.
Hi, guys. Thanks for taking the question, and appreciate you reinstating the guide. I kind of have a multipart question. Are you able to disclose how many DOS and Ignite customers you have today, and what is the average ARR for DOS customers in 2026 versus Ignite customers in 2026? Just when you say data infrastructure is commoditized, I guess when did that occur? Who are the competitors on the data infrastructure side, and how much of the DOS or Ignite ARR would you ascribe to data infrastructure versus the intelligence layer? Thanks.
Hey, Jess. Really appreciate the question. I mean, what we have provided in the prepared remarks as well as in the earnings release document is full detail around what we expect from a downsell and churn perspective. We don't have a logo count that we'll be disclosing at this point in time, but we'll keep everyone apprised of how we're projecting there. It does continue to still be less common for an enterprise client to exit entirely. What we are saying is that clients are generally continuing, even if we do see that downsell or churn on the data infrastructure side, they are continuing to maintain those application relationships with us.
I would just add to the fact you mentioned when did the data platform become commoditized. I think as we talked on prior calls and indicated that the folks like Databricks coming in and Snowflake and cross-industry tech vendors who are working to really enable that data platform layer, but they lack the intelligence that sits on top. They're building the infrastructure layer to support these organizations, and that's happening at times. We can still do the whole thing for clients who need that. Ultimately, what we do now is we have that intelligence layer that can sit on top of that data platform. That Ignite Intelligence can enable our clients and future clients with a much greater improvement opportunity through the intelligence we provide.
Thank you. We'll now move on to Aidan Conniff with Stifel. Your line is open.
Hi, all. Thanks for taking my question. I have a two-parter. First, in the $30 million of anticipated churn and down sell, is that entirely the data infrastructure layer? Secondly, thanks for providing the bookings metrics. How quickly are you expecting those to then convert to revenue?
Hey, Aidan . Appreciate the question. Yeah, related to the $30 million in anticipated churn or down sell, I would say it's heavily focused on the data infrastructure side. It's not 100% data infrastructure. We are seeing some of that churn come out of the application side as well. Primarily focused more on data infrastructure. Then to the second part of that question. I'm sorry, could you repeat that second part, Aidan? Apologize.
Yeah. Just in terms of the bookings you guys provided, how are you thinking about those then converting to revenue in terms of the timeframe, we should see them appear?
Got it. Yeah, appreciate you repeating. We would expect bookings to convert into revenue. Typically, it takes about three to six months for those bookings to convert into revenue. It really does depend on the project or on the technology that we're deploying, but that would be most common, would be three to six months.
Thank you. We'll move on to Daniel Grosslight with Citi. Your line is open. Please go ahead.
Hey, thanks for taking the question. This is the response of Daniel. I know you mentioned earlier in the call that your pipeline supports moderate bookings in 2Q and positive momentum. Does this positive momentum represent, like, a change in behavior among potential clients relative to your initial expectations, or would you characterize those behavior overall steady and there's still a little bit hesitant hesitancy in the market? Thanks.
I think it can be attributed to, just our approach. I mean, we recently added a new head of marketing. We've got a new chief growth officer, and we're really focused on how we are taking our platform and our capabilities to market and how we're messaging those solutions in market so people understand exactly what it is that we do as an organization. Health systems are still making purchases today, but the bar is definitely higher. The ROI threshold is higher. They don't want just one solution. They want a partner who can provide multiple solutions like we can across cost intelligence, labor intelligence or clinical intelligence, consumer intelligence.
When you can come to them with a message of how well we understand you as a 18 years in healthcare with tremendous improvement data that sits on top of it, and then the ability to convert that data into meaningful outcomes and measurable improvement for them across multiple areas of their business, that capability is truly unique and differentiated in the market, and we do anticipate that driving the back half of the year.
Understood. Thank you.
Thank you. Once again, if you would like to ask a question, please press star one now on your telephone keypad. We'll move next to Ryan Daniels with William Blair. Your line is open.
Yeah, thanks for taking the question, all the color thus far. Ben, one for you. I just wanted to dig into the DOS-related ARR churn and potential buy down. Can you talk a little bit more about the $52 million and what actually delineates the $22 million you anticipate to retain versus the $30 million? What are the characteristics defining your ability to retain some of that ARR versus the potential risk? Then, you know, what are you guys doing to mitigate that risk going forward, or is it just likely gone at this point given some of the conversion structures already in place? Thanks.
Thanks for the question. We are working hard to retain as much of that as we can. As we did our assessment over the last really few months, we went line by line against every DOS to Ignite migration account and put a plan together to support them. We're not gonna lose them all. Some will down sell as opposed to full churn obviously. Ultimately, we do have an approach, and we are hopeful to make some inroads there. We just wanna make sure, you know, we're communicating clearly, we're building credibility and making sure that we're setting the right expectations in the market. We do have a plan to go and try and retain as much of that revenue as we can through those account-by-account approaches.
Thank you. There are no further questions at this time. I'm happy to turn the floor back over to Ben Albert for additional or closing remarks.
I'd like to thank everybody for joining us today. I think we're super excited about what Health Catalyst can become as we go forward. We're very focused right now on the fundamentals, the launch of Project Nexus to transform our operating model and drive our company forward. We're investing in the areas that we believe will drive growth for our organization. We're trying to provide as much transparency as we possibly can so you can all really understand where our business is and where our business is going. We recognize that our performance hasn't been where we want it, and that we're gonna be judged by the performance that we create here, and we're very focused on executing against that. Thank you all very much for joining us today. Appreciate it.
Thank you. This concludes today's Health Catalyst first quarter 2026 earnings conference call. Please disconnect your line at this time and have a wonderful day.