American Well (AMWL) Q4 2025 earnings summary

Executive summary

• 2025 marked a pivotal year with a major transformation, focusing on a unified tech platform, divesting non-core activities, and driving improved revenue quality through contract renewals and new client wins.

• Over 15 payer contract renewals were completed, including a significant 3-year Elevance renewal, positioning the company for strong commercial momentum and a clear path to cash flow breakeven in Q4 2026.

• AI integration and automation are central to the strategy, enhancing patient experience, operational efficiency, and enabling rapid deployment of clinical programs.

Financial highlights

• Full year 2025 revenue was $249.3 million, with subscription revenue rising to $132.4 million (53% of total revenue), and AMG visit revenue at $94.3 million.

• Q4 2025 revenue was $55.3 million, with subscription revenue at $28.8 million and AMG visit revenue at $23.7 million.

• Q4 gross margin was 51.2%, and full year gross margin was 53%; operating expenses fell 30.7% year-over-year.

• Net loss and adjusted EBITDA loss were both reduced by approximately $100 million year-over-year; Q4 net loss was $25.2 million, and adjusted EBITDA loss was $10.3 million.

• Ended 2025 with $182.3 million in cash and marketable securities and no debt.

Outlook and guidance

• 2026 revenue guidance is $195–$205 million, with AMG visits expected between 1.32 million and 1.37 million.

• Adjusted EBITDA loss for 2026 is projected at $24–$18 million; Q1 2026 revenue guidance is $48–$53 million with an adjusted EBITDA loss of $7–$5 million.

• Positive cash flow from operations is expected in Q4 2026.

• Guidance assumes continued subscription stability, visit volume trends, cost discipline, and incremental AI-driven efficiencies.