DocGo Inc. (DCGO) Q1 2026 Earnings Report, Transcript and Summary

Good afternoon, ladies and gentlemen, and welcome to the DocGo First Quarter Earnings Conference Call. [Operator Instructions] This call is being recorded on Monday, May 11, 2026. I would now like to turn the conference over to Mike Cole, Vice President of Investor Relations. Please go ahead.

Thank you, operator. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call other than statements of historical fact are forward-looking statements. The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expectations. Forward-looking statements are inherently subject to substantial risks, uncertainties and assumptions, many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements. These risks, uncertainties and assumptions include, but are not limited to, those discussed in risk factors and elsewhere in DocGo's annual report on Form 10-K, quarterly reports on Form 10-Q, our earnings release for this quarter and other reports and statements filed by DocGo with the SEC to which your attention is directed. Actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward-looking statements. In addition, today's call contains references to non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are included in our earnings release and the current report on Form 8-K that includes our earnings release, which is posted on our website, docgo.com as well as filed with the SEC. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time. We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law. At this time, it is now my pleasure to turn the call over to Mr. Lee Bienstock, CEO of DocGo. Lee, please go ahead.

Thank you, Mike, and thank you all for joining us today. We reported a strong top line of $75.6 million in revenue during the first quarter with an adjusted EBITDA loss of $10.2 million. Additionally, we increased our 2026 revenue guidance from a range of $290 million to $310 million to $300 million to $315 million, while leaving our 2026 adjusted EBITDA guidance unchanged at a loss of $5 million to $10 million. I would like to take a few minutes and break down the revenue and profitability aspects individually. First, a major driver of our strong revenue performance and increased revenue guidance is our virtual care offering, SteadyMD. We noted this upward trend in our last earnings call, and we are pleased to share that this trend has accelerated. During the first quarter, SteadyMD generated in excess of $9 million in revenue, beating the previous high set in the fourth quarter of last year by roughly $1 million and completed approximately 1.1 million total visits and lab orders during the period, up 38% when compared to last year. SteadyMD recently entered into a new contract with a leading online pharmacy to provide virtual care services for weight loss prescriptions and a broad scope of general clinical services, which will fuel continued growth. Second, our mobile phlebotomy offering is performing exceptionally well. While their revenue base is smaller, we are now projecting as much as 75% growth for this business in 2026, which is well above our previous expectation, and we anticipate our rate of home visits to increase from 600 per day currently to 900 per day by the end of 2026. We've opened new territories in Upstate New York and Pennsylvania to meet demand for our services, and we are planning to launch services in Florida, which is a new state for us. We are expanding our use of technology as well, working with a major national lab to integrate our order intake into their applications to allow doctors to order home visits directly through the lab systems and deploying AI automation for order intake and customer service to help increase our margins. And third, we have signed recent new contracts and expansions with payers and providers for our care gap closure, PCP and transition of care services. We have now surpassed 1.6 million lives assigned to us for care gap services since inception, and we've increased the number of visits completed 46% year-over-year. Also of note, we have begun an aggressive pace of onboarding for PCP and longitudinal care services, and our panel now has over 1,000 patients, the vast majority of which were enrolled in Q1. Our goal is for this business line to break even in late 2026, dramatically lessening the investment level that has been required to launch and grow this business over the last few years. Regarding our medical transportation business, we have recently had several significant renewals in addition to some smaller wins, further solidifying the long-term revenue profile of this business segment. We renewed our contract with one major New York hospital system for an additional year and renewed our contract with another major New York health system for 2 additional years and added their Staten Island facilities. We signed a contract to provide service for a long-term acute care hospital in Chattanooga, Tennessee, signed contracts to provide medical transportation with several hospice facilities in Wisconsin and signed a new nonemergency patient transport services contract for the Great Western Hospitals NHS Foundation Trust in the United Kingdom. In addition to what we have factored into our updated revenue guidance, our business development pipeline remains strong and supportive of continued growth with multiple opportunities for medical transportation growth, both in the U.S. and especially in our U.K. operations. Consistent with our approach, we will update guidance accordingly if and when contracts are entered into. Collectively, we cannot be more pleased with the near-term revenue growth opportunities for our consolidated business. Now I'd like to shift gears and break down the gross margin and SG&A lines to provide some color behind our decision to increase revenue expectations while keeping our adjusted EBITDA guidance unchanged. We experienced labor inefficiencies as a result of SteadyMD's exceptional growth. As I mentioned previously, we had high expectations for this business in 2026, and those lofty expectations are being exceeded. Their dramatic growth required us to pay increased incentives to our current clinicians to cover shifts while we worked to bridge a hiring gap. As a result, this negatively impacted our consolidated gross margin by approximately 60 basis points. During the first quarter, we leveraged DocGo's recruiting expertise to increase SteadyMD's clinical workforce by over 45%, and we expect this added workforce to help meet pent-up demand for SteadyMD services in the second half of the year. In addition, we saw a significant increase in fuel costs in March, driven by the war in the Middle East. We estimate that every $1 increase at the pump cost us about 35 basis points of consolidated gross margin. Our average price paid in March was $3.69 compared to an average cost of $2.93 per gallon in January and February. Average fuel costs in Q2 to date have remained at this elevated level, which we expect to be a continued drag on gross margin over the near term, unlike the temporary narrowing of SteadyMD's margins I just described, which has already corrected in the second quarter so far. And last, if we adjust our operating expenses to exclude depreciation, stock-based compensation and other nonrecurring items, we saw a decrease from $35.7 million in the fourth quarter of last year to $34.1 million in the first quarter of this year. We feel this is the most accurate representation of how our cost-cutting efforts are working their way through our financials. There is undoubtedly a lag in this process, and we are just starting to see the impact from many of the cost cuts made late last year. Our expectation is that we will see an acceleration in this improvement in the coming quarters based on steps that have already been taken and additional cuts already underway in the second quarter. In sum, we saw margin headwinds driven by the geopolitical tensions influencing fuel prices and the aggressive pace of operational expansion that was beyond our initial expectations. We believe that these margin constraints are temporary in nature and not reflective of our long-term profitability profile. Our top line is strong and getting even stronger. We achieved record volumes across all major business lines in the first quarter, with U.S. Medical Transportation increasing 17%, health care in the home increasing 46%, mobile phlebotomy increasing 8%, cardiac and remote patient monitoring increasing 13% and virtual care and lab orders increasing 37% year-over-year. Before handing it to Norm, I would also like to briefly address the strategic alternatives process that was announced on March 16 of this year. While I'm obviously limited in what I can say, the company's evaluation of strategic alternatives remains ongoing. While there can be no assurance that this process will result in DocGo pursuing any particular transaction or other strategic outcome, we will share further developments as appropriate. Now I will hand it over to Norm to review the financial details.

Thank you, Lee, and good afternoon. Total revenue for the first quarter of 2026 was $75.6 million compared to $96 million in the first quarter of 2025. The year-over-year revenue decline was entirely due to the wind down of migrant-related projects. Removing migrant-related revenues, we saw a revenue increase of 24% year-over-year in Q1. Now this was partially due to the recent acquisition of SteadyMD, which added $9.5 million in revenues in Q1 of this year. Removing the impact of both the migrant-related revenues in the 2025 period and the SteadyMD revenues in the 2026 period and revenues still increased by about 8% year-over-year. Medical transportation services revenue increased to $51.9 million in Q1 of 2026 from $50.8 million in transport revenues that we recorded in the first quarter of 2025 and were the highest quarterly transport revenues in DocGo's history. Revenues were driven higher by gains in both large and small U.S. markets with some of the strongest growth in markets like New York, Texas and Tennessee. We continue to see increasing demand across most of our markets. Mobile Health revenue for the first quarter of 2026 was $23.6 million, down from $45.2 million in the first quarter of last year, driven again by the wind down of migrant revenues. Non-migrant mobile health revenues more than doubled, driven by increases in care gap closures, remote patient monitoring and mobile phlebotomy and by the inclusion of revenues from SteadyMD, which we acquired during the fourth quarter of 2025. Removing the impact of SteadyMD, Mobile Health revenues still increased by about 38% year-over-year. Adjusted EBITDA for the first quarter of 2026 was a negative $10.2 million compared to an adjusted EBITDA of negative $3.9 million in the first quarter of 2025. The adjusted gross margin, which removes the impact of depreciation and amortization and is the measure of margins that we track most closely, was 31.6% in the first quarter of 2026 compared to 32.1% in the first quarter of 2025. However, looking at only the revenues from business lines that were active in both periods, thereby removing Migrant revenues of $35 million and gross profits of $12.3 million from the first quarter of 2025 and removing SteadyMD revenues of $9.5 million and gross profits of $2.8 million from the first quarter of 2026, the adjusted gross margins of the underlying business would have been 31.9% in Q1 of 2026, up about 1.5 points from 30.4% in last year's first quarter. During the first quarter of 2026, adjusted gross margins for the Medical Transportation segment were 31.9% compared to 30.8% in Q1 of 2025. Medical Transportation gross margins are still being restrained by higher-than-planned effective hourly wages for field labor. However, we took solid strides toward increasing our field headcount in the first quarter of 2026, and we saw the overtime rate decline in the first quarter of 2026, closer to the sub-10% overtime rates we saw in the first half of 2024. Transport gross margins were also impacted by increased fuel costs, as Lee described earlier. Mobile Health segment adjusted gross margin was 31% versus 30.8% in the first quarter of 2025. SteadyMD gross margins were several points lower than normal, reflecting the aggressive hiring in the first quarter to catch up to the increased demand from large customers. This factor, which is expected to reverse itself starting in Q2, was offset by greater relative contributions from higher-margin service lines within mobile health, such as remote patient monitoring and mobile phlebotomy. While revenue came in well above expectations and gross margins were generally in line, operating expenses came in higher than anticipated. This is due to the need to ramp up the hiring, onboarding and training of mobile health clinical staff to meet customer demand as well as the fact that our cost-cutting decisions regarding vendor spending and corporate headcount made in late Q4 and into 2026 won't meaningfully impact our income statement until the second quarter. With SteadyMD's recent hiring push behind us, our continued cost-cutting efforts in Q1 and additional savings from the efficiency portfolio initiative that we discussed on last quarter's call and that are anticipated to have a positive impact on our second half 2026 results, we continue to expect sequential declines in SG&A in dollar terms as we go throughout the year. As of March 31, 2026, our total cash and cash equivalents, including restricted cash and investments, came to $59.9 million, down from $68.3 million at the end of 2025. Our cash balance at quarter end was lower than we had expected due to the delay in collecting migrant-related accounts receivable owed by New York City's Department of Housing Preservation and Development, which we had expected to see during the first quarter. However, on April 1, the first day of the second quarter, we received approximately $8 million in these receivables, and we are working on collecting the remainder of these receivables. With some further, albeit smaller operating losses in Q2 of 2026 and several growth-related initiatives requiring working capital, we would expect further declines in cash in the near term. This could create some working capital pressure, which is expected to ease in the second half of the year, in line with our planned return to profitability. Turning to 2026 for the rest of 2026. As Lee mentioned in his comments earlier, and as we pointed out in our press release, we have updated and increased our revenue guidance for the year based upon what we have seen in the first 4-plus months of the year and the positive volume trends across most of our business lines. We now see full year revenues in the range of $310 million to $315 million, up from the range of $290 million to $300 million that we shared in mid-March and higher than our initial guidance of $280 million to $300 million. Now this does not include any revenues from migrant-related projects and would represent a 19% to 25% growth over 2025's base revenues. We continue to anticipate a full year adjusted EBITDA loss in the range of $5 million to $10 million, which is unchanged from our previous guidance. At this point, I'd like to turn the call back over to the operator for the question-and-answer session. Operator, please proceed.

[Operator Instructions] With that, your first question comes from the line of Ryan MacDonald with Needham.

This is Matt Shea on for Ryan. Maybe starting with the SteadyMD business. Nice to see the momentum continuing from last quarter, especially with the new win. Lee, maybe just double-click on this segment. What kind of pipeline are you seeing for new logos versus growth with existing logos? And are you seeing most of this demand from online pharmacies for weight loss or any other customer types worth calling out? And then, Norm, maybe when thinking about the top line guidance, it seems like majority was driven by the SteadyMD weight loss customers, but curious if you can put any finer points on that.

Absolutely. Matt, great to hear from you. Really appreciate the question. And on the part of the question relating to the growth and the pipeline of what we're seeing in SteadyMD, as I mentioned in our prepared remarks, we're very, very encouraged and excited about the growth prospects there. I think the growth is coming from really both avenues, our existing customer base. We continue to grow our capacity and grow our volumes with our existing customer base that we've been working with now for quite some time. And we have been adding new logos pretty consistently over the course of the end of last year and as we head into this year, which is also fueling further growth. And the big push we made really in the first quarter of this year was to ramp the hiring in order to meet this growth and meet the demand. In terms of the types of customers we're working with, we're really working with -- you mentioned it, the online pharmacies. I mentioned one that we're expanding with quickly. Digital health companies, wellness companies, digital wearable companies as well are all partnering with us as well as your typical labs that you might expect as well. So really seeing growth from across that space. Yes, it's weight loss, but it's also general wellness trend as well as sort of the consumerization of health care is really pushing growth for us there. So we're really, really excited about it. The SteadyMD team is a great, great team, a great addition. And as we go through the year here, some of the growth is also going to come from DocGo's in-home visits. We really want to drive SteadyMD's telehealth capacity to be a key component of overseeing prescribing treatment planning the visits that are happening in the home with our mobile health clinicians. That's a big, big area of integration for us as we go throughout the year here and will help us also expand our margins for those in-home visits. So we're really seeing it across the board, really great addition to the team, really fits nicely into the future of health care, care anywhere vision that we're pursuing, and we couldn't be more excited. Norm?

Matt, in terms of the top line, I think you're referring to the guidance that we've given where we're going to a range of $300 million to $315 million, so let's say a midpoint of $307.5 million and you compare that to where we were before, which is $290 million to $300 million. So let's take a $295 million midpoint. So we essentially are adding $12 million to the guidance. There are a couple of ways of looking at it. Number one, I would say that when I look at our quarterly results for Q1, the number that we did, which was about $75.5 million, $75.6 million is probably about anywhere from $3 million to $4 million ahead of where we thought we would be. So that gets us off to a good start. But when you break it down by the different business entities, so the $12 million or so increase in guidance for the top line midpoint to midpoint, I'd say about $8 million to $9 million of that is probably related to SteadyMD. We necessarily projected it in a somewhat conservative way, right? We only had the company for about a month or 2 at the time that we made our last guidance, we gave our last guidance, and it's pleasantly surprised us with volumes with that volume growth, as Lee has mentioned. But that's only one part of it. The transport business is performing very well. We had a thesis that we've talked about on this call a couple of times, wherein if we had -- we knew we had the demand, we looked at the number of calls and trips that we couldn't take because we didn't have enough personnel. And we knew that if we would add to our headcount, we would add to our field labor that, that would translate into more volume. And that's worked. So, so far, that part is definitely working. So if you think about it that way, then that definitely adds to the growth as well or at least it validates the transport growth we expected. And then you have some of our smaller business lines within mobile health like the mobile phlebotomy business and the CRMS business, remote patient monitoring business, which grew like 20% year-over-year in the first quarter. So again, I would say that the majority of the increase relates to SteadyMD, but we're seeing some solid volume growth, as Lee mentioned in his prepared comments, really across all of our business lines.

Okay. That's great color. I appreciate that from both of you. And then maybe touching on another area that sounded really strong this quarter, again, with being the payer and the care gap closure business, nice to see lives there crossing the, call it, 1.5 million mark. Maybe just first, it's a very dynamic year for the payers. Any changes in terms of how they're looking to use you for these care gap closures or any services they want you to prioritize more maybe than what had been prioritized in the past? And then second, I think earlier this year at our conference, you had sort of talked about a pipeline of 2 to 4 more incremental payers that you could sign on in the first half of this year. I wasn't sure from your prepared remarks if you had brought 1 or 2 on maybe this quarter, but maybe just update us on that thinking there, if that's still the right way to think about the incremental payers you're bringing on in the first half and maybe where you're at on that so far?

Absolutely. I'm glad you mentioned that. So in terms of what the payers are looking for us to do, I think it's pretty consistent with what we've been seeing as we've built this out really over the last 18 to 24 months, which is really absolutely the care gap service, care gap closure, particularly for patients that are falling through the cracks, drifting, unattached, that continues to be a big need in the market, really no change there, and we've been ramping up our ability and growing -- really growing our volumes year-over-year as we go throughout building up that business. I think the other piece that we're really seeing is when we go visit the care gap -- the open care gap patients, we are seeing that a lot of them are just also unattached or don't know who their primary care provider is and a very large percentage, the majority of which that don't have a PCP are opting for us to become their PCP. So those are the services really that we're adding on top of the care gap closure services, and we've continued to do that. We saw in the first quarter, it was pretty interesting when we go to see the patients in their homes for care gap and also for PCP services, we're seeing that 60% of the patients we go and visit have 2 or more chronic conditions. And a big percentage of them have 3 or more chronic conditions. 20% of them have social needs or risks that are impacting their health outcomes. We also see that 42% of the patients had chronic conditions that had never before been documented. So these are big drivers for the health plans, and we're able to uncover this, that we're able to meet patients where they're at. And so -- and that goes along with our 50% plus readmission reduction that we're seeing with our longitudinal care patients that we've been working with. So we're really seeing great impact on health outcomes. We're really starting to provide more longitudinal care in addition to the care gap services. And uncovering chronic conditions that had been undocumented before is a big, big benefit to the health plan and of course, to the patient. So that's really what the plans are using us for. That's what we're -- that's the data and the insight that we're providing back to them, and it's proving out to be very, very valuable. And of course, we think we'll be successful and continue to grow the company as we provide more and more value. The majority of all of the plans that we work with have told us that they would like to expand with us over the coming year. So again, that's really given us a lot of excitement and optimism and enthusiasm for what we're doing there. On the new logos, I know you mentioned that, Matt, on the new logos, we'll announce them as it makes sense, but we're absolutely on pace to add 2 to 4 new logos in the first half of this year.

And the next question comes from the line of Pito Chickering with Deutsche Bank.

This is Kieran Ryan on for Pito. Appreciate all the color that you gave there. I guess just stepping back, could you maybe just help us just understand kind of the puts and takes around the reiteration of the EBITDA guidance just as far as kind of how the tailwinds from the really strong outperformance on revenues and with SteadyMD. Maybe offset by some incremental headwinds on kind of the labor cost and transportation and with SteadyMD and then on the fuel side. Just how should we think about that all kind of balancing out towards the reiterated range?

It sort of answered the question itself, Kieran. But what's happening is we feel we have some really good momentum on the revenue side as evidenced by the fact that we outperformed our number for Q1 and we raised the guidance for the full year. And the reason why we left the overall EBITDA guidance the same even with a higher revenue expectation is for those reasons that you mentioned, right? There'll be a little bit of pressure on gross margins in the transport piece in Q2 because of fuel prices. Lee mentioned that our average gas price was about $3.69 per gallon in March, up from that $2.93 in January and February. That number is currently running at about $4. We don't think that, that's going to last really beyond the second quarter, but that's something that we have to take into account. Granted, we're not as leveraged to fuel prices maybe as we were in the past when we were only an ambulance company. But it still will have an impact and could have an impact for us of maybe 1/3 of a point to 0.5 point in gross margin, which will obviously have an impact on -- will offset some of the gain that we would have from having higher margins than were originally projecting. On the operating expense side, so some of the stuff that Lee mentioned relates to SteadyMD. I did say in my comments that our -- there's been a lag in our cost cutting or in the way that, that sort of flows its way through to our income statement. So we expect to pick up some benefit there in Q2, but we're starting at a somewhat higher point. So we just want to build in a little bit of conservatism as far as that goes as well if operating expenses continue to run a little bit hot compared to where we expected things.

Got it. That's helpful. And then I think you had said if we adjust both SteadyMD and the migrant revenues in 1Q '25, mobile health growth was 38% in the quarter. And I see you're kind of grouping some business lines in together, Health Care at Any Address, which seems to account for the most of the dollars in mobile health. Can you just help us kind of understand what -- which business lines are driving the most growth on a dollar basis ex SteadyMD because there's obviously some really strong percentage growth rates there that are all contributing, but just so we can understand that a bit better.

Yes. So I think on a dollar basis, you're seeing our patient monitoring business have really strong growth year-over-year, also really strong profitability profile as well in that growth. You also see growth in the health care in the home business, our care gap in primary care continues to grow year-over-year, and you're seeing growth in our mobile phlebotomy offering as well. So those are the 3 pieces. And then, of course, SteadyMD, which you mentioned. So those are really the pieces that are growing the fastest. They're starting to integrate with one another, SteadyMD overseeing the DocGo visits in the home, utilizing phlebotomists for the care gap visits in the home, utilizing patient monitoring for patients where it makes sense when we go and visit them in the home. And so that care at any address health care anywhere portfolio, we're really excited to see that growing and one playing and feeding the other is sort of a vision that we have as we go to provide care virtually in person and remotely. And that's the piece that's growing the fastest at the company right now.

And the next question comes from the line of Richard Close with Canaccord Genuity.

Yes. Maybe just a follow-up to that last question and some of the earlier questions. But just with respect to SteadyMD first, I think coming out of the fourth quarter, you had said something that's like a $25 million to $30 million business and call it, in 2026. So I guess based on the comments on the guidance, is, call it, $34 million to $39 million a good number for SteadyMD now for '26? Why don't we start there?

Yes. Richard, I appreciate it. So I think, as Norm mentioned, SteadyMD did about $9.5 million in the quarter for Q1. Now we do tend to see Q1 and Q4 as the highest levels for SteadyMD sort of as you go in those winter months as you close out the year and start the year. But as you're mentioning, that $9.5 million kind of puts them at that $36 million run rate for the year, but understanding that the middle months of the year tend to be a little bit lower on the volume. Now that being said, we are bringing on additional customers. We are onboarding additional customers that will potentially smooth that out as we go throughout the year. But that's basically, as you mentioned, that's the pace they're on as we exit Q1.

Okay. And then just to be clear, with respect to the, call it, $23.6 million for mobile health, you have the $9.5 million for SteadyMD. There's like absolutely no migrant in any of those numbers or the mobile health for the quarter. That's completely gone, correct?

That's correct.

Okay. And then maybe back to the question right before me in terms of -- so if we looked at like remote monitoring, if we ex out the mobile SteadyMD from the $23.6 million of total mobile, is remote monitoring the biggest chunk of what's remaining in there?

It's the biggest -- Richard, it's the biggest single one. It was a little bit more than $4 million, I'd say, $4.1 million in the quarter. But to give you an idea, the clinical staffing business was about $3.8 million, $3.7 million, $3.8 million. So it was a close second. But yes, it is actually the biggest one, operating at a margin for the quarter of over 60%. Natural margin is probably a little bit lower than that, but it's solidly over 50%. So that really helps the overall margin picture for Mobile Health.

Okay. And we're throwing around a bunch of terms here, but clinical staffing is care gap closure and PCP and that's correct?

So the clinical staffing is basically our portion of the business where we support mobile clinics and clinical staffing for our health care partners. So it's essentially programs that we run on behalf of clinical groups like the -- we have groups like radiology groups and so forth that we run staffed clinics for.

It's a legacy government medical services business that we bought in, I think, back in 2022.

Okay. So remote monitoring is $4.1 million, you got staffing at $3.8 million, and then it would be care gap closure or the home, health care in the home and then mobile phlebotomy.

Correct. Yes. And the health care in the home, we -- again, the mobile phlebotomy is one of the service offerings that we do in the home, right? So primary care, care gap closure, mobile phlebotomy. In those scenarios, we're sending a clinician into the home. That's sort of the care in the home service line. We're calling out mobile phlebotomy because it's one of the fastest-growing components of that care in the home business.

So a big growth and a lot of those off of relatively small, but continued progress there. With respect to fuel prices, when you say you would expect some relief there, just maybe on transport, how much is the fixed rate programs versus the lease rate programs as a percentage? How is that trending? And do you get any relief on fuel on those agreements? Or how do we think about that?

On the leased-hour arrangements?

Yes.

No, I don't think there's anything that's built in there. I mean we were talking about it here over the last few weeks. In general, whether it's on the headcount side or the fuel side, we really need to go back on some of our contracts and try to work in some sort of automatic indexed cost adjustment, but it doesn't exist on the vast majority of our contracts. Where this plays out is that from a lease hour perspective versus fee-for-service, then we kind of look at it and say the fewer trips we have, the better because we're not using up the fuel. But other than that, that's not something really that's under our control.

Okay. Okay. And then with respect to the cost savings in this -- they're kicking in the second quarter. When do you get like the full sort of the full positive impact from the cost cutting? Is that like midway through the third quarter or actually here in the second quarter?

I would say the full impact would probably be sometime in the third quarter. And I say that thinking about the sort of list we have of the very specific cost-cutting measures. Richard, part of the reason why we saw higher expenses than we would have expected in -- we initially expected in Q1 is typically, what will happen is we will swap out one vendor for another vendor. That's lower priced or we will just stop working with a vendor. But it's the kind of thing where you've got a list of vendors and you've got these cost savings that are identified and executed, but there's a lag because I might have a contract with that vendor that goes through the end of March, even though I told them in January that we're not using their services anymore or I told them back in December, I'm not using their services anymore. And it's the same thing with some of the personnel. As we sort of shift into more of the corporate layer here, where we're trying to take some cost out. What ends up happening is that we'll have situations where someone is told, hey, look, we've identified this position for elimination, but we need you to stick around for another 30 days or 60 days. It sort of gets you into that next quarter. And that's why that ends up happening. So knowing what we have executed so far in Q2, and what we have on the calendar to execute between now and the end of Q2, I would say that we're not going to get the full benefit of all of those things during this quarter. But by third quarter, we should get almost all of it. Obviously, in Q4, we'll have whatever took place at the end of Q2 and Q3 hitting the P&L. So if things flow through the way we anticipate and without other things coming up that would cause us to add to our headcount or to take on other vendors that we don't currently have, we would expect that sequential decline in operating expenses as we go into Q2, 3 and 4.

Okay. And then good job on collecting. I guess you said $8 million April 1 or something like that.

Yes. [indiscernible] mix.

Okay. How much is still out there? And what's the thought process on when that comes in?

Yes. So from HPD, which is the one that we talked about Housing Preservation and Development, there's about, I guess, $13 million left. We are in the process of communicating with them, sending them, in some cases, the very same information that we sent them last time, in some cases, sending it a different way. There's a formal process by which we would go through that. They have now laid out for us exactly what it is that is "missing" in order for us to get paid on those items. And we're gathering that information and are sending it over. I'm going to say -- I mean, look, I look in their payment system, I think there's probably another $1 million or so that will come in maybe in the next couple of weeks. But beyond that, we would expect it to come in over the balance of 2026. One thing that we have learned, even though we have now collected 97% of that contract is that it gets really, really difficult to predict the exact timing of when those payments are going to be made. And so we try to err on the side of being conservative. I will point out, when we talk about migrant revenues on the other hand, so there's HPD, but there's also New York City Health and Hospitals, the HERC program that we talked about, all that's been collected, and that was collected on a very timely basis in terms of the stuff that we billed as we came to the last days of those programs in late 2025. So I don't think there's anything material that's outstanding on any of those contracts as we sit here, that was all brought in during Q1. So it's really that $13 million or so that's sort of sitting out there that we are working very, very hard to collect.

And the next question comes from the line of David Larsen with BTIG.

This is Jenny Shen on for Dave. I just wanted to ask more about the weight management program or business within SteadyMD. I think you mentioned in the prepared remarks a new partnership or contract with an online pharmacy. Can you just speak more about that? Are you partnering with the pharmacy that offers the branded medications? Or are they offering the compounds? And how does that revenue sharing work?

Yes. So on the revenue, we charge a per visit rate. There's no revenue sharing. It's just we charge our contracted rate, as you mentioned, Jenny. In terms of your part of the question relating to the weight loss medication, we're working with the branded weight loss medications, the pharmacies that are offering those branded weight loss options and we are the clinical visit as part of that prescription as part of that prescribing process. So that's really what's driving that growth there. Of course, we're seeing, obviously, in the marketplace, a big tailwind and growth in that space, and we are participating in that.

Okay. Perfect. And then can you remind us how much of revenue do you expect the payer business to contribute in 2026? And how much is SteadyMD do you think?

Absolutely. So as we mentioned, we updated the guidance to $300 million to $315 million for the year. And we expect, again, as we shared on the last earnings call, we expect about $85 million to $100 million to come from the Mobile Health segment and then about $210 million to come, $215 million to come from the Medical Transportation segment for the remainder of the year. SteadyMD, as was mentioned, I think Richard asked about it specifically. Again, SteadyMD exited Q1 at a $9.5 million quarter. And so they're contributing roughly that $35 million, $36 million as we go throughout the year in our projections.

And that concludes your question-and-answer session. I would like to turn it back to Lee Bienstock for closing remarks.

Thank you so much. Appreciate everybody joining us and looking forward to speaking with you again soon. Have a great evening.

Thank you. Ladies and gentlemen, this concludes today's conference call. Thank you all for joining. You may now disconnect.