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agilon health, Inc.: Q1 FY2026 earnings call

What management said about Q1 FY2026, from the documents filed with the SEC on 6 May 2026: press release. Guidance figures: 4 raised, 1 narrowed, 9 new, 3 kept. The quarter’s numbers.

Key takeaways

  • Revenue fell 7% on lower membership: Total revenue was $1.42 billion against $1.53 billion a year earlier. Management said lower membership was partly offset by improved pricing, contract economics and burden of illness performance. Source
  • Adjusted EBITDA rose to $54 million: Adjusted EBITDA was $54 million against $21 million. Management linked the result to its earlier items and to ACO REACH performance; ACO model entities contributed $27 million. Source
  • Medical margin and gross profit rose: Medical margin was $149 million against $128 million, up 16%. Gross profit was $65 million against $51 million, up 28%. Source
  • Members fell 11% year over year: Members on the platform were 536,000 at March 31, 2026, against 605,000 a year earlier, including 426,000 Medicare Advantage members and 110,000 ACO model beneficiaries. Source
  • Full-year revenue, margin and EBITDA raised: Full-year 2026 guidance: total revenues $5,680 million to $5,805 million, medical margin $350 million to $400 million, Adjusted EBITDA $10 million to $40 million; each raised from the prior range. Source
  • Second quarter guidance first given: Second quarter 2026 ranges: total revenues $1,435 million to $1,475 million, medical margin $115 million to $130 million, Adjusted EBITDA $15 million to $25 million, geography entry costs $5 million. Source
  • Tim O’Rourke named CEO: Tim O’Rourke, with more than 25 years of healthcare leadership, was welcomed as CEO. The release names Ronald A. Williams as Executive Chairman. Source

“We are seeing early returns from investments in data and technology, clinical execution, and operating discipline”

Ronald A. Williams, Executive Chairman

Guidance

AreaPeriodFigureAgainst last quarter
Total revenues SourceYear ended December 31, 2026$5,680 to $5,805 ($M)Raised from $5,410 to $5,580 ($M)
Medical margin SourceYear ended December 31, 2026$350 to $400 ($M)Raised from $300 to $350 ($M)
Adjusted EBITDA SourceYear ended December 31, 2026$10 to $40 ($M)Raised from ($15) to $15 ($M)
Adjusted EBITDA from ACO model entities SourceFiscal year 2026$25-$30 millionRaised from $20-$25 million
Geography entry costs SourceYear ended December 31, 2026$15 millionKept
Medicare Advantage members, year-end SourceYear ended December 31, 2026425,000 to 435,000Kept
Total members live on platform, year-end SourceYear ended December 31, 2026525,000 to 540,000Kept
Average Medicare Advantage members SourceYear ended December 31, 2026430,000 to 437,000Narrowed, low end up from 427,000 to 437,000
Member risk scores SourceYear-over-year, 20261.5% increase, net of v28New
Medicare Advantage members, end of quarter SourceQuarter ended June 30, 2026434,000 to 444,000New
ACO REACH members, end of quarter SourceQuarter ended June 30, 2026106,000 to 109,000New
Total members live on platform, end of quarter SourceQuarter ended June 30, 2026540,000 to 553,000New
Average Medicare Advantage members SourceQuarter ended June 30, 2026449,000 to 460,000New
Total revenues SourceQuarter ended June 30, 2026$1,435 to $1,475 ($M)New
Medical margin SourceQuarter ended June 30, 2026$115 to $130 ($M)New
Adjusted EBITDA SourceQuarter ended June 30, 2026$15 to $25 ($M)New
Geography entry costs SourceQuarter ended June 30, 2026$5 ($M)New

What changed from last quarter

  • Guidance raised: Full-year 2026 total revenues, medical margin and Adjusted EBITDA guidance were increased. Source
  • Guidance raised: The expected 2026 Adjusted EBITDA contribution from ACO REACH was increased to $25 million to $30 million, based on first-quarter performance. Source
  • Guidance raised: The low end of full-year 2026 average Medicare Advantage membership guidance was raised to 430,000; the high end was unchanged. Source
  • Guidance kept: Year-end 2026 Medicare Advantage, ACO REACH and total membership guidance was kept at the prior ranges. Source
  • New guidance: Quarterly guidance for the second quarter of 2026 was given, covering membership, total revenues, medical margin, Adjusted EBITDA and geography entry costs. Source
  • New: A full risk contract signed in the first quarter of 2026 in an existing market with a new payor was added to revised full-year guidance. Source
  • New: Tim O’Rourke was welcomed as chief executive officer. Source
  • New: Revised full-year guidance includes an assumed 1.5% year-over-year increase in member risk scores, net of v28. Source

Results and growth drivers

  • Revenue fell 7% on lower membership: Total revenue was $1.42 billion against $1.53 billion a year earlier. Management said lower membership was partly offset by improved pricing, contract economics and burden of illness performance. Source
  • Net income rose to $49 million: Net income was $49 million against $12 million; diluted EPS was $2.94 against $0.73. The figure includes $19 million of adjustments on sale of assets within discontinued operations. Source
  • Adjusted EBITDA rose to $54 million: Adjusted EBITDA was $54 million against $21 million. Management linked the result to its earlier items and to ACO REACH performance; ACO model entities contributed $27 million. Source
  • Medical margin and gross profit rose: Medical margin was $149 million against $128 million, up 16%. Gross profit was $65 million against $51 million, up 28%. Source

Membership and contracts

  • Members fell 11% year over year: Members on the platform were 536,000 at March 31, 2026, against 605,000 a year earlier, including 426,000 Medicare Advantage members and 110,000 ACO model beneficiaries. Source
  • Exits drove the membership decline: Management attributed the year-over-year change mainly to previously disclosed market exits and to payor exits in certain markets, tied to a disciplined contracting approach. Source
  • Full risk contract added with new payor: A full risk contract signed in the first quarter 2026 in an existing market with a new payor was added to the revised full-year guidance. Source

“We remain confident in our 2026 outlook and long-term growth trajectory.”

Ronald A. Williams, Executive Chairman

Medical margin and costs

  • Medicare Advantage cost trend reserved at 7.4%: Medical margin includes Medicare Advantage cost trend reserved at 7.4%, the same approximate rate the prior release gave for the fourth quarter 2025. Source
  • Platform and entry costs fell: Platform support costs were $37.6 million against $44.2 million. Geography entry costs were $1.7 million against $6.6 million. Source
  • Severance rose; stock compensation fell: Severance and related costs were $6.1 million against $0.5 million. Stock-based compensation expense was $6.3 million against $16.7 million. Source

ACO model entities

  • ACO entities added $27 million: ACO model entities are not consolidated. They contributed $27 million to Adjusted EBITDA against $20 million a year earlier; their medical margin was $72.1 million. Source
  • ACO entities held $47 million cash: $47 million of cash was associated with the unconsolidated ACO model entities at quarter end, against $91 million at December 31, 2025. Source
  • ACO REACH contribution raised: Management raised its expected 2026 ACO REACH Adjusted EBITDA contribution to $25 million to $30 million, from $20 million to $25 million, based on first-quarter performance. Source

“We are also strengthening our Total Care Model - expanding clinical pathways, improving quality, and deepening payor alignment - positioning us for more predictable outcomes and sustained margin expansion.”

Ronald A. Williams, Executive Chairman

Full-year and second quarter guidance

  • Full-year revenue, margin and EBITDA raised: Full-year 2026 guidance: total revenues $5,680 million to $5,805 million, medical margin $350 million to $400 million, Adjusted EBITDA $10 million to $40 million; each raised from the prior range. Source
  • Second quarter guidance first given: Second quarter 2026 ranges: total revenues $1,435 million to $1,475 million, medical margin $115 million to $130 million, Adjusted EBITDA $15 million to $25 million, geography entry costs $5 million. Source
  • Year-end membership ranges unchanged: Year-end 2026 Medicare Advantage members of 425,000 to 435,000, ACO REACH members of 100,000 to 105,000 and total members of 525,000 to 540,000 were kept at prior ranges. Source
  • Average members and risk scores changed: Average Medicare Advantage members guidance moved to 430,000 to 437,000 from 427,000 to 437,000. Management assumes member risk scores rise 1.5% year over year, net of v28. Source

Capital, cash and balance sheet

  • Cash and securities $303 million: Cash, cash equivalents and marketable securities were $303 million at March 31, 2026, with total debt of $32 million. Restricted cash and equivalents were $71.6 million. Source
  • Operating cash flow turned positive: Net cash provided by operating activities was $23.7 million, against $32.0 million used a year earlier. Purchases of property and equipment were $3.1 million. Source
  • Equity method income of $11.7 million: Income from equity method investments was $11.7 million against $12.7 million, and other income, net was $16.0 million against $9.3 million. Source
  • Debt repayments and issuance costs: The company repaid $3.5 million of long-term debt and paid $1.6 million of debt issuance costs in the quarter. Source

Strategy, technology and leadership

  • Investments showing early returns: Management said investments in data and technology, clinical execution and operating discipline are producing early returns, and it cites progress on strategic priorities. Source
  • Tim O’Rourke named CEO: Tim O’Rourke, with more than 25 years of healthcare leadership, was welcomed as CEO. The release names Ronald A. Williams as Executive Chairman. Source
  • Total Care Model strengthening under way: Management described expanding clinical pathways, improving quality and deepening payor alignment in the Total Care Model, aimed at more predictable outcomes and margin expansion. Source

Coming up, as management said on 6 May 2026

  • Sharper execution under new CEO: Management expects the new CEO to sharpen execution, with faster pull through from action to outcome and increased value for stakeholders. Source
  • Second quarter 2026 guidance ranges: Management gave second quarter ranges for membership, total revenues, medical margin, Adjusted EBITDA and geography entry costs, for the quarter ending June 30, 2026. Source
  • ACO entity EBITDA expected $25 - $30 million: Management expects ACO model entities to contribute about $25 million to $30 million of Adjusted EBITDA in fiscal 2026. Source

Figures management reported

FigureReported
Total members live on platform Source536,000 at March 31, 2026
Medicare Advantage members Source426,000 at March 31, 2026
Average Medicare Advantage members Source424,000 in the first quarter 2026
Medicare Advantage cost trend reserved Source7.4%

Risks management discussed

  • Operational: New members typically dilute Medical Margin per member per month, so the PMPM figure can move as membership mix changes. Source

Earlier plans management reported on

  • Not stated: Management expects Medical Margin to rise in absolute dollars as the platform matures, though Medical Margin per member per month can vary with new members. Source
  • Not stated: Management expects platform support costs to decrease over time as a percentage of revenue as physician partners add members and revenue grows. Source

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.