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Hinge Health beat Q1 expectations with revenue of $182 million, up 47% year over year, and raised its full-year 2026 guidance. The company also posted stronger profitability, including an 85% gross margin, $46 million in non-GAAP operating income, and $42 million in free cash flow.
AI and automation are driving operating leverage, helping Hinge Health scale more efficiently and expand margins. Management said more than 95% of clinician hours tied to traditional physical therapy have been automated, contributing to higher margins and a better outlook for operating income.
The company is expanding beyond musculoskeletal care with the launch of Migraine Care, its first program outside MSK. Early adoption has been strong, but management expects only minimal revenue contribution in 2026, with more meaningful impact likely in 2027.
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Hinge Health (NYSE:HNGE) reported first-quarter 2026 results that topped its prior outlook and raised its full-year guidance, citing stronger-than-expected member engagement, growth in eligible lives and continued operating leverage from artificial intelligence and automation.
Co-Founder and CEO Daniel Perez said the company generated $182 million in first-quarter revenue, up 47% from $124 million in the year-earlier period and above its guidance range of $171 million to $173 million. Last-12-months calculated billings rose 52% year over year to $770 million.
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“We had a strong start to the year,” Perez said, adding that Hinge Health’s business is “scaling efficiently” as AI and automation investments help the company serve more members while expanding margins.
Hinge Health reported an 85% gross margin for the quarter, up from 81% in the first quarter of 2025. Non-GAAP operating income was $46 million, exceeding the company’s prior guidance range of $30 million to $32 million. Operating margin was 25%, compared with 12% a year earlier.
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Free cash flow totaled $42 million in the quarter, compared with $4 million in the prior-year period, representing a free cash flow margin of 23%. CFO James Budge said the company ended the quarter with $407 million in cash and cash equivalents. Hinge Health also repurchased 2.5 million shares during the quarter for $105 million, and diluted weighted average share count fell to 82.4 million shares.
Budge said the revenue outperformance was driven by better-than-expected billings from both higher yields and more eligible lives. He said new clients are converting members at a faster rate, while legacy clients are also seeing yield growth. The company now expects yield to trend “slightly north of 4%” for the year.
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For the second quarter, Hinge Health expects revenue of $194 million to $196 million, representing 40% year-over-year growth at the midpoint, and operating income of $47 million to $49 million. For full-year 2026, the company raised its revenue outlook to $798 million to $804 million, up from a prior range of $732 million to $742 million. It also increased its full-year operating income guidance to $205 million to $215 million, up from $151 million to $156 million.
Budge said about half of the guidance increase was attributable to yield improvements and half to lives growth. He also said slower-than-anticipated hiring, partly because AI has increased efficiency across operating categories, contributed to the higher margin outlook.
Perez highlighted the launch of Hinge Health’s Migraine Care program as the company’s first expansion beyond muscle and joint pain. He described migraine as a chronic pain condition with neurological overlap with neck and spine conditions already treated by Hinge Health.
The program includes the company’s Enso neuromodulation device, AI-powered tracking designed to identify personal triggers, and exercise therapy and lifestyle guidance from care teams. Perez said Hinge Health received 510(k) clearance from the U.S. Food and Drug Administration to extend Enso into Migraine Care.
According to Perez, one in six U.S. adults has migraine, and roughly 75% of people with migraine also have musculoskeletal pain. He said migraine sufferers drive more than $16,000 in average annual healthcare spending, more than double that of people without migraine, and that migraine costs U.S. businesses an estimated $78 billion annually.
In response to an analyst question, Perez said early testing showed that 56% of people in the company’s trial saw pain fall from severe or moderate to mild or none with at least one Enso waveform. He also said Enso was 1.9 times more likely than a placebo device to reduce pain.
The company said the Migraine Care program will roll out later this month. Perez said more than 125 clients had adopted the program within a few weeks, representing more than 2 million eligible lives. Budge said revenue contribution from migraine is expected to be minimal in 2026, with a more meaningful impact expected in 2027. Perez said the billing model for migraine will be the same usage-based model used for the company’s digital physical therapy offering.
Perez said Hinge Health created “substantially more pipeline” in the first quarter than in the year-earlier period, with momentum across client verticals and markets. He said the company’s sales cycle remains seasonal, with most new client decisions typically occurring in the second half of the year as employers finalize benefits decisions.
The CEO also pointed to progress in the small and midsize business segment, where pipeline lives added in the first quarter were up more than 100% year over year. He said SMB sales cycles are faster than large enterprise sales cycles because smaller organizations make decisions more quickly.
HingeSelect, the company’s offering that connects members to in-person providers when needed, ended the quarter with 4,100 provider locations. Perez said access to HingeSelect was expanded through one national pharmacy benefit manager partner and three of the five largest national health plans by self-insured lives.
Perez said about 85% of members who engage through HingeSelect are able to move forward with conservative care, avoiding what he described as low-value, high-cost care such as imaging, procedures and elective surgeries. He said HingeSelect is one of the top topics in discussions with prospects and existing clients, though he described it as a more complicated sale than migraine.
Executives repeatedly framed AI as central to Hinge Health’s operating model. Perez said the company has automated more than 95% of clinician hours associated with traditional physical therapy, and Budge said AI and automation have supported gross margin expansion and operating leverage.
As of the end of the first quarter, about 80% of contracted lives were on Hinge Health’s engagement-based pricing model, a level the company expects to remain consistent for the rest of the year. Budge said nearly all new customers in recent selling seasons have come on under that model, while some legacy customers have not prioritized shifting from the older upfront model.
Looking ahead, Perez said the core musculoskeletal market remains “massive and under-penetrated” and that the migraine launch demonstrates the company’s ability to extend its platform into other conditions. He said mental health is not on the company’s near- or medium-term roadmap, describing it as a crowded space, while noting that neurology is an area the company views as underserved.
“We didn’t come this far with digital physical therapy to stop at digital physical therapy,” Perez said.
Hinge Health (NYSE: HNGE) is a digital musculoskeletal (MSK) clinic that provides end-to-end solutions for the prevention and management of musculoskeletal conditions. The company's platform combines wearable motion sensors, personalized exercise therapy guided by licensed physical therapists, and behavioral health coaching to deliver tailored treatment plans. By integrating technology with evidence-based clinical protocols, Hinge Health aims to reduce pain, improve mobility and decrease reliance on more invasive interventions such as surgery or opioid prescriptions.
Founded in 2015 and headquartered in San Francisco, Hinge Health partners with employers, health plans and other payers to offer its self-directed, app-based programs.
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The article "Hinge Health Q1 Earnings Call Highlights" was originally published by MarketBeat.
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