Revenue Growth — Strong Start to 2026
Total company revenue of $569.6 million in Q1 2026, up 13.7% year‑over‑year versus $500.8 million. Excluding Nova and Pivot contributions, revenue was $520.3 million, a 6.3% increase versus prior year.
Visit Volume Expansion
Total patient visits increased 6.7% to an average of more than 54,000 visits per day. Workers' compensation visits per day rose 9.6% and employer services visits per day increased 4.8%. Excluding Nova, total visits per day increased 2.9%; workers' compensation +6.2%; employer services +0.7%.
Revenue per Visit and Mix Improvement
Overall revenue per visit grew ~3.1% year‑over‑year. Workers' compensation revenue per visit increased 2% (from $209 to $213) and employer services revenue per visit increased 2.7% (from $94 to $97).
Adjusted EBITDA and Margin Expansion
Adjusted EBITDA was $120.7 million in Q1 2026, up 17.6% versus $102.7 million in Q1 2025. Adjusted EBITDA margin improved by 69 basis points to 21.2% (from 20.5%). Trailing twelve‑month adjusted EBITDA reached $450 million, up $85 million (23%) from IPO baseline.
Adjusted Net Income and EPS Growth
Adjusted net income attributable to the company was $51.5 million and adjusted EPS was $0.40 in Q1 2026, up from $42.2 million and $0.33, respectively, in Q1 2025.
On‑Site Health Clinics — Rapid Expansion
On‑site health clinics revenue was $37.2 million in Q1 2026, a 125% increase year‑over‑year (driven largely by Pivot acquisition). Excluding Pivot, on‑site revenue grew 20.9% year‑over‑year. On‑site run‑rate approaching $150 million (from $64 million in 2024).
Successful M&A Integration and Synergies
March 2025 Nova integration complete and ahead of plan, tracking to a transaction multiple below 7.5x adjusted EBITDA. June 2025 Pivot integration complete and ahead of plan, tracking to a transaction multiple below 9x.
Improved Cash Flow and Strengthened Guidance
Operating cash flow of $21.0 million in Q1 (vs $11.7 million prior year). Free cash flow of $9.9 million vs negative $4.0 million prior year. Company raised 2026 guidance: revenue to $2.275B–$2.375B (+$25M midpoints), adjusted EBITDA to $460M–$480M (+$10M range), and free cash flow to $215M–$235M (raised at both ends).
Cost of Services and Center Efficiency Gains
Cost of services improved to 70.1% of revenue from 71.3% in prior year quarter, driven by staffing efficiencies and center level margin gains.
Capital Deployment and Shareholder Returns
Repurchased ~661,000 shares for $15 million during Q1 and paid $8 million in dividends. Board declared a cash dividend of $0.0625 per share. Ended quarter with $61.7 million cash and $1.58 billion total debt, net leverage 3.4x with expectation to finish year below 3x.