Hinge Health Q1 2026 Earnings Call Transcript

Quartr
Provided by Quartr
May 5, 2026

Key Takeaways

  • Positive Sentiment: Q1 beat and strong unit economics: Revenue of $182M (+47% YoY) with an 85% gross margin, 25% operating margin ($46M operating income) and $42M free cash flow (23% FCF margin), signaling scalable, AI-driven operating leverage.
  • Positive Sentiment: Raised full‑year guidance: 2026 revenue guidance increased to $798M–$804M (midpoint +36% YoY) and operating income to $205M–$215M, with about half the upside from higher yields and half from larger eligible lives.
  • Positive Sentiment: New migraine program & FDA clearance: Launched a migraine care offering with 510(k) clearance for the Enso device and early adoption by 125 clients covering >2M eligible lives, with meaningful revenue expected in 2027 as the program scales.
  • Positive Sentiment: Commercial momentum and product expansion: Pipeline materially larger versus Q1 2025 with strong SMB traction, Hinge Select at 4,100 provider locations and new distribution through a PBM and major health plans, although most new deals still close in H2.
  • Neutral Sentiment: Policy stance and capital actions: Management opted not to apply to CMS's ACCESS model over clinical oversight concerns (staying on the sidelines for now); balance sheet remains healthy with $407M cash and $105M of share repurchases in Q1.
AI Generated. May Contain Errors.
Earnings Conference Call
Hinge Health Q1 2026
00:00 / 00:00

There are 16 speakers on the call.

Speaker 8

Ladies and gentlemen, thank you for joining us, and welcome to the Hinge Health First Quarter 2026 earnings call. After today's prepared remarks, we will host a question and answer session. If you would like to ask a question, please raise your hand. If you have dialed in to today's call, please press star 9 to raise your hand and star 6 to unmute. I will now hand the conference over to Bianca Buck, Head of Investor Relations. Bianca, please go ahead.

Operator

Good afternoon, and welcome to Hinge Health's first quarter 2026 earnings call. I'm Bianca Buck, Head of Investor Relations. With me on the call are Daniel Perez, our Co-founder and CEO, and James Budge, our CFO. Our President, Jim Pursley, is spending this week advancing relationships with some of the largest state and local governments in the country, so can't be with us today. I wanna thank everyone for joining us. As a reminder, this conference call is being recorded. All relevant materials are available on the investor relations section of our website. Today's discussion will include forward-looking statements, which are subject to various risks, uncertainties and assumptions. These statements reflect our current views and expectations regarding future events, including expected performance of our business, future financial results, and growth strategies.

Operator

While these statements represent our good faith judgment and beliefs, actual results may differ materially from those projected or implied. We undertake no obligation to update any forward-looking statements except as required by law. For a detailed discussion of the risks, please refer to our SEC filings, including our annual report on Form 10-K for the year ended December 31st, 2025. We expect to file our latest quarterly report on Form 10-Q in the coming days. All income statement financial measures discussed today are non-GAAP, except for revenue, which is GAAP. These measures should be viewed in addition to and not as a substitute for our GAAP results. Reconciliations to the most comparable GAAP measures are included in our earnings release appendix. With that, I'll turn it over to Dan.

Speaker 3

Thanks, Bianca. I'm excited to share our first quarter 2026 results. We had a strong start to the year. Let me tell you why. I'll cover 3 things today. First, our Q1 financial performance, which came in well above expectations. Second, the launch of our migraine care program, our first expansion beyond muscle and joint pain, and a proof point that our platform can automate care delivery across multiple conditions. Third, where we stand commercially as we head into the sales season. I'll hand it over to James to go deeper in our financials and updated guidance. After that, we'll take your questions. Let's get into it. We delivered strong results across all key financial metrics this quarter, outperforming our expectations and demonstrating the continued strength of our business.

Speaker 3

Starting with revenue, we generated $182 million in Q1, representing 47% year-over-year growth compared to $124 million in the first quarter of 2025. This performance came in well above our guidance range of $171 million-$173 million, showing the continued strong demand we're seeing across our client and member base. Our LTM calculated billings reached $770 million, up an impressive 52% from $507 million in the prior year period, reflecting the continued expansion of our member base and strong engagement with our platform. On profitability, we achieved a gross margin of 85%, demonstrating continued care team and hardware efficiency as we scale our platform.

Speaker 3

Our operating margin was 25%, generating $46 million in operating income, exceeding our guidance range of $30 million-$32 million for the quarter. Our free cash flow performance was excellent once again. At $42 million, it was 10x higher year-over-year for a free cash flow margin of 23%. These are strong numbers, and they reflect something important. Our business is scaling efficiently. Our AI and automation investments are driving real operating leverage. We're serving more members, delivering improved outcomes, and reducing costs for clients, all while expanding margins. That's the triple aim in action, and it's also what makes this model durable in a world where every company is being asked what AI means for their business. For us, AI is an accelerant, helping us better deliver the triple aim whilst building a uniquely efficient business.

Speaker 3

We've spent over a decade building the number 1 rated digital MSK app, leveraging data from the millions of members we served to develop technology that automates over 95% of clinician hours associated with traditional PT. Combine that with our distribution, almost 3,000 clients, 60-plus health plans, PBMs, TPAs, and ecosystem partnerships, and we have a double walled moat, advanced platform capabilities on 1 side, difficult to replicate commercial reach on the other, and frankly, in the age of AI, when things are easier to build than ever, proprietary data and preferential access to clients is a recipe for outsized returns. James will unpack the financials in more detail shortly, including our raised guidance for the year. Let me shift to product and an expansion I've been waiting a long time to talk to you about.

Speaker 3

Our vision is to use technology to automate care, transforming outcomes, improving experiences, and reducing costs. We've proven this in MSK. Over 2 million people served, 21 peer-reviewed papers with demonstrable outcomes, and the top-rated digital musculoskeletal app. Here's the thing: We've spent years building a unified platform for our core technical and clinical capabilities from enrollment to treatment, outcomes collection, member engagement, nerve stimulation, and more. Combined with a leading go-to-market motion, we're well-positioned to extend into adjacent conditions. This quarter, I'm excited to share that we're launching our migraine care program. Migraine is a form of chronic pain that shares neurological roots with the neck and spine conditions we already treat.

Speaker 3

The nerves in the neck and head converge in a shared pain processing center, so not surprisingly, roughly 75% of people with migraine also have MSK pain. Our existing neck program members have already reported fewer migraine days and lower medication usage simply from engaging with our existing product. The scale of the problem is massive. 1 in 6 U.S. adults has migraine, and the prevalence rate is twice as high for women. On average, migraine sufferers drive more than $16,000 in annual healthcare spend, over double that of people without migraine. Nationally, migraine costs U.S. businesses an estimated $78 billion each year and drives absenteeism and reduced productivity. Our migraine care program delivers 3 things. First, rapid drug-free pain relief using our groundbreaking neuromodulation device, Enso. What's more, we just received 510(k) clearance from the FDA to extend Enso into migraine care.

Speaker 3

This means for many people, we could deliver drug-free migraine relief in minutes. AI-powered tracking that helps members identify personal triggers across environmental, lifestyle, and dietary factors. Proactive prevention through exercise therapy and clinically proven lifestyle guidance from our care teams, designed to reduce both the frequency and severity of attacks. Our Migraine Care Program will roll out later this month. The client response has been overwhelming. In just a few weeks, we've had over 125 clients adopt the program, representing more than 2 million eligible lives. Time and again, our clients mention that they themselves or a family member or someone they know is afflicted with migraine. We expect revenue contribution to be minimal this year, with a more meaningful impact beginning in 2027. The real significance is what this demonstrates.

Speaker 3

We didn't come this far with digital physical therapy to stop at digital physical therapy. Migraine is a compelling data point in the broader applicability of our platform. The clinical overlap is strong, our capabilities translate directly, and the speed of client adoption, over 2 million lives approved within weeks, underlines the credibility we've built with our clients and partners. This is exactly the kind of innovation that gets us excited about the decades of work ahead. We're building infrastructure to automate healthcare delivery across multiple conditions. Migraine is our next step, but it won't be the last. With that, let me now speak to our commercial progress. As many of you know, our sales cycle follows a predictable seasonal pattern.

Speaker 3

The first half of the year is primarily focused on building our pipeline and nurturing prospects, and we typically close the majority of new clients during the second half of the year as employers finalize their benefits decision for the following year. This quarter, we created substantially more pipeline compared to Q1 2025, which gives us confidence as we look ahead to the back half of the year. The interest level from prospects continues to be strong, and we're seeing good momentum across our client verticals and markets. Our investments in the SMB space are also paying off, where we're seeing substantially more pipeline generated in that category than in years past. We also continue to win at record rates, and the competitive takeaway trends we saw last year have also persisted, which speaks to the strength of our platform and the value proposition we're delivering to clients.

Speaker 3

Our Hinge Select offering is also seeing positive momentum. We ended Q1 with 4,100 provider locations, and we're also thrilled to share that we recently expanded Hinge Select access through 1 of our national PBM partners and 3 of the 5 largest national health plans by self-insured lives. We expect this to help accelerate client adoption during our sales season in the second half of the year. While I don't want to get ahead of ourselves, the fundamentals we're seeing gives us good reason to be optimistic. We expect the combination of strong pipeline development, solid win rates, and the added value we can now offer through our migraine care and Hinge Select programs to position us well for the foreseeable future. With that, let me turn it over to James.

Speaker 6

Thank you, Dan. Let me start by reminding everyone how our billings model works. Our calculated billings are driven by three key components: the number of average eligible lives multiplied by our yield, which is the percentage of those lives that actually engage with our programs, multiplied by our average selling price per engaged member. For Q1, our LTM calculated billings reached $770 million, representing an exceptional 52% year-over-year growth rate compared to $507 million in the prior year period. Revenue came in at $182 million, up 47% from $124 million in Q1 2025. This result meaningfully exceeded our guidance range of $171 million-$173 million. This revenue beat was driven by better-than-expected billings stemming from strong performance in both yields and lives.

Speaker 6

On the yield front, we're seeing two continuing and encouraging trends. We are converting members from new clients at a faster rate, and our legacy clients are also growing yields. This demonstrates that our platform continues to resonate with members across all cohorts and that our AI-powered personalization and targeted enrollment improvements are driving real results. On the lives side, we've seen two beneficial drivers. First, as in prior years, newly launched clients have come in with more lives than we anticipated. Second, our legacy clients have also increased in size overall, suggesting no impact on our business from any AI-driven employee displacement. This increase in eligible lives speaks to the diversification of our client base across industries and the essential nature of MSK Care and employee benefits packages to create better outcomes for members and lower costs for clients.

Speaker 6

Moving to pricing, as of the end of Q1 2026, around 80% of our contracted lives were using our new engagement-based pricing model. We expect this percentage to stay consistent throughout the rest of the year. Moving to profitability metrics, our gross margin for Q1 was 85%, up from 81% in Q1 2025. This 400 basis point improvement reflects our continued care team efficiency gains as we leverage AI and automation to serve more members without proportional increases in care delivery costs, all while sending Enso to more members than in prior years. We achieved strong operating leverage across all expense categories. Total operating expenses were 60% of revenue in Q1, down from 69% in the prior year period, demonstrating our ability to continue to scale efficiently as we grow.

Speaker 6

This translated to strong profitability with $46 million in income from operations, well above our guidance range of $30 million-$32 million for Q1. Our operating margin was 25% compared to 12% in Q1 2025, an improvement of over 1,300 basis points year over year. Free cash flow performance was excellent at $42 million for Q1 compared to $4 million in Q1 2025. This represents a free cash flow margin of 23%, up from 3% in the prior year period, primarily driven by higher billings and improved efficiency. From a balance sheet perspective, we ended Q1 with $407 million in cash and cash equivalents. During the quarter, we continued executing on our share repurchase program, purchasing 2.5 million shares for $105 million.

Speaker 6

Our diluted weighted average share count as of Q1 dropped to 82.4 million shares, down 2.5% compared to the ending 2025 figure. Our diluted net income per share attributable to common shareholders for the quarter was $0.45. Looking forward, based on our strong Q1 performance and strong outlook for the remainder of the year, we're raising the expected outcomes for all elements of our guidance. For Q2 2026, we expect revenue to be in the range of $194 million-$196 million, representing 40% year-over-year growth at the midpoint. For income from operations, we're projecting $47 million-$49 million for the second quarter or a 25% margin at the midpoint.

Speaker 6

For the full year 2026, we're raising our revenue guidance to $798 million-$804 million, up from our previous guidance of $732 million-$742 million. At the midpoint of $801 million, this represents 36% year-over-year growth, up from the 25% previously expected at the midpoint. We're also raising our full year income from operations guidance to $205 million-$215 million, or a 26% margin at the midpoint, up from our previous range of $151 million-$156 million, or a 21% margin at the midpoint. Several factors are driving this upward revision to our guidance.

Speaker 6

Average eligible lives for the year are expected to be slightly higher than what we previously shared, as we're seeing stronger than anticipated growth from both new client launches and expansion within our existing client base. Additionally, our yield is trending up to slightly north of 4% as both new and legacy clients are seeing better member yields than we initially projected. Of our guidance raise, approximately half is attributable to yield improvements and half from lives growth. The increase in our income from operations and margin expansion comes from two primary sources. First, the top-line outperformance, and second, some slower hiring than anticipated as AI has increased our efficiency across all operating categories.

Speaker 6

We do still expect to catch up on hiring as we move throughout the year, and in the meantime, these savings give us additional operating leverage while still maintaining our commitment to investing and expanding our product portfolio and commercial reach. For share count expectations in 2026, we anticipate ending the year with 82 million-84 million diluted shares outstanding, which does not include the impact of the continued execution of our share repurchase program. Before I turn it back to Dan, I want to remind everyone that we'll be hosting our annual client conference Movement in Chicago on June 10. This year, we're excited to welcome analysts and investors to attend our inaugural investor track alongside the main conference. You'll have the opportunity to hear directly from leaders across our company and get to mingle with the people who make Hinge Health a success, our clients, members, and partners.

Speaker 6

You can register on our investor relations website, where we also just uploaded an agenda, and we'd love to see you there. With that, let me turn it back over to Dan to wrap up.

Speaker 3

Thanks, James. Looking at our strong Q1 performance and the trajectory we're on, I'm incredibly optimistic about Hinge Health's future. We're bullish on our business for several key reasons. First, our core MSK market remains massive and under-penetrated. We have a tremendous runway for growth even before expanding into new areas. Second, our expansion into migraine care and strong client demand in this space signifies that our platform can successfully automate healthcare delivery for other conditions. Our distribution affords us uniquely powerful paths to market, and we're deepening the value we deliver to clients. AI now lets us build faster than ever, but our distribution channels turn innovation into adoption at scale. Third, our financial performance continues to demonstrate the scalability and durability of our business model. We're generating strong cash flows, investing innovation and growth, all while returning capital to shareholders.

Speaker 3

What excites me most is that we're just scratching the surface of what's possible. Healthcare remains one of our economy's last redoubts of manual labor, and we have the opportunity to transform how care is delivered across multiple conditions. Our vision to build a new health system that uses technology to scale and automate care delivery isn't just a long-term aspiration. It's happening right now, one condition at a time, and we're moving with urgency to extend our leadership position. Our journey is just getting started. We have decades of work ahead. I'm confident our best days are still in front of us. Thank you all for joining us today and for your continued support of our mission. Bianca, let's open it up for questions.

Operator

Thanks, Dan. Operator, we're now ready to take questions.

Speaker 8

We will now begin the question and answer session. Please limit yourself to 1 question and 1 follow-up. If you would like to ask a question, please raise your hand now. If you have dialed in to today's call, please press star 9 to raise your hand and star 6 to unmute. Please stand by while we compile the Q&A roster. Your first question comes from the line of Saket Kalia with Barclays. Your line is open. Please go ahead.

Speaker 13

Okay, great. Hey, guys. Can you hear me okay?

Speaker 3

Yeah, we got you.

Speaker 13

Okay, excellent. Well, hey, thanks for taking my questions here, and great start to the year. Congrats.

Speaker 3

Thank you.

Speaker 13

Dan, I'd love to start with you and maybe dig into the migraine program a little bit. I'm curious, how do you think about the market opportunity here for Hinge in that market? I'm sure you went through some exhaustive testing there. What were some of your findings on sort of how effective Enso and sort of the combined offering was in addressing that problem?

Speaker 3

Great question. Overall, our vision is to transform outcomes, experience, cost by using technology to automate care delivery, and we see migraine as just a natural extension of that vision. The clinical need for better migraine care is pretty overwhelming. 1 in 6 American adults suffer from migraine, yet there's only, like, 700 headache specialists in the entire country to serve tens of millions of people. Our early outcomes and member demand have been very strong. A big unmet clinical need alone wouldn't have justified our entry. We're also extending into migraine because our existing platform that we've built makes us very uniquely capable of delivering care well and at scale. You could see that with our 125 customers who have bought into migraine so quickly.

Speaker 3

It tells us, you know, 1, the clinical need is as acute as we believed, secondly, our enterprise reputation and distribution are doing real work there. Just to underline for a second, distribution, because I think there's a lot of anxiety right now of AI disruption, whether it's software or healthcare specifically. Focusing on healthcare, the hardest part in healthcare isn't actually building the product, it's getting paid for it. We've spent a decade plus building a client base of nearly 3,000 logos, 60 plus health plan, PBM and other partner relationships. That's just not something a new entrant, AI native or otherwise, replicates in a quarter or even a year. That requires contracts, clinical evidence, trust, integrations built over time.

Speaker 3

When you put that together, our migraine launch really sits on top of our clinical evidence base, which, you know, takes years to build our proprietary data, which is still compounding with every member, and our hardware that, you know, unlike software in the age of AI, isn't coming out of the tap. Again, the distribution mode I just mentioned. Those ingredients are really a recipe for a durable competitive advantage in our view, and you're seeing it show up in our free cash flow and our return on invested capital.

Speaker 3

With regards to the outcomes we were seeing as well, 56% of people in our trial that demonstrated that their pain went down from severe or moderate down to mild or none, with at least one of our Enso waveforms. When we compared it to placebo, we were 1.9x more likely to reduce pain with our Enso device versus placebo device. We're seeing really, really strong impact. We submitted our packet to FDA in December. Really excited to get clearance from FDA in April of this year.

Speaker 13

That's awesome. Super helpful and exciting outcomes. James, maybe for my follow-up for you, I'm staying on that topic, and maybe it's early to ask this, but how do you think about pricing for the migraine program just from a high level? I guess I ask that just because, you know, physical therapy has ongoing exercises through your, your device where this is kind of more Enso based. I'm curious how you would maybe compare and contrast the pricing models.

Speaker 3

Yeah. Maybe I'll give a few tidbits, and then Dan can add as well, 'cause he's got some good insights there also. I would just remind a few of the comments we made in our prepared remarks, which is that in the models this year, don't expect a lot of revenue, but due in 2027. This is about getting signups this year. We've already got a number of clients, Dan mentioned over 125, with 2 million+ members attached to them. Signups are going great so far. We think this sets us up well for 2027. Just generally more usage and more consumption with 80% of our clients now on the usage-based model or engagement model, however you wanna think about that.

Speaker 3

The more usage we have through Enso, connections for migraine or any other indications means more opportunities to build.

Speaker 13

Yeah. With regards to our billing model for migraine as well, just to dip in, it'll be the same as our digital physical therapy model. We wanna keep things as simple for our clients as possible. As James mentioned, it'll be our usage-based model, 80% of our books already on it. You know, we have in-app treatment sessions for digital physical therapy, and in-app treatment sessions for migraine. For migraine, you're right that a lot of our treatment sessions are mediated by our FDA-cleared neuromodulation device, Enso. However, we also have exercise treatment sessions for migraine, as 75% of migraine sufferers also have musculoskeletal pain or comorbid musculoskeletal pain, particularly neck pain.

Speaker 13

Overall, we wanna make sure that those with a comorbid musculoskeletal condition could still be treated for their musculoskeletal condition, and those treatment plans will be blended. Our aim is to just have a bigger impact with our clients so we can improve their outcomes, experience and lower their costs. Got it. Super helpful. Thanks, guys.

Speaker 3

Yeah. Thank you.

Speaker 8

Your next question comes from the line of Jailendra Singh with Truist Securities.

Speaker 5

Thank you, and thanks for taking my questions, and congrats on a very strong quarter. It is very encouraging to see consistent yield improvement and outperformance now slightly north of 4% in the quarter. Given what you've seen, you've been seeing in legacy clients, as well as trends in new lives and all the impact from your initiatives, how do you think about the long-term view on where yields can get to? What is the ceiling there? Will that be dependent on you guys rolling out new programs like migraine, or you can achieve that with your existing offerings and solutions?

Speaker 3

Great question. This is Dan. The way we see it is, you know, about 90% of people see a physical therapist in any given year. We think with better access, lower cost, that should be closer to 12%-15% of people should see a physical therapist. After all, about half of us have a musculoskeletal condition in any given year. We are currently trending towards a little over 4% yield this year for additional physical therapy program. You can see, you know, where we're targeting long term at the low end, the 9% and we think we're expanding the TAM of people who could see a physical therapist.

Speaker 3

Migraine, however, simply expands that opportunity while de-risking our ability to continue growing yield overall by giving us more shots on goal. Overall, what we're really chasing is clinical impact. We want to help more people every day with our care programs, we can transform outcomes, experience, and the cost structure.

Speaker 5

Got it. My follow-up on the ACCESS, CMS ACCESS Model. Can you expand on what you needed to see to participate in that program? It seems the company had an intent to apply to the program, but ultimately decided against it.

Speaker 3

Great question. Look, we applaud CMS's goal of expanding access to evidence-based care, and it's great to see CMS be entrepreneurial. You're right, we did not apply. We believe that the ACCESS program, as currently designed, will not deliver any aspect of the AAA. Moreover, it's structured in such a way as to necessitate the removal of any clinical oversight, putting one of the most vulnerable patient populations, in our opinion, Medicare, at risk. Even for employer populations who are a full generation younger, we provide a care team. Notably, we've had conversations with CMS. We're hopeful they'll continue to iterate and develop models that increase access to high-quality care for Americans on Medicare, Right now we will stay on the sidelines.

Speaker 5

Great. Thanks a lot.

Speaker 8

Your next question comes from the line of Richard Close with Canaccord Genuity.

Speaker 9

Yeah, thanks for the question. Excuse me. Congratulations. Dan, I was wondering if you could put some added details on the commentary with respect to the pipeline being substantially higher, and then I have a follow-up for James.

Speaker 3

Sure. We're seeing broad-based interest across several different client segments, from SMB employers to large enterprises. Our SMB segment, we recently hired several new reps, and they're delivering very strongly. The number of lives we've added to the pipeline in that segment in Q1 is up over 100% year-over-year. What's particularly encouraging is the interest in our expanded capabilities as well. Prospects as clients who haven't yet bought Hinge Health have been on the sideline or they're with a different solution, are very excited about our Migraine Program and Hinge Select, which gives us a lot more ways to add value and to start conversations with prospective clients. Again, our sales cycles haven't materially changed.

Speaker 3

This is, you know, they still follow a seasonal pattern, where most decisions will happen on the back half of the year as it's happened, you know, in the full decade we've been in business. The quality of conversations has improved because we're solving more problems for our clients.

Speaker 9

Okay. As a follow-up, James, maybe walk us through the eligible lives coming in higher than anticipated and then, you know, driving the guidance revision as well. How does that work? I mean, don't you know the lives, like when you're signing a client and, you know, is it just coming in with more lives, when all is said and done? Or how does all that work there?

Speaker 6

Yeah, great question. Let me break it into two. We're obviously, if you added, call it rounding to 5 million new lives last year, about 80% of our new lives coming into this year came from existing clients. Half of our upside in lives comes from those existing clients when they give us the new files coming into the new year. They just showed up with a lot more lives than we expected. Our clients are growing in headcount, and that's, you know, a great thing for them and obviously a great thing for us. Sort of goes against the narrative that everybody's getting rid of their employees. At least for our clients, it's the opposite right now. Then the other half is our new clients that come on board.

Speaker 6

What we do is when we sign them up, we take an estimate of the number of employees, obviously informed by the people that we've done a contract with at the client. They'll give us an estimate of the number of employees, but we don't get the final count until we get their official files when we get into the launch sequence with them early in the year. We generally, we always have taken a pretty low estimate, just so we always come in above that. That happened again as we came to 2026. We got an estimate of what we thought those aggregate lives would look like for those new clients, when the final files came in, they came in quite a bit higher.

Speaker 9

Okay. That's helpful. Thank you.

Speaker 6

Yep.

Speaker 8

Apologies. Your next question comes from the line of Ryan Daniels. A kind reminder to press star 6 to unmute. Your line is open. Please go ahead.

Speaker 11

Yeah, guys. Congrats on the strong results. Thanks for taking the question. Just one on Hinge Select. Looks like continued momentum there, both in number of providers and covered lives. Can you talk a little bit more about what you're hearing in the marketplace about demand for that offering? I'd be curious about your intentions on, you know, expanding that to other areas like ambulatory surgery centers or even broader patient navigation opportunities.

Speaker 3

Great question. I'll start with our focus areas on Hinge Select. Our key focus areas as we continue to invest in this program or this product is, one, improving the density of our provider network. We've hit over 4,100 provider locations. We wanna get that substantially higher over the course of the year. Expanding access within our book of business, particularly making Hinge Select available via our distribution partners. We're very proud to say that now, through the top five national health plans, are allowing Hinge Select to be bought via our partnership with them and with our shared clients as well. We wanna continue to expand that, the distribution of Hinge Select. It's also having a big impact.

Speaker 3

We're seeing about 85% of members who are able to engage are able to move forward with conservative care. That is, they're avoiding low-value, high-cost care, imaging, procedures, elective surgeries, and these are the highest risk members to begin with, which is exactly the outcomes we're going for, and it really allow us to expand the ROI conversations we're having with our clients. It's one of the top discussions we're having with prospects as well as our existing clients, Hinge Select. We anticipate most of the pipeline that we close for Hinge Select will be in the second half of the year. Undoubtedly, it's a more complicated sale than migraine.

Speaker 11

Okay, perfect. Very helpful. As my follow-up, you know, just as you look at the product expansion recently, you know, obviously the focus on chronic pain, you've now got the migraine program. It seems like there's a lot of correlation there to maybe broader behavioral health or mental health conditions, and I'm curious what your thoughts are on that as a potential expansion area or adjunct to kind of what you're moving into today. Thanks.

Speaker 3

Great question. You know, our again, our vision is to use technology to scale and automate the delivery of care, and we think most care will eventually be amenable to care delivery itself will be amenable to automation. It's, you know, it's gonna take many years, many decades even, to capture most of healthcare. We've, you know, $640-ish million of trailing twelve months revenue. We're only about 1% of the PT market in America. Itself is just 1% of total healthcare spend in America. We're 1% of 1%. We got a lot of growth to do, or growth ahead of us, within health. We're looking at our roadmap.

Speaker 3

One of the few things I could say with confidence that is not, you know, at least in the near or medium term roadmap, is mental health, however. It's a crowded space. We're excited about the way it's evolving. There's a lot of other areas where, you know, you're almost competing with non-consumption. Neurology is an area that's vastly underserved, and that is long overdue care automation, and we're really excited about, you know, planting a flag here in neurology, as well as several other areas we're looking at. We're not saying never to mental health. The plans might change in four years, five years, certainly 10 years. At the moment, it's not on our roadmap.

Speaker 11

Okay. Thanks for the color.

Speaker 3

Great question.

Speaker 8

Your next question comes from the line of Craig Hettenbach with Morgan Stanley. Your line is open. Please go ahead.

Speaker 2

Yes, thanks. Just have a question on the continued progress on member yield expansion. Any other details you can share, be it Hinge Connect, kind of effective marketing campaign strategies, just some of the things that are keeping that momentum going?

Speaker 3

Sure. On new clients, we're seeing faster member adoption, which we attribute to, you know, a more fulsome, better product as they're launching with our latest product features from day one. This is combined with our improved outreach techniques, including our targeted enrollment initiatives that leverage our Hinge Connect data. For legacy clients, the yield growth is similarly coming from improved product and member experience. You know, we're capturing more members needing care while bringing members back at higher rates than historically we've seen, coupled with those improved marked enrollment initiatives. We really like these trends. That's why we're raising yield expectations to slightly north of 4%. You know, I do want to emphasize it's not just enrollment that's performing well.

Speaker 3

We've invested enormously in our post-enrollment engagement because after all, if somebody signs up or enrolls but doesn't do their treatment, we simply won't have a good shot at improving their outcomes and reducing costs. Our post-enrollment engagement is performing really, really well. We believe it's trending 2 to 3 times higher than second place, and that's where we're able to drive so much of our ROI for our clients.

Speaker 2

Got it. Just as my follow-up question, you could see it in the numbers and performance in terms of the AI efficiencies that you're delivering. What's the confidence in the ability to sustain that? When I think about kind of the care team, it's been running roughly flattish. How are you thinking about AI and technology continuing to scale as your members continue to increase?

Speaker 3

You know, we are investing in AI, like many businesses out there, up and down our organization. We're fortunate that, you know, a third of our headcount already is in R&D, such that we have a lot of folks who are using AI in, you know, every facet of their job, day to day, and that's allowing us to weave that throughout the organization. In terms of our care team efficiencies, there's, you know, a lot more room to grow in terms of those efficiencies, but not just on our care team. You know, we're looking at a lot of other efficiencies for our cost structure. We also like where our cost structure is right now to begin with.

Speaker 3

At an 85% gross margin, we're at the point where, you know, we wanna continue to invest in the product experience and not just run up the score on gross margin. I don't think that's the right long-term decision for a business of our scale. We want to continue to reinvest in the product, inclusive of the care team experience, but reinvest in the product, even if that means treading water on gross margin moving forward.

Speaker 6

Yeah. Maybe I'd just add to that, Craig.

Speaker 3

I think as a reminder, we doubled the distribution percentage of our Enso devices in 2025 relative to 2024. We've said that we're going to send even more Enso devices in 2026. That's the competing factor against the care team efficiencies that sort of flattens out gross margin a little bit around 85%, maybe a little bit more room to grow there because of the care team efficiencies. We are gonna be sending more Enso devices 'cause it produces better outcomes and more opportunities to use our product. I think we said in a past conversation that the engagement in our product on the therapy sessions goes up dramatically more when someone uses, when someone uses Enso, which improves the ROI story there. A lot of, a lot more Enso coming out this year.

Speaker 3

Where I do think there's opportunity still, quite a bit, is in the operating margin line. We've largely hit our target margins. If you recall back to our IPO, our gross margin target was 82%-85%. We're already at the high end of that, and we're getting really close already to our operating margin. In fact, actually at 25%, we are at our operating margin target that we had. Well ahead of schedule. That is one of the topics we'll be addressing at the Investor Day at Movement. We'd love for everyone to come. We'll give an updated model, and you can sort of reasonably conclude there will be higher targets, at least at the operating margin level than what we have today out there.

Speaker 2

Got it. Thank you.

Speaker 3

Yep.

Speaker 8

Your next question comes from the line of Jessica Tassan with Piper Sandler.

Speaker 7

Hi, guys. Thank you so much for the question. Congrats on the results. We're looking forward to the Movement conference. I guess on the migraine product, I'm interested to know, how are you all delivering ROI there? Are you helping clients avoid prescription drugs? Are you helping mitigate some of that incremental $8,000 of average healthcare spend per migraine patient per year? Just how are you thinking about delivering ROI, and are you holding your new products to that same 2.4 to 1 ROI standard that we know is prevailing across the existing MSK product?

Speaker 3

Great questions. Yeah, you're right. A lot of the migraine costs are driven by peripheral healthcare costs of people with migraine. They're not sleeping as well sometimes. They're just not as healthy. If you could address their migraine, you could hopefully address overall total healthcare spend as well. You're also right to say a big component of direct migraine spend is these new migraine drugs that have come out, which by the way, we're not opposed to. These drugs are effective. For many people, they could provide very meaningful relief. However, they are very pricey. They could be, you know, $800-$1,400 per month, these migraine drugs. They do not come without side effects.

Speaker 3

By giving people a non-pharmaceutical option in their toolkit to address their migraine pain, our hope is that they it's a good complement to their pharmaceutical regimen, such that they do not have to use these drugs as frequently, and they could reduce costs overall on there as well. With regards to our ROI studies, we'll actually be hopefully publishing ROI studies in the near future on our impact for migraine.

Speaker 7

Okay, great. Just second question would be on Hinge Select. As you guys go to the market with that product, during your selling season, can you just give us an update on how you're planning to kind of price or commercialize this offering? Should we think about it as increasing or as kind of one of the sessions within the existing ARPU number for clients within Hinge? Just how should we think about layering it into the model for 2027 as you start to kind of accelerate sales heading into next year? Thanks.

Speaker 3

Sorry, just to clarify, you're asking, like, how we'll model the impact of Hinge Select in our client base or our revenue model or?

Speaker 7

Yeah, exactly. Basically asking, you know, will a Hinge Select in-person physical therapy session just appear within that ARPU number and be priced effectively the same as an Enso session or a virtual MSK session into that?

Speaker 3

You know, there is an admin fee attached to every in-person session delivered, whether, you know, we send them to in-person physical therapy or imaging or a doctor visit in person. There is an admin fee that is charged, and that is added to our revenue there for us brokering that in-person visit as part of our network. We're actually gonna share a lot more about Hinge Select model at our investor conference at Movement as well. You're thinking about it in the right way, in that there is a certain admin fee attached. It's not a PEPM, it's only-

Speaker 7

Great. Okay, got it. Thank you, guys.

Speaker 3

Thank you.

Speaker 8

Your next question comes from the line of Rishi Jaluria with RBC Capital Markets. Your line is open. Please go ahead.

Speaker 10

Wonderful. Thanks so much for taking my questions. Great to see continued strong execution of the business, especially given the uncertain environment, to say the least, that we're in. Dan, I wanted to start with you and continue on the migraine side. A really exciting announcement. Obviously a huge opportunity ahead. If you think about the incremental investments that you have to make there, maybe can you walk us through what do those investments look like? What does the timeline to get kind of quote "market ready" look like? For example, is a current Enso device, you know, ready for that, or do you need to kind of retool it, for, you know, to make it a little bit more migraine specific? If you think about marketing campaigns and driving awareness within your existing customers, what do those investments look like?

Speaker 10

Help us understand some color there, and then I got a quick follow-up for James.

Speaker 3

Great. Great question, and something we've thought a lot about, and I think more digital health companies are thinking about as they become multi-product companies. We've actually spent the last several years preparing for this moment. First of all, it's actually investing in our tech infrastructure and our key capabilities to, you know, what's determined in something now is called, you know, platforming your capabilities so they can be mixed and matched and used for future products. That's like platforming from your enrollment capability to your, you know, enrollment, or I should say your member outreach capabilities, your outcomes collection, your treatment conditions, or treatment delivery. Everything has been platformized such that they could be they become reusable components.

Speaker 3

Migraine is the exemplification of that strategy, it largely leverages what we've already built. There are some new things that you have to build, I'd say, you know, 75% was already built in our infrastructure, which is really great. The long pull specifically for migraine, whereas as you point out hardware, that is always slower than software. We had a head start, it was adjusted for migraine, our neuromodulation device. Of course from there, you know, another long pull is our data gathering. From there, our FDA submission and discussion with FDA leading up to the clearance. We're always evaluating other areas where we could automate care.

Speaker 3

We'll look for conditions with meaningful spend where we feel we could transform outcomes and experience at a fraction of today's cost. Ideally where we think we could move with haste. I'd say that the resources needed for migraine, it was very efficient relative to the resources needed to build digital physical therapy where it is today. We anticipate future products to be similarly capital efficient, given they will continue to leverage capabilities that we've already built.

Speaker 10

Okay, got it. Super helpful. James, if we think about, you know, the growing portion of your customer base that's on the consumption or engagement model, so to speak. Can you speak a little bit about what are you observing in terms of metrics within your existing customer base? You know, be it, are those on the engagement model, do they exhibit higher yield, because there's maybe lower cost to adoption? Is it helping on the ARPU side as they get over that kind of 13-session barrier or break-even point I think you've talked about prior? Or is it even helping with landing new customer logos as well because the view of the startup cost is seen as lower? Maybe just help us understand what you've observed so far in your business. Thanks.

Speaker 6

Yeah, great question. All of those observations you made would be relevant at the client level, the benefits leader, the person making the decision on whether to go with the engagement model or the paid-upfront model. For the member that's actually using the product, they see no distinction. They probably don't even know whether the company they work for is on the consumption model or on the paid-upfront model. From a usage perspective, there's no distinguishable difference between the two.

Speaker 3

I'd say it does help in our client conversations in that there's a lot of, I think rightful cynicism sometimes in the digital health space or, you know, healthcare space that products are built and sold to employers or sold to health plans or Medicare managed plans. There's not a lot of engagement, yet they're paying a case rate, right? They might be paying upfront for the case, and the case rate is there, or they're paying a PEPM, and the service provider isn't really on the hook to ensure people are actually using the product and getting better. What our engagement model demonstrates is our confidence that we will actually engage people, that we are not just gonna enroll people, that people are gonna use our product, and they're gonna get better.

Speaker 3

We put our fees at risk for ROI, we put our fees at risk for clinical outcome, and we put our fees at risk to ensure that people are actually using the product. The fact that, you know, other digital health companies, including MSK, have struggled to match this pricing model, which is so favorable of client-friendly and so many clients prefer the model. The fact that they've failed to match us really underlines the fact that they don't have the engagement that we do. You know, as mentioned before, we feel like we probably have two to three times higher engagement on a per member basis than anybody else in digital MSK. You know, we build products that people wanna use, and you see it in our numbers.

Speaker 10

Very, very helpful. Thanks, James.

Speaker 8

Your next question comes from the line of Elizabeth Anderson with Evercore ISI. Your line is open. Please go ahead.

Speaker 4

Hey, guys. Good afternoon, and thanks so much for the question. Dan, you just mentioned it in passing in your prior comment. I was wondering if you could talk a little bit more about your MA and sort of full risk strategy. I know that's not as key as some other parts of the story. Still an important area of expansion for the business. Just wanted to hear sort of your updated thoughts on that and sort of how you see things going and the sort of plan into 2027. Thank you.

Speaker 3

Great question. We are, there's you could say in the U.S. there's 3 key groups of covered lives that we're targeting, your self-insured lives, fully insured and Medicare Advantage. Medicare Advantage is the area that is going through a lot of change right now. Original Medicare has been a particular Medicare Advantage. I think a lot of the sponsors in here have been going through a lot of change as well. We've been particularly focused on our self-insured and fully insured group. Our fully insured group, I think last year was up the highest it's ever been. In Q1 probably contributed more to new lives than just about any Q1 that we've ever had before.

Speaker 3

We're also seeing, you know, strong growth in our federal plans as well, which is a separate subgroup of self-insured employers given it's a different decision-making process with federal. Yeah, fully insured and ASO are growing very robustly, particularly fully insured. It really underlines, by the way, the ROI we're able to deliver. We forecast we probably have like a logarithm, more fully insured customers than second place in digital MSK. What we like best about, you know, a fully insured customer buying Hinge Health is that these are actuaries for a living. That means they've really looked at our numbers, they've looked at the ROI we're able to deliver, and they have underwritten the cost of Hinge Health for these fully insured lives.

Speaker 3

That really is a powerful validation of our approach and our outcomes.

Speaker 4

Great. Thanks so much.

Speaker 3

Great question.

Speaker 8

Your next question comes from the line of Brian Peterson with Raymond James. Your line is open. Please go ahead.

Speaker 1

Thanks, guys, and all my congrats on the strong quarter. I'll keep it to one. I know you mentioned that you have 80% of customers on the new pricing model, and I thought you said that that would stay about at the same rate. I'm curious, why wouldn't that migrate closer to 100%? Is there anything keeping that from a customer perspective? Just wanted to make sure I understand that dynamic. Thanks, guys.

Speaker 3

To be honest, it's just status. Some customers will move slower, some customers will move faster. What we're seeing is that it's gonna continue to tick up, but it's not like the biggest priority to change billing models for some customers. They have, like, they're changing their health plan, they're changing their PBM. Maybe they're trying to onboard a new mental health vendor, and to change billing models sometimes requires, like, legal input to update the contract, et cetera. It's just not the highest priority for some customers.

Speaker 6

You can probably safely say, Brian, the last couple years after we introduced the model, which is last year and this year's selling season, close to 100% have come on under the engagement model. The legacy, some of those older clients, to Dan's point, it just hasn't been a top priority for them.

Speaker 3

Yeah, almost no new customer is on the older billing model. Almost all new customers are engaged in consumption model.

Speaker 1

Got it. Thanks, guys.

Speaker 3

Great question.

Speaker 8

Your next question comes from the line of David Grossman with Stifel. Your next question comes from the line of Scott Schoenhaus with KeyBank.

Speaker 14

Hey, guys, can you hear me?

Speaker 6

Yeah. Yeah, we got you.

Speaker 14

Okay, good. Thanks for taking my question. I wanted to talk about the new Migraine program. I guess, Dan, you talked about, obviously, you know, you think 12%-15% yield was your prior kind of ceiling. Maybe talk about where that is now with the Migraine program. My follow-up, I'll bundle it all together, is: How do you effectively target these customers in this new program? You know, historically, you've leveraged claims data and EHR data. What else are you doing to target these people in your Migraine enrollment program? Thanks.

Speaker 3

Great question. For traditional physical therapy, again, about 9% of people see a physical therapist in a given year. That's relatively consistent across employer types. Some employers, a little more, some employers, a little less, but it's roughly around 9% of adults. Yeah, you're right. Our opinion is that that's underutilized and that there is more demand and more need, frankly, for physical therapy in America than is currently being delivered, and that access is as constrained utilization for physical therapy. We also see physical therapy as, you know, high-value spend. The more you spend on physical therapy in America, whether it's digital or in person, by the way, the lower your downstream cost.

Speaker 3

We would like to continue to increase or improve access to PT so that more people use it. For PT in particular, yeah, we'd like to expand the TAM from nine to, you know, 12 to 15. Migraine gives us a parallel path for traditional enrollments. Some will, you know, be enrolling in Migraine and digital physical therapy, some will enroll in only digital physical therapy, and some will enroll in just Migraine. Time will tell where, you know, our yields forecast, we'll share more at our investor conference in Movement and more over time. As it's a new product.

Speaker 3

With 1 in 6 adults impacted by migraine, you know, about 20% of women, about 10% of men, we are confident that there is a large unmet clinical need there. Did I cover all the question or did I miss part of it?

Speaker 14

Targeting. How are you effectively targeting? You know, for the PT patient, you've leveraged medical claims data historically and then live EHR data. You know, how are you targeting these people that have migraine issues?

Speaker 3

It's similar. Pharmaceuticals is a little bit more of a relevant data point as well for migraine that is not always as relevant for physical therapy and musculoskeletal care. A lot of meds in musculoskeletal care, you know, relatively few people actually do receive opiates, so some people are just taking TYLENOL and Advil, which won't show up in the data. Obviously, it is over-the-counter, but some of these migraine meds are not over-the-counter, and so they will be showing up in the RX spend.

Speaker 3

It'll be very similar approaches that we've taken with our digital physical therapy product, both broad awareness for people suffering in silence or just, you know, going to a primary care physician, looking at claims, looking at pharmacy spend, as well as, you know, member to member enrollment or referrals. You know, basically leveraging all of our similar channels for driving awareness that we do for digital physical therapy with slightly more emphasis as well on RX data.

Speaker 14

Perfect. Thank you.

Speaker 3

Great question.

Speaker 8

Your next question comes from the line of Ryan MacDonald from Needham & Company. Your line is open. Please go ahead.

Speaker 12

Thanks for taking my questions. Congrats on an amazing quarter. I've got two on the migraine, one for Dan and one for James. Dan, as you're talking to your clients that are already initially adopting migraine, the 125 thus far, I'm curious at what are those conversations look like as those customers balance sort of upfront, managing upfront healthcare costs with sort of ROI in the back end. Are they thinking about migraine care in a way where they're gonna have clinical eligibility requirements? 'Cause when we look at the TAM, obviously it's a much smaller population that are sort of clinically diagnosed with migraine. Are they sort of, I guess, capping sort of utilization in the early stages as they experiment on it?

Speaker 12

James, for you, given that Enso is sort of a core component of the migraine program moving forward, how should we think about the rate with which sort of Enso deployment grows within the member base as we start getting into, you know, next year and what potential impact that could have on gross margins over time? Thanks.

Speaker 3

I'll start on the migraine enrollment and the sales process. You know, when we're having very productive conversation with our employer customers. Overwhelmingly, when we speak to somebody, either they or somebody on the team or a spouse is afflicted with migraine. I've gotten more inbound from customers who are on LinkedIn since our announcement saying, "Hey, I'm impacted. How soon can I personally sign up?" Or, "My wife is impacted. How soon can my wife or my spouse sign up?" We really struck a nerve, a pun unavoidable, with our migraine care program. When we speak to our employer customers, there's a recognition that, yes, their costs have gone up.

Speaker 3

In fact, I was in one conversation where they immediately pulled up their pharma spend and said this was one of their largest or fastest growing areas of spend. There's a recognition that this is an unmet clinical need that they have not been able to deliver good care for. There's a huge amount of dissatisfaction with the status quo. I think 3 in 5 people are dissatisfied with their current level of their migraine care, in particular because it takes them so long to speak to a specialist. There's a recognition from employers that when somebody does have migraine, whatever their job is, they are not gonna show up to work that day. If they're working remote, they're not gonna be very productive.

Speaker 3

They're gonna be in a dark room, with the door closed and not looking at a screen. Whether they're blue collar or white collar, they're pretty much out of commission for that day. There's a recognition of its impact on their overall employer or employee base. We've had pretty straightforward conversations. There is a need for ROI. There's also a recognition that their members or employees as well as the dependents on the plan, need access to better care. James.

Speaker 6

Yeah. I'll just add on to the second question, maybe just a quick reminder that when our cost of goods sold, about half of it comes from Enso cost and about half from the care team. Largely any Enso increases have been offset by efficiencies in the care team. We see that again in 2026 and likely again in 2027. Specific to your question, though, we did increase our Enso distributions in 2025 by about 2x over 2024 as far as percentage of members that received it. I imagine this year we will probably bounce up again about 40% increase over last year, given what we're already planning plus migraines. You can imagine when we're planning this year, we already had an idea of migraines, it's not like something brand new to us in the last month.

Speaker 6

We already factored that into our forecast for the year.

Speaker 12

Awesome. Appreciate all the color. Congrats again.

Speaker 6

Yeah.

Speaker 8

For your final question today, we will go to Stan Berenshteyn with Wells Fargo. Your line is open. Please go ahead.

Speaker 15

Hi, thanks for squeezing me in here. Maybe two quick ones for me. First, for the 20% of lives still on the subscription pricing, have there been any changes in pricing at renewal? I have a follow-up.

Speaker 6

No. No. Short answer is the pricing has remained the same for on the upfront model for several years now.

Speaker 15

Okay, great. On the pipeline, you called out Q1 substantially higher versus prior year. I think you also called out SMB as materially stronger. Is the sales cycle any different for SMBs versus, you know, maybe larger enterprise accounts? Any color there will be helpful. Thank you.

Speaker 3

Sure, yeah. SMB, the sales process is much faster. It's just that, you know, smaller organizations make decisions much quicker, and it's just a much faster, more efficient sale.

Speaker 6

Hey, maybe if I could just add, Stan. I just want to make a reminder. We talked about adding more capacity and more personnel on our SMB team a couple of different conference calls last year. For me anyway, I think it's just great to see that when we put our minds to investing, we make smart decisions on where to put those investing dollars, whether it's product to put out things like migraine or whether it's in the SMB space in our commercial side to drive more pipeline there. I think I think we're pretty wise around here on how we, how we choose to invest.

Speaker 15

Great. Thanks so much.

Speaker 6

Yep.

Speaker 8

That is all the time we have for questions. I will now turn the call back to Daniel Perez for closing remarks.

Speaker 3

First of all, thank you, everybody, for dialing in and for learning more about our business and for our investors who have put their capital into our business as well. We are, as you can see from our quarters, and our expanding product portfolio, we are not standing still. There's a lot of runway ahead. As I mentioned briefly, we are just 1% of 1% right now in terms of the total TAM that we believe we've tackled. It'll take us many decades ahead, but we're excited about the progress.

Speaker 3

Hopefully you're gonna see a lot more at our client conference Movement, where we also have our investor conference on June ninth and tenth, as well as in the coming quarters as we share more products. Hope you have a good rest of your day.

Speaker 8

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

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