I cover healthcare service at Bank of America. Thrilled to be introducing Dave Bourdon, CEO at LifeStance. It's only a 15-minute presentation, so without further ado, I'll turn it over to you.
Thanks, Andrew. Appreciate it. I appreciate the opportunity to share a little bit about LifeStance with you. We're the category leader in outpatient mental health care, and there's a tremendous opportunity in front of us. Before we get into that, a little housekeeping is our forward-looking statements. All right. I mentioned that we have a tremendous opportunity in front of us, and I think about it in two ways. The first is some of the macro themes that are benefiting LifeStance and the mental health outpatient industry, and then things that are unique to LifeStance. Let's start with the industry. Outpatient mental health, it's an attractive industry, and where we play in that is think of us as like the primary care of mental health.
We don't do things like residential or inpatient, as well as we don't do special services, for example, like the autism therapy or the ABA, which you're hearing a lot in the news. There's pressure from the payers, pressure from the states. We do not play in that space. Again, we're really think of ourselves as the primary care of mental health. As a matter of fact, if you go to one of our centers, it's like visiting your PCP office. That's what it looks like for us. All right? It's about a $50 billion TAM for outpatient mental health, it's growing. The reason it's growing is a couple of things. The first is that you just have an increasing demand for mental health services.
You think about what's going on in the macro environment, the increasing stressors, and then you have just an increase in diagnosis and awareness. People are going into their physical health, so their practitioner, so it could be a PCP, going into their OBGYN, whatever the case is, and what they're realizing is that there's a comorbidity there. To be able to better treat that patient, they're identifying that there's some mental health needs. The result of that diagnosis is increasing the needs for mental health. That's one aspect. Another aspect is if you go back to I'll date myself. I'm an old guy.
I've got, I have four kids in their 20s now, but, you know, when I was their age, there was a social stigma associated with going to get mental health services. It just wasn't something that you did. You could be looked down upon. As that stigma lessens, that's also increasing utilization because there was a lot of people in the U.S., there still is even today, that need mental health services, and were not seeking them. Again, with that social stigma reducing, that's increasing the demand for our services. Another aspect that isn't talked about as much is there's an affordability challenge.
The reason I mention that related to outpatient mental health is because of really almost decades of underinvestment, you could even go to the extreme of neglect by payers, whether that's commercial payers or the federal government, reimbursement for mental health practitioners, I mean, it was extremely low. As a result, most wouldn't accept insurance. They'd only take cash pay. That has continued, but there's pressure on that cash pay environment because patients can't afford it. They want to be able to use their health benefits. Part of their health benefits is mental health care. They're putting pressure on the industry, whether that's on the payer side, about increasing network adequacy.
What you have is this migration from cash pay into insurance, and I'll get to LifeStance in a second, but that's another macro theme that is benefiting us. All right? Last thing I'll mention about the industry, because it's different than the rest of the healthcare, the healthcare ecosystem is highly fragmented industry and just in the early stages of consolidation. Most outpatient mental health practitioners are at small practices or even individual practices. We're the largest, say, we're the category leader. The next tier of practices that look like us are a fraction of our size. Again, we're in the early days of consolidation in a highly fragmented marketplace. All of those trends benefit LifeStance. All right? Let's get into LifeStance. We're unique, and we're not unique for any one thing.
We're unique for really a handful of things that combined really make us compelling. Let me briefly walk through those. First is scale. Mentioned we're the largest, over 8,300 clinicians. We did 9 million visits with patients last year. We had about 1 million patients. We're across 33 states and growing. All right? The next is hybrid. We have both virtual and in-person capabilities. We'll do millions of visits, both virtually and in person in 2026. Most of our competitors that are the newer entrants in the marketplace since COVID are virtual only. Us having that brick-and-mortar, we have over 575 centers across our 33 states, is a big competitive advantage for us. The third thing I'd mention is we have a broad range of services and licensure.
Our core services are therapy and psychiatry, which is mostly medication management. When you think about therapy, we have master's level therapists, we have social workers, and we have psychologists. On the psychiatry side, we have psychiatrists and nurse practitioners, again, mainly doing medication management. In addition to those services, we also are starting to provide what we call specialty service lines. We're already the national leader in neuro psych testing. Think of neuro psych testing, an example of that being you have a child, you're not sure if they have ADHD. You can bring them in. You go through a battery of tests with a clinician who specializes in this service, and then they'll be able to provide, render an opinion around what, you know, what the situation is with your child.
That's an example of neuropsych testing. Newer services for us are related to treatment-resistant depression, and these. You're hearing a lot about these in the news, and these are SPRAVATO and TMS. We're early in the days of rolling that out. Because of our brick-and-mortar footprint, we're able to roll this out at scale and in a very capital efficient way. That's our broad range of services. The last thing I'd mention is connects to the cash pay to insurance comment that I made earlier. We focus on patients that are coming from commercial payers. That's 90% of our revenue is coming from that channel. We get the remainder from the government as a payer, a little bit directly from patients.
Again, our focus is on commercial patients. Those are the first four. If you wrap those all up, what ends up happening is that becomes a very compelling value proposition for us to medical practices and inpatient mental health facilities to be a referral partner. When they need care for their patients, outpatient mental health, they're referring their patients to us for that care. That's our primary channel of getting new patients. That's free. You can't charge for that. It's actually, it's a win-win, right? We're holistically treating their patient with them and getting that patient to a better health outcome. As a result, part of the special sauce for us is that our cost of acquiring new patients is very low. We're below 2% of revenue in cost of acquiring new patients.
That's unseen in the rest of the mental health industry, with many of our competitors having to spend multiples of that to be able to get new patients in the door. Again, it's because of that preferred partner relationship. What does all this mean? It's resulting in a model that's delivering differentiated results. I'll start with the patient, 'cause it kinda always starts and ends there. When you think about a patient satisfaction, if you look across our 575 centers, we're averaging 4.7 out of five Google stars. All right. If somebody's searching for outpatient mental health care, if we have a center in their area, they're seeing that great rating. We're getting a lot of new patients in the door.
Again, that's free advertising for us, but it's also demonstrating the great work that our clinicians are doing in providing, you know, such a high quality service to the patients. The next thing I'd mention is outcomes. Last year, we started tracking the outcomes for our patients. We are doing this through surveys on a systematic basis, and we've got a lot of rich data as a result of that. Recently, we put out a study where we had followed 180,000 LifeStance patients that had depression or anxiety. What we found was that roughly three-quarters of those had a clinically significant improvement in their care. We were pleased with that. At the same time, we view that as that's the starting point, and really now it's about how do we do even better.
We're very excited as we really step with both feet into this clinical excellence journey. By doing well with the patients, that results in some really solid financial outcomes. A few stats there. If you look at the midpoint of our guide for revenue for 2026, what you see is that we have a three-year CAGR of 16%, driven by organic growth. Right? Very attractive on the top line. If you go to the bottom line, back in 2023, we were at about 5.5% adjusted EBITDA margins. You go to the midpoint of the guide for this year, it's over 12.5%. Significant improvement in our earnings margin performance. You're like, "Okay," keep following that down. Free cash flow.
This will be our third year of positive free cash flow. We have a very capital efficient business, a very strong balance sheet, gives us a lot of flexibility. This will be our second year in a row of having positive net income. Those are milestones that we're really proud of in our growth as a public company and as we're maturing. That's kind of the current year as we think about long-term. What we've talked about is anytime we're stepping into a year, we expect to achieve mid-teens top line growth. When we think about long-term margins, we're targeting, or I shouldn't even say targeting. We can see a path to about 15%-20% EBITDA margins. We don't necessarily think that's the ceiling, but we can see a path to that.
We were getting a lot of questions around the timing of that. When, when are you gonna get to that 15%? Let's say. Recently, we put out guidance that by 2028, we will achieve mid-teens EBITDA margins. All right. That's the financials. You know, I'm gonna end with where I started, and that is that this is an exciting time for LifeStance. You have the demand is increasing for our services. We're uniquely positioned. You know, our model and our performance really gives us confidence in being able to meet the needs of future patients, as well as being a compelling place for clinicians to practice. That's it. That's, appreciate the time and being able to tell the LifeStance story, and have a great day.