A reconciliation of these non-GAAP financial measures for the most comparable GAAP measures is available in the earnings press release and Form 8-K filed with the SEC today. In 2025, we made meaningful progress across all of our initiatives, which has translated into strong first quarter performance and increased expectations for our full year 2026 outlook. Each of these efforts are designed to improve predictability and alignment with our physician partners, reduce variability, and support durable margin expansion over time. As Jeff will discuss in more detail, this has enabled us to increase our revenue and Adjusted EBITDA expectations, in part due to better progress on the validation of our burden of illness initiatives.

Going forward, we will continue to enhance the data pipeline to support clinically actionable insights, as well as improve network design and care model innovation. We are continuing to increase our focus on high-risk patients, an increasingly important focus for all constituents in the Medicare space. With that said, given it is early in the year, we believe it remains prudent to maintain our net cost trend outlook of approximately 7% for full year 2026. As a reminder, the congestive heart failure, or CHF program, remains the most mature pathway deployed across 90% of our markets.

We are working with partners to deploy enhanced caregiver models, structured early-stage pathways, and virtual diagnostics. We're beginning our 2027 payer contracting process, where we plan to take the same disciplined and partnership-oriented approach with our payers, focused on shared profitability and durable margin expansion. Second, our AI-enabled technology platform and enhanced data capabilities deployed in very close proximity to the physician are allowing us to identify opportunities earlier, act faster, and manage performance with greater precision. We are raising our outlook for financial performance this year due to the early impact of these initiatives and remain confident in the long-term strength of our unique partnership model.

What went well
  • Exceeded the top end of guidance for total revenue, medical margin, and Adjusted EBITDA in Q1, prompting a raised full-year 2026 outlook
  • Adjusted EBITDA of $54 million versus $21 million in Q1 2025, reflecting higher medical margin, OpEx discipline, and favorable ACO REACH results
  • Medical margin of $149 million versus $128 million a year ago, above the high end of guidance
  • ACO REACH Adjusted EBITDA of $27 million, about $5 million ahead of expectations, aided by CMS removing fraudulent urinary catheter and suspect skin substitute costs from 2025 performance
  • Revised estimated full-year risk-score increase to 1.5% (net of V28), up from the prior 0.4% estimate, driven by the enhanced data pipeline with member-level risk scores on ~85% of members
  • CHF program, deployed across 90% of markets, shifted inpatient first-diagnosis rates from ~25% to under 5%; full-year 2025 cost trend now estimated at 6.2%, down from 6.5%
What went wrong
  • Medicare Advantage membership fell to 426,000 from 491,000 a year ago, driven by measured growth, previously disclosed market exits, and payer exits from disciplined contracting
  • Revenue declined to ~$1.42 billion from ~$1.53 billion in Q1 2025 on the membership decline
  • Recorded a conservative Q1 cost trend of 7.4% given limited paid-claims visibility early in the year, with Part B and inpatient costs continuing to escalate
  • Favorable 2025 medical-cost development (~$12 million) was offset by additional Part D reserves, so prior-year development produced effectively no net benefit in the quarter
  • ACO REACH membership declined to 110,000 from 114,000 in the prior-year period

Guidance Changes

MetricPeriodCurrent guidance
RevenueFY2026~$5.7 billion (midpoint)
Medical marginFY2026~$375 million (midpoint)
Adjusted EBITDAFY2026~$25 million (midpoint)
Net cost trendFY2026~7%
Risk-score increase (net of V28)FY20261.5%
RevenueQ2 2026$1.45 billion (midpoint)
Medical marginQ2 2026$123 million (midpoint)
Adjusted EBITDAQ2 2026$20 million (midpoint)
ACO REACH Adjusted EBITDAFY2026$25 million-$30 million
Year-end cashFY2026at least $125 million

Performance Breakdown

MetricYoYNote
Revenue ~$1.42B vs ~$1.53B (down) Membership decline, partially offset by more constructive 2026 rates and higher estimated risk scores
Adjusted EBITDA $54M vs $21M (up) Higher medical margin, OpEx discipline, and favorable ACO REACH performance
Medical margin $149M vs $128M (up) Higher revenue and lower overall medical expenses in the quarter
Medicare Advantage membership 426,000 vs 491,000 (down) Measured growth approach, market exits finalized Jan 1 2026, and payer exits from profitability-focused contracting
ACO REACH membership 110,000 vs 114,000 (down) Not separately explained beyond membership trend
ACO REACH Adjusted EBITDA $27M, ~$5M ahead of expectations CMS removal of fraudulent urinary catheter and suspect skin substitute costs from 2025 and corresponding benchmark changes

Earnings Call Themes & Trends

TopicPrevious mentionCurrent periodTrend
Enhanced data pipeline and risk-adjustment visibilityPipeline went live end of Q1 2025; prior full-year risk-score estimate 0.4%Member-level risk scores on ~85% of members; full-year risk-score increase now estimated at 1.5% net of V28—
AI in clinical and operational workflows—Generative-AI insights integrated into clinical workflows and AI-driven risk stratification/suspecting; limited early OpEx impact, larger impact on revenue and medical cost—
Clinical program scalingCHF program initiated about a year agoCHF most mature (90% of markets); scaling COPD/lung health and dementia pathways through 2026—
Disciplined payer contracting~$127 million full-year contracting benefit from 2026 executed contracts2026 contracts finalized and flowing through; 2027 contracting underway with focus on percent-of-premium, Part D, and risk corridors—
Part D risk reduction~30% of members carried Part D risk in 2025Less than 15% Part D exposure in 2026, with aim to reduce further—
2027 rate notice—Starting point in line with CMS's 5.33% effective growth rate; minimal exposure to unlinked chart reviews; confident it can offset the 1.12% normalization factor—

Q&A Summary

Truist: Why maintain the $25M-$30M full-year ACO REACH EBITDA guide despite the strong quarter, implying no further contribution?
The ~$5M Q1 benefit related to 2025 performance (suspect skin substitutes and urinary catheters CMS backed out); it is too early in the year to adjust REACH performance expectations further.
Truist: Are the AI-driven efficiencies incremental to the $35M 2026 OpEx benefit or already in guidance?
AI bifurcates into OpEx efficiencies and above-the-line impact; expect limited early OpEx impact but more significant effect on revenue and medical cost, with value typically showing up later.
Needham: Is the COPD/dementia rollout on track (50-70%+ of markets by end of Q2), and does scaling add to 2026 or 2027 profitability?
Yes on the rollout and yes it can add value to 2026, but benefits must show up in claims, which takes time; CHF, initiated a year ago, is the most mature and is already showing outcomes.
Wells Fargo: Please bridge the sources of medical-margin upside in the quarter versus guidance.
Variance was roughly $26M vs guide midpoint: the risk-adjustment update is ~$50M for the full year (about half in the quarter), plus Q1 seasonal margin on the new full-risk contract that is modeled break-even for the full year.
Jefferies: Was there no Part D recognized in Q1, and what did the second-half 2025 favorable development look like?
Prior-year development was ~$12M for the quarter (2025 dates of service), but it was offset by added Part D reserves given limited data (30% of members had Part D risk in 2025, final reconciliation not until Q3), so there was effectively no net benefit.
TD Cowen: What was attractive about the new risk contract and what was the guidance pickup?
It is a new payer contract in a market with an existing physician group, roughly $200M in revenue modeled at break-even margin for the year; viewed as a multi-year margin improvement opportunity.
Evercore: How is the ~50bps payer-bid tailwind and payer contracting benefit tracking?
Payers are focused on restoring margin, which is favorable for agilon; the ~$127M full-year contracting benefit came from already-executed contracts and is flowing through in Q1.
Baird: How is the opportunity to potentially double payer incentive contributions (from ~$25M in 2025) tracking in 2026?
The opportunity has doubled, but the guide conservatively assumes the same 2025 performance level; it is very early with no data yet, though management is confident in delivering superior quality.
William Blair: When does agilon go back on offense to grow the member base and partner pipeline?
There is some embedded in-market growth as people turn 65 and as groups add physicians; the current focus is in-market growth and execution, and the time to expand more broadly is not here yet.

More on agilon health, inc.

Reported 2026-05-06 · figures from the agilon health, inc. Q1 2026 earnings call.

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