American Well (NYSE:AMWL) executives said fiscal 2025 marked a “pivotal” year of transformation as the company narrowed its strategy to focus on its technology platform, reduced costs, and entered 2026 with what management described as clear visibility toward achieving positive cash flow from operations in the fourth quarter of 2026.
On Amwell’s fourth-quarter and full-year 2025 earnings call, Chairman and CEO Dr. Ido Schoenberg and CFO and COO Mark Hirschhorn emphasized a market environment they believe is increasingly driven by platform consolidation, automation, and measurable return on investment, particularly among payers and government customers.
Management frames a market shift toward consolidation and automation
Against that backdrop, Schoenberg said “technology-enabled care is no longer optional,” and he positioned hybrid care—combining automation with targeted clinician time—as essential for reducing costs and improving outcomes. He also described AI as accelerating changes across engagement, intake, decision support, workflows, risk stratification, and outcomes measurement, while noting the need to manage risk and operate within regulated environments.
Schoenberg said Amwell’s strategy is to provide a unified, “API-first” platform that allows sponsors to consolidate their digital health stack, swap clinical programs more easily, and improve member experience through “a single, simple, personalized” front door. He highlighted resilience and security as key purchasing criteria and pointed to Amwell’s contract with the Defense Health Agency (DHA) as validation that the platform meets stringent security standards.
2025 transformation: divestitures, renewals, and a smaller but “higher-quality” revenue base
Management said Amwell made a “decisive choice” in 2025 to focus exclusively on offering what it called the best technology platform in the market, and it divested non-core activities, including the sale of APC. Schoenberg said the company restructured and “dramatically reduced” its cost base while realigning product roadmap and go-to-market investments.
Commercially, Schoenberg said the company executed more than 15 payer contract renewals in 2025, representing the “vast majority” of existing payer subscription revenue, along with new logo wins. He cited DHA renewals, Blue Cross Blue Shield of Florida going live in January, and a three-year renewal with Elevance as examples.
Entering 2026, Schoenberg acknowledged the top line is smaller after reducing non-core activity, but he characterized the remaining revenue as “high quality,” “sticky,” and higher upside. He said 2026 priorities include AI-enhanced patient experience, faster third-party integrations, improved clinical data utilization, and quicker deployments—executed with what he called strict fiscal discipline.
Financial results: subscription mix rises, losses narrow, and Q4 revenue declines
Hirschhorn reported total revenue of $249.3 million for fiscal 2025. Subscription revenue represented 53% of total revenue, up from 45% in 2024, which he said reflects a deliberate shift toward more predictable SaaS-based revenue. He added that both net loss and adjusted EBITDA loss improved by approximately $100 million each year-over-year, attributing the changes to cost actions and a more focused operating model.
For the fourth quarter, Hirschhorn said performance reflected stronger subscription retention, increased visit volume in specialty care and virtual primary care, and cost efficiencies tied to the transformation plan. He also said the company began seeing early benefits from AI integration across operations.
- Q4 revenue: $55.3 million, down 22.1% year-over-year.
- Q4 subscription revenue: $28.8 million, down 22% year-over-year, driven primarily by a step-down in the DHA contract in summer 2025, churn earlier in 2024, and reprioritization away from certain areas.
- AMG visit revenue: $23.7 million, down 18.7% year-over-year, reflecting the APC sale and remaining churn from 2024.
- Paid AMG visits: roughly 340,000, flat year-over-year; total platform visits were 1.0 million, down 28.4% from 1.4 million a year earlier.
- Gross margin: 51.2%, down 280 basis points year-over-year; Hirschhorn cited near-term margin pressure but said the mix is shifting toward higher-margin SaaS over time.
- Operating expenses: $55.3 million (including D&A), down 30.7% year-over-year; operating expenses were 96.7% of revenue versus 108.7% in the prior-year quarter.
- Adjusted EBITDA: loss of $10.3 million, improving from a loss of $22.8 million in Q4 2024.
- Net loss: $25.2 million, compared with $30.7 million in Q3 2025; Hirschhorn said that represented a 43.5% improvement year-over-year.
On liquidity, Hirschhorn said cash burn in Q4 was approximately $19 million. Amwell ended the year with about $182 million in cash and marketable securities and no debt.
2026 guidance and the path to positive operating cash flow
Amwell issued 2026 guidance calling for revenue of $195 million to $205 million, AMG visits of 1.32 million to 1.37 million, and an adjusted EBITDA loss of $24 million to $18 million. For the first quarter of 2026, the company guided to revenue of $48 million to $53 million and an adjusted EBITDA loss of $7 million to $5 million.
Hirschhorn said the outlook assumes continued subscription stability, specialty care and virtual primary care visit trends, ongoing cost discipline, and incremental automation and AI-driven efficiencies. Based on that outlook, he reiterated management expects positive cash flow from operations in the fourth quarter of 2026.
Q&A: DHA renewal timing, AI competition, and government pipeline
During Q&A, Schoenberg said 2025 included signing 50 contracts, “most of which are renewals,” which he said helped secure the recurring revenue base. As a result, he said open renewals in 2026 are “significantly lower,” with the primary exception being the DHA renewal expected in the summer.
Pressed on competitive dynamics around new AI entrants, Schoenberg said Amwell is “very bullish” on AI’s impact and has implemented AI across workflows and products, but argued the bigger challenge for customers is integrating multiple AI-driven clinical programs into a consistent, regulated infrastructure. He said Amwell’s role is to provide that baseline infrastructure so customers can add, switch, and govern programs without rebuilding the “digital front door” each time.
Asked about guidance headwinds and tailwinds, Hirschhorn said a potential tailwind could come from earlier adoption of the company’s platform in government-related opportunities. He said Amwell is participating in RFIs and RFPs across all 50 states and has additional government segment opportunities, with expected updates in the second quarter. Hirschhorn said none of that revenue is included in current 2026 guidance, and he suggested conversions could contribute to backlog with potential revenue impact in 2027.
Hirschhorn also explained the prior DHA revenue step-down stemmed from the elimination of Amwell’s digital behavioral health and automated care programs in summer 2025 due to a cost-efficiency mandate; the base contract was renewed, but those programs were not. He said the company feels positive about revisiting those program components in the upcoming renewal and described the potential impact as “significant” and “material,” without providing contract value.
Schoenberg closed by saying the company believes it has improved the “quality” of its revenue and positioned the business for longer-lasting customer relationships and higher-margin same-store expansion as sponsors add more clinical programs, including AI-driven offerings, on top of the platform.
About American Well (NYSE:AMWL)
American Well, operating under the trade name Amwell, is a Boston-based digital health company that develops and delivers telehealth solutions to healthcare providers, payers, employers and patients. Through its cloud-based platform, the company enables secure virtual visits, remote patient monitoring and integrated care coordination across a range of medical disciplines, including primary care, behavioral health, chronic disease management and urgent care.
The company’s core offering, the Amwell Telehealth Platform, facilitates live video consultations, asynchronous messaging, e-prescribing and electronic health record integration.
