Executive Summary

Q4 revenue was $71.0M (flat year over year), with subscription revenue up sharply to $36.9M and gross margin improving to 48% (+11 points sequentially). Adjusted EBITDA improved to $(22.8)M from $(31.0)M in Q3; GAAP net loss was $(44.6)M .
Mix shift continued: AMG visit revenue was $29.2M; total visits were ~1.4M (down ~18% YoY), while average revenue per visit reached $77 and ACVs expanded (health plan ACV: $963K; health system ACV: $488K) .
Guidance: 2025 revenue $250–$260M (subscription mix “nearly 60%”), AMG visits 1.30–1.35M, and adjusted EBITDA $(55)M to $(45)M; Q1 2025 revenue $59–$61M and adjusted EBITDA $(18)M to $(20)M .
Strategic updates: divested Amwell Psychiatric Care (APC) to sharpen focus and add up to $30M cash; DHA (Military Health System) deployment progressing with positive feedback and expected step-up in Q2 2025 software revenue; management reiterated goal to achieve positive cash flow in 2026 .
Estimates comparison: Wall Street consensus (S&P Global) was unavailable at the time of analysis due to request limits, so beats/misses vs. consensus could not be assessed (see Estimates Context) [GetEstimates error].

What Went Well and What Went Wrong

What Went Well

Subscription acceleration and margin expansion: “Software revenue grew well over 30% over Q3’s results… We accelerated our adjusted EBITDA improvements for the third quarter in a row” as gross margin rose to 48% in Q4 (+11 points vs Q3) .
Government momentum at DHA: “Many of our programs are now fully deployed… feedback is very positive… final expansion of on-demand visits and complete international deployment expected in early Q3,” highlighting execution on the largest growth initiative in company history .
Portfolio refocus and pipeline quality: Divested APC to focus on core platform and “bolster our balance sheet significantly by adding up to $30 million in cash”; expanding clinical programs (e.g., adding Vida Health for obesity/diabetes) and reporting larger, higher-quality RFP pipeline .

What Went Wrong

Visit headwinds: Total Q4 visits ~1.4M, ~18% lower YoY; management cited market-wide and client execution softness and expects less churn going forward .
One-time G&A spike: G&A was $34.8M in Q4, ~38% higher than Q3, “primarily due to a one-time bad debt accrual related to losses caused by the Change Healthcare cyber event,” though G&A remains a cost-reduction focus .
Lower forward revenue outlook vs earlier framework: FY25 guidance at $250–$260M is below the longer-term FY25 framework discussed earlier in 2024 ($335–$350M), with EBITDA guidance now $(55)M to $(45)M vs prior $(35)M to $(45)M (low end worse), reflecting a more conservative stance and APC divestiture headwind .

Financial Results

Consolidated Results (oldest → newest)

Metric	Q2 2024	Q3 2024	Q4 2024
Revenue ($M)	$62.8	$61.0	$71.0
Gross Margin (%)	37%	37%	48%
Net Loss ($M, GAAP)	$(50.6)	$(44.0)	$(44.6)
Adjusted EBITDA ($M)	$(35.0)	$(31.0)	$(22.8)
Total Visits (M)	~1.5	~1.4	~1.4

Revenue Mix

Revenue Component ($M)	Q2 2024	Q3 2024	Q4 2024
Subscription	$27.5	$26.2	$36.9
AMG Visit Revenue	$28.7	$27.5	$29.2
Services & Carepoint	$6.6	$7.3	$4.9

KPIs and Operating Metrics

KPI	Q2 2024	Q3 2024	Q4 2024
Visits on Converge (%)	~70%	~70%	~70% (metric to be sunset)
Average Revenue per Visit	N/A	$83	$77
Health Plan ACV ($K)	N/A	N/A	$963
Health System ACV ($K)	N/A	N/A	$488

Q4 YoY Comparison

Metric	Q4 2023	Q4 2024
Revenue ($M)	$70.7	$71.0
Net Loss ($M, GAAP)	$(50.0)	$(44.6)
Adjusted EBITDA ($M)	$(36.9)	$(22.8)
EPS (Basic & Diluted)	$(3.37)	$(2.77)

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Revenue	FY 2025	$335–$350M (framework discussed Feb 2024)	$250–$260M (reflects APC divestiture)	Lowered
Adjusted EBITDA	FY 2025	$(35)M to $(45)M (Feb 2024)	$(55)M to $(45)M	Lowered at low end; maintained at high end
Subscription Mix (%)	FY 2025	N/A	“Nearly 60% of total 2025 revenues”	New disclosure
AMG Visits (M)	FY 2025	N/A	1.30–1.35	New disclosure
Revenue	Q1 2025	N/A	$59–$61M	New disclosure
Adjusted EBITDA	Q1 2025	N/A	$(18)M to $(20)M	New disclosure

Notes: 2024 guidance was revised in Q3 (revenue to $247–$252M; adjusted EBITDA to $(137)M to $(142)M) and reiterated/divested adjustments were discussed in early 2025; company targets positive cash flow in 2026 .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q2 & Q3 2024)	Q4 2024 Commentary	Trend
DHA (Military Health System) Deployment	Q2: Self-guided behavioral health live; enterprise go-live planned Q4’24 . Q3: On track for enterprise; step-up in Q4 subscription anticipated .	Programs largely deployed; strong feedback; enterprise/global rollouts continue, with further expansion into early Q3; expecting Q2’25 one-time step-up in DHA software revenue and renewal for 3+ years via Leidos sole-source .	Positive execution; revenue visibility improving
Revenue Mix & Margin	Q2: Subscription to be “roughly similar” YoY; GM ~high-30s; 2025 GM >50% with DHA . Q3: GM 37%; subscription uplift expected in Q4 .	Subscription grew to $36.9M; GM 48% in Q4; target nearly 60% subscription in 2025 .	Improving mix and margins
Costs & Efficiency	Q2: R&D and SG&A declining; EBITDA guide improved . Q3: Continued cost alignment, improved EBITDA guide .	Opex reductions continue; Q4 G&A had one-time cyber-related accrual; 2025 plan reduces R&D >10%, Sales & Marketing ~25%, G&A >20% YoY .	Ongoing cost discipline
Visits & Churn	Q2: Visits ~flat; softness emerging . Q3: Visits soft; lowered revenue guide .	Q4 visits down ~18% YoY; churn expected to be less significant in 2025 .	Stabilizing; deemphasizing visit dependence
Platform/Partners	Q2: Added Hello Heart; deep EHR and payer integrations emphasized . Q3: Added Sword Health; rev-share with partners .	Added Vida Health (obesity/diabetes, GLP-1s) to programs; positioning as orchestration layer for third-party programs .	Expanding ecosystem
Capital & Liquidity	Q2/Q3: Strong cash, no debt .	$228M cash & marketable securities, 0 debt; objective to achieve positive cash flow in 2026 .	Stable liquidity; clear cash flow target

Management Commentary

“We are successfully launching our full solution across the U.S. Military Health System, the most significant growth initiative in our history… advancing us to generate positive cash flow during 2026, with a robust cash position.” – Ido Schoenberg, CEO .
“We have the greatest visibility into our revenues today as compared to any other time in this company's history… [with] in excess of 90% visibility into this 2025 guide.” – Mark Hirschhorn, CFO/COO .
“Our fourth quarter gross profit margin was 48%, higher by 11 points compared to Q3… adjusted EBITDA for the quarter was negative $22.8 million versus negative $36.9 million in Q4 2023.” – Mark Hirschhorn .
On DHA renewal: “DHA announced providing Leidos with a sole source grant… an extension of 3 more years… [we] believe that closing this extension is a very low risk to not happen.” – Ido Schoenberg .
On EBITDA drivers: “The vast majority of the increase in EBITDA is coming from the shift from transactional visit revenue to subscription revenue… probably a 1/3, 2/3 relationship with 1/3 from cost reductions.” – Mark Hirschhorn .

Q&A Highlights

DHA progress and renewal: Deployment “going as well, maybe better than we hoped”; Leidos sole-source extension anticipated; funding viewed as low-risk given scope (Oracle EHR and others) and military support .
2025 revenue bridge: APC divestiture removes >$25M visit revenue; DHA expected to contribute materially (analyst floated $40M; management indicated this was “likely close to half” of expected 2025 DHA revenue), with visibility supported by contractual subscription base .
Churn and visits: 2024 attrition was “significant” (managed and market-driven); management expects “far less significant impact from churn” in 2025 .
One-time vs recurring DHA: Majority recurring subscription; some one-time implementation fees; incremental Q2 step-up expected as go-lives continue .
2026 cash flow: Target reaffirmed; if growth undershoots, further cost containment would offset to achieve positive cash flow from operations in 2026 .

Estimates Context

S&P Global (Capital IQ) consensus data for Q4 2024 revenue and EPS was unavailable at the time of analysis due to a request limit error. As a result, we cannot quantify beats/misses vs. consensus for this quarter. We will update with consensus comparisons once access is restored [GetEstimates error].

Key Takeaways for Investors

Mix shift is working: Subscription software acceleration and 11-point sequential gross margin improvement to 48% drove a step-up in adjusted EBITDA, despite flat revenue and lower visits .
DHA is the key catalyst: Continued deployment, expected renewal via Leidos, and Q2 2025 step-up in DHA software revenues support 2025 subscription mix approaching 60% and margin gains .
Leaner operating model: R&D, S&M, and G&A poised to decline meaningfully in 2025; management remains focused on cost and cash discipline with $228M cash and no debt .
Lower near-term top-line vs earlier frameworks: FY25 revenue guidance ($250–$260M) is below prior longer-term expectations ($335–$350M); however, profitability trajectory is driven more by mix and cost than volume .
De-risking visit exposure: Visit declines (~18% YoY) and churn pressures appear to be normalizing; emphasis shifts to recurring subscription and partner program monetization .
Strategic focus: APC divestiture simplifies the portfolio and adds cash; partnerships (e.g., Vida/GLP-1s) broaden higher-margin, orchestrated offerings across payer and provider channels .
Trading implications: Watch for DHA renewal confirmation and Q2’25 software revenue step-up; monitor subscription mix and Opex run-rate for further EBITDA improvement; consensus beats/misses pending S&P data refresh [GetEstimates error].

Appendix: Additional Press Releases (Q4 2024 context)

CFO expanded to COO effective Jan 1, 2025, aligning operational and growth strategies, supporting focus on profitable growth and 2026 cash flow goal .
APC divestiture for ~$21M upfront cash (plus earn-out) to Avel eCare, reinforcing focus on high-margin software and 2026 cash flow target .

All financial and qualitative claims are sourced from company filings, press releases, and earnings call transcripts as cited.

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