Aug 13, 2026 earnings call — Expansion of nurse navigation and strong emergent service growth
Q2 revenue was $1.49 billion, 3.3% year-over-year growth.
Revenue $1.5B (est $1.5B) · EPS $-1.84 (est $0.26) · Next-quarter revenue outlook $5.9B–$6.2B
Key quotes
"In the second quarter, we navigated nearly 29,000 calls through this program, up 50% year-over-year."
"We bring together clinical capabilities through air, ground, technology and care navigation assets in a way that allows us to serve communities, health systems, payers, federal and state agencies and patients across a broad range of settings."
"This was partially offset by an approximate $16 million payer mix shift impact from the expiration of the Affordable Care Act exchange subsidies as patients shifted out of commercial insurance and into self-pay,"
Analyst Q&A 8
IDR arbitration revenue and payer mix
Q (Scott Fidel · Goldman Sachs): The analyst asked for more context on the IDR dynamics year-to-date and how prior-year adjustments affected results. He also asked how payer mix changes (including exchange impacts) explain year-over-year results and the outlook into the back half of the year.
A: Management said last year's second quarter had a large out-of-period IDR change and this year was much smaller, which explains most of the delta. They said they have improved their estimates and expect IDR-driven revenue to be more predictable (around a 0 plus or minus 5% range). They also said the payer mix shift is driven mainly by lower volumes from big exchange providers and that the change has been consistent since April and is included in guidance; they have levers like subsidies and contract repricing if needed.
"What that really says is we've been able to really dial in the estimates." — Brian Tierney (CFO)
Why capture rates improved; oil and World Cup
Q (Elizabeth Anderson · Evercore): She asked what drove the improved capture rate — weather or structural changes. She also asked whether oil price assumptions continue and whether the World Cup revenue is material.
A: Management said capture rate improvements came from multiple levers: technology, hiring pilots and medics, better demand visibility via transport.net, and IFR aircraft that reduce weather impact. They said the World Cup was only a couple million dollars and not all flowed to earnings. On fuel, they use the forward curve, with an average near $80 a barrel for the rest of the year and about $10-plus million per quarter of incremental fuel cost baked into guidance.
"The World Cup was a couple of million dollars, a very low revenue piece and not all of that flows through to earnings." — Brian Tierney (CFO)
IDR timing and new contract wins
Q (Benjamin Rossi · JPMorgan): He asked whether the step down from out-of-period IDR benefits in the back half would be similar to the first half. He also asked for more detail on the new business wins and expected contribution in the back half.
A: Management said the second half of last year had just under $100 million of those out-of-period IDR benefits, implying a similar magnitude if none are received this year. On new wins, they described multiple 911 wins in air and ground: expanding Airbase footprints that give operational synergies, more aircraft linked into transport.net, and two new ground 911 wins in communities in the Southeast that tie into existing air operations.
"It's just under $100 million was in that second half of the year last year." — Brian Tierney (CFO)
Nurse navigation rollout and debt/M&A plans
Q (Albert Rice · UBS): He asked how much of the footprint Nurse Navigation covers today, the ultimate target, and the limits on rollout pace. He also asked about the 3.3x/3.0x leverage targets and what kinds of M&A they might pursue.
A: Management said Nurse Nav is in about 29 communities today, covering just shy of 20 million lives, and they see potential across their served geographies (about 200 million lives) and a path toward 100 million covered lives over several years. They said Nurse Nav improves margins (Brian cited roughly 150 basis points lift in markets deployed) and can be deployed via three growth channels (existing footprint expansion, Rural Health Transformation Fund bids, and large municipal models). On leverage and M&A, they said they have roughly 15 targets, will scrutinize deals, and may prefer winning business organically or buying where it accelerates ops, while weighing delevering.
"So we're probably 29 communities today of coverage, representing just shy of 20 million covered lives." — Nicola Loporcaro (CEO·CHAIR)
IDR rule effects and subsidy headwind
Q (Joanna Gajuk · BofA): She asked how the final IDR regulation (lower arbitration fees and other changes) would affect their IDR experience and whether health-plan lobbying might change the process. She also asked if the subsidy expiration headwind is roughly $15–$16 million per quarter and whether that is an EBITDA headwind.
A: Management said they think payer pushback is more about other provider groups, and they continue to work to bring large payers in network while still beating holdouts in IDR. They said the new IDR rules cleaned up the process and the lower fees are a slight tailwind in the very low millions annually (about $1 million–$2 million). They confirmed the subsidy impact is both revenue and EBITDA and about $15 million–$16 million per quarter in guidance.
"We do appreciate the lower fees that it's a slight tailwind for us in the very, very low millions of dollars range, $1 million, $2 million on an annual basis." — Brian Tierney (CFO)
Airbase growth and in-network progress
Q (Andrew Mok · Barclays): He asked what drove the increase in air bases (was it planned or from wins) and how to think about pace for the rest of the year. He also asked where in-network rates stand and progress on getting payers in network.
A: Management corrected the count: they added 3 or 4 air bases in the quarter (not 10) and said more aircraft are coming over the next couple years, with high single digits expected for the rest of the year; some supplier delays pushed a few deliveries into 2027 by months. They said the new aircraft are tied to contracts and planned. On payers, they said IDR wins yield higher rates than in-network, but they prefer in-network for faster cash and fewer denials; contracts they're signing are just below IDR rates and about 69% of air reimbursement was in-network in Q2.
"No, I think we were up 3 or 4 bases in the quarter, not 10." — Brian Tierney (CFO)
Second-half volumes and efficiency actions
Q (Craig Hettenbach · Morgan Stanley): He asked about volume expectations (ground and air) in the implied second-half guidance and whether market changes differ from the first half. He also asked for details on operating efficiency drivers and tech initiatives to expand margins.
A: Management said second-half base growth and starts are projected into their guidance, and they are watching weather and wildfire impacts that can affect air operations. They said efficiency actions include matching labor to volume, back-office improvements, procurement focus, and about 40–50 AI-related initiatives to drive continual incremental improvements. They also emphasized better alignment and standardization across their platform while keeping local operational flexibility and that they have an AI governance committee focused on patient care.
"I mean we should be better today than we were yesterday and a little better tomorrow than we are today." — Brian Tierney (CFO)
Drivers of back-half margin compression
Q (Citi): He noted guidance expects lower EBITDA margins in the back half and asked what is driving the margin compression, given new ground 911 contracts should help NRT.
A: Management said the payer/exchange impacts that began in the second quarter will continue to affect the back half. They also cited Iran conflict-related cost increases: fuel spiked late March and an incremental ~$10 million plus per quarter of fuel cost has flowed through the P&L, plus higher airfare, shipping, and unexpected surcharges (even on office supply delivery) that add to back-half costs.
"We've really seen that $10 million plus a quarter really run through the P&L." — Brian Tierney (CFO)